稳定型冠状动脉疾病患者的心绞痛与未来心血管事件：来自降低动脉粥样硬化血栓形成以持续健康（REACH）注册研究的见解
Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease: Insights From the Reduction of Atherothrombosis for Continued Health (REACH) Registry.
作者信息
Eisen Alon, Bhatt Deepak L, Steg P Gabriel, Eagle Kim A, Goto Shinya, Guo Jianping, Smith Sidney C, Ohman E Magnus, Scirica Benjamin M
机构信息
Brigham and Women's Hospital, Boston, MA Harvard Medical School, Boston, MA.
Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodeling), Université Paris-Diderot, Sorbonne Paris Cité, Paris, France FACT (French Alliance for Cardiovascular Clinical Trials), Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France INSERM U-1148, Paris, France National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom.
出版信息
J Am Heart Assoc. 2016 Sep 28;5(10):e004080. doi: 10.1161/JAHA.116.004080.
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.
背景
冠心病患者中，心绞痛与未来心血管事件的关联程度长期以来一直存在争议。
方法与结果
纳入参加REACH注册研究的已确诊冠心病门诊患者，并对其进行4年随访。基线时的心绞痛定义为需要进行发作性或永久性抗心绞痛治疗。主要终点为心血管死亡、心肌梗死或卒中的复合终点。次要终点包括心力衰竭、心血管住院和冠状动脉血运重建。使用Cox模型和逻辑回归模型检验心绞痛与首次/总事件之间的独立关联。在26159例已确诊冠心病患者中，13619例（52%）在基线时有心绞痛。与无心绞痛患者相比，有心绞痛患者年龄更大、女性更多，且心力衰竭和多血管疾病更多（每项P<0.001）。与无心绞痛患者相比，有心绞痛患者首次主要终点事件发生率更高（14.2%对16.3%，未调整风险比1.19，CI 1.11-1.27，P<0.001；调整后风险比1.06，CI 0.99-1.14，P=0.11），总主要终点事件发生率更高（调整后风险比1.08，CI 1.01-1.16，P=0.03）。有心绞痛患者发生心力衰竭（调整后比值比1.17，CI 1.06-1.28，P=0.002）、心血管住院（调整后比值比1.29，CI 1.21-1.38，P<0.001）和冠状动脉血运重建（调整后比值比1.23，CI 1.13-1.34，P<0.001）的风险增加。
结论
与无心绞痛的稳定型冠心病患者相比，有心绞痛的患者未来发生心血管事件的发生率更高。调整后，心绞痛仅与心血管死亡、心肌梗死或卒中存在弱关联，但与心力衰竭、心血管住院和冠状动脉血运重建显著相关。
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