The Impact of Self-Reported Family History of Coronary Artery Disease on the Outcomes of Patients Hospitalized for Acute Coronary Syndrome: Data from ACSIS Registry 2000-2013

Introduction Family history (FH) of premature atherosclerotic vascular disease (pCAD) is a well-established risk factor for development of coronary heart disease (CAD). However, its impact on patient’s outcome after an acute coronary syndrome (ACS) is unknown.

Aim To evaluate the outcomes of ACS patients by the presence/absence of FH of pCAD

Methods All patients ≤65 at admission who had an ACS event and were enrolled in the national ACSIS registry between 2000 and 2013 were included. Patients were grouped by the presence or absence of self-reported FH of pCAD. Nearest neighbor propensity score matching (PSM) was applied to create an evenly matched cohort of patients. Outcomes included 30-day MACE (defined as the composite of death, unstable angina pectoris, myocardial infarction, stroke, stent thrombosis and urgent revascularization) and its individual components. Long term death was presented using Kaplan-Meier curves and compared with cox regression analysis.

Results Of 7173 ACS patients 33.9% reported FH of pCAD. They were younger, with lower rates of diabetes, prior cerebro-vascular and kidney diseases, but had higher rates of smoking and hyperlipidemia. The PSM cohort included 1810 pairs of evenly matched patients. Short term outcomes did not differ between the groups, as well as 1-year mortality (2.4% and 2.2% with/without FH, respectively). During long-term follow-up (median 7.6 years), mortality rate was lower in the FH group (HR 0.82, 95% CI 0.69 - 0.99).

Conclusions Patients with self-reported FH of pCAD presented with ACS at a younger age with a lower burden of comorbidities. In the PSM cohort, there were no differences in short and intermediate term outcomes based on the presence/absence of FH of pCAD. However, the FH group had better long-term survival. Further research is required to determine whether this finding represent a protective effect of familial/genetic factors in terms of long term survival.

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