Author + information
- Received December 12, 2017
- Revision received February 8, 2018
- Accepted February 13, 2018
- Published online May 2, 2018.
- Martial Hamon, MDa,
- Gilles Lemesle, MDb,
- Thibaud Meurice, MDc,
- Olivier Tricot, MDd,
- Nicolas Lamblin, MDe and
- Christophe Bauters, MDe,∗ ()
- aUniversity Hospital of Caen, Caen University, Caen, France
- bUniversity of Lille, Inserm, CHU Lille, Institut Pasteur, U1011, Lille, France
- cHôpital Privé Le Bois, Lille, France
- dCentre Hospitalier de Dunkerque, Dunkerque, France
- eUniversity of Lille, Inserm, CHU Lille, Institut Pasteur, U1167, Lille, France
- ↵∗Address for correspondence:
Dr. Christophe Bauters, Hôpital Cardiologique, CHU de Lille, Boulevard Prof. Leclercq, F-59000, Lille, France.
Objectives The authors sought to describe the incidence, determinants, and outcome of elective coronary revascularization (ECR) in patients with stable coronary artery disease (CAD).
Background Observational data are lacking regarding the practice of ECR in patients with stable CAD receiving modern secondary prevention.
Methods The authors analyzed coronary revascularization procedures performed during a 5-year follow-up in 4,094 stable CAD outpatients included in the prospective multicenter CORONOR (Suivi d'une cohorte de patients COROnariens stables en région NORd-Pas-de-Calais) registry.
Results Secondary prevention medications were widely prescribed at inclusion (antiplatelet agents 96.4%, statins 92.2%, renin-angiotensin system antagonists 81.8%). A total of 481 patients underwent ≥1 coronary revascularization procedure (5-year cumulative incidences of 3.6% [0.7% per year] for acute revascularizations and 8.9% [1.8% per year] for ECR); there were 677 deaths during the same period. Seven baseline variables were independently associated with ECR: prior coronary stent implantation (p < 0.0001), absence of prior myocardial infarction (p < 0.0001), higher low-density lipoprotein cholesterol (p < 0.0001), lower age (p < 0.0001), multivessel CAD (p = 0.003), diabetes mellitus (p = 0.005), and absence of treatment with renin-angiotensin system antagonists (p = 0.020). Main indications for ECR were angina associated with a positive stress test (31%), silent ischemia (31%), and angina alone (25%). The use of ECR had no impact on the subsequent risk of death, myocardial infarction, or ischemic stroke (hazard ratio: 1.04; 95% confidence interval: 0.76 to 1.41).
Conclusions These real-life data show that ECR is performed at a rate of 1.8% per year in stable CAD patients widely treated by secondary medical prevention. ECR procedures performed in patients without noninvasive stress tests are not rare. Having an ECR was not associated with the risk of ischemic adverse events.
This study was supported by the Fédération Française de Cardiologie, Paris, France. Dr. Lemesle has received fees for lectures or consulting from Amgen, AstraZeneca, Bayer, Biopharma, Bristol-Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, MSD Schering, Pfizer, Sanofi, Servier, and The Medicines Company. Dr. Lamblin has received a research grant from Pfizer; and fees for lectures or consulting from Actelion, AstraZeneca, Bayer, Bristol-Myers Squibb, GlaxoSmithKline, MSD Schering, Novartis, Pfizer, Sanofi, and Servier. Dr. Bauters has received travel grants from Amgen, Boehringer Ingelheim, MSD Schering, and Servier. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 12, 2017.
- Revision received February 8, 2018.
- Accepted February 13, 2018.
- 2018 American College of Cardiology Foundation
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