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学科主题: 临床医学
题名:
Prevalence of Anginal Symptoms and Myocardial Ischemia and Their Effect on Clinical Outcomes in Outpatients With Stable Coronary Artery Disease Data From the International Observational CLARIFY Registry
作者: Steg, Philippe Gabriel1,2,3,4; Greenlaw, Nicola5; Tendera, Michal6; Tardif, Jean-Claude7; Ferrari, Roberto8,9,10,11; Al-Zaibag, Muayed12; Dorian, Paul13; Hu, Dayi14; Shalnova, Svetlana15; Jose Sokn, Fernando16,17; Ford, Ian5; Fox, Kim M.4; Prospective Observational
刊名: JAMA INTERNAL MEDICINE
发表日期: 2014-10-01
DOI: 10.1001/jamainternmed.2014.3773
卷: 174, 期:10, 页:1651-1659
收录类别: SCI
文章类型: Article
WOS标题词: Science & Technology
类目[WOS]: Medicine, General & Internal
研究领域[WOS]: General & Internal Medicine
关键词[WOS]: HEART-DISEASE ; FOLLOW-UP ; PROGNOSTIC VALUE ; SILENT ISCHEMIA ; MANAGEMENT ; DIAGNOSIS ; PECTORIS ; RISK ; REVASCULARIZATION ; INTERVENTION
英文摘要:

IMPORTANCE In the era of widespread revascularization and effective antianginals, the prevalence and prognostic effect of anginal symptoms and myocardial ischemia among patients with stable coronary artery disease (CAD) are unknown.

OBJECTIVE To describe the current clinical patterns among patients with stable CAD and the association of anginal symptoms or myocardial ischemia with clinical outcomes.

DESIGN, SETTING, AND PARTICIPANTS The Prospective Observational Longitudinal Registry of Patients With Stable Coronary Artery Disease (CLARIFY) registry enrolled outpatients in 45 countries with stable CAD in 2009 to 2010 with 2-year follow-up (median, 24.1 months; range, 1 day to 3 years). Enrollees included 32 105 outpatients with prior myocardial infarction, chest pain, and evidence of myocardial ischemia, evidence of CAD on angiography, or prior revascularization. Of these, 20291 (63.2%) had undergone a noninvasive test for myocardial ischemia within 12 months of enrollment and were categorized into one of the following 4 groups: no angina or ischemia (n = 13207 [65.1%]); evidence of myocardial ischemia without angina (silent ischemia) (n = 3028 [14.9%]); anginal symptoms alone (n = 1842 [9.1%]); and angina and ischemia (n = 2214 [10.9%]).

EXPOSURES Stable CAD.

MAIN OUTCOME AND MEASURE The composite of cardiovascular (CV)-related death or nonfatal myocardial infarction.

RESULTS Overall, 4056 patients (20.0%) had anginal symptoms and 5242 (25.8%) had evidence of myocardial ischemia on results of noninvasive testing. Of 469 CV-related deaths or myocardial infarctions, 58.2% occurred in patients without angina or ischemia, 12.4% in patients with ischemia alone, 12.2% in patients with angina alone, and 17.3% in patients with both. The hazard ratios for the primary outcome relative to patients without angina or ischemia and adjusted for age, sex, geographic region, smoking status, hypertension, diabetes mellitus, and dyslipidemia were 0.90 (95% CI, 0.68-1.20; P = .47) for ischemia alone, 1.45 (95% CI, 1.08-1.95; P = .01) for angina alone, and 1.75 (95% CI, 1.34-2.29; P < .001) for both. Similar findings were observed for CV-related death and for fatal or nonfatal myocardial infarction.

CONCLUSIONS AND RELEVANCE In outpatients with stable CAD, anginal symptoms (with or without ischemia on noninvasive testing) but not silent ischemia appear to be associated with an increased risk for adverse CV outcomes. Most CV events occurred in patients without angina or ischemia. Copyright 2014 American Medical Association. All rights reserved.

语种: 英语
项目资助者: Servier, France
WOS记录号: WOS:000345909100027
Citation statistics:
内容类型: 期刊论文
URI标识: http://ir.bjmu.edu.cn/handle/400002259/67882
Appears in Collections:北京大学第二临床医学院_期刊论文

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作者单位: 1.Med Univ Silesia, Div Cardiol 3, Katowice, Poland
2.Univ Hosp Ferrara, Dept Cardiol, Ferrara, Italy
3.Maria Cecilia Hosp, Ferrara, Italy
4.State Res Ctr Prevent Med, Moscow, Russia
5.Inst Adrogue, Dept Cardiol, Buenos Aires, DF, Argentina
6.Univ Glasgow, Robertson Ctr Biostat, Glasgow, Lanark, Scotland
7.INSERM, Unit 1148, Paris, France
8.Univ Paris Diderot, Sorbonne Paris Cite, Paris, France
9.Hop Bichat Claude Bernard, AP HP, Dept Cardiol, Dept Hosp Univ FIRE Fibrosis Inflammat & Remodeli, F-75018 Paris, France
10.Univ London Imperial Coll Sci Technol & Med, Royal Brompton Hosp, Natl Heart & Lung Inst, Inst Cardiovasc Med & Sci, London, England
11.Univ Montreal, Dept Med, Montreal Heart Inst, Montreal, PQ H3C 3J7, Canada
12.Univ Hosp Ferrara, Lab Technol Adv Therapies Ctr, Ferrara, Italy
13.Ettore Sansavini Hlth Sci Fdn, Grp Villa Maria Care & Res, Maria Cecili Hosp, Cotignola, Italy
14.Natl Guard Hlth Affairs, King Abdul Aziz Cardiac Ctr, Riyadh, Saudi Arabia
15.Univ Toronto, Div Cardiol, St Michaels Hosp, Toronto, ON, Canada
16.Peking Univ, Peoples Hosp, Inst Heart, Beijing 100871, Peoples R China
17.Univ Buenos Aires, Dept Cardiol, Buenos Aires, DF, Argentina

Recommended Citation:
Steg, Philippe Gabriel,Greenlaw, Nicola,Tendera, Michal,et al. Prevalence of Anginal Symptoms and Myocardial Ischemia and Their Effect on Clinical Outcomes in Outpatients With Stable Coronary Artery Disease Data From the International Observational CLARIFY Registry[J]. JAMA INTERNAL MEDICINE,2014,174(10):1651-1659.
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