According to the study, researchers from the European Society of Cardiology (ESC) CICD Pilot Registry, they evaluated the mortality and hospitalization rates at 6 months are high among patients with chronic ischemic cardiovascular disease (CICD).
Dr. Michel Komajda said, "This was expected for non-ST-elevation myocardial infarction (NSTEMI) patients but not so for patients with stable coronary artery disease or peripheral artery disease.” Dr. Komajda and colleagues summarize the 6-month follow-up data and the clinical outcomes of 2,200 patients (mean age, 67) in four cohorts:
1. patients with chronic coronary artery disease (CAD) and non-ST-elevation acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) within 72 hours after symptom onset (ACS-PCI group)
2. patients with chronic stable CAD undergoing elective coronary intervention (elective PCI group)
3. patients with stable CAD
4. patients undergoing peripheral artery disease (PAD) interventions.
During follow-up, 2.6% of patients died, mostly from cardiovascular causes, and 22.5% were hospitalized, mostly for cardiovascular causes – for a composite rate of all-cause death or all-cause rehospitalization of 23.7% and a composite rate of cardiovascular death or cardiovascular hospitalization of 19.5% at 6 months.
Both composite outcomes were significantly more common in the ACS-PCI group and the PAD group than in the other two groups, according to the January 16 European Journal of Preventive Cardiology online report. Independent predictors of all-cause death/all-cause hospitalization included older age, a history of previous peripheral revascularization, chronic kidney disease, chronic obstructive pulmonary disease (COPD), and being in the ACS-PCI group.
COPD and being in either the ACS-PCI group or the PAD group independently predicted cardiovascular death or hospitalization, whereas older age, a history of chronic kidney disease, and geographical region independently predicted all-cause deaths. “A remarkable finding is the very high rate of events in patients with PAD,” Dr. Komajda said.
“This population is at very high cardiovascular risk and, since these patients are frequently followed up outside cardiology departments, emphasis should be made to have proper cardiovascular assessment of this population.” Over time, there was a mild but significant decrease in the rate of prescription of angiotensin-converting enzyme (ACE) inhibitors, angiotensin-receptor blockers, beta-blockers, mineralocorticoid-receptor antagonists, and antiplatelet agents.
“'Stable' patients with coronary artery disease are not so stable,” Dr. Komajda said. “This should lead to more-aggressive secondary-prevention measures in this high-risk population and to a close follow-up, since there was a trend for a decline in rate of prescription of recommended medications at six months.”
Researchers concludes that, “The medical management of this condition remains suboptimal, and emphasizes the need to conduct a larger registry with long-term follow-up to evaluate clinical practice in Europe and improve the management of CICD patients.” “Specific programs to improve adherence to guidelines and follow-up procedures should be promoted by scientific societies and/or healthcare systems.”