Cardiology Department, Assistance Publique-Hôpitaux de Paris, Hôpital Avicenne, 125 rue de Stalingrad, 93000 Bobigny, France.
Paris 13 University, 74 rue Marcel Cachin, 93000 Bobigny, France.
Eur Heart J. 2020 Jan 14;41(3):347-356. doi: 10.1093/eurheartj/ehz660.
Over the last decades, the profile of chronic coronary syndrome has changed substantially. We aimed to determine characteristics and management of patients with chronic coronary syndrome in the contemporary era, as well as outcomes and their determinants.
Data from 32 703 patients (45 countries) with chronic coronary syndrome enrolled in the prospective observational CLARIFY registry (November 2009 to June 2010) with a 5-year follow-up, were analysed. The primary outcome [cardiovascular death or non-fatal myocardial infarction (MI)] 5-year rate was 8.0% [95% confidence interval (CI) 7.7-8.3] overall [male 8.1% (7.8-8.5); female 7.6% (7.0-8.3)]. A cox proportional hazards model showed that the main independent predictors of the primary outcome were prior hospitalization for heart failure, current smoking, atrial fibrillation, living in Central/South America, prior MI, prior stroke, diabetes, current angina, and peripheral artery disease. There was an interaction between angina and prior MI (P = 0.0016); among patients with prior MI, angina was associated with a higher primary event rate [11.8% (95% CI 10.9-12.9) vs. 8.2% (95% CI 7.8-8.7) in patients with no angina, P < 0.001], whereas among patients without prior MI, event rates were similar for patients with [6.3% (95% CI 5.4-7.3)] or without angina [6.4% (95% CI 5.9-7.0)], P > 0.99. Prescription rates of evidence-based secondary prevention therapies were high.
This description of the spectrum of chronic coronary syndrome patients shows that, despite high rates of prescription of evidence-based therapies, patients with both angina and prior MI are an easily identifiable high-risk group who may deserve intensive treatment.
ISRCTN43070564.
在过去的几十年中，慢性冠状动脉综合征的特征发生了很大变化。我们旨在确定当代慢性冠状动脉综合征患者的特征和治疗方法，以及结局及其决定因素。
对前瞻性观察性 CLARIFY 登记处（2009 年 11 月至 2010 年 6 月）中 32703 例（来自 45 个国家）慢性冠状动脉综合征患者的数据进行了分析，这些患者接受了 5 年随访。主要结局[心血管死亡或非致死性心肌梗死（MI）]5 年发生率为 8.0%[95%置信区间（CI）7.7-8.3]（男性 8.1%（7.8-8.5）；女性 7.6%（7.0-8.3））。Cox 比例风险模型显示，主要结局的独立预测因素为心力衰竭既往住院、当前吸烟、心房颤动、居住在中/南美洲、既往 MI、既往卒中和糖尿病、当前心绞痛和外周动脉疾病。心绞痛与既往 MI 之间存在交互作用（P = 0.0016）；在既往 MI 患者中，心绞痛与更高的主要事件发生率相关[11.8%（95% CI 10.9-12.9）比无心绞痛患者 8.2%（95% CI 7.8-8.7），P < 0.001]，而在无既往 MI 的患者中，有或无心绞痛的患者的事件发生率相似[6.3%（95% CI 5.4-7.3）和 6.4%（95% CI 5.9-7.0），P > 0.99]。证据为基础的二级预防治疗的处方率较高。
对慢性冠状动脉综合征患者谱的描述表明，尽管证据为基础的治疗方案的处方率很高，但既有心绞痛又有既往 MI 的患者是一个容易识别的高风险群体，可能需要强化治疗。
ISRCTN43070564。
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