Long-term prognosis in 990 medically treated Japanese patients with coronary artery disease

Long-term Survival in a Spanish Population With Stable Ischemic Heart Disease. The CICCOR Registry

INTRODUCTION AND OBJECTIVES

Data are lacking on the long-term prognosis of stable ischemic heart disease (SIHD). Our aim was to analyze long-term survival in patients with SIHD and to identify predictors of mortality.

METHODS

A total of 1268 outpatients with SIHD were recruited in this single-center prospective cohort study from January 2000 to February 2004. Cardiovascular and all-cause death during follow-up were registered. All-cause and cardiovascular mortality rates were compared with those in the Spanish population adjusted by age, sex, and year. Predictors of these events were investigated.

RESULTS

The mean age was 68±10 years and 73% of the patients were male. After a follow-up lasting up to 17 years (median 11 years), 629 (50%) patients died. Independent predictors of all-cause mortality were age (HR, 1.08; 95%CI, 1.07-1.11; P <.001), diabetes (HR, 1.36; 95%CI, 1.14-1.63; P <.001), resting heart rate (HR, 1.01; 95%CI, 1.00-1.02; P <.001), atrial fibrillation (HR, 1.61; 95%CI, 1.22-2.14; P=.001), electrocardiographic changes (HR, 1.23; 95%CI, 1.02-1.49; P=.02) and active smoking (HR, 1.85; 95%CI, 1.31-2.80; P=.001). All-cause mortality and cardiovascular mortality rates were significantly higher in the sample than in the general Spanish population (47.81/1000 patients/y vs 36.29/1000 patients/y (standardized mortality rate, 1.31; 95%CI, 1.21-1.41) and 15.25/1000 patients/y vs 6.94/1000 patients/y (standardized mortality rate, 2.19; 95%CI, 1.88-2.50, respectively).

CONCLUSIONS

The mortality rate was higher in this sample of patients with SIHD than in the general population. Several clinical variables can identify patients at higher risk of death during follow-up.

Long-Term Outcome of First-Generation Metallic Coronary Stent Implantation in Patients With Coronary Artery Disease Observational Study Over a Decade

BACKGROUND

In the era of drug-eluting stents, percutaneous coronary intervention (PCI) has been considered an established therapeutic modality for patients with coronary artery disease (CAD). However, little is known about the long-term prognosis.

METHODS AND RESULTS

Using data obtained from a single-center registry for cases of first-generation bare metallic stent (BMS) implantation, a 10-year follow-up study in patients with CAD was performed. Data for 125 serial patients (aged 62+/-9 years, 104 males) in whom a BMS was successfully implanted was analyzed. Cardiac death (n=16 [12.8%]), including sudden cardiac death (n=9 [7.2%]), non-cardiac death (n=17 [13.6%]) and non-fatal acute myocardial infarction (n=16 [12.8%]) were documented. At 10 years, cumulative probabilities of target and non-target lesion revascularization were 20.5% and 41.5%, respectively, and only 39.2% of the patients were free from cardiac events (cardiac death/myocardial infarction/unplanned revascularization). Age and left ventricular ejection fraction (LVEF) were significant predictors of total death, and LVEF and the use of diuretics were predictors of cardiac events.

CONCLUSIONS

Stabilization of the initial stented site was relatively good and the majority of cardiac events might have originated in non-target lesions. Prevention of systemic arteriosclerosis progression is important for patients with CAD, even after successful PCI.

Risk factors that discriminate 'high- risk' from 'low-risk' Japanese patients with coronary artery disease

Although various risk factors have been implicated in the progression of coronary artery disease (CAD), coronary risk factors specifically related to the long-term prognosis for high-risk CAD have not been determined. The study enrolled 311 consecutive Japanese patients with CAD who underwent diagnostic coronary arteriography and divided them into 2 groups: (i) 135 high-risk patients with either impaired left ventricular function (ejection fraction <50%) or multivessel disease and (ii) 176 low-risk patients with normal left ventricular function and 0- or 1-vessel disease. The prevalence of risk factors including age, gender, smoking, hypertension, diabetes mellitus (DM), obesity and lipid variables were compared between the 2 groups. The prevalence of DM, a serum high-density lipoprotein (HDL)-cholesterol level below 35 mg/dl and a serum lipoprotein (Lp) (a) level above 25 mg/dl was significantly higher in the high-risk group as compared with the low-risk group. Multiple logistic regression analysis demonstrated that DM (odds ratio (OR): 1.72, 95% confidence intervals (CI): 1.02-2.92, p<0.05), a low HDL-cholesterol level (OR: 2.49, 95% CI: 1.49-4.17, p<0.001) and a high Lp(a) level (OR: 1.68, 95% CI: 1.02-2.76, p<0.05) were all independent risk factors for high-risk CAD. However, if the patients with 0-vessel disease were excluded from the low-risk group, a low HDL-cholesterol level was found to be the only independent predictor for high-risk CAD (OR: 2.07, 95% CI: 1.15-3.70, p<0.05). Among both men and smokers in this population, a higher Lp(a) level was found to be a significant predictor for high-risk CAD. A low serum level of HDL-cholesterol, a high serum level of Lp(a) and DM were significant predictors of high-risk in patients with CAD. Among patients with a significant coronary stenosis or left ventricular dysfunction, a low serum level of HDL-cholesterol was the only significant predictor for high-risk CAD.

Coronary artery bypass grafting. Late result of actual 10-years follow-up in 376 patients

OBJECTIVES

The aim of this study was to analyze the long-term results of coronary artery bypass grafting in Japanese patients who were followed more than 10 years after surgery, and, without resorting to actuarial methods, to determine the factors that influence long-term survival.

SUBJECTS AND METHODS

From January 1984 through December 1986, 376 patients received coronary artery bypass grafting at the Department of Cardiothoracic Surgery of Juntendo University; it is these patients who comprise the subject of this study. Of the 376 patients, 328 were males (87.2%) and the mean patient age was 58.5 years (range: 32 to 78 years). Single vessel disease was present in 36 patients (10.8%), double vessel disease in 89 patients (26.7%), triple vessel disease in 150 patients (45.0%) and 58 patients (17.4%) with 50% of more stenosis of the left main coronary artery. The mean number of grafts used was 2.3 grafts per patient, while internal thoracic artery conduits were used in 66 patients (17.6%).

RESULTS

The 10-year survival rate for the entire series of patients was 81.4%. Patients receiving internal thoracic artery grafts had a 10-year survival rate of 94.0%, superior to the 78.0% rate found in patients who received only saphenous vein grafts. Other risk factors associated with reduced survival rates, besides non-use of internal thoracic artery, were: advanced age, diabetes mellitus, hypertension, presence of left main coronary artery disease, and severely impaired left ventricular function. The 10-year cardiac event free rate in the total group was 80.4%. Of 70 patients who died during the follow-up period, 19 deaths were due to cardiac causes (27.1%), 19 due to malignant neoplasm (27.1%) and 13 due to the cerebral vascular accident (18.6%).

CONCLUSIONS

Univariate analysis revealed that: the use of only saphenous vein grafts (P = 0.0055), advanced age (P < 0.0001), diabetes mellitus (P < 0.0001), hypertension (P = 0.0282), presence of left main coronary artery disease (P = 0.0140), and severely impaired left ventricular function (P = 0.0075) are associated with reduced survival in patients undergoing coronary artery bypass grafting in this cohort of patients.