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Elective Coronary Revascularization Procedures in Patients With Stable Coronary Artery Disease: Incidence,
Martial Hamon1, Gilles Lemesle2, Thibaud Meurice3
1University Hospital of Caen, Caen University, Caen, France.
Insights
Elective coronary revascularization (ECR) occurs annually in 1.8% of stable coronary artery disease (CAD) patients on secondary prevention. ECR did not impact the risk of death, myocardial infarction, or ischemic stroke in this cohort.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Limited observational data exist on elective coronary revascularization (ECR) in stable coronary artery disease (CAD) patients receiving modern secondary prevention.
- Understanding ECR trends and outcomes in this population is crucial for clinical practice guidelines.
Purpose of the Study:
- To describe the incidence, determinants, and outcomes of ECR in patients with stable CAD.
- To evaluate the association between ECR and subsequent adverse cardiovascular events.
Main Methods:
- Analysis of a prospective, multicenter registry (CORONOR) of 4,094 stable CAD outpatients with 5-year follow-up.
- Assessment of secondary prevention medication use at baseline.
- Identification of factors associated with ECR and its impact on mortality, myocardial infarction, and ischemic stroke.
Main Results:
- The 5-year cumulative incidence of ECR was 8.9% (1.8% per year).
- Seven variables independently predicted ECR: prior stent, no prior MI, higher LDL-C, younger age, multivessel CAD, diabetes, and no RAS antagonist use.
- Indications for ECR included angina with positive stress test (31%), silent ischemia (31%), and angina alone (25%).
Conclusions:
- ECR is performed in 1.8% annually among stable CAD patients on comprehensive secondary medical prevention.
- ECR procedures are performed even without noninvasive stress tests.
- Elective coronary revascularization was not associated with a reduced risk of subsequent ischemic adverse events.
Objectives:
The authors sought to describe the incidence, determinants, and outcome of elective coronary revascularization (ECR) in patients with stable coronary artery disease (CAD).
Background:
Observational data are lacking regarding the practice of ECR in patients with stable CAD receiving modern secondary prevention.
Methods:
The authors analyzed coronary revascularization procedures performed during a 5-year follow-up in 4,094 stable CAD outpatients included in the prospective multicenter CORONOR (Suivi d'une cohorte de patients COROnariens stables en région NORd-Pas-de-Calais) registry.
Results:
Secondary prevention medications were widely prescribed at inclusion (antiplatelet agents 96.4%, statins 92.2%, renin-angiotensin system antagonists 81.8%). A total of 481 patients underwent ≥1 coronary revascularization procedure (5-year cumulative incidences of 3.6% [0.7% per year] for acute revascularizations and 8.9% [1.8% per year] for ECR); there were 677 deaths during the same period. Seven baseline variables were independently associated with ECR: prior coronary stent implantation (p < 0.0001), absence of prior myocardial infarction (p < 0.0001), higher low-density lipoprotein cholesterol (p < 0.0001), lower age (p < 0.0001), multivessel CAD (p = 0.003), diabetes mellitus (p = 0.005), and absence of treatment with renin-angiotensin system antagonists (p = 0.020). Main indications for ECR were angina associated with a positive stress test (31%), silent ischemia (31%), and angina alone (25%). The use of ECR had no impact on the subsequent risk of death, myocardial infarction, or ischemic stroke (hazard ratio: 1.04; 95% confidence interval: 0.76 to 1.41).
Conclusions:
These real-life data show that ECR is performed at a rate of 1.8% per year in stable CAD patients widely treated by secondary medical prevention. ECR procedures performed in patients without noninvasive stress tests are not rare. Having an ECR was not associated with the risk of ischemic adverse events.
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