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Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease: Insights From the Reduction of Atherothrombosis for Continued Health ( REACH ) Registry

View Article: PubMed Central - PubMed

ABSTRACT

Background: The extent to which angina is associated with future cardiovascular events in patients with coronary artery disease has long been debated.

Methods and results: Included were outpatients with established coronary artery disease who were enrolled in the REACH registry and were followed for 4 years. Angina at baseline was defined as necessitating episodic or permanent antianginal treatment. The primary end point was the composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included heart failure, cardiovascular hospitalizations, and coronary revascularization. The independent association between angina and first/total events was examined using Cox and logistic regression models. Out of 26 159 patients with established coronary artery disease, 13 619 (52%) had angina at baseline. Compared with patients without angina, patients with angina were more likely to be older, female, and had more heart failure and polyvascular disease (P<0.001 for each). Compared with patients without angina, patients with angina had higher rates of first primary end‐point event (14.2% versus 16.3%, unadjusted hazard ratio 1.19, CI 1.11–1.27, P<0.001; adjusted hazard ratio 1.06, CI 0.99–1.14, P=0.11), and total primary end‐point events (adjusted risk ratio 1.08, CI 1.01–1.16, P=0.03). Patients with angina were at increased risk for heart failure (adjusted odds ratio 1.17, CI 1.06–1.28, P=0.002), cardiovascular hospitalizations (adjusted odds ratio 1.29, CI 1.21–1.38, P<0.001), and coronary revascularization (adjusted odds ratio 1.23, CI 1.13–1.34, P<0.001).

Conclusions: Patients with stable coronary artery disease and angina have higher rates of future cardiovascular events compared with patients without angina. After adjustment, angina was only weakly associated with cardiovascular death, myocardial infarction, or stroke, but significantly associated with heart failure, cardiovascular hospitalization, and coronary revascularization.

No MeSH data available.


Related in: MedlinePlus

Kaplan–Meier rates of the primary composite end point of cardiovascular death, MI, or stroke by presence of angina at baseline in the overall period (A), and landmark analysis during the first 6 months (B) and during 6 months to 4 years (C). The Kaplan–Meier curves demonstrate a higher rate of the composite primary end point of cardiovascular death, MI, or stroke in patients with angina, as compared to patients without angina. MI indicates myocardial infarction.
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jah31767-fig-0001: Kaplan–Meier rates of the primary composite end point of cardiovascular death, MI, or stroke by presence of angina at baseline in the overall period (A), and landmark analysis during the first 6 months (B) and during 6 months to 4 years (C). The Kaplan–Meier curves demonstrate a higher rate of the composite primary end point of cardiovascular death, MI, or stroke in patients with angina, as compared to patients without angina. MI indicates myocardial infarction.

Mentions: During follow‐up, the rate of the composite primary end point of cardiovascular death, MI, or stroke was 16.3% in patients with angina and 14.2% in patients without angina (unadjusted HR 1.19, 95% CI 1.11–1.27, P<0.001; Figure 1). In a landmark analysis, this difference in the rate of the primary end point between patients with versus without angina became statistically significant after 6 months from baseline and it remained significant at 4 years (Figure 1). The rate of each individual component of the composite primary end point was also higher among patients with angina (Table 2). After adjusting for multiple variables (Tables 2 and 3), the association between angina and the composite of cardiovascular death, MI, or stroke was attenuated (adjusted HR 1.06, 95% CI 0.99–1.14, P=0.11), and so was the association between angina and each of the individual components (Table 2). An analysis of the total number of events during follow‐up demonstrated that angina was significantly, albeit weakly, associated with the total number of the primary end‐point events (rate ratio 1.08, 95% CI 1.01–1.16, P=0.03; Table 4).


Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease: Insights From the Reduction of Atherothrombosis for Continued Health ( REACH ) Registry
Kaplan–Meier rates of the primary composite end point of cardiovascular death, MI, or stroke by presence of angina at baseline in the overall period (A), and landmark analysis during the first 6 months (B) and during 6 months to 4 years (C). The Kaplan–Meier curves demonstrate a higher rate of the composite primary end point of cardiovascular death, MI, or stroke in patients with angina, as compared to patients without angina. MI indicates myocardial infarction.
© Copyright Policy - creativeCommonsBy-nc-nd
Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC5121505&req=5

jah31767-fig-0001: Kaplan–Meier rates of the primary composite end point of cardiovascular death, MI, or stroke by presence of angina at baseline in the overall period (A), and landmark analysis during the first 6 months (B) and during 6 months to 4 years (C). The Kaplan–Meier curves demonstrate a higher rate of the composite primary end point of cardiovascular death, MI, or stroke in patients with angina, as compared to patients without angina. MI indicates myocardial infarction.
Mentions: During follow‐up, the rate of the composite primary end point of cardiovascular death, MI, or stroke was 16.3% in patients with angina and 14.2% in patients without angina (unadjusted HR 1.19, 95% CI 1.11–1.27, P<0.001; Figure 1). In a landmark analysis, this difference in the rate of the primary end point between patients with versus without angina became statistically significant after 6 months from baseline and it remained significant at 4 years (Figure 1). The rate of each individual component of the composite primary end point was also higher among patients with angina (Table 2). After adjusting for multiple variables (Tables 2 and 3), the association between angina and the composite of cardiovascular death, MI, or stroke was attenuated (adjusted HR 1.06, 95% CI 0.99–1.14, P=0.11), and so was the association between angina and each of the individual components (Table 2). An analysis of the total number of events during follow‐up demonstrated that angina was significantly, albeit weakly, associated with the total number of the primary end‐point events (rate ratio 1.08, 95% CI 1.01–1.16, P=0.03; Table 4).

View Article: PubMed Central - PubMed

ABSTRACT

Background: The extent to which angina is associated with future cardiovascular events in patients with coronary artery disease has long been debated.

Methods and results: Included were outpatients with established coronary artery disease who were enrolled in the REACH registry and were followed for 4&nbsp;years. Angina at baseline was defined as necessitating episodic or permanent antianginal treatment. The primary end point was the composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included heart failure, cardiovascular hospitalizations, and coronary revascularization. The independent association between angina and first/total events was examined using Cox and logistic regression models. Out of 26&nbsp;159 patients with established coronary artery disease, 13&nbsp;619 (52%) had angina at baseline. Compared with patients without angina, patients with angina were more likely to be older, female, and had more heart failure and polyvascular disease (P&lt;0.001 for each). Compared with patients without angina, patients with angina had higher rates of first primary end&#8208;point event (14.2% versus 16.3%, unadjusted hazard ratio 1.19, CI 1.11&ndash;1.27, P&lt;0.001; adjusted hazard ratio 1.06, CI 0.99&ndash;1.14, P=0.11), and total primary end&#8208;point events (adjusted risk ratio 1.08, CI 1.01&ndash;1.16, P=0.03). Patients with angina were at increased risk for heart failure (adjusted odds ratio 1.17, CI 1.06&ndash;1.28, P=0.002), cardiovascular hospitalizations (adjusted odds ratio 1.29, CI 1.21&ndash;1.38, P&lt;0.001), and coronary revascularization (adjusted odds ratio 1.23, CI 1.13&ndash;1.34, P&lt;0.001).

Conclusions: Patients with stable coronary artery disease and angina have higher rates of future cardiovascular events compared with patients without angina. After adjustment, angina was only weakly associated with cardiovascular death, myocardial infarction, or stroke, but significantly associated with heart failure, cardiovascular hospitalization, and coronary revascularization.

No MeSH data available.


Related in: MedlinePlus