Chronic Coronary Syndromes Nowadays

Multiple drugs and treatment strategies have emerged in recent years to change significantly the prognosis of patients who suffer from stable chronic angina or, in terms of the latest guidelines, “chronic coronary syndromes.” This semantic change may seem of little importance, but it is intended to remind us that these are not stable patients, but patients whose progress presents stable phases and acute phases.

This study analyzed data from 32,703 patients (from 45 countries) with chronic coronary syndromes enrolled in the CLARIFY registry from November 2009 to June 2010, with a 5-year follow-up.

The primary endpoint, cardiovascular death or non-fatal infarction, was 8% for the overall population (male 8.1%; female 7.6%).

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The most important independent predictors of risk were prior hospitalization for heart failure, current smoking, living in Central/South America, prior infarction, prior stroke, diabetes, angina symptoms, and peripheral vascular disease.

There was a strong interaction in patients who had a history of prior infarction and who experienced angina symptoms, compared with patients with a history of infarction who were asymptomatic (11.8% vs. 8.2%, p < 0.001).

Among patients who had never experienced an infarction, the rate of events was similar for those with and without angina (6.3% vs. 6.4%, p > 0.99).

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The rate of drug prescription based on evidence for secondary prevention was very high.

Conclusion

This registry describes the whole spectrum of patients with stable coronary syndromes and shows that, despite adequate secondary prevention, patients with both angina and prior infarction have high rates of events. This high-risk subgroup is easily identifiable and warrants intensive treatment.

Original Title: Long-term outcomes of chronic coronary syndrome worldwide: insights from the international CLARIFY registry.

Reference: Emmanuel Sorbets et al. European Heart Journal (2020) 41, 347–355.

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