Chronic coronary syndromes without standard modifiable cardiovascular risk factors and outcomes: the CLARIFY registry
Author:
Roger Guillaume1ORCID, Ducrocq Grégory12, Mesnier Jules12ORCID, Sayah Neila12, Abtan Jérémie12, Ferrari Roberto34, Ford Ian5ORCID, Fox Kim M6, Tardif Jean-Claude7ORCID, Tendera Michal8ORCID, Feldman Laurent J12, Elbez Yedid9, Steg Philippe Gabriel1210ORCID, , Steg P G, Ferrari R, Ford I, Fox K M, Tardif J C, Tendera M, Sokn Fernando José, Reid Christopher, Lang Irene, Van den Branden Frank, César Luis Machado, Luqman Nazar, Goudev Assen, Dorian Paul, Hu Dayi, Widimsky Petr, Hassager Christian, Danchin Nicolas, Kääb Stefan, Vardas Panos, Sulaiman Kadhim J, Al Mahmeed Wael, Al Suwaidi Jassim, Al Rashdan Ibrahim, Abdulkader Fuad, Merkely Béla, Kaul Upendra, Daly Kieran, Tavazzi Luigi, Ferrari Roberto, Jang Yangsoo, Erglis Andrejs, Laucevičius Aleksandras, Jamaluddin Ahmad Nizar, Gamba Marco Alcocer, Tulevski Igor I, Stępińska Janina, Morais Jońo, Macarie Cezar, Oganov Rafael, Shalnova Svetlana, Al-Zaibag Muayed, Hou Mak Koon, Kamensky Assoc Gabriel, Fras Zlatko, Kanič Vojko, Naidoo Datshana Prakesh, Zamorano José Luis, Rickli Hans, Jaussi Andres, Sriratanasathavorn Assoc Charn, Kalra Paul, Lutai Mykhailo, Parkhomenko Oleksandr, Nguyen Lan Viet, Henry Ronald, Ahuad Guerrero A, Basara M, Belcastro F, Bertarini J A, Cazenave C, Dreycopp H, Egido J, Estrella J, Garofalo D, Giordano J, Lagioia H, Lago N, La Greca R, Lema L, Lopez Cabanillas N, Luquez H, Miller C, Prada E, Rodenas P, Schena R G, Suarez G, Tomatti A, Colquhoun D M, Conradie A, Cox S, Cross D, Fathi R, Fitzgerald B, Hamilton-Craig I, Holt G, Jayasinghe S R, Mai N, Moolman J, Motyer R A, Phillips K, Rafter A, Rahman A, Rainbird A, Scalia G, Taylor A, West P, Alford K, Amor R, Astridge P, Bastian B, Bates F, Doohan M M, Du Plooy J, Ford J C, Kanagaratnam L, Khoury V, Parkin R, Rogers J, Sceats G, Waldman A, Wang D, Wright S, Ardill J, Aylward P, Beltrame J F, Bradley J, Heddle W, Joseph M, Rajendran S, Varughese S, Brice E, Hockings B, Janssen J, Kozlowski A, O'Shea J, Tan J, Playford D A, Woollard K, Ajani A, Barron G, Better N, Carruthers T, Chan B, Chan R, Cotroneo J, Counsell J T, Eccleston D S, Forge B H R, Hamer A, Horrigan M, Jelinek V M J, Lew R, O'Donnell D, Panetta F, Sebastian M, Shetty P, Soward A, Srivastava P, Strathmore N F, Sylivris S, Szto G, Veth V, Yip T, Badr-Eslam R, Kleemann L, Steurer G, Mörz-Proszowski B, Auhser F, Teleky U, Sepp G, Beinhauer A, Kerö D, Lavicka C, Perger T, Hadjiivanov V, Feldner-Busztin M, Mika R, Filip W, Mahr A, Toplak J, Millauer M G, Haralambus P, Walcher K, Karner K H, Ziak E, Painsipp P, Frank U, Suntinger A, Gritsch W, Bode G, Herrmann R, Raffelsberger R, Topf H, Moser E, Föchterle J, Honsig T, Mayr K, Mayr H, Kaserbacher R, Dzien A, Galehr E, Felbermayer M, Schwarz R, Amini R, Appeltants H, Ballet A, De Niel C, Berkenboom G, Bernard X, Bouvy T, Claeys M, Dascotte Y, Davin L, De Backer T, De Meester A, De Ridder S, Dendale P, Denef K, Emonts M, Geraedts J T M, Goethals M, Grégoire J-M, Herbots T, Hoffer E, Hutse W H J, Lafontaine P, Lefebvre P, Lesseliers H, Odent G, Pasquet A, Peperstraete B, Purnode P, Rogowsky A, Rosseel M, Salembier J-P, Surmont P, Vandeplas A M F, Van de Walle S, Van den Branden F, Vandergoten P, Vanhauwaert B G, Vanneste L, Vercammen J, Verleyen D, Vermander D, Weytjens C, Rocha de Lorenzo A, Felice Castro Issa A, Mahler Mioto B, de Brito Vianna C, Okawabata C, Giusti Rossi E, Fernandes F, Pitella F, Henpin Yue Cesena F, Monteiro Ferreira J F, Junior J F, Tonet L, Machado Cesar L, Gowdak L H, Matos M A, Moretti M, Vicente Amato R, Tadeu Munhoz R, Coimbra S R, Rocha de Lorenzo A, Felice Castro Issa A, Mahler Mioto B, de Brito Vianna C, Okawabata C, Giusti Rossi E, Fernandes F, Pitella F, Henpin Yue Cesena F, Monteiro Ferreira J F, Junior J F, Tonet L, Machado Cesar L, Gowdak L H, Matos M A, Moretti M, Vicente Amato R, Tadeu Munhoz R, Coimbra S R, Luqman