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Long-term outcome poor for medically managed multivessel CAD

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Patients with angina and multivessel coronary artery disease face poor long-term outcomes with medical management, according to a report in the December issue of the American Heart Journal.

“In reality, there are few effective therapies proven to reduce mortality in patients with ischemic heart disease,” Dr. Matthew A. Cavender from the Cleveland Clinic Foundation in Ohio told Reuters Health by email. “Our study highlights the poor outcomes among patients with ischemic heart disease and illustrates the potential impact that an effective therapy could have.”

Dr. Cavender and his colleagues used the Duke Databank of Cardiovascular Disease to investigate the long-term outcomes of 2776 patients with multivessel coronary artery disease. These patients had undergone catheterization to assess their severe angina, without revascularization (for up to 30 days afterward).

“At 1 year, 11% had died, 14% had died or had nonfatal MI, 29% had a cardiac rehospitalization, and 10% underwent late revascularization,” the authors report. “The 1-year event rate for the composite of death, MI, late revascularization, or cardiac rehospitalization was 38%.”

Significant independent predictors of death at 1 year included older age, severity of medical comorbidities, renal insufficiency, coronary artery disease, and other factors, whereas prior coronary artery bypass graft surgery had a protective effect against death, cardiac rehospitalization, and late revascularization.

“At 5 years, 37% died, 44% died or had nonfatal MI, 61% had a cardiac rehospitalization, and 27% underwent late revascularization. The 5-year event rate for the composite of death, MI, late revascularization, or cardiac hospitalization was 76%,” they continued.

“Reducing morbidity and mortality from ischemic heart disease must start with the primary prevention of coronary artery disease,” Dr. Cavender said. “Individuals must take responsibility for their health and adopt preventive strategies by improving their diet, increasing exercise, and refraining from tobacco.”

“For patients with established ischemic heart disease, stem cell therapies offer tremendous hope,” Dr. Cavender added. “The Cleveland Clinic is participating in the National Institutes of Health Cardiovascular Cell Therapy Research Network and is currently enrolling patients in studies which utilize stem cells harvested from the patients’ own bone marrow. If proven to be both safe and efficacious, cellular therapies would be ideal for patients with ischemic heart disease.”

Am Heart J 2009;158:933-940.