Batty, J. orcid.org/0000-0003-4102-5418, Del Toro, T., Drayton, D.J. et al. (6 more authors) (2025) Multimorbidity in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. JACC: Advances, 4 (8). 102006. ISSN: 2772-963X
Abstract
Background Multimorbidity (the presence of multiple long-term conditions) increases the complexity of management decisions for patients presenting with acute coronary syndrome (ACS). Objectives The purpose of this study was to ascertain the prevalence of multimorbidity in ACS and assess its impact on clinical management and outcomes. Methods Medline, Web of Science, Embase, and Cochrane were searched to July 2024 for studies that reported: 1) the prevalence of multimorbidity in patients with incident ACS or 2) ACS management and/or clinical outcomes, stratified by multimorbidity status. Random-effects meta-analysis was performed to calculate pooled summary statistics and was supported by narrative synthesis. Results Overall, 41 studies were included. Those at low risk of bias (23 studies; npooled = 9,227,657) demonstrated a pooled prevalence of multimorbidity of 46.6% (95% CI: 38.9%-54.2%). Study-level determinants of prevalence included study setting (high-income: 48.5% [40.5%-56.5%] vs low- to middle-income countries: 35.3 [30.5%-40.3%]); P = 0.006) and the number of conditions in the per-study definition of multimorbidity (R2 = 79.6%; P < 0.001). Individual-level determinants of multimorbidity included advanced age, non–ST-segment elevation presentation, previous cardiac procedures, and greater body mass index. Multimorbidity was associated with reduced usage of invasive management and secondary preventative medication. Multimorbidity was associated with short-term mortality (≤30 day; relative risk [RR]pooled 95% CI: 1.43 [95% CI: 1.14-1.78]; P < 0.01) and longer-term mortality (>30 day; RRpooled: 1.87 [95% CI: 1.51-2.32]; P < 0.01). Each additional pre-existing long-term condition was associated with a 16% excess risk of mortality (RRpooled: 1.16 [95% CI: 1.06-1.26]; P < 0.01). Conclusions Multimorbidity is common, associated with reduced use of guideline-directed therapies and adverse clinical outcomes in patients with ACS. (The prevalence of multimorbidity and its impact on clinical outcomes in patients with acute myocardial infarction: a systematic review and meta-analysis; CRD42023447122)
Metadata
Item Type: | Article |
---|---|
Authors/Creators: |
|
Copyright, Publisher and Additional Information: | © 2025 The Authors. This is an open access article under the terms of the Creative Commons Attribution License (CC-BY 4.0), which permits unrestricted use, distribution and reproduction in any medium, provided the original work is properly cited. |
Keywords: | acute coronary syndrome, aging, multimorbidity, comorbidity, myocardial infarction |
Dates: |
|
Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) |
Funding Information: | Funder Grant number Wellcome Trust R127002 |
Depositing User: | Symplectic Publications |
Date Deposited: | 18 Jun 2025 10:06 |
Last Modified: | 12 Aug 2025 13:12 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.jacadv.2025.102006 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:227940 |