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Angina symptoms linked with elevated risk for CV events in patients with stable CAD
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In outpatients with stable CAD, those with symptoms of angina were at higher risk for adverse CV outcomes, but the same trend of increased risk was not observed in outpatients with stable CAD and silent ischemia, according to data from the CLARIFY registry.
Researchers enrolled outpatients with stable CAD in 45 countries in the Prospective Observational Longitudinal Registry of Patients with Stable Coronary Artery Disease (CLARIFY) registry and followed them for a median of 24.1 months.
For the present analysis, researchers evaluated 20,291 patients who had undergone a noninvasive test for myocardial ischemia within 12 months of enrollment. Patients were stratified into four groups: no angina or ischemia (65.1%); evidence of silent ischemia, defined as myocardial ischemia without angina (14.9%); symptoms of angina, but not ischemia (9.1%); angina and ischemia (10.9%).
The primary outcome was a composite of CV-related death and nonfatal MI.
Philippe Gabriel Steg
Philippe Gabriel Steg, MD, FESC, FACC, and colleagues observed the primary outcome in 469 patients during the study period. More than 58% of events occurred in patients without angina or ischemia, 12.4% occurred in patients with ischemia alone, 12.2% occurred in patients with angina alone and 17.3% occurred in patients with angina and ischemia.
Steg and colleagues calculated HRs after adjusting for age, sex, geographic region, smoking status, hypertension, diabetes and dyslipidemia. Compared with patients without angina or ischemia, those with ischemia alone did not have an elevated risk for the primary outcome (HR=0.9; 95% CI, 0.68-1.2), but patients with angina alone (HR=1.45; 95% CI, 1.08-1.95) and patients with angina and ischemia (HR=1.75; 95% CI, 1.34-2.29) did have a greater risk.
“Angina symptoms alone, even without evidence of myocardial ischemia, were associated with high event rates and identified a group of patients at high risk for CV-related death or MI,” Steg, director of the coronary care unit in the cardiology department at Hôpital Bichat, Paris, professor of cardiology at the Université Paris – Diderot, and a member of the Cardiology Today’s Intervention Editorial Board, and colleagues wrote. The researchers noted that “most CV-related deaths and MIs occurred in patients without angina or ischemia, emphasizing the importance of implementing optimal medical therapy and preventive measures regardless of symptoms or ischemia.”
Further, 70% of events occurred in patients with no evidence of myocardial ischemia, so “focusing management of stable CAD solely on the prevention of ischemia does not address the risks incurred by these patients,” the researchers concluded.
Disclosure: The study was funded by research grants from Servier. See the full study for a list of the researchers’ relevant financial disclosures.
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