Long-term morbidity and mortality among medically managed patients with angina and multivessel coronary artery disease.

BACKGROUND: There are little data regarding outcomes in patients with angina and severe coronary artery disease (CAD) treated with medical management. Using the Duke Databank of Cardiovascular Disease, we describe the prevalence and long-term outcomes of patients with angina and multivessel CAD treated medically after catheterization. METHODS: Patients undergoing catheterization for angina (chest pain without recent revascularization or myocardial infarction) with severe CAD (>or=75% stenosis in >or=2 epicardial vessels) were identified (n = 8,555). One and five year outcomes in the 32% (n = 2,776) of patients who did not receive revascularization in the 30 days after catheterization were described. Predictors of 1-year death, cardiac rehospitalization, and late revascularization in this population were identified. RESULTS: The population had a median age of 66, were mostly male, had significant comorbidities, and most had prior revascularization. Outcomes were poor at 1 and 5 years: death (11% and 37%), cardiac rehospitalization (29% and 61%), and late revascularization (10% and 27%). The cumulative rate of death, myocardial infarction, late revascularization, or cardiac rehospitalization occurred in 38% at 1 year and 76% at 5 years. Prior coronary artery bypass grafting was the only variable independently associated with protection from death, cardiac rehospitalization, and late revascularization. CONCLUSIONS: Medical management after catheterization is a common in patients with severe CAD and angina. Of patients treated with medical management, one third will have a recurrent cardiac event within the first year highlighting the poor outcomes and high utilization of resources by this patient population.

Profile of chronic and recurrent angina pectoris in a referral population.

Angina pectoris (AP) often responds to treatment, but in some, it becomes chronic or recurs over time. Identifying patients with continued AP is a necessary to understand its associations and implications. A baseline cohort with coronary disease and AP were surveyed 6 months and 1 year after catheterization for self-reported symptoms and quality of life. Patients were divided into 3 groups: chronic AP, recurrent AP, and AP free. Baseline characteristics, medications, revascularization, and quality of life are described. Regression analysis determined independent associations with chronic AP. Of the 1,109 patients with complete 1-year follow-up, 19% (n = 207) had chronic AP, 11% (n = 126) had recurrent AP, but most (70%, n = 776) were AP free. Patients with chronic and recurrent AP had similar cardiac histories, had more single vessel coronary disease, and underwent revascularization less often. Patients with recurrent AP had lower educational status and more often smoked. Patients with chronic AP were younger, were women, had higher body mass index, had more depression and lung disease, and had more frequent baseline AP. They also took more antianginals and other medications and had reduced physical function and health-related quality of life in relation to the persistence and frequency of symptoms (p <0.001). In conclusion, patients with chronic and recurrent AP represent unique populations in whom AP continues to negatively impact quality of life despite contemporary care.