Abstract 4261: Long-Term Morbidity and Mortality among Patients with Angina and Multivessel Coronary Artery Disease in the Duke Cardiovascular Databank
Stable angina is thought to have a good prognosis; however, little is known about outcomes in patients with severe coronary artery disease (CAD) and angina who are medically managed. We describe the prevalence and long term outcomes of patients with angina and multivessel CAD who received medical therapy following catheterization. Using the Duke Databank of Cardiovascular Disease, patients undergoing catheterization for angina (chest pain without recent revascularization or MI) with severe CAD (≥75% stenosis in ≥2 major epicardial vessels) were identified (n=8,555). Long term outcomes in the 32% (n=2,776) of patients who did not receive revascularization in the 30 days following catheterization are described. This population had a mean age of 65, was mostly male (67%) and had significant comorbidities (74% HTN, 39% diabetes, 38% CHF, 20% cerebrovascular disease, and 10% GFR <30). The majority of patients had undergone prior revascularization (56% CABG, 23% PCI). A cumulative event rate of death, MI, late revascularization (>30 Days from initial cath) or cardiac rehospitalization occurred in 50.3% at 1 year. Individual one year rates were: mortality 11%, Death or MI 14%, Cardiac rehospitalization 19.4% and late revascularization 9.5%. (Figure⇓) One third of patients with severe CAD and angina are medically managed following heart catheterization. Late revascularization is infrequent in this population despite the high rate of recurrent cardiac hospitalization, death and MI. This demonstrates a need for intensified medical therapy to mitigate the high morbidity and mortality seen in this symptomatic, high risk population.