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. 2023 Aug 29;23(1):428.
doi: 10.1186/s12872-023-03469-4.

Medical care and biomarker-based assessment of mortality in two cohorts of patients with chronic coronary syndrome 10 years apart

Martin Rehm  1 , Andrea Jaensch  1 , Ben Schöttker  2 , Ute Mons  2   3 , Harry Hahmann  4 , Wolfgang Koenig  1   5   6 , Hermann Brenner  2   7   8 , Dietrich Rothenbacher  9   10
Affiliations

Medical care and biomarker-based assessment of mortality in two cohorts of patients with chronic coronary syndrome 10 years apart

Martin Rehm et al. BMC Cardiovasc Disord. .

Abstract

Background: This study aimed to describe the characteristics and mortality of two cohorts of patients with chronic coronary syndrome (CCS) recruited with identical study designs in the same rehabilitation clinics but approximately 10 years apart.

Methods: The KAROLA cohorts included patients with CCS participating in an inpatient cardiac rehabilitation programme in Germany (KAROLA-I: years 1999/2000, KAROLA-II: 2009-2011). Blood samples and information on sociodemographic factors, lifestyle, and medical treatment were collected at baseline, at the end of rehabilitation, and after one year of follow-up. A biomarker-based risk model (ABC-CHD model) and Cox regression analysis were used to evaluate cardiovascular (CV) and non-CV mortality risk.

Results: We included 1130 patients from KAROLA-I (mean age 58.7 years, 84.4% men) and 860 from KAROLA-II (mean age 60.4 years, 83.4% men). Patients in the KAROLA-I cohort had significantly higher concentrations of CV biomarkers and fewer patients were taking CV medications, except for statins. The biomarker-based ABC-CHD model provided a higher estimate of CV death risk for patients in the KAROLA-I cohort (median 3-year risk, 3.8%) than for patients in the KAROLA-II cohort (median 3-year risk, 2.7%, p-value for difference < 0.001). After 10 years of follow-up, 91 (8.1%) patients in KAROLA-I and 45 (5.2%) in KAROLA-II had died from a CV event.

Conclusions: Advances in disease management over the past 20 years may have led to modest improvements in pharmacological treatment during cardiac rehabilitation and long-term outpatient care for patients with CCS. However, modifiable risk factors such as obesity have increased in the more recent cohort and should be targeted to further improve the prognosis of these patients.

Keywords: Biomarkers; Cardiac rehabilitation; Chronic coronary syndrome; Mortality; Pharmacological treatment; Risk factors.

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Conflict of interest statement

Wolfgang Koenig reports consulting fees from AstraZeneca, Novartis, Pfizer, The Medicines Company, DalCor Pharmaceuticals, Kowa, Amgen, Corvidia Therapeutics, Daiichi-Sankyo, Genentech, Novo Nordisk, Esperion, OMEICOS, LIB Therapeutics, NewAmsterdam Pharma, TenSixteen Bio; speaker honoraria from Amgen, Novartis, Berlin-Chemie, Sanofi, and Bristol-Myers Squibb, grants and non-financial support from Abbott, Roche Diagnostics, Beckmann, and Singulex, outside the submitted work. The other authors have no competing interests to declare that are relevant to the content of this article. All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
Cumulative incidence curves for competing mortality events in KAROLA-I (n = 1130) and KAROLA-II (n = 860) (cumulative deaths over time at the bottom of the graphs)
See this image and copyright information in PMC

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