Angina and future cardiovascular events in stable patients with coronary artery disease

Insights from the Reduction of Atherothrombosis for Continued Health (REACH) registry

on Behalf of the REACH Registry Investigators

    Research output: Contribution to journalArticle

    15 Citations (Scopus)

    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 (US)
    Article numbere004080
    JournalJournal of the American Heart Association
    Volume5
    Issue number10
    DOIs
    StatePublished - Jan 1 2016

    Fingerprint

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

    Keywords

    • Angina
    • Cardiovascular events
    • Coronary artery disease

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

    Cite this

    @article{5966f9e625454db38f105d92275898a3,
    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.",
    keywords = "Angina, Cardiovascular events, Coronary artery disease",
    author = "{on Behalf of the REACH Registry Investigators} and Alon Eisen and Bhatt, {Deepak L.} and Steg, {P. Gabriel} and Eagle, {Kim A.} and Shinya Goto and Jianping Guo and Smith, {Sidney C.} and Ohman, {E. Magnus} and Scirica, {Benjamin M.} and Heidi Andersen-Dalheim and Paul Anderson and Bill Anell and Sam Arber and Kathleen Armstrong and Dean Arnot and Alan Baldam and Ian Barratt and Sebastian Barresi and Jeff Beder and Michael Benson and Frederick Bergman and James Best and Rajesh Bhasim and Geoff Bovell and Neil Bowman and Mal Brkic and David Bromberger and David Brown and Jean Brown and Michael Brownstein and Angela Bruce and John Buonopane and Steven Burns and Alexis Butler and Danny Byrne and Judith Carson and Peter Cassimatis and Greig Chaffey and Dianne Chambers and Chan, {Wing Jung} and Ben Chan and James Cheatham and Rachel Chen and Brian Cheong and Christina Cheung and John Chin and Anthony Chiu and Eric Choo and Andrew Chow and James Edwards",
    year = "2016",
    month = "1",
    day = "1",
    doi = "10.1161/JAHA.116.004080",
    language = "English (US)",
    volume = "5",
    journal = "Journal of the American Heart Association",
    issn = "2047-9980",
    publisher = "Wiley-Blackwell",
    number = "10",

    }

    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 - on Behalf of the REACH Registry Investigators

    AU - Eisen, Alon

    AU - Bhatt, Deepak L.

    AU - Steg, P. Gabriel

    AU - Eagle, Kim A.

    AU - Goto, Shinya

    AU - Guo, Jianping

    AU - Smith, Sidney C.

    AU - Ohman, E. Magnus

    AU - Scirica, Benjamin M.

    AU - Andersen-Dalheim, Heidi

    AU - Anderson, Paul

    AU - Anell, Bill

    AU - Arber, Sam

    AU - Armstrong, Kathleen

    AU - Arnot, Dean

    AU - Baldam, Alan

    AU - Barratt, Ian

    AU - Barresi, Sebastian

    AU - Beder, Jeff

    AU - Benson, Michael

    AU - Bergman, Frederick

    AU - Best, James

    AU - Bhasim, Rajesh

    AU - Bovell, Geoff

    AU - Bowman, Neil

    AU - Brkic, Mal

    AU - Bromberger, David

    AU - Brown, David

    AU - Brown, Jean

    AU - Brownstein, Michael

    AU - Bruce, Angela

    AU - Buonopane, John

    AU - Burns, Steven

    AU - Butler, Alexis

    AU - Byrne, Danny

    AU - Carson, Judith

    AU - Cassimatis, Peter

    AU - Chaffey, Greig

    AU - Chambers, Dianne

    AU - Chan, Wing Jung

    AU - Chan, Ben

    AU - Cheatham, James

    AU - Chen, Rachel

    AU - Cheong, Brian

    AU - Cheung, Christina

    AU - Chin, John

    AU - Chiu, Anthony

    AU - Choo, Eric

    AU - Chow, Andrew

    AU - Edwards, James

    PY - 2016/1/1

    Y1 - 2016/1/1

    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.

    KW - Angina

    KW - Cardiovascular events

    KW - Coronary artery disease

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    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 -