Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease

Insights From the Reduction of Atherothrombosis for Continued Health (REACH) Registry

Alon Eisen, Deepak L. Bhatt, Gabriel Steg, Kim A. Eagle, Shinaya Goto, Jianping Guo, Sidney C. Smith, Magnus Ohman, Benjamin M. Scirica, REACH Registry Investigators

Research output: Contribution to journalArticle

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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.
Original languageEnglish
Article numbere004080
JournalJournal of the American Heart Association
Volume5
Issue number10
Early online date28 Sep 2016
DOIs
Publication statusPublished - 3 Oct 2016

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Registries
Coronary Artery Disease
Health
Heart Failure
Odds Ratio
Hospitalization
Logistic Models
Stroke
Myocardial Infarction
Outpatients

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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. / Eisen, Alon; Bhatt, Deepak L. ; Steg, Gabriel ; Eagle, Kim A.; Goto, Shinaya; Guo, Jianping ; Smith, Sidney C.; Ohman, Magnus ; Scirica, Benjamin M.; REACH Registry Investigators.

In: Journal of the American Heart Association, Vol. 5, No. 10, e004080, 03.10.2016.

Research output: Contribution to journalArticle

Eisen, Alon ; Bhatt, Deepak L. ; Steg, Gabriel ; Eagle, Kim A. ; Goto, Shinaya ; Guo, Jianping ; Smith, Sidney C. ; Ohman, Magnus ; Scirica, Benjamin M. ; REACH Registry Investigators. / Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease : Insights From the Reduction of Atherothrombosis for Continued Health (REACH) Registry. In: Journal of the American Heart Association. 2016 ; Vol. 5, No. 10.
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title = "Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease: Insights From the Reduction of Atherothrombosis for Continued Health (REACH) Registry",
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.",
author = "Alon Eisen and Bhatt, {Deepak L.} and Gabriel Steg and Eagle, {Kim A.} and Shinaya Goto and Jianping Guo and Smith, {Sidney C.} and Magnus Ohman and Scirica, {Benjamin M.} and Mary Macleod and {REACH Registry Investigators}",
note = "The REACH Registry was sponsored by Sanofi‐Aventis, Bristol‐Myers Squibb, and the Waksman Foundation (Tokyo, Japan) and is endorsed by the World Heart Federation.",
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TY - JOUR

T1 - Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease

T2 - Insights From the Reduction of Atherothrombosis for Continued Health (REACH) Registry

AU - Eisen, Alon

AU - Bhatt, Deepak L.

AU - Steg, Gabriel

AU - Eagle, Kim A.

AU - Goto, Shinaya

AU - Guo, Jianping

AU - Smith, Sidney C.

AU - Ohman, Magnus

AU - Scirica, Benjamin M.

AU - Macleod, Mary

AU - REACH Registry Investigators

N1 - The REACH Registry was sponsored by Sanofi‐Aventis, Bristol‐Myers Squibb, and the Waksman Foundation (Tokyo, Japan) and is endorsed by the World Heart Federation.

PY - 2016/10/3

Y1 - 2016/10/3

N2 - 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.

AB - 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.

U2 - 10.1161/JAHA.116.004080

DO - 10.1161/JAHA.116.004080

M3 - Article

VL - 5

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 10

M1 - e004080

ER -