Multimorbidity in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis
Authors' conclusion
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).
Study context
- Population
- Patients with incident acute coronary syndrome (ACS)pooled n of 23 studies at low risk of bias, 41 studies included overall
- Participants
- 9,227,657 patients
- Comparison
- ACS management and/or clinical outcomes, stratified by multimorbidity status
- Outcome
- Pooled prevalence of multimorbidity (low risk of bias studies)
Methodological detailsrandom-effects meta-analysis, narrative synthesis
- Random-effects meta-analysis
- Narrative synthesis
Pooled result
As reported in the abstract
Pooled prevalence of multimorbidity
46.6%
95% CI 38.9%–54.2%
Further pooled results
Short-term mortality · ≤30 day
| RR (95% CI) | P value | ||
|---|---|---|---|
| Multimorbidity | 1.43 (1.14–1.78) | P < 0.01 | |
| 0.512Relative risk (log scale) |
Longer-term mortality · >30 day
| RR (95% CI) | P value | ||
|---|---|---|---|
| Multimorbidity | 1.87 (1.51–2.32) | P < 0.01 | |
| 0.512Relative risk (log scale) |
| Outcome | RR (95% CI) | P value | |
|---|---|---|---|
| Mortality per additional pre-existing long-term condition16% excess risk of mortality | 1.16 (1.06–1.26) | P < 0.01 | |
| 0.512Relative risk (log scale) |
| Outcome | High-income | Low- to middle-income countries | P value |
|---|---|---|---|
| Prevalence by study setting | 48.5% (range 40.5%–56.5%) | 35.3 (range 30.5%–40.3%) | P = 0.006 |
Prevalence by number of conditions in the per-study definition of multimorbidity
- R2
- 79.6%
- P
- P < 0.001
Individual-level determinants of multimorbidity
- Advanced age, non-ST-segment elevation presentation, previous cardiac procedures, and greater body mass index
Invasive management and secondary preventative medication
- Multimorbidity was associated with reduced usage of invasive management and secondary preventative medication
Original publication
Multimorbidity in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis. JACC Adv. Published 22 July 2025. doi:10.
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