Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease: Insights From the Reduction of Atherothrombosis for Continued Health (REACH) Registry.

Abstract

The extent to which angina is associated with future cardiovascular events in patients with coronary artery disease has long been debated.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).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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Published Version (Please cite this version)

10.1161/JAHA.116.004080

Publication Info

Eisen, Alon, Deepak L Bhatt, P Gabriel Steg, Kim A Eagle, Shinya Goto, Jianping Guo, Sidney C Smith, E Magnus Ohman, et al. (2016). Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease: Insights From the Reduction of Atherothrombosis for Continued Health (REACH) Registry. Journal of the American Heart Association, 5(10). 10.1161/JAHA.116.004080 Retrieved from https://hdl.handle.net/10161/20596.

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Ohman

Erik Magnus Ohman

Professor of Medicine

Dr. Ohman, Professor of Medicine, received medical degrees from the Royal College of Surgeons in Ireland and the National University of Ireland (1984, Fellowship 1984-1987), and completed his training in cardiology at Duke University (1987-1991), where he has remained on faculty. In 2001, he became Chief of Cardiology at the University of North Carolina at Chapel Hill, where he founded the UNC Heart Center and became its first director. In 2005 he returned to Duke to pursue his interest in advanced coronary disease as the Director of the Program for Advanced Coronary Disease. Since that time, he has been appointed to Associate Director of the Duke Heart Center, the Kent and Siri Rawson Director for the Program for Advanced Coronary Disease, and most recently, Vice-Chair of Development and Innovation in the Department of Medicine.

Dr. Ohman’s clinical and research interests include interventional cardiology and high-risk supported PCI, and treatment of patients with advanced/complex coronary disease. He has researched how to improve patient care through the use of guidelines-based therapies and adherence, and examining global cardiovascular risk and health. He has been a participant on numerous guidelines writing committees, served on the ACC/AHA oversight committee for guidelines development, and has served on the steering committees for trials on ST-elevation myocardial infarction and non-ST-elevation ACS. He is a consultant to the National Institutes of Health, and a consultant for the FDA Advisory Panel for Cardiovascular Devices. 

Dr. Ohman has published over 600 peer-reviewed papers and three books in cardiovascular medicine. He holds three U.S. patents in reperfusion therapy. He is an associate editor for the American Heart Journal and serves on the editorial boards of the Journal of the American College of Cardiology and the American Journal of Cardiology.  He is a Fellow of the Royal College of Physicians in Ireland, the Royal Society of Medicine (U.K.), the European Society of Cardiology, the Society of Cardiac Angiography and Interventions, and the American College of Cardiology. 


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