The impact of cerebral small vessel disease burden on prognosis in patients with acute coronary syndrome

<sec><strong>Background</strong> Acute coronary syndrome (ACS) presents with a variable prognosis, posing significant public health challenges. This study investigated the potential link between cerebral small vessel disease (CSVD) burden and outcomes in patients with ACS. </sec><sec><strong>Methods</strong> In this retrospective cohort study, ACS patients admitted to Beijing Friendship Hospital, Capital Medical University, Beijing, China from January 2020 to October 2021, were analyzed. CSVD burden was assessed using magnetic resonance imaging markers, including white matter lesions, lacunar infarcts, cerebral microbleeds, and enlarged perivascular spaces. The correlation between CSVD burden and clinical outcomes, including major adverse cardiovascular and cerebrovascular events, myocardial infarction (MI), target vessel revascularization, stroke, and mortality was examined over a one-year follow-up. </sec><sec><strong>Results</strong> Out of 248 patients, 216 patients were categorized into the low score group (LSG-CSVD) and 32 patients were categorized into the high score group (HSG-CSVD). Patients in the HSG-CSVD group exhibited significantly worse prognosis, with an elevated risk of major adverse cardiovascular and cerebrovascular events, MI, and target vessel revascularization. After adjusting for age, sex, hypertension, troponin T, and estimated glomerular filtration rate, a significantly higher risk of MI was observed in the HSG-CSVD group (HR = 4.51, 95% CI: 1.53–13.26, <i>P</i> = 0.006). Subgroup analysis by age and sex consistently demonstrated increased adverse outcomes in the HSG-CSVD. </sec><sec><strong>Conclusions</strong> The study highlights a direct association between increased CSVD burden and poorer ACS outcomes, particularly in MI risk. These findings underscore the importance of considering CSVD burden as a crucial prognostic factor in ACS management, facilitating risk stratification and guiding personalized treatment strategies. </sec>