In stable CAD outpatients, cardiovascular death occurred at 1.3% per year, with previous hospitalization for decompensated heart failure strongly predicting mortality (SHR 3.10; 95% CI 2.19-4.40).
Cohort (n=4,184)
What are the long-term causes and predictors of cardiovascular death in patients with stable coronary artery disease receiving modern secondary prevention?
In stable CAD patients on modern secondary prevention, cardiovascular mortality is primarily driven by heart failure and sudden death, and risk can be stratified using simple baseline clinical variables.
Hazard Ratio: 3.1 (95% CI 2.19–4.4)
BACKGROUND: There is limited knowledge on the residual risk of cardiovascular death (CVD) in patients with stable coronary artery disease (CAD) who receive modern secondary prevention. Our aim was to analyze the causes of death and to determine predictors of CVD in the 5-year CORONOR registry. METHODS: We studied 4184 consecutive CAD outpatients who were free from any myocardial infarction (MI) or coronary revascularization for more than 1 year at inclusion. Antithrombotics were prescribed in 99%, statins in 92%, inhibitors of renin-angiotensin system in 82%, and β-blockers in 79%; 86% had prior coronary revascularization. Follow-up was performed at 5 years with adjudication of the causes of death. RESULTS: There were 677 deaths during follow-up. The cause of death was cardiovascular in 269 patients (1.3%/year), with 99 deaths from heart failure (HF), 91 sudden deaths, and 65 vascular deaths (stroke, MI, limb or mesenteric ischemia, aortic aneurysm). Predictors of CVD were age subhazard ratio (SHR)=1.06 (1.04-1.07) per year increase, previous hospitalization for decompensated HF SHR=3.10 (2.19-4.40), left ventricular ejection fraction SHR=0.97 (0.96-0.98) per percentage increase, prior aortic or peripheral intervention SHR=1.61 (1.12-2.13), and estimated glomerular filtration rate SHR=0.99 (0.98-1.00) per ml/min/1.73m increase]. In analyses stratified on age, prior HF, and left ventricular ejection fraction, the estimated 5-year cardiovascular mortality rates varied from less than 2% to more than 50%. CONCLUSION: In stable CAD patients widely treated by secondary prevention medications, the main causes of CVD are death from HF and sudden death. The risk of CVD can be predicted by simple baseline variables. New therapeutic strategies are needed for the high-risk patients.
Bauters et al. (Wed,) conducted a cohort in stable coronary artery disease (n=4,184). Baseline clinical variables (e.g., previous hospitalization for decompensated heart failure) was evaluated on cardiovascular death (SHR 3.10, 95% CI 2.19-4.40). In stable CAD outpatients, cardiovascular death occurred at 1.3% per year, with previous hospitalization for decompensated heart failure strongly predicting mortality (SHR 3.10; 95% CI 2.19-4.40).