Elective Coronary Revascularization Procedures Evaluated in Patients With Stable CAD

May 14, 2018—Findings from a study describing the incidence, determinants, and outcomes of elective coronary revascularization (ECR) in patients with stable coronary artery disease (CAD) were published by Martial Hamon, MD, et al in Journal of the American College of Cardiology (JACC): Cardiovascular Interventions (2018;11:868–875).

The study investigators concluded that ECR is performed at a rate of 1.8% per year in stable CAD patients widely treated by secondary medical prevention. They advised that ECR procedures performed in patients without noninvasive stress tests are not rare and that ECR was not associated with the risk of ischemic adverse events.

As summarized in JACC: Cardiovascular Interventions, the investigators analyzed coronary revascularization procedures performed during 5-year follow-up in 4,094 stable CAD outpatients included in the prospective multicenter CORONOR registry. Secondary prevention medications were widely prescribed at inclusion (antiplatelet agents, 96.4%; statins, 92.2%; renin-angiotensin system antagonists, 81.8%).

A total of 481 patients underwent one or more coronary revascularization procedures (5-year cumulative incidences of 3.6% [0.7% per year] for acute revascularizations and 8.9% [1.8% per year] for ECR). There were 677 deaths during the same period.

The investigators found that seven baseline variables were independently associated with ECR: previous coronary stent implantation (P < .0001), absence of previous myocardial infarction (P < .0001), higher low-density lipoprotein cholesterol (P < .0001), younger patient age (P < .0001), multivessel CAD (P = .003), diabetes mellitus (P = .005), and absence of treatment with renin-angiotensin system antagonists (P = .02).

Main indications for ECR were angina associated with positive stress test findings (31%), silent ischemia (31%), and angina alone (25%). ECR had no impact on the subsequent risk of death, myocardial infarction, or ischemic stroke (hazard ratio, 1.04; 95% confidence interval, 0.76–1.41), reported the investigators in JACC: Cardiovascular Interventions.