Original Research

Ten-year predictors of major adverse cardiovascular events in patients without angina

Preesha Premsagar, Colleen Aldous, Tonya Esterhuizen
South African Family Practice | Vol 65, No 1 : Part 3| a5629 | DOI: https://doi.org/10.4102/safp.v65i1.5629 | © 2023 Preesha Premsagar, Colleen Aldous, Tonya Esterhuizen | This work is licensed under CC Attribution 4.0
Submitted: 01 September 2022 | Published: 04 August 2023

About the author(s)

Preesha Premsagar, Department of Internal Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
Colleen Aldous, Department of Clinical Medicine, Nelson R. Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
Tonya Esterhuizen, Division of Epidemiology/Biostatistics, Department of Global Health, Faculty of Medical and Health Sciences, Stellenbosch University, Stellenbosch, South Africa

Abstract

Background: Longstanding cardiovascular risk factors cause major adverse cardiovascular events (MACE). Major adverse cardiovascular events prediction may improve outcomes. The aim was to evaluate the ten-year predictors of MACE in patients without angina.

Methods: Patients referred to Inkosi Albert Luthuli Hospital, Durban, South Africa, without typical angina from 2002 to 2008 were collected and followed up for MACE from 2009 to 2019. Survival time was calculated in months. Independent variables were tested with Cox proportional hazard models to predict MACE morbidity and MACE mortality.

Results: There were 525 patients; 401 (76.0%) were Indian, 167 (31.8%) had diabetes at baseline. At 10-year follow up 157/525 (29.9%) experienced MACE morbidity, of whom, 82/525 (15.6%) had MACE mortality. There were 368/525 (70.1%) patients censored, of whom 195/525 (37.1%) were lost to follow up. For MACE morbidity, mean and longest observation times were 102.2 and 201 months, respectively. Predictors for MACE morbidity were age (hazard ratio [HR] = 1.025), diabetes (HR = 1.436), Duke Risk category (HR = 1.562) and Ischaemic burden category (HR = 1.531). For MACE mortality, mean and longest observation times were 107.9 and 204 months, respectively. Predictors for MACE mortality were age (HR = 1.044), Duke Risk category (HR = 1.983), echocardiography risk category (HR = 2.537) and Ischaemic burden category (HR = 1.780).

Conclusion: Among patients without typical angina, early ischaemia on noninvasive tests indicated microvascular disease and hyperglycaemia, predicting long-term MACE morbidity and MACE mortality.

Contribution: Diabetes was a predictor for MACE morbidity but not for MACE mortality; patients lost to follow-up were possibly diabetic patients with MACE mortality at district hospitals. Early screening for ischaemia and hyperglycaemia control may improve outcomes.


Keywords

Cox model; diabetes; Indian; morbidity; mortality

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