Determinants of the clinical presentation of acute coronary syndromes.

INTRODUCTION: Two clinical presentations of acute coronary syndrome (ACS) have been defined: ST- segment elevation ACS (STEACS) or non-ST-segment elevation ACS (NSTEACS). The mechanism that determines the clinical presentation of ACS is not clearly understood. The aim of this study was to define the association between cardiovascular risk factors and other clinical variables with the clinical presentation of ACS as STEACS or NSTEACS.

METHODS: We analyzed data of patients prospectively included in the Epi-Cardio Registry with a diagnosis of ACS from April 2006 to April 2018. A total of 10 019 patients were included in the study.

RESULTS: In the multivariate analysis, male sex (OR 1.5) and active smoking (OR 1.71) were positively associated with STEACS presentation. Conversely, hypertension (OR 0.71), dyslipidemia (OR 0.74), age (OR 0.97 per quintile), history of myocardial infarction (OR 0.57), chronic angina (OR 0.44), presence of comorbidities (OR 0.64), and extension of coronary heart disease (OR 0.84) were negatively associated with STEACS. Women differed from men by presenting a higher incidence of NSTEACS, due to a greater proportion of ACS without obstructive coronary heart disease.

CONCLUSION: Some cardiovascular risk factors and other clinical variables are independently associated with the presentation of ACS as ST EACS or NSTEACS. These findings confirm the influence of risk factors and clinical history on the pathophysiology, clinical and electrocardiographic presentation of ACS.