Impact of multimorbidity patterns on outcomes and treatment in patients with coronary artery disease

Area of Science:

• Cardiology
• Clinical Medicine
• Public Health

Background:

• Coronary artery disease (CAD) is increasingly prevalent in aging populations.
• Multimorbidity complicates CAD management, affecting patient outcomes and quality of life.
• Identifying distinct multimorbidity patterns is crucial for personalized treatment strategies in CAD.

Purpose of the Study:

• To identify and characterize multimorbidity patterns in patients with coronary artery disease.
• To evaluate the impact of these patterns on clinical outcomes, including mortality and complications.
• To assess the efficacy and safety of dual antiplatelet therapy (DAPT) within different multimorbidity profiles.

Main Methods:

• Analysis of large-scale registry data from the DCEM (NCT05797402) and BleeMACS (NCT02466854) cohorts.
• Categorization of 188,860 CAD patients into three distinct multimorbidity patterns based on comorbidity profiles.
• Comparative analysis of clinical outcomes and DAPT effectiveness across the identified patient groups.

Main Results:

• Three multimorbidity patterns were identified: Class 1 (cardiovascular-kidney-metabolic, highest risk), Class 2 (hypertension-dyslipidaemia, intermediate risk), and Class 3 (non-specific, lowest risk).
• Class 1 patients exhibited a six-fold higher in-hospital mortality and four-fold increase in severe complications versus Class 3.
• In Class 1, DAPT (aspirin plus clopidogrel) significantly reduced 1-year all-cause mortality (HR 0.60) without increasing major bleeding risk.

Conclusions:

• CAD patients with a cardiovascular-kidney-metabolic comorbidity profile represent the highest-risk group.
• Targeted dual antiplatelet therapy, specifically aspirin and clopidogrel, offers a significant survival benefit in this high-risk population.
• This DAPT regimen is effective in reducing mortality without a substantial increase in bleeding complications for high-risk CAD patients.