Long-term outcomes in patients with coronary artery disease in ambulatory practice: 10-year follow-up
M. M. Luk'yanov,
E. Yu. Andreenko,
S. Yu. Martsevich,
S. S. Yakushin,
K. G. Pereverzeva,
A. N. Kozminsky,
E. A. Pravkina,
V. G. Klyashtorny,
A. A. Gurbanova,
R. N. Shepel,
O. M. Drapkina https://doi.org/10.15829/1728-8800-2025-4630
EDN: LOWWWB
Abstract
Aim. To evaluate outcomes over 10-year follow-up and the risks of adverse events in patients with coronary artery disease (CAD) within an outpatient registry.
Material and methods. The RECVAZA outpatient registry, based at three clinics in Ryazan, included 2548 patients with CAD (age, 70,4±10,8 years; men, 28,5%). The following outcomes were assessed from 2012 to 2023 (follow-up period, 8,2±3,3 years): death, myocardial infarction (MI), cerebrovascular accident (CVE), and hospitalization for cardiovascular disease (CVD). Outcome information was obtained from medical records, surveys, and electronic databases.
Results. During 10-year follow-up, 1321 patients with coronary artery disease (CAD) died in the RECVASA registry, which is 51,8%. The main causes of death were CVD (44,4%) and cancer (8,8%). A particularly high proportion of deaths was observed among patients who, at the time of inclusion in the study, had prior stroke (71,9%) and MI (61,5%); a combination of CAD with hypertension (HTH), heart failure (HF) and atrial fibrillation (AF) (79%); age ≥80 years (91,7%). The highest all-cause and cardiovascular death risk was associated with age (hazard ratio (HR)=1,06 and HR=1,07; p<0,001); male sex (HR=1,70 and HR=1,62; p<0,001); prior CVE (HR=1,86 and HR=2,13; p<0,001); type 2 diabetes (HR=1,55 and HR=1,67; p<0,001); decreased hemoglobin level (HR=1,66 and HR=1,72; p<0,001); increased hemoglobin level (HR=1,63 and HR=1,92; p=0,005 and 0,004); smoking (HR=1,51; p=0,001 and HR=1,72; p=0,003), respectively. The risk of MI was most associated with male sex and prior MI (HR=1,77 and HR=2,61; p<0,001), while the risk of CVE — with AF and prior CVE (HR=1,65 and 3,78; p<0,001), with systolic blood pressure <110 mm Hg (HR=2,72; p=0,01). Hospitalization for CVD more than once every 2 years was associated with a higher death risk (by 1,6 times), but a lower rate — with a lower risk (by 1,9 times) than in its absence. When quadruple therapy was prescribed, including a renin-angiotensin system blocker, a beta-blocker, a statin, and an antiplatelet/anticoagulant agent in the presence/absence of AF, compared to those prescribed 0-1 of these, the all-cause and cardiovascular death risk was 3,5 and 4,2 times lower, respectively.
Conclusion. Over 10-year follow-up, 51,8% of patients with coronary artery disease (CAD) died. The highest mortality rate was observed in patients with prior MI and SVE, type 2 diabetes, a combination of CAD, HTN, HF, and AF, and low hemoglobin levels. Hospitalizations for CVD more than once every two years were associated with a higher death risk, but a lower hospitalization rate was associated with a lower risk than in patients with no cardiovascular hospitalizations. Prescription of quadruple therapy with a renin-angiotensin system blocker, a beta-blocker, a statin, and an antithrombotic agent, when indicated, reduced the all-cause and cardiovascular mortality risk by 3,5 and 4,2 times, respectively.
Keywords
coronary artery disease,
outpatient prospective registry,
multimorbidity,
cardiovascular pharmacotherapy,
outcomes,
adverse event risk assessment
Supporting agencies: State assignment: "Modeling the risk of chronic noncommunicable diseases/cardiovascular diseases based on Russian prospective population studies in order to create a national scale for predicting the risk of developing diseases".
About the Authors
M. M. Luk'yanov
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Russian Federation
Petroverigsky Lane, 10, bld. 3, Moscow, 101990
E. Yu. Andreenko
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Russian Federation
Petroverigsky Lane, 10, bld. 3, Moscow, 101990
S. Yu. Martsevich
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Russian Federation
Petroverigsky Lane, 10, bld. 3, Moscow, 101990
S. S. Yakushin
Pavlov Ryazan State Medical University
Russian Federation
Russian Federation
Vysokovoltnaya st., 2, bldg. 9, Ryazan, 390026
K. G. Pereverzeva
Pavlov Ryazan State Medical University
Russian Federation
Russian Federation
Vysokovoltnaya st., 2, bldg. 9, Ryazan, 390026
A. N. Kozminsky
Pavlov Ryazan State Medical University
Russian Federation
Russian Federation
Vysokovoltnaya st., 2, bldg. 9, Ryazan, 390026
E. A. Pravkina
Pavlov Ryazan State Medical University
Russian Federation
Russian Federation
Vysokovoltnaya st., 2, bldg. 9, Ryazan, 390026
V. G. Klyashtorny
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Russian Federation
Petroverigsky Lane, 10, bld. 3, Moscow, 101990
A. A. Gurbanova
Pavlov Ryazan State Medical University
Russian Federation
Russian Federation
Vysokovoltnaya st., 2, bldg. 9, Ryazan, 390026
R. N. Shepel
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Russian Federation
Petroverigsky Lane, 10, bld. 3, Moscow, 101990
O. M. Drapkina
National Medical Research Center for Therapy and Preventive Medicine
Russian Federation
Russian Federation
Petroverigsky Lane, 10, bld. 3, Moscow, 101990
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What is already known about the subject?
- Coronary artery disease (CAD), especially in patients with multiple comorbidities, is associated with an unfavorable prognosis.
What might this study add?
- This study characterized groups of patients with CAD and identified the main factors influencing the risk of death and adverse events over a 10-year follow-up period.
- Groups of patients with CAD with the highest mortality during this period were described.
- We established that the use of complete quadruple pharmacotherapy (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, statins, and antiplatelet /anticoagulant agents in the absence/presence of atrial fibrillation) is associated with a 3-fold reduction in all-cause death risk.
- In patients with CAD, frequent hospitalizations for CVD (>1 every two years) are associated with a higher death risk over 10 years, while less frequent hospitalizations are associated with a lower risk than in those who have not been hospitalized.
Review
For citations:
Luk'yanov M.M., Andreenko E.Yu., Martsevich S.Yu., Yakushin S.S., Pereverzeva K.G., Kozminsky A.N., Pravkina E.A., Klyashtorny V.G., Gurbanova A.A., Shepel R.N., Drapkina O.M. Long-term outcomes in patients with coronary artery disease in ambulatory practice: 10-year follow-up. Cardiovascular Therapy and Prevention. 2025;24(10):4630. (In Russ.) https://doi.org/10.15829/1728-8800-2025-4630. EDN: LOWWWB
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