Major adverse cardiovascular events in bulgarian patients with chronic coronary syndrome

Background: In primary prevention, most guidelines rely on atherosclerotic cardiovascular disease risk assessment to determine the appropriateness and intensity of risk factor modification. Aims: This study aimed to analyze the prognostic role of risk factors, comorbidities, and coronary artery calcium score (CACS) for major adverse cardiovascular events (MACEs) in Bulgarian patients with chronic coronary syndrome. An observational study conducted in a cardiology department. This observational study included 214 patients. The study population was divided into three major groups according to their CACS level estimated with the Agatston calculating model: 0 (group I), 1-400 (group II), and > 400 (group III) Agatston units (AU). The patients were followed-up for MACE development over a mean period of 3.8 years. Subjects and Methods: The Cox proportional hazard regression analysis was performed. Results: The MACE rate in patients with CACS = 0 was significantly higher in patients with low-density lipoprotein > 3 mmol/L (hazard ratio [HR] 3.5; 95% confidence interval [CI] 1.87-6.64; P < 0.05) and with paroxysmal atrial fibrillation (HR 4.33; 95% CI 1.25-16.92; P < 0.05). In group II, the incidence of MACE was significantly elevated in patients with coronary calcium volume > 75 Hounsfield units (HU) (HR 3.56; 95% CI 1.39-9.14; P < 0.05), calcium score of aortic valve > 30 AU (HR 3.2; 95% CI 1.36-4.76; P < 0.05), and left ventricular mass over 125 g (HR 3.24; 95% CI 1.65-7.56; P < 0.05). Conclusions: Our data revealed that different factors in the risk profile of the three patient groups were associated with an increased rate of MACEs.