In outpatients with stable CAD, MI incidence was linked to very late stent thrombosis and elevated risk for mortality, according to new data published in the Journal of the American College of Cardiology.
“MI is the most commonly feared event in patients with established CAD; however, there is limited information on the incidence, risk factors and prognostic impact of MI when it occurs in outpatients with stable CAD,” Gilles Lemesle, MD, of the Université de Lille, Inserm, CHU Lille, Institut Pasteur in Lille, France, and colleagues wrote.
The CORONOR study enrolled 4,184 outpatients with stable CAD in a multinational registry between February 2010 and April 2011.
Patients were eligible for the study if they showed signs of CAD, defined by previous MI, previous coronary revascularization or obstruction of 50% of the luminal diameter of at least one native vessel on coronary angiography.
Researchers determined a linear risk for incident MI (0.8% annually), with one-third of cases being STEMI.
There was an association between current smoking, LDL, multivessel CAD, diabetes with glycosylated hemoglobin > 7% and persistent angina with increased risk for incident MI. However, prior CABG was associated with decreased risk for incident MI.
Incident MI was linked to increased risk for death (HR = 2.05; P < .0001) when used as a time-dependent variable, Lemesle and colleagues wrote.
Among patients with a stent, there was a causal relationship between very late stent thrombosis and MI in 20% of MI cases, occurring more frequently in those with STEMI than in those with non-STEMI (59% vs. 26%, P = .001), according to the researchers.
Patients with MI and very late stent thrombosis had an adjusted mortality rate four times higher compared with patients with MI not related to a stented site, they wrote.
“In the present study, all-cause mortality was doubled in those patients who had an MI during follow-up vs. those who avoided MI,” the researchers wrote. “This highlights the importance of trying to prevent these events. The identification of factors associated with incident MI could shed light on relevant implicated mechanisms.” – by Dave Quaile
Disclosure: Lemesle reports receiving lecture and consultant fees from AstraZeneca, Bayer, Biopharma, Bristol-Myers Squibb, Boehringer Ingelheim, Daiichi Sankyo, Eli Lilly, Merck/Schering-Plough, Pfizer, Sanofi, Servier and The Medicines Company. Please see the full study for a list of the other researchers’ relevant financial disclosures.