Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2020 Jan 14;41(3):347-356.
doi: 10.1093/eurheartj/ehz660.

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

Emmanuel Sorbets  1   2   3   4   5 , Kim M Fox  3   4 , Yedid Elbez  5 , Nicolas Danchin  6   7 , Paul Dorian  8 , Roberto Ferrari  9 , Ian Ford  10 , Nicola Greenlaw  10 , Paul R Kalra  11 , Zofia Parma  12 , Svetlana Shalnova  13 , Jean-Claude Tardif  14 , Michal Tendera  12 , José Luis Zamorano  15 , Emmanuelle Vidal-Petiot  6   16 , Philippe Gabriel Steg  3   4   5   6 ; CLARIFY investigators
Affiliations
Observational Study

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

Emmanuel Sorbets et al. Eur Heart J. .

Abstract

Aims: Over the last decades, the profile of chronic coronary syndrome has changed substantially. We aimed to determine characteristics and management of patients with chronic coronary syndrome in the contemporary era, as well as outcomes and their determinants.

Methods and results: Data from 32 703 patients (45 countries) with chronic coronary syndrome enrolled in the prospective observational CLARIFY registry (November 2009 to June 2010) with a 5-year follow-up, were analysed. The primary outcome [cardiovascular death or non-fatal myocardial infarction (MI)] 5-year rate was 8.0% [95% confidence interval (CI) 7.7-8.3] overall [male 8.1% (7.8-8.5); female 7.6% (7.0-8.3)]. A cox proportional hazards model showed that the main independent predictors of the primary outcome were prior hospitalization for heart failure, current smoking, atrial fibrillation, living in Central/South America, prior MI, prior stroke, diabetes, current angina, and peripheral artery disease. There was an interaction between angina and prior MI (P = 0.0016); among patients with prior MI, angina was associated with a higher primary event rate [11.8% (95% CI 10.9-12.9) vs. 8.2% (95% CI 7.8-8.7) in patients with no angina, P < 0.001], whereas among patients without prior MI, event rates were similar for patients with [6.3% (95% CI 5.4-7.3)] or without angina [6.4% (95% CI 5.9-7.0)], P > 0.99. Prescription rates of evidence-based secondary prevention therapies were high.

Conclusion: This description of the spectrum of chronic coronary syndrome patients shows that, despite high rates of prescription of evidence-based therapies, patients with both angina and prior MI are an easily identifiable high-risk group who may deserve intensive treatment.

Clinical registry: ISRCTN43070564.

Keywords: Angina; Chronic coronary syndrome; Coronary artery disease; Myocardial infarction.

PubMed Disclaimer

Figures

Take home figure
Take home figure
Kaplan–Meier estimate curves for cardiovascular death or myocardial infarction according to angina status and history of prior myocardial infarction. P-value for interaction between angina and prior myocardial infarction in multivariable Cox model. CV, cardiovascular; MI, myocardial infarction.
Figure 1
Figure 1
Forest plot for multivariable analysis to determine the main predictors of cardiovascular death or myocardial infarction in the entire CLARIFY population. BP, blood pressure; CABG, coronary artery bypass graft; COPD, chronic obstructive pulmonary disease; CV, cardiovascular; HF, heart failure; MI, myocardial infarction; PCI, percutaneous coronary intervention.
None
See this image and copyright information in PMC

Comment in

References

    1. Timmis A, Townsend N, Gale C, Grobbee R, Maniadakis N, Flather M, Wilkins E, Wright L, Vos R, Bax J, Blum M, Pinto F, Vardas PESC Scientific Document Group. European Society of Cardiology: cardiovascular Disease Statistics 2017. Eur Heart J 2018;39:508–579. - PubMed
    1. Puymirat E, Simon T, Cayla G, Cottin Y, Elbaz M, Coste P, Lemesle G, Motreff P, Popovic B, Khalife K, Labeque JN, Perret T, Le Ray C, Orion L, Jouve B, Blanchard D, Peycher P, Silvain J, Steg PG, Goldstein P, Gueret P, Belle L, Aissaoui N, Ferrieres J, Schiele F, Danchin NUSIK, USIC 2000, and FAST-MI investigators. Acute myocardial infarction: changes in patient characteristics, management, and 6-month outcomes over a period of 20 years in the FAST-MI Program (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) 1995 to 2015. Circulation 2017;136:1908–1919. - PubMed
    1. Jernberg T, Johanson P, Held C, Svennblad B, Lindback J, Wallentin LSWEDEHEART/RIKS-HIA. Association between adoption of evidence-based treatment and survival for patients with ST-elevation myocardial infarction. JAMA 2011;305:1677–1684. - PubMed
    1. Baigent C, Blackwell L, Collins R, Emberson J, Godwin J, Peto R, Buring J, Hennekens C, Kearney P, Meade T, Patrono C, Roncaglioni MC, Zanchetti A.. Aspirin in the primary and secondary prevention of vascular disease: collaborative meta-analysis of individual participant data from randomised trials. Lancet 2009;373:1849–1860. - PMC - PubMed
    1. Wallentin L, Becker RC, Budaj A, Cannon CP, Emanuelsson H, Held C, Horrow J, Husted S, James S, Katus H, Mahaffey KW, Scirica BM, Skene A, Steg PG, Storey RF, Harrington RA, Investigators P, Freij A, Thorsen M.. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med 2009;361:1045–1057. - PubMed

Publication types

Associated data