Clinical characteristics and predictors of mortality in patients with refractory angina due to obstructive and non-obstructive chronic coronary syndromes: a contemporary retrospective cohort study
Notice bibliographique
Résumé
Abstract Background Refractory angina (RA) is a major global cardiovascular healthcare challenge due to the increasing burden of chronic coronary syndromes (CCS) worldwide and an ageing population [1, 2]. Patients suffer from persistent life-limiting angina despite maximal guideline-directed treatment; experience a poor quality of life; and incur significant excess healthcare costs. RA represents a large unmet clinical need with few contemporary data on the clinical characteristics and outcomes of these patients. Purpose This study investigated the characteristics and prognosis of patients with RA due to both obstructive and non-obstructive CCS. Methods Retrospective single-centre observational cohort study of patients diagnosed with RA, managed in a tertiary cardiac centre with a dedicated specialist angina service, between May 1995 to August 2023. Mortality was obtained from a national healthcare database and patient characteristics from hospital electronic records. Statistical analyses included descriptive statistics, Kaplan-Meier survival, univariate and multivariate Cox proportional hazard regression analyses. Results 558 patients (mean age 61±12) were included (Table 1). Most were males (n=350; 63%), had raised BMI (median 28 [25-31]), and a Canadian Cardiovascular Society Class of ≥2 (n=495; 85%). Hypertension (63%), dyslipidaemia (61%) and current/former smoking (63%) were the most common cardiovascular risk factors. Rates of diabetes mellitus (40%) and previous myocardial infarction (MI, 41%) were similar. Previous CABG±PCI (43%) was more prevalent than PCI alone (27%). 87% had a normal LVEF ≥50%. 68 patients died over a median follow-up of 6 years. 5-year mortality rate was 7.4% (95%CI: 0.89-0.95) and 10-years, 14% (95%CI: 0.82-0.89). On multivariate analysis, age (hazard ratio [HR] 1.1; P<0.01), diabetes mellitus (HR 2.2; P<0.01) and a reduced LVEF (41-49%: HR 2.4; <40%: HR 2.7; both P<0.01) were independent predictors of mortality. Prior revascularisation (PCI or CABG) was associated with a worse 5-year (9.3 vs. 2.8%) and 10-year (18 vs. 2.8%) mortality compared to those with no revascularisation (P=0.0001; Figure 1). Conclusion In an analysis of the clinical characteristics and outcomes of patients with RA from a contemporary single centre cohort, diabetes mellitus, a modifiable risk factor and impaired left ventricular function were major predictors of mortality. Prior revascularisation also conferred a significantly worse prognosis. Compared to previous US and European cohorts [3, 4], we observed lower rates of MI and revascularisation. Whilst patients with RA with no obstructive epicardial coronary disease contributed to an overall improved mortality rate, mortality in patients with prior revascularisation and obstructive CCS was also better than previously reported and support the favourable prognosis of RA. These findings inform the understanding of the treatment priorities for patients with RA.Table 1.Patient demographics Figure 1.Kaplan-Meier survival analysis
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».