PARIS – Patients with angina who were also more than 3 months out from a prior MI had a significantly increased rate of subsequent cardiovascular death or nonfatal MI in a study of nearly 33,000 patients, a finding that identified angina as a new red flag when following post-MI patients.
Mitchel L. Zoler/MDedge News
Dr. Emmanuel Sorbets
“Angina and prior MI was a higher-risk subgroup that may warrant more intensive management. This is new,” Emmanuel Sorbets, MD, said at the annual congress of the European Society of Cardiology.
The finding came from review of 32,703 patients from 45 countries with stable coronary artery disease enrolled in the CLARIFY (Prospective Observational Longitudinal Registry of Patients with Stable Coronary Artery Disease) registry during 2009-2010, a population that appeared to uniformly meet the new definition of chronic chromic syndromes recently published by a task force of the society (Eur Heart J. 2019 Aug 31. doi: 10.1093/eurheartj/ehz425).
Among the CLARIFY patients, 60% had an MI more than 3 months prior to enrollment (the registry excluded patients with more proximate MIs), and in this subgroup angina at baseline was linked with a 3.6% absolute increase in the rate of cardiovascular death or nonfatal MI compared with post-MI patients without angina at baseline during a median 5 year follow-up. This translated into a 44% relative increase that remained statistically significant after adjustment for several demographic and clinical factors, said Dr. Sorbets, a cardiologist at Avicenne Hospital in Bobigny, France. The cumulative incidence of the combined endpoint was 11.8% among post-MI patients with baseline angina and 8.2% in those without angina. Among patients without a prior MI, the presence or absence of angina at entry into the registry had no link with the incidence of later outcomes. Concurrently with Dr. Sorbets’ report at the congress, the results appeared in an article published online (Eur Heart J. 2019 Sep 3;doi: 10.1093/eurheartj/ehz660).
This finding should immediately influence practice, said Sanjay Sharma, MD, professor of inherited cardiac diseases and sports cardiology at St. George’s University, London. “One of the messages from this study is that we now have a very easy way to measure a high-risk factor,” and that patients who present with angina more than 3 months after an MI “require intensive investigation and aggressive management,” he said. The new evidence identified post-MI patients with angina as having a “semi-urgent” condition that needs added anti-anginal treatment and, if symptoms persist, possible revascularization, especially patients without prior revascularization, he said in a video interview. Although the study did not analyze the type of MI linked with these poor outcomes, Dr. Sharma speculated that certain patients with a prior non ST-elevation MI may face the greatest danger it they did not undergo percutaneous coronary revascularization at the time of their MI.
CLARIFY is sponsored by Servier. Dr. Sorbets has received personal fees from Servier, AstraZeneca, Bayer, Bristol-Myers Squibb, Merck Sharpe & Dohme, and Novartis. Dr. Sharma had no relevant disclosures.