H N, Yakovova S, Mantcheva M, Mincheva V, Baurenski L, Karastanev K, Yordanova V, Peneva Y, Wong P, Fagan M, Sabe G, Villasenor F M, Son W K, 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Berlingieri J, Nisker W, Boutros G, Bakbak A I, Lasalle L, Chen L L, Chen M H, Chen M Y, Chen X P, Chen Y D, Cong H L, Ding S F, Dong J T, Dong S H, Du Z M, Feng L L, Gao W, Ge H, Ge S J, Guo T, Guo Y, Huang Z, Huo Y, Jin H G, Ke Y N, Li H W, Li H M, Li Z C, Li Y J, Liu J L, Liu Q L, Liu S W, Lv S Z, Miao W, Pan G Z, Pu X D, Qian Z M, Su X, Tao J H, Wang H P, Wang J A, Wang N F, Wang T, Wang W, Wang Y, Wei M, Wu S Y, Wu Y J, Xiong L G, Xu D, Yan J, Yang K, Yang M, Yang T L, Yang X L, Yu J M, Zeng H S, Zhang H, Zhang H Q, Zhang L, Zhou S X, Zhou Y L, Bozkova J, Carda J, Dedkova S, Dufka A, Fridrich J, Hodac T, Jirmar R, Kadleckova A, Karlicek M, Krupicka J, Kuchar J, Lavicka V, Leso J, Lorenc Z, Micko M, Navratil P, Petrova I, Povolna P, Raisova L, Raska P, Ravlyk V, Schlesingerova S, Smrckova E, Sternthal P, Stursova H, Vymetal P, Wiggers P, Markenvard J, Andersen L K, Frost L, Refsgaard J, Strange S, Egstrup K, Sykulski R, Hildebrant P, Haghfelt T, Ege M, Saaby L, Cattan S, Adam M, 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Affiliation:
1. Cardiology Department, AP-HP, Hôpital Bichat , 46 Rue Henri Huchard, 75018 Paris , France 2. Université Paris-Cité, INSERM U1148, FACT (French Alliance for Cardiovascular Trials) , 46 Rue Henri Huchard, 75018 Paris , France 3. Centro Cardiologico Universitario di Ferrara, University of Ferrara , Ferrara , Italy 4. Scientific Department of Medical Trial Analysis (MTA) , Lugano , Switzerland 5. Robertson Centre for Biostatistics, University of Glasgow , Glasgow , UK 6. National Heart and Lung Institute, Imperial College , London , UK 7. Montreal Heart Institute, Université de Montréal , Montreal, Quebec , Canada 8. Department of Cardiology and Structural Heart Disease, Medical University of Silesia , Katowice , Poland 9. Signifience Statistics , Paris , France 10. Institut Universitaire de France , 1 rue Descartes, 75231 Paris , France
Abstract
Abstract
Background and Aims
It has been reported that patients without standard modifiable cardiovascular (CV) risk factors (SMuRFs—diabetes, dyslipidaemia, hypertension, and smoking) presenting with first myocardial infarction (MI), especially women, have a higher in-hospital mortality than patients with risk factors, and possibly a lower long-term risk provided they survive the post-infarct period. This study aims to explore the long-term outcomes of SMuRF-less patients with stable coronary artery disease (CAD).
Methods
CLARIFY is an observational cohort of 32 703 outpatients with stable CAD enrolled between 2009 and 2010 in 45 countries. The baseline characteristics and clinical outcomes of patients with and without SMuRFs were compared. The primary outcome was a composite of 5-year CV death or non-fatal MI. Secondary outcomes were 5-year all-cause mortality and major adverse cardiovascular events (MACE—CV death, non-fatal MI, or non-fatal stroke).
Results
Among 22 132 patients with complete risk factor and outcome information, 977 (4.4%) were SMuRF-less. Age, sex, and time since CAD diagnosis were similar across groups. SMuRF-less patients had a lower 5-year rate of CV death or non-fatal MI (5.43% [95% CI 4.08–7.19] vs. 7.68% [95% CI 7.30–8.08], P = 0.012), all-cause mortality, and MACE. Similar results were found after adjustments. Clinical event rates increased steadily with the number of SMuRFs. The benefit of SMuRF-less status was particularly pronounced in women.
Conclusions
SMuRF-less patients with stable CAD have a substantial but significantly lower 5-year rate of CV death or non-fatal MI than patients with risk factors. The risk of CV outcomes increases steadily with the number of risk factors.
Publisher
Oxford University Press (OUP)
Cited by
1 articles.
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