Limits...
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 and unadjusted hazard ratios (95% CI) of the primary composite end point of CVD, MI, or stroke in patients with and without angina, stratified by patients’ risk according to the REACH risk score for recurrent Cardiovascular events.17 Data were available for 24 315 patients. Stratifying the patients to quartiles according to the REACH risk score for recurrent Cardiovascular events, patients in higher quartiles had higher rates of the primary end point of CVD, MI, or stroke. Angina was associated with the primary end point in lower‐risk patients, whereas it was not associated with the primary end point in patients at higher risk of recurrent Cardiovascular events. CVD indicates cardiovascular death; HR, hazard ratio; KM, Kaplan–Meier; MI, myocardial infarction.
© Copyright Policy - creativeCommonsBy-nc-nd
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC5121505&req=5

jah31767-fig-0003: Kaplan–Meier rates and unadjusted hazard ratios (95% CI) of the primary composite end point of CVD, MI, or stroke in patients with and without angina, stratified by patients’ risk according to the REACH risk score for recurrent Cardiovascular events.17 Data were available for 24 315 patients. Stratifying the patients to quartiles according to the REACH risk score for recurrent Cardiovascular events, patients in higher quartiles had higher rates of the primary end point of CVD, MI, or stroke. Angina was associated with the primary end point in lower‐risk patients, whereas it was not associated with the primary end point in patients at higher risk of recurrent Cardiovascular events. CVD indicates cardiovascular death; HR, hazard ratio; KM, Kaplan–Meier; MI, myocardial infarction.

Mentions: Stratifying the patients to quartiles according to the REACH risk score for recurrent cardiovascular events,17 patients in higher quartiles had higher rates of the primary end point of cardiovascular death, MI, or stroke (Figure 3). Interestingly, angina was associated with the primary end point in lower‐risk patients (unadjusted HR angina versus no angina 1.17, 95% CI 0.98–1.41, P=0.09 in quartile I; 1.21, 95% CI 1.02–1.43, P=0.03 in quartile II), whereas it was not associated with the primary end point in patients at higher risk for recurrent cardiovascular events (unadjusted HR angina versus no angina 0.95, 95% CI 0.84–1.09, P=0.47 in quartile III; 0.98, 95% CI 0.87–1.10, P=0.69 in quartile IV; Figure 3).


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 and unadjusted hazard ratios (95% CI) of the primary composite end point of CVD, MI, or stroke in patients with and without angina, stratified by patients’ risk according to the REACH risk score for recurrent Cardiovascular events.17 Data were available for 24 315 patients. Stratifying the patients to quartiles according to the REACH risk score for recurrent Cardiovascular events, patients in higher quartiles had higher rates of the primary end point of CVD, MI, or stroke. Angina was associated with the primary end point in lower‐risk patients, whereas it was not associated with the primary end point in patients at higher risk of recurrent Cardiovascular events. CVD indicates cardiovascular death; HR, hazard ratio; KM, Kaplan–Meier; MI, myocardial infarction.
© Copyright Policy - creativeCommonsBy-nc-nd
Related In: Results  -  Collection

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

jah31767-fig-0003: Kaplan–Meier rates and unadjusted hazard ratios (95% CI) of the primary composite end point of CVD, MI, or stroke in patients with and without angina, stratified by patients’ risk according to the REACH risk score for recurrent Cardiovascular events.17 Data were available for 24 315 patients. Stratifying the patients to quartiles according to the REACH risk score for recurrent Cardiovascular events, patients in higher quartiles had higher rates of the primary end point of CVD, MI, or stroke. Angina was associated with the primary end point in lower‐risk patients, whereas it was not associated with the primary end point in patients at higher risk of recurrent Cardiovascular events. CVD indicates cardiovascular death; HR, hazard ratio; KM, Kaplan–Meier; MI, myocardial infarction.
Mentions: Stratifying the patients to quartiles according to the REACH risk score for recurrent cardiovascular events,17 patients in higher quartiles had higher rates of the primary end point of cardiovascular death, MI, or stroke (Figure 3). Interestingly, angina was associated with the primary end point in lower‐risk patients (unadjusted HR angina versus no angina 1.17, 95% CI 0.98–1.41, P=0.09 in quartile I; 1.21, 95% CI 1.02–1.43, P=0.03 in quartile II), whereas it was not associated with the primary end point in patients at higher risk for recurrent cardiovascular events (unadjusted HR angina versus no angina 0.95, 95% CI 0.84–1.09, P=0.47 in quartile III; 0.98, 95% CI 0.87–1.10, P=0.69 in quartile IV; Figure 3).

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