Dynamics and prognostic role of persistent angina in chronic coronary syndrome with clinical, angiographic and stress CMR evidence of ischemia

Dynamics and prognostic role of persistent angina in chronic coronary syndrome with clinical, angiographic and stress CMR evidence of ischemia

Abstract Background In patients with established chronic coronary syndrome (CCS), the significance of myocardial ischemia is a controversial issue. Persistent angina within the first year after treatment intervention has ranged widely in previous studies and its association with subsequent hard clin...

Ausführliche Beschreibung

Gespeichert in:
Bibliographische Detailangaben
Veröffentlicht in:European heart journal 2024-10, Vol.45 (Supplement_1)
Hauptverfasser: Merenciano-Gonzalez, H, Perez, N, De Dios, E, Monmeneu, J V, Lopez-Lereu, M P, Gavara, J, Rios-Navarro, C, Marcos Garces, V, Moratal, D, Bayes-Genis, A, Sanz-Sanchez, J, Martinez-Dolz, L, Sanchis, J, Nunez, J, Bodi, V
Format: Artikel
Sprache:eng
Online-Zugang:Volltext
Tags: Tag hinzufügen
Keine Tags, Fügen Sie den ersten Tag hinzu!
container_end_page
container_issue Supplement_1
container_start_page
container_title European heart journal
container_volume 45
creator Merenciano-Gonzalez, H
Perez, N
De Dios, E
Monmeneu, J V
Lopez-Lereu, M P
Gavara, J
Rios-Navarro, C
Marcos Garces, V
Moratal, D
Bayes-Genis, A
Sanz-Sanchez, J
Martinez-Dolz, L
Sanchis, J
Nunez, J
Bodi, V
description Abstract Background In patients with established chronic coronary syndrome (CCS), the significance of myocardial ischemia is a controversial issue. Persistent angina within the first year after treatment intervention has ranged widely in previous studies and its association with subsequent hard clinical events is unclear. We aim to evaluate the long-term dynamics of angina class and the prognostic role of persistent angina in symptomatic chronic coronary syndrome (CCS) patients with abnormal stress cardiovascular magnetic resonance (CMR) and altered angiography. Methods We analyzed 486 CCS patients with Canadian Cardiovascular Society angina class ≥2, perfusion deficit in stress CMR and severe lesions in angiography submitted to treatment intervention (medical therapy plus, if feasible, CMR-guided revascularization). The dynamics and association of persistent angina at 6 months post-intervention with subsequent cardiac death, myocardial infarction, and admission for heart failure were investigated. Results All patients displayed angina class ≥2 (mean: 2.7±0.7), abnormal stress CMR (mean ischemic burden: 6.2±3 segments) and severe angiographic lesions. Most underwent CMR-guided revascularization (n=392, 81%). The angina resolution rate was 78% at 6 months, and 79%, 77%, and 75% at 1, 2, and 5 years respectively. Compared with medical treatment alone, CMR-guided revascularization was associated with less persistent angina (19% vs. 35%; HR 0.42 [0.2–0.7]; p=0.003). During an 8.3-year median follow-up, persistent angina was independently associated with higher subsequent cardiac death rates (18% vs. 4%; HR 10.9 [4.1–29.2]; p
doi_str_mv 10.1093/eurheartj/ehae666.1329
format Article
