Among Patients with Surgical Coronary Artery Disease who do not Receive Revascularisation, Higher Antianginal Usage Predicts Long-Term Mortality.

Abstract

Background: Medically managed patients with surgical coronary artery disease (CAD) who do not receive revascularisation, either surgically or percutaneously, may suffer significant anginal symptoms. We interrogate the relationship between degree of antianginal usage and mortality in this vulnerable cohort. Method(s): Consecutive medically managed patients with surgical CAD discussed at cardiac conference of a tertiary Australian institution were included between 2012-2021. Surgical CAD was defined as stenosis >70% (or FFR<0.8) in a triple vessel distribution or double vessel distribution with a dominant circumflex and/or significant left main stenosis. 30-day and 12-month readmission and cardiac complication rate were recorded alongside long-term mortality data until 31 December 2023. Patients on >1 antianginal were compared to those on <=1. Result(s): 121 patients were included after multidisciplinary discussion. Of these, 93 (76.9%) were prescribed beta blockers, 45 (37.2%) long-acting nitrates, 9 (7.4%) nicorandil and 7 (5.8%) perhexiline. 103 (85.1%) were taking at least one agent with 39 (32.2%) taking >1. Median follow-up was 3.6 years (IQR 1.9-6.4). Patients on >1 antianginal were similar to those on <=1 in age [74.5 (63.5-82.5) vs 73.6 (67.6-80.4), p=0.90], male gender [29 (74.4%) vs 56 (68.3%), p=0.50] and diabetic prevalence [25 (64.1%) vs 43 (52.4%), p=0.23]. A higher proportion of patients on >1 agent suffered cardiac death during follow-up [15 (38.5%) vs 16 (19.5%), p=0.026, HR 2.58( 1.11-6.00, p=0.029)], and there was a trend towards increased 12-month cardiac readmissions [19 (50.0%) vs 25(32.1%), p=0.062] (Figure). Conclusion(s): This study demonstrates that patients with medically managed surgical CAD who require multiple antianginals are at high-risk of subsequent cardiac mortality. This suggests reconsidering revascularisation in patients on multiple antianginals. [Formula presented]Copyright � 2024