What is the clinical evidence from this study?

Study design: Cohort. Population: Variant angina (n=2476). Intervention: Poor medication adherence vs. Good medication adherence. Primary outcome: All-cause mortality (HR 1.90, 95% CI 1.40-2.57).

April 6, 2017Open Access

Incidence and factors associated with mortality in 2,476 patients with variant angina in Korea

HKHack‐Lyoung KimInterventional Cardiology JKJayeun KimSeoul National University HKHyun Joo KimIncheon National University

Key Result

In patients with variant angina, poor medication adherence significantly increased the risk of all-cause mortality (HR 1.90) compared to good adherence.

Study Design

Type

Cohort (n=2,476)

Structured PICO

Population

2,476 patients with variant angina in South Korea, including 42.9% women, followed for a median of 4.9 years to assess mortality and prognostic factors.

Outcome

All-cause mortality and cardiovascular mortalityhard clinical

In patients with variant angina, traditional cardiovascular risk factors, poor medication adherence, and low household income are independent predictors of long-term mortality.

Main Result

Hazard Ratio: 1.9 (95% CI 1.4–2.57)

Limitations

Potential coding inaccuracies inherent to health insurance-based databases
Methods used for variant angina diagnosis were not available
Lack of information on other risk factors such as cigarette smoking, combined atherosclerotic coronary stenosis, and multi-vessel spasm
Lack of information on medications other than vasodilators
Follow-up periods varied among individual patients depending on the date of diagnosis

Abstract

This study investigated the incidence and risk factors of mortality in 2,476 patients with variant angina (VA) using the National Health Insurance Service-National Sample Cohort between 2004 and 2011. The risk factors of all-cause and cardiac mortality were investigated using Cox proportional hazards model. Most patients (69.5%) were less than 65 years and 42.9% were women. During the median follow-up duration of 4.9 years, there were 178 (7.2%) and 95 (3.8%) cases of all-cause and cardiac mortality, respectively. Older age, hypertension, diabetes mellitus, poor medication adherence, low household income and tertiary teaching hospitals were independent predictors for all-cause mortality, while older age, hypertension, low household income and tertiary teaching hospitals were independent predictors for cardiac mortality. In conclusion, our findings suggest that traditional risk factor control and continued medication are important to improve VA outcomes, and that household income-level factors should be considered in the assessment of risk of VA patients.

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