The effect of follow-up reexamination on the long-term prognosis of patients with acute coronary syndrome undergoing coronary angiography

Background: Patients with acute coronary syndrome (ACS) remain at high risk for recurrent adverse cardiovascular events after discharge. Patient adherence to secondary prevention is poor. This study proposes a follow-up center-based secondary prevention program to assess whether a structured cardiologist-led follow-up and reexamination protocol influences ACS patient prognosis.

Methods: A total of 9,534 ACS patients undergoing coronary angiography were retrospectively included and divided into a reexamination group (n = 6,804) and a non-reexamination group (n = 2,730) according to whether they were reexamined within one year or not. The patients were followed up after discharge for 3 years, and clinical outcomes were recorded. The primary outcome was cardiac death. 

Results: Reexamination within 12 months was significantly associated with a reduced risk of cardiac death (adjusted hazard ratio [aHR], 0.58; 95% confidence interval [CI], 0.44–0.75) at 3 years after ACS. Among patients who underwent reexamination, the risk of cardiac death was 50% lower (aHR, 0.50; 95% CI, 0.35–0.70) and 63% lower (aHR, 0.37; 95% CI, 0.20–0.67) in the high-frequency (more than or equal to 2 times within one year) and long-term (continued reexamination after the first year of follow-up) reexamination groups, respectively. Similar results were observed after propensity score matching analysis. 

Conclusions: Participation in a structured follow-up and reexamination programme significantly reduces the risk of cardiac death among ACS survivors. Establishing a follow-up center could be of great significance in improving patient prognoses.