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

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16 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
Article numbere004080
JournalJournal of the American Heart Association
Volume5
Issue number10
DOIs
Publication statusPublished - 2016 Jan 1

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

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

@article{a4a7bbacef984f32aaffd964ef98a82d,
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 = "{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 Chow, {Anna Marie}",
year = "2016",
month = "1",
day = "1",
doi = "10.1161/JAHA.116.004080",
language = "English",
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 - Chow, Anna Marie

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.

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U2 - 10.1161/JAHA.116.004080

DO - 10.1161/JAHA.116.004080

M3 - Article

C2 - 27680665

AN - SCOPUS:84994417481

VL - 5

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 10

M1 - e004080

ER -