Document Detail

Prevalence of Anginal Symptoms and Myocardial Ischemia and Their Effect on Clinical Outcomes in Outpatients With Stable Coronary Artery Disease: Data From the International Observational CLARIFY Registry.
MedLine Citation:
PMID:  25110899     Owner:  NLM     Status:  Publisher    
Importance: In the era of widespread revascularization and effective antianginals, the prevalence and prognostic effect of anginal symptoms and myocardial ischemia among patients with stable coronary artery disease (CAD) are unknown.
Objective: To describe the current clinical patterns among patients with stable CAD and the association of anginal symptoms or myocardial ischemia with clinical outcomes.
Design, Setting, and Participants: The Prospective Observational Longitudinal Registry of Patients With Stable Coronary Artery Disease (CLARIFY) registry enrolled outpatients in 45 countries with stable CAD in 2009 to 2010 with 2-year follow-up (median, 24.1 months; range, 1 day to 3 years). Enrollees included 32 105 outpatients with prior myocardial infarction, chest pain, and evidence of myocardial ischemia, evidence of CAD on angiography, or prior revascularization. Of these, 20 291 (63.2%) had undergone a noninvasive test for myocardial ischemia within 12 months of enrollment and were categorized into one of the following 4 groups: no angina or ischemia (n = 13 207 [65.1%]); evidence of myocardial ischemia without angina (silent ischemia) (n = 3028 [14.9%]); anginal symptoms alone (n = 1842 [9.1%]); and angina and ischemia (n = 2214 [10.9%]).
Exposures: Stable CAD.
Main Outcome and Measure: The composite of cardiovascular (CV)-related death or nonfatal myocardial infarction.
Results: Overall, 4056 patients (20.0%) had anginal symptoms and 5242 (25.8%) had evidence of myocardial ischemia on results of noninvasive testing. Of 469 CV-related deaths or myocardial infarctions, 58.2% occurred in patients without angina or ischemia, 12.4% in patients with ischemia alone, 12.2% in patients with angina alone, and 17.3% in patients with both. The hazard ratios for the primary outcome relative to patients without angina or ischemia and adjusted for age, sex, geographic region, smoking status, hypertension, diabetes mellitus, and dyslipidemia were 0.90 (95% CI, 0.68-1.20; P = .47) for ischemia alone, 1.45 (95% CI, 1.08-1.95; P = .01) for angina alone, and 1.75 (95% CI, 1.34-2.29; P < .001) for both. Similar findings were observed for CV-related death and for fatal or nonfatal myocardial infarction.
Conclusions and Relevance: In outpatients with stable CAD, anginal symptoms (with or without ischemia on noninvasive testing) but not silent ischemia appear to be associated with an increased risk for adverse CV outcomes. Most CV events occurred in patients without angina or ischemia.
Trial Registration: Identifier: ISRCTN43070564.
Philippe Gabriel Steg; Nicola Greenlaw; Michal Tendera; Jean-Claude Tardif; Roberto Ferrari; Muayed Al-Zaibag; Paul Dorian; Dayi Hu; Svetlana Shalnova; Fernando José Sokn; Ian Ford; Kim M Fox;
Related Documents :
23827399 - Percutaneous coronary intervention in patients with previous coronary artery bypass gra...
23572059 - Impact of inflammation on adverse cardiovascular events in patients with acute coronary...
23074589 - Clinical and electrophysiological predictors of ventriculoatrial conduction in patients...
24488609 - Release kinetics of early ischaemic biomarkers in a clinical model of acute myocardial ...
16290989 - Coronary artery calcifications in the long-term follow-up of kawasaki disease.
24210989 - Spanish catheter ablation registry. 12th official report of the spanish society of card...
22616639 - Late left ventricular perforation by active fixation pacemaker lead implanted in the ri...
15519029 - Moderate and chronic hemodynamic overload of sheep atria induces reversible cellular el...
2389839 - Do thallium myocardial perfusion scan abnormalities predict survival in sarcoid patient...
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-8-11
Journal Detail:
Title:  JAMA internal medicine     Volume:  -     ISSN:  2168-6114     ISO Abbreviation:  JAMA Intern Med     Publication Date:  2014 Aug 
Date Detail:
Created Date:  2014-8-11     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101589534     Medline TA:  JAMA Intern Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Previous Document:  Effects of the relative values of alternatives on preference for free-choice in humans.
Next Document:  Smooth muscle cell phenotypic switch: implications for foam cell formation.