fullrecord <record><control><sourceid>oup_cross</sourceid><recordid>TN_cdi_crossref_primary_10_1093_eurheartj_ehae666_1329</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><oup_id>10.1093/eurheartj/ehae666.1329</oup_id><sourcerecordid>10.1093/eurheartj/ehae666.1329</sourcerecordid><originalsourceid>FETCH-LOGICAL-c899-595d7e165b2e934b5d6d6e931a44a6569d20dd5d64189e1b51a70ca00e6fed153</originalsourceid><addsrcrecordid>eNqNkE1OwzAQhS0EEqVwBeQDkNZO4mm8ROVXKkJCXbCLXHvSuGrtyE5BvQRnxv0Ra1YzmnnfPM0j5JazEWeyGOM2tKhCvxpjqxAARrzI5RkZcJHnmYRSnJMB41JkANXnJbmKccUYq4DDgPw87JzaWB2pcoZ2wS-dj73VNPg1Ut_QDkO0sUfXJ8XSOkWto7oN3iWR9qmqsKNx50zwG6Tftm-pXtu0Veu7A-KXQXVtUu8dYh8wRjp9-6D4ZQ06fXCxUbe4seqaXDRqHfHmVIdk_vQ4n75ks_fn1-n9LNOVlJmQwkyQg1jkKItyIQwYSB1XZalAgDQ5MyZNS15J5AvB1YRpxRhCg4aLYkjgeFYHH2PApu6C3aRHas7qfaj1X6j1KdR6H2oC-RH02-6_zC8izoOH</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>Dynamics and prognostic role of persistent angina in chronic coronary syndrome with clinical, angiographic and stress CMR evidence of ischemia</title><source>Oxford University Press Journals All Titles (1996-Current)</source><creator>Merenciano-Gonzalez, H ; Perez, N ; De Dios, E ; Monmeneu, J V ; Lopez-Lereu, M P ; Gavara, J ; Rios-Navarro, C ; Marcos Garces, V ; Moratal, D ; Bayes-Genis, A ; Sanz-Sanchez, J ; Martinez-Dolz, L ; Sanchis, J ; Nunez, J ; Bodi, V</creator><creatorcontrib>Merenciano-Gonzalez, H ; Perez, N ; De Dios, E ; Monmeneu, J V ; Lopez-Lereu, M P ; Gavara, J ; Rios-Navarro, C ; Marcos Garces, V ; Moratal, D ; Bayes-Genis, A ; Sanz-Sanchez, J ; Martinez-Dolz, L ; Sanchis, J ; Nunez, J ; Bodi, V</creatorcontrib><description>Abstract Background In patients with established chronic coronary syndrome (CCS), the significance of myocardial ischemia is a controversial issue. Persistent angina within the first year after treatment intervention has ranged widely in previous studies and its association with subsequent hard clinical events is unclear. We aim to evaluate the long-term dynamics of angina class and the prognostic role of persistent angina in symptomatic chronic coronary syndrome (CCS) patients with abnormal stress cardiovascular magnetic resonance (CMR) and altered angiography. Methods We analyzed 486 CCS patients with Canadian Cardiovascular Society angina class ≥2, perfusion deficit in stress CMR and severe lesions in angiography submitted to treatment intervention (medical therapy plus, if feasible, CMR-guided revascularization). The dynamics and association of persistent angina at 6 months post-intervention with subsequent cardiac death, myocardial infarction, and admission for heart failure were investigated. Results All patients displayed angina class ≥2 (mean: 2.7±0.7), abnormal stress CMR (mean ischemic burden: 6.2±3 segments) and severe angiographic lesions. Most underwent CMR-guided revascularization (n=392, 81%). The angina resolution rate was 78% at 6 months, and 79%, 77%, and 75% at 1, 2, and 5 years respectively. Compared with medical treatment alone, CMR-guided revascularization was associated with less persistent angina (19% vs. 35%; HR 0.42 [0.2–0.7]; p=0.003). During an 8.3-year median follow-up, persistent angina was independently associated with higher subsequent cardiac death rates (18% vs. 4%; HR 10.9 [4.1–29.2]; p&lt;0.001), myocardial infarction (24% vs. 6%; HR 5.8 [3.2–10.4]; p&lt;0.001), and admission for heart failure (31% vs. 14%; HR 2.7 [1.7–4.2]; p&lt;0.001). Conclusions In CCS patients with robust diagnostic evidence by symptoms, stress CMR and angiography, sustained improvement of anginal symptoms can be achieved in most patients after treatment intervention. Angina resolution is more frequent in patients treated with CMR-guided revascularization and is associated with fewer cardiac events.Central Figure.Persistent angina and MACE risk</description><identifier>ISSN: 0195-668X</identifier><identifier>EISSN: 1522-9645</identifier><identifier>DOI: 10.1093/eurheartj/ehae666.1329</identifier><language>eng</language><publisher>US: Oxford University Press</publisher><ispartof>European heart journal, 2024-10, Vol.45 (Supplement_1)</ispartof><rights>The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. 2024</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids></links><search><creatorcontrib>Merenciano-Gonzalez, H</creatorcontrib><creatorcontrib>Perez, N</creatorcontrib><creatorcontrib>De Dios, E</creatorcontrib><creatorcontrib>Monmeneu, J V</creatorcontrib><creatorcontrib>Lopez-Lereu, M P</creatorcontrib><creatorcontrib>Gavara, J</creatorcontrib><creatorcontrib>Rios-Navarro, C</creatorcontrib><creatorcontrib>Marcos Garces, V</creatorcontrib><creatorcontrib>Moratal, D</creatorcontrib><creatorcontrib>Bayes-Genis, A</creatorcontrib><creatorcontrib>Sanz-Sanchez, J</creatorcontrib><creatorcontrib>Martinez-Dolz, L</creatorcontrib><creatorcontrib>Sanchis, J</creatorcontrib><creatorcontrib>Nunez, J</creatorcontrib><creatorcontrib>Bodi, V</creatorcontrib><title>Dynamics and prognostic role of persistent angina in chronic coronary syndrome with clinical, angiographic and stress CMR evidence of ischemia</title><title>European heart journal</title><description>Abstract Background In patients with established chronic coronary syndrome (CCS), the significance of myocardial ischemia is a controversial issue. Persistent angina within the first year after treatment intervention has ranged widely in previous studies and its association with subsequent hard clinical events is unclear. We aim to evaluate the long-term dynamics of angina class and the prognostic role of persistent angina in symptomatic chronic coronary syndrome (CCS) patients with abnormal stress cardiovascular magnetic resonance (CMR) and altered angiography. Methods We analyzed 486 CCS patients with Canadian Cardiovascular Society angina class ≥2, perfusion deficit in stress CMR and severe lesions in angiography submitted to treatment intervention (medical therapy plus, if feasible, CMR-guided revascularization). The dynamics and association of persistent angina at 6 months post-intervention with subsequent cardiac death, myocardial infarction, and admission for heart failure were investigated. Results All patients displayed angina class ≥2 (mean: 2.7±0.7), abnormal stress CMR (mean ischemic burden: 6.2±3 segments) and severe angiographic lesions. Most underwent CMR-guided revascularization (n=392, 81%). The angina resolution rate was 78% at 6 months, and 79%, 77%, and 75% at 1, 2, and 5 years respectively. Compared with medical treatment alone, CMR-guided revascularization was associated with less persistent angina (19% vs. 35%; HR 0.42 [0.2–0.7]; p=0.003). During an 8.3-year median follow-up, persistent angina was independently associated with higher subsequent cardiac death rates (18% vs. 4%; HR 10.9 [4.1–29.2]; p&lt;0.001), myocardial infarction (24% vs. 6%; HR 5.8 [3.2–10.4]; p&lt;0.001), and admission for heart failure (31% vs. 14%; HR 2.7 [1.7–4.2]; p&lt;0.001). Conclusions In CCS patients with robust diagnostic evidence by symptoms, stress CMR and angiography, sustained improvement of anginal symptoms can be achieved in most patients after treatment intervention. Angina resolution is more frequent in patients treated with CMR-guided revascularization and is associated with fewer cardiac events.Central Figure.Persistent angina and MACE risk</description><issn>0195-668X</issn><issn>1522-9645</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><recordid>eNqNkE1OwzAQhS0EEqVwBeQDkNZO4mm8ROVXKkJCXbCLXHvSuGrtyE5BvQRnxv0Ra1YzmnnfPM0j5JazEWeyGOM2tKhCvxpjqxAARrzI5RkZcJHnmYRSnJMB41JkANXnJbmKccUYq4DDgPw87JzaWB2pcoZ2wS-dj73VNPg1Ut_QDkO0sUfXJ8XSOkWto7oN3iWR9qmqsKNx50zwG6Tftm-pXtu0Veu7A-KXQXVtUu8dYh8wRjp9-6D4ZQ06fXCxUbe4seqaXDRqHfHmVIdk_vQ4n75ks_fn1-n9LNOVlJmQwkyQg1jkKItyIQwYSB1XZalAgDQ5MyZNS15J5AvB1YRpxRhCg4aLYkjgeFYHH2PApu6C3aRHas7qfaj1X6j1KdR6H2oC-RH02-6_zC8izoOH</recordid><startdate>20241028</startdate><enddate>20241028</enddate><creator>Merenciano-Gonzalez, H</creator><creator>Perez, N</creator><creator>De Dios, E</creator><creator>Monmeneu, J V</creator><creator>Lopez-Lereu, M P</creator><creator>Gavara, J</creator><creator>Rios-Navarro, C</creator><creator>Marcos Garces, V</creator><creator>Moratal, D</creator><creator>Bayes-Genis, A</creator><creator>Sanz-Sanchez, J</creator><creator>Martinez-Dolz, L</creator><creator>Sanchis, J</creator><creator>Nunez, J</creator><creator>Bodi, V</creator><general>Oxford University Press</general><scope>AAYXX</scope><scope>CITATION</scope></search><sort><creationdate>20241028</creationdate><title>Dynamics and prognostic role of persistent angina in chronic coronary syndrome with clinical, angiographic and stress CMR evidence of ischemia</title><author>Merenciano-Gonzalez, H ; Perez, N ; De Dios, E ; Monmeneu, J V ; Lopez-Lereu, M P ; Gavara, J ; Rios-Navarro, C ; Marcos Garces, V ; Moratal, D ; Bayes-Genis, A ; Sanz-Sanchez, J ; Martinez-Dolz, L ; Sanchis, J ; Nunez, J ; Bodi, V</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c899-595d7e165b2e934b5d6d6e931a44a6569d20dd5d64189e1b51a70ca00e6fed153</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Merenciano-Gonzalez, H</creatorcontrib><creatorcontrib>Perez, N</creatorcontrib><creatorcontrib>De Dios, E</creatorcontrib><creatorcontrib>Monmeneu, J V</creatorcontrib><creatorcontrib>Lopez-Lereu, M P</creatorcontrib><creatorcontrib>Gavara, J</creatorcontrib><creatorcontrib>Rios-Navarro, C</creatorcontrib><creatorcontrib>Marcos Garces, V</creatorcontrib><creatorcontrib>Moratal, D</creatorcontrib><creatorcontrib>Bayes-Genis, A</creatorcontrib><creatorcontrib>Sanz-Sanchez, J</creatorcontrib><creatorcontrib>Martinez-Dolz, L</creatorcontrib><creatorcontrib>Sanchis, J</creatorcontrib><creatorcontrib>Nunez, J</creatorcontrib><creatorcontrib>Bodi, V</creatorcontrib><collection>CrossRef</collection><jtitle>European heart journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Merenciano-Gonzalez, H</au><au>Perez, N</au><au>De Dios, E</au><au>Monmeneu, J V</au><au>Lopez-Lereu, M P</au><au>Gavara, J</au><au>Rios-Navarro, C</au><au>Marcos Garces, V</au><au>Moratal, D</au><au>Bayes-Genis, A</au><au>Sanz-Sanchez, J</au><au>Martinez-Dolz, L</au><au>Sanchis, J</au><au>Nunez, J</au><au>Bodi, V</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Dynamics and prognostic role of persistent angina in chronic coronary syndrome with clinical, angiographic and stress CMR evidence of ischemia</atitle><jtitle>European heart journal</jtitle><date>2024-10-28</date><risdate>2024</risdate><volume>45</volume><issue>Supplement_1</issue><issn>0195-668X</issn><eissn>1522-9645</eissn><abstract>Abstract Background In patients with established chronic coronary syndrome (CCS), the significance of myocardial ischemia is a controversial issue. Persistent angina within the first year after treatment intervention has ranged widely in previous studies and its association with subsequent hard clinical events is unclear. We aim to evaluate the long-term dynamics of angina class and the prognostic role of persistent angina in symptomatic chronic coronary syndrome (CCS) patients with abnormal stress cardiovascular magnetic resonance (CMR) and altered angiography. Methods We analyzed 486 CCS patients with Canadian Cardiovascular Society angina class ≥2, perfusion deficit in stress CMR and severe lesions in angiography submitted to treatment intervention (medical therapy plus, if feasible, CMR-guided revascularization). The dynamics and association of persistent angina at 6 months post-intervention with subsequent cardiac death, myocardial infarction, and admission for heart failure were investigated. Results All patients displayed angina class ≥2 (mean: 2.7±0.7), abnormal stress CMR (mean ischemic burden: 6.2±3 segments) and severe angiographic lesions. Most underwent CMR-guided revascularization (n=392, 81%). The angina resolution rate was 78% at 6 months, and 79%, 77%, and 75% at 1, 2, and 5 years respectively. Compared with medical treatment alone, CMR-guided revascularization was associated with less persistent angina (19% vs. 35%; HR 0.42 [0.2–0.7]; p=0.003). During an 8.3-year median follow-up, persistent angina was independently associated with higher subsequent cardiac death rates (18% vs. 4%; HR 10.9 [4.1–29.2]; p&lt;0.001), myocardial infarction (24% vs. 6%; HR 5.8 [3.2–10.4]; p&lt;0.001), and admission for heart failure (31% vs. 14%; HR 2.7 [1.7–4.2]; p&lt;0.001). Conclusions In CCS patients with robust diagnostic evidence by symptoms, stress CMR and angiography, sustained improvement of anginal symptoms can be achieved in most patients after treatment intervention. Angina resolution is more frequent in patients treated with CMR-guided revascularization and is associated with fewer cardiac events.Central Figure.Persistent angina and MACE risk</abstract><cop>US</cop><pub>Oxford University Press</pub><doi>10.1093/eurheartj/ehae666.1329</doi></addata></record>
fulltext fulltext
identifier ISSN: 0195-668X
ispartof European heart journal, 2024-10, Vol.45 (Supplement_1)
issn 0195-668X
1522-9645
language eng
recordid cdi_crossref_primary_10_1093_eurheartj_ehae666_1329
source Oxford University Press Journals All Titles (1996-Current)
title Dynamics and prognostic role of persistent angina in chronic coronary syndrome with clinical, angiographic and stress CMR evidence of ischemia
url https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-02-08T01%3A22%3A41IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-oup_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Dynamics%20and%20prognostic%20role%20of%20persistent%20angina%20in%20chronic%20coronary%20syndrome%20with%20clinical,%20angiographic%20and%20stress%20CMR%20evidence%20of%20ischemia&rft.jtitle=European%20heart%20journal&rft.au=Merenciano-Gonzalez,%20H&rft.date=2024-10-28&rft.volume=45&rft.issue=Supplement_1&rft.issn=0195-668X&rft.eissn=1522-9645&rft_id=info:doi/10.1093/eurheartj/ehae666.1329&rft_dat=%3Coup_cross%3E10.1093/eurheartj/ehae666.1329%3C/oup_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_id=info:pmid/&rft_oup_id=10.1093/eurheartj/ehae666.1329&rfr_iscdi=true