Angina and Future Cardiovascular Events in Stable Patients With Coronary Artery Disease: Insights From the Reduction of Atherothrombosis for Continued Health (REACH) Registry.
The extent to which angina is associated with future cardiovascular events in patients with coronary artery disease has long been debated.



Included were outpatients with established coronary artery disease who were enrolled in the REACH registry and were followed for 4 years. Angina at baseline was defined as necessitating episodic or permanent antianginal treatment. The primary end point was the composite of cardiovascular death, myocardial infarction, or stroke. Secondary end points included heart failure, cardiovascular hospitalizations, and coronary revascularization. The independent association between angina and first/total events was examined using Cox and logistic regression models. Out of 26 159 patients with established coronary artery disease, 13 619 (52%) had angina at baseline. Compared with patients without angina, patients with angina were more likely to be older, female, and had more heart failure and polyvascular disease (P<0.001 for each). Compared with patients without angina, patients with angina had higher rates of first primary end-point event (14.2% versus 16.3%, unadjusted hazard ratio 1.19, CI 1.11-1.27, P<0.001; adjusted hazard ratio 1.06, CI 0.99-1.14, P=0.11), and total primary end-point events (adjusted risk ratio 1.08, CI 1.01-1.16, P=0.03). Patients with angina were at increased risk for heart failure (adjusted odds ratio 1.17, CI 1.06-1.28, P=0.002), cardiovascular hospitalizations (adjusted odds ratio 1.29, CI 1.21-1.38, P<0.001), and coronary revascularization (adjusted odds ratio 1.23, CI 1.13-1.34, P<0.001).



Patients with stable coronary artery disease and angina have higher rates of future cardiovascular events compared with patients without angina. After adjustment, angina was only weakly associated with cardiovascular death, myocardial infarction, or stroke, but significantly associated with heart failure, cardiovascular hospitalization, and coronary revascularization.
Brigham and Women's Hospital, Boston, MA Harvard Medical School, Boston, MA.
Alon
A
Eisen
Brigham and Women's Hospital, Boston, MA Harvard Medical School, Boston, MA.
Deepak L
DL
Bhatt
Département Hospitalo-Universitaire FIRE (Fibrosis, Inflammation, Remodeling), Université Paris-Diderot, Sorbonne Paris Cité, Paris, France FACT (French Alliance for Cardiovascular Clinical Trials), Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France INSERM U-1148, Paris, France National Heart and Lung Institute, Royal Brompton Hospital, Imperial College, London, United Kingdom.
P Gabriel
PG
Steg
University of Michigan Health System, Ann Arbor, MI.
Kim A
KA
Eagle
Department of Medicine, Tokai University School of Medicine, Isehara, Japan.
Shinya
S
Goto
Brigham and Women's Hospital, Boston, MA Harvard Medical School, Boston, MA.
Jianping
J
Guo
Heart and Vascular Center, University of North Carolina at Chapel Hill, NC.
Sidney C
SC
Smith
Duke University Medical Center, Durham, NC.
E Magnus
EM
Ohman
Brigham and Women's Hospital, Boston, MA Harvard Medical School, Boston, MA bscirica@partners.org.
Benjamin M
BM
Scirica
D000368:Aged; D060050:Angina, Stable / Q000453:epidemiology*; D002318:Cardiovascular Diseases / Q000401:mortality*; D016022:Case-Control Studies; D003324:Coronary Artery Disease / Q000453:epidemiology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology*; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D020521:Stroke / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology
angina; cardiovascular events; coronary artery disease
JAMA. 2012 Oct 3;308(13):1340-9
23032550
Eur Heart J. 2012 Nov;33(22):2831-40
22922505
JAMA. 2006 Mar 22;295(12):1404-11
16551712
Arch Intern Med. 2008 Jul 14;168(13):1423-8
18625923
JAMA. 2010 Sep 22;304(12):1350-7
20805624
Int J Cardiol. 2013 Sep 10;167(6):2938-43
22985742
Am J Cardiol. 1981 Feb;47(2):233-7
7468472
Am Heart J. 2006 Apr;151(4):786.e1-10
16569533
Am J Med. 2012 Jul;125(7):695-703.e1
22727237
Am J Cardiol. 2014 Oct 1;114(7):997-1002
25110069
Eur Heart J. 2013 Oct;34(38):2949-3003
23996286
J Am Coll Cardiol. 2013 Feb 19;61(7):712-3
23410542
J Am Coll Cardiol. 2013 Feb 19;61(7):702-11
23410541
JAMA. 2007 Mar 21;297(11):1197-206
17374814
Eur Heart J. 2009 Oct;30(19):2318-26
19720633
Circulation. 2016 Jan 26;133(4):e38-360
26673558
Am Heart J. 2003 Dec;146(6):1015-22
14660993
JAMA Intern Med. 2014 Oct;174(10):1651-9
25110899
JAMA. 2006 Jan 11;295(2):180-9
16403930
Am J Cardiol. 2003 Sep 15;92 (6):705-7
12972112
N Engl J Med. 2015 Aug 13;373(7):610-20
26267622
Circulation. 2009 Dec 8;120(23):2330-6
19933930
N Engl J Med. 2007 Apr 12;356(15):1503-16
17387127
J Am Coll Cardiol. 1988 Jan;11(1):20-6
3335698