Long-term morbidity and mortality among medically managed patients with angina and multivessel coronary artery disease

Background There are little data regarding outcomes in patients with angina and severe coronary artery disease (CAD) treated with medical management. Using the Duke Databank of Cardiovascular Disease, we describe the prevalence and long-term outcomes of patients with angina and multivessel CAD treated medically after catheterization. Methods Patients undergoing catheterization for angina (chest pain without recent revascularization or myocardial infarction) with severe CAD (>= 75% stenosis in >= 2 epicardial vessels) were identified (n = 8,555). One and five year outcomes in the 32% (n = 2,776) of patients who did not receive revascularization in the 30 days after catheterization were described. Predictors of 1-year death, cardiac rehospitalization, and late revascularization in this population were identified. Results The population had a median age of 66, were mostly male, had significant comorbidities, and most had prior revascularization. Outcomes were poor at 1 and 5 years: death (11% and 37%), cardiac rehospitalization (29% and 61%), and late revascularization (10% and 27%). The cumulative rate of death, myocardial infarction, late revascularization, or cardiac rehospitalization occurred in 38% at 1 year and 76% at 5 years. Prior coronary artery bypass grafting was the only variable independently associated with protection from death, cardiac rehospitalization, and late revascularization. Conclusions Medical management after catheterization is a common in patients with severe CAD and angina. Of patients treated with medical management, one third will have a recurrent cardiac event within the first year highlighting the poor outcomes and high utilization of resources by this patient population. (Am Heart J 2009; 158: 933-40.)