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Review
. 2016:2016:3769152.
doi: 10.1155/2016/3769152. Epub 2016 Apr 27.

Assessing Risk in Patients with Stable Coronary Disease: When Should We Intensify Care and Follow-Up? Results from a Meta-Analysis of Observational Studies of the COURAGE and FAME Era

Umberto Barbero  1 , Fabrizio D'Ascenzo  2 , Freek Nijhoff  3 , Claudio