Burden of Hospital Admission and Repeat Angiography in Angina Pectoris Patients with and without Coronary Artery Disease: A Registry-Based Cohort StudyReportar como inadecuado




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Aims

To evaluate risk of hospitalization due to cardiovascular disease CVD and repeat coronary angiography CAG in stable angina pectoris SAP with no obstructive coronary artery disease CAD versus obstructive CAD, and asymptomatic reference individuals.

Methods and Results

We followed 11,223 patients with no prior CVD having a first-time CAG in 1998–2009 due to SAP symptoms and 5,695 asymptomatic reference individuals from the Copenhagen City Heart Study through registry linkage for 7.8 years median. In recurrent event survival analysis, patients with SAP had 3–4-fold higher risk of hospitalization for CVD irrespective of CAG findings and cardiovascular comorbidity. Multivariable adjusted hazard ratios95%CI for patients with angiographically normal coronary arteries was 3.02.5–3.5, for angiographically diffuse non-obstructive CAD 3.93.3–4.6 and for 1–3-vessel disease 3.6–4.1rangeall P<0.001. Mean accumulated hospitalization time was 3.53.0–4.0days-10 years follow-up in reference individuals and 4.53.8–5.2-7.05.4–8.6-6.75.2–8.1-6.15.2–7.4-8.66.6–10.7 in patients with angiographically normal coronary arteries-angiographically diffuse non-obstructive CAD-1-, 2-, and 3-vessel disease, respectively all P<0.05, age-adjusted. SAP symptoms predicted repeat CAG with multivariable adjusted hazard ratios for patients with angiographically normal coronary arteries being 2.31.9–2.9, for angiographically diffuse non-obstructive CAD 5.54.4–6.8 and for obstructive CAD 6.6–9.4rangeall P<0.001.

Conclusions

Patients with SAP symptoms and angiographically normal coronary arteries or angiographically diffuse non-obstructive CAD suffer from considerably greater CVD burdens in terms of hospitalization for CVD and repeat CAG compared with asymptomatic reference individuals even after adjustment for cardiac risk factors and exclusion of cardiovascular comorbidity as cause. Contrary to common perception, excluding obstructive CAD by CAG in such patients does not ensure a benign cardiovascular prognosis.



Autor: Lasse Jespersen , Steen Z. Abildstrom, Anders Hvelplund, Jan K. Madsen, Soren Galatius, Frants Pedersen, Soren Hojberg, Eva Presc

Fuente: http://plos.srce.hr/



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