Defecation During Hospitalization for Acute Coronary Syndrome and Future Cardiovascular Events

BackgroundGut function is vital for human health, and defecation frequency can serve as a fundamental marker including various abnormal patterns. However, the link between a defecation pattern and future adverse events in patients with acute coronary syndrome (ACS) remains uncertain. The aim of this study was to investigate the association between defecation patterns during hospitalization and future cardiovascular events in patients with ACS. MethodsThis two-center retrospective observational cohort study included 1949 patients hospitalized for ACS between 2012 and 2019. For a comprehensive assessment of defecation in a general ward, we examined three indicators: "frequency of non-defecation days," "consecutive non-defecation days," and "maximum daily defecation frequency," in addition to "average daily defecation frequency". Patients were divided according to Youden index-derived cutoff values of each defecation frequency indicators. The primary outcome was a composite of all-cause mortality, myocardial infarction, ischemic stroke, and hemorrhagic stroke. ResultsDuring the follow-up period (median, 48 months; IQR 30-74 months), 405 of 1949 (20.8%) patients developed the primary outcome. In total, 229 patients died (96 cardiovascular deaths and 133 non-cardiovascular deaths), and there were 142, 57, 28, and 113 patients with non-fatal myocardial infarction, nonfatal ischemic stroke, nonfatal hemorrhagic stroke, and hospitalized due to heart failure, respectively. High "frequency of non-defecation days" ([≥]33.5%) (hazard ratio [HR], 1.507; 95% confidence interval [95%CI], 1.191-1.907; P=0.0006) and high "maximum daily defecations frequency" ([≥] 5 times in a single day) (HR, 1.670; 95%CI, 1.203-2.317; P=0.002) were associated with an increased risk of future cardiovascular events in the multivariate models. High "frequency of non-defecation days" and high "maximum daily defecations frequency" exhibit distinct characteristics: the former was associated with long-term cardiovascular mortality, all-cause mortality, myocardial infarction, and cerebral hemorrhage, while the latter was linked to cancer-related mortality, non-cardiovascular mortality, cerebral infarction, and heart failure. ConclusionsAmong patients with ACS who survived to discharge, abnormal defecation patterns as assessed by increased frequency of non-defecation days and high-frequency defecations within a single day, were independently associated with future cardiovascular events. Clinical PerspectiveO_ST_ABSWhat Is New?C_ST_ABSO_LIThis is the first study to investigate defecation patterns during the acute phase in patients with ACS and utilize reliable records of defecation during hospitalization rather than relying on survey-based assessments. C_LIO_LIIn patients with ACS, both increased frequency of non-defecation days and high-frequency defecations within a single day were independently associated with an increased risk of future cardiovascular events, controlling for various confounding factors including age, severity of ACS, medications, and dietary intake. C_LI What Are the Clinical Implications?O_LIAbnormal defecation patterns, such as frequent non-defecation days and high-frequency defecations within a single day, serve as indicators of "gut frailty." C_LIO_LIThe presence of these abnormal defecation patterns may suggest a residual risk in patients post-ACS. Additional research is essential to explore the underlying mechanisms and potential therapeutic interventions. C_LI