Abstract 16647: Clinical Characteristics and Outcomes of Patients With Ischemic Cardiomyopathy and Persistent Angina Pectoris: From the Duke Databank for Cardiovascular Disease
Background: The impact of refractory angina pectoris (AP) in patients (pts) with ischemic cardiomyopathy (ICM) has not been well delineated. We investigated the clinical characteristics and outcomes of ICM pts with persistent AP in the year following index cardiac catheterization.
Methods: Pts who underwent coronary angiography at Duke University from 2000-2010 with EF<40% and a diagnosis of ICM with persistent AP were compared to similar pts without persistent AP. Persistent AP was defined by pt report on follow-up survey within one yr of index catheterization. Time to event was examined using Kaplan-Meier and Cox proportional hazards modeling methods for death/hospitalization (hosp), and death/MI/revascularization/stroke (MACE).
Results: Of 965 pts with ICM and follow-up on angina within 1 yr, 298 (31%) had persistent AP. These pts had more comorbidities, and more previous revascularization than pts without persistent AP. Both groups had high use of aspirin, beta-blockers, and ACE-inhibitors (all >85%) but modest oral nitrate use (~20%). Over a median follow-up of >5 yrs, pts with persistent AP had increased event rates for death/hosp (Figure) and MACE compared to pts without persistent AP (5-yr event rates of 89% vs. 78% and 55% vs. 48%, respectively). After multivariable adjustment, persistent AP remained associated with increased risk for death/hosp (HR 1.33; 95% CI, 1.13-1.56) and MACE (HR 1.26; 95% CI, 1.05-1.52).
Conclusion: Persistent AP is common in patients with ICM despite medical therapy and previous revascularization and is independently associated with increased long-term death/rehosp. Future prospective studies of persistent AP in ICM pts are warranted.
- © 2013 by American Heart Association, Inc.