Long-term outcomes in patients with coronary artery disease in ambulatory practice: 10-year follow-up

Le résumé fourni par la source

Aim . To evaluate outcomes over 10-year follow-up and the risks of adverse events in patients with coronary artery disease (CAD) within an outpatient registry. Material and methods . The RECVAZA outpatient registry, based at three clinics in Ryazan, included 2548 patients with CAD (age, 70,4±10,8 years; men, 28,5%). The following outcomes were assessed from 2012 to 2023 (follow-up period, 8,2±3,3 years): death, myocardial infarction (MI), cerebrovascular accident (CVE), and hospitalization for cardiovascular disease (CVD). Outcome information was obtained from medical records, surveys, and electronic databases. Results . During 10-year follow-up, 1321 patients with coronary artery disease (CAD) died in the RECVASA registry, which is 51,8%. The main causes of death were CVD (44,4%) and cancer (8,8%). A particularly high proportion of deaths was observed among patients who, at the time of inclusion in the study, had prior stroke (71,9%) and MI (61,5%); a combination of CAD with hypertension (HTH), heart failure (HF) and atrial fibrillation (AF) (79%); age ≥80 years (91,7%). The highest all-cause and cardiovascular death risk was associated with age (hazard ratio (HR)=1,06 and HR=1,07; p<0,001); male sex (HR=1,70 and HR=1,62; p<0,001); prior CVE (HR=1,86 and HR=2,13; p<0,001); type 2 diabetes (HR=1,55 and HR=1,67; p<0,001); decreased hemoglobin level (HR=1,66 and HR=1,72; p<0,001); increased hemoglobin level (HR=1,63 and HR=1,92; p=0,005 and 0,004); smoking (HR=1,51; p=0,001 and HR=1,72; p=0,003), respectively. The risk of MI was most associated with male sex and prior MI (HR=1,77 and HR=2,61; p<0,001), while the risk of CVE — with AF and prior CVE (HR=1,65 and 3,78; p<0,001), with systolic blood pressure <110 mm Hg (HR=2,72; p=0,01). Hospitalization for CVD more than once every 2 years was associated with a higher death risk (by 1,6 times), but a lower rate — with a lower risk (by 1,9 times) than in its absence. When quadruple therapy was prescribed, including a renin-­angiotensin system blocker, a beta-blocker, a statin, and an antiplatelet/anticoagulant agent in the presence/absence of AF, compared to those prescribed 0-1 of these, the all-cause and cardiovascular death risk was 3,5 and 4,2 times lower, respectively. Conclusion . Over 10-year follow-up, 51,8% of patients with coronary artery disease (CAD) died. The highest mortality rate was observed in patients with prior MI and SVE, type 2 diabetes, a combination of CAD, HTN, HF, and AF, and low hemoglobin levels. Hospitalizations for CVD more than once every two years were associated with a higher death risk, but a lower hospitalization rate was associated with a lower risk than in patients with no cardiovascular hospitalizations. Prescription of quadruple therapy with a renin-­angiotensin system blocker, a beta-blocker, a statin, and an antithrombotic agent, when indicated, reduced the all-cause and cardiovascular mortality risk by 3,5 and 4,2 times, respectively.

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.