CLARIFY registry reveals worse prognosis in patients with angina and prior MI
Angina in patients with a history of myocardial infarction (MI) is associated with a higher rate of cardiovascular (CV) death or nonfatal MI, according to late-breaking results from the CLARIFY registry presented at the European Society of Cardiology (ESC) Congress 2019 and World Congress of Cardiology (WCC) 2019.
“The news is that angina is associated with worse prognosis only in patients with prior MI and not in those who have not had it before,” said first author, Dr Emmanuel Sorbets of Hospital Avicenne of Bobigny, France. In patients with prior MI, the rate of primary event, defined as CV death or nonfatal MI, was 11.8 percent (95 percent confidence interval [CI], 10.9 to 12.9) in those with angina symptoms vs 8.2 percent (95 percent CI, 7.8 to 8.7) in those with no angina (p<0.001). Among patients without prior MI, event rates were similar for patients with (6.3 percent; 95 percent CI, 5.4 to 7.3) or without angina (6.4 percent; 95 percent CI, 5.9 to 7.0; p>0.99). [Eur Heart J 2019, doi: 10.1093/eurheartj/ehz660]
Between November 2009 and June 2010, the CLARIFY registry (Prospective Observational Longitudinal Registry of Patients with Stable Coronary Artery Disease) enrolled 32,703 patients with chronic coronary syndrome (mean age, 64.2; 77.6 percent male) from 45 high-, middle- and low-income countries, which were organized into six geographical areas: Western/Central Europe, Eastern Europe, Middle East, Asia, Central/South America, and some Commonwealth countries (Australia, Canada, South Africa, UK).
“The main goals of CLARIFY were to describe the demographics, clinical characteristics and management of patients with chronic coronary syndrome, as well as to assess the rates and determinants of outcomes in these patients,” said Sorbets.
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.
“In spite of the demographic differences, where the females enrolled in our study were older, had higher rates of treated hypertension, and had lower rates of current smoking, prior MI, PCI, and CABG, yet more commonly experienced anginal symptoms, the primary outcomes were very similar for both men and women,” commented Sorbets.
The 5-year primary outcome rate was 8.0 percent overall (95 percent CI, 7.7 to 8.3), 8.1 percent for males (95 percent CI, 7.8 to 8.5) and 7.6 percent for females (95 percent CI, 7.0 to 8.3). “Therefore, gender is not an independent predictor of CV death or nonfatal MI,” noted Sorbets.
Secondary prevention therapies, such as antiplatelet agents, statins, beta-blockers, and renin-angiotensin system inhibitors (angiotensin-converting enzyme inhibitors or angiotensin receptor blockers), were used by 95.2 percent, 82.9 percent, 75.3 percent, and 76.3 percent of patients, respectively.
“But the high medication rates did not translate into achieving therapeutic targets for a large proportion of patients,” noted Sorbets. “Only 29 percent of patients achieved the latest and most stringent recommended targets of <130/80 mm Hg for blood pressure, only 20.1 percent achieved the latest target for LDL-cholesterol of <70 mg/dL, and just 7.4 percent of patients achieved both therapeutic goals.” [Eur Heart J 2018;39:3021; Eur Heart J 2019, doi: 10.1093/eurheart/ehz425]
“In this broad population with chronic coronary syndrome, rates of major CV events were lower than those observed in historical datasets, which may reflect improved global medical care. However, patients with both angina and prior MI are an easily identifiable high-risk group, which may warrant more intensive treatment,” concluded Sorbets.