title: Assessing Risk in Patients with Stable Coronary Disease: When Should We Intensify Care and Follow-Up? Results from a Meta-Analysis of Observational Studies of the COURAGE and FAME Era.
abstract: Background. A large number of clinical and laboratory markers have been appraised to predict prognosis in patients with stable angina, but uncertainty remains regarding which variables are the best predictors of prognosis. Therefore, we performed a meta-analysis of studies in patients with stable angina to assess which variables predict prognosis. Methods. MEDLINE and PubMed were searched for eligible studies published up to 2015, reporting multivariate predictors of major adverse cardiac events (MACE, a composite endpoint of death, myocardial infarction, and revascularization) in patients with stable angina. Study features, patient characteristics, and prevalence and predictors of such events were abstracted and pooled with random-effect methods (95% CIs). Major adverse cardiovascular event (MACE) was the primary endpoint. Results. 42 studies (104,559 patients) were included. After a median follow-up of 57 months, cardiovascular events occurred in 7.8% of patients with MI in 6.2% of patients and need for repeat revascularization (both surgical and percutaneous) in 19.5% of patients. Male sex, reduced EF, diabetes, prior MI, and high C-reactive protein were the most powerful predictors of cardiovascular events. Conclusions. We show that simple and low-cost clinical features may help clinicians in identifying the most appropriate diagnostic and therapeutic approaches within the broad range of outpatients presenting with stable coronary artery disease.
authors.affiliation: Division of Cardiology, University of Turin, Turin, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Barbero
authors.affiliation: Division of Cardiology, University of Turin, Turin, Italy; Meta-Analysis and Evidence Based Medicine Training in Cardiology (METCARDIO), Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: D'Ascenzo
authors.affiliation: Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: Freek
authors.initials: F
authors.lastname: Nijhoff
authors.affiliation: Division of Cardiology, University of Turin, Turin, Italy; Meta-Analysis and Evidence Based Medicine Training in Cardiology (METCARDIO), Rome, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Moretti
authors.affiliation: Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy; Department of Angiocardioneurology, IRCCS Neuromed, Pozzilli, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Biondi-Zoccai
authors.affiliation: Department of Interventional Cardiology, Istituto Clinico Humanitas, IRCCS, Rozzano, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Mennuni
authors.affiliation: Cardiothoracovascular Department, Ferrarotto Hospital, University of Catania, Catania, Italy.
authors.forename: Davide
authors.initials: D
authors.lastname: Capodanno
authors.affiliation: Division of Cardiology, University of Turin, Turin, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Lococo
authors.affiliation: MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Lipinski
authors.affiliation: Division of Cardiology, University of Turin, Turin, Italy.
authors.forename: Fiorenzo
authors.initials: F
authors.lastname: Gaita