Utilidad pronóstica de la angina persistente tras revascularización percutánea en el síndrome coronario crónico con angiografía y RMC de estrés alteradas
Nerea Pérez-Solé , Elena de Dios , José V. Monmeneu , María P. López-Lereu , José Gavara , César Ríos-Navarro , Víctor Marcos-Garces , Héctor Merenciano , Clara Bonanad , Joaquim Cánoves , Félix Platero , Andrea Ventura , David Moratal , Antoni Bayés-Genís , Jorge Sanz , Manuel Jiménez-Navarro , Luis Martínez-Dolz , Juan Sanchis , Julio Núñez , Vicente Bodí
{"title":"Utilidad pronóstica de la angina persistente tras revascularización percutánea en el síndrome coronario crónico con angiografía y RMC de estrés alteradas","authors":"Nerea Pérez-Solé , Elena de Dios , José V. Monmeneu , María P. López-Lereu , José Gavara , César Ríos-Navarro , Víctor Marcos-Garces , Héctor Merenciano , Clara Bonanad , Joaquim Cánoves , Félix Platero , Andrea Ventura , David Moratal , Antoni Bayés-Genís , Jorge Sanz , Manuel Jiménez-Navarro , Luis Martínez-Dolz , Juan Sanchis , Julio Núñez , Vicente Bodí","doi":"10.1016/j.recesp.2024.09.007","DOIUrl":null,"url":null,"abstract":"<div><h3>Introduction and objectives</h3><div>In patients with established chronic coronary syndrome (CCS), the significance of persistent angina is controversial. We aimed to evaluate the prognostic role of persistent angina in symptomatic CCS patients with abnormal stress cardiovascular magnetic resonance (CMR) and altered angiographic findings undergoing percutaneous revascularization.</div></div><div><h3>Methods</h3><div>We analyzed 334 CCS patients with Canadian Cardiovascular Society angina class ≥<!--> <!-->2, perfusion deficits on stress CMR and severe lesions in angiography who underwent medical therapy optimization plus CMR-guided percutaneous revascularization. We investigated the association of persistent angina at 6 months postintervention with subsequent cardiac death, myocardial infarction, and hospital admission.</div></div><div><h3>Results</h3><div>All patients had angina class ≥<!--> <!-->2 (mean: 2.8<!--> <!-->±<!--> <!-->0.7), abnormal stress CMR (mean ischemic burden: 5.8<!--> <!-->±<!--> <!-->2.7 segments), and severe angiographic lesions. The angina resolution rates were 81% at 6 months, and 81%, 81%, and 77% at 1, 2, and 5 years, respectively. During a median follow-up of 8.9 years, persistent angina was independently associated with higher rates of subsequent cardiac death (13% vs 4%; HR, 3.7; 95%<span>C</span>I, 1.5-9.2; <em>P</em> <!-->=<!--> <!-->.005), myocardial infarction (24% vs 6%; HR, 4.9; 95%CI, 2.4–9.9; <em>P</em> <!--><<!--> <!-->.001), and hospital admission for heart failure (27% vs 13%; HR, 2.7; 95%CI, 1.5–5.2; <em>P</em> <!-->=<!--> <!-->.001).</div></div><div><h3>Conclusions</h3><div>In CCS patients with robust diagnostic evidence from symptoms, stress CMR, and angiography, persistent angina after percutaneous revascularization is a strong predictor of subsequent cardiac death, myocardial infarction, and hospital admission for heart failure.</div></div>","PeriodicalId":21299,"journal":{"name":"Revista espanola de cardiologia","volume":"78 5","pages":"Pages 425-436"},"PeriodicalIF":5.9000,"publicationDate":"2024-11-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Revista espanola de cardiologia","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0300893224003907","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction and objectives
In patients with established chronic coronary syndrome (CCS), the significance of persistent angina is controversial. We aimed to evaluate the prognostic role of persistent angina in symptomatic CCS patients with abnormal stress cardiovascular magnetic resonance (CMR) and altered angiographic findings undergoing percutaneous revascularization.
Methods
We analyzed 334 CCS patients with Canadian Cardiovascular Society angina class ≥ 2, perfusion deficits on stress CMR and severe lesions in angiography who underwent medical therapy optimization plus CMR-guided percutaneous revascularization. We investigated the association of persistent angina at 6 months postintervention with subsequent cardiac death, myocardial infarction, and hospital admission.
Results
All patients had angina class ≥ 2 (mean: 2.8 ± 0.7), abnormal stress CMR (mean ischemic burden: 5.8 ± 2.7 segments), and severe angiographic lesions. The angina resolution rates were 81% at 6 months, and 81%, 81%, and 77% at 1, 2, and 5 years, respectively. During a median follow-up of 8.9 years, persistent angina was independently associated with higher rates of subsequent cardiac death (13% vs 4%; HR, 3.7; 95%CI, 1.5-9.2; P = .005), myocardial infarction (24% vs 6%; HR, 4.9; 95%CI, 2.4–9.9; P < .001), and hospital admission for heart failure (27% vs 13%; HR, 2.7; 95%CI, 1.5–5.2; P = .001).
Conclusions
In CCS patients with robust diagnostic evidence from symptoms, stress CMR, and angiography, persistent angina after percutaneous revascularization is a strong predictor of subsequent cardiac death, myocardial infarction, and hospital admission for heart failure.
期刊介绍:
Revista Española de Cardiología, Revista bilingüe científica internacional, dedicada a las enfermedades cardiovasculares, es la publicación oficial de la Sociedad Española de Cardiología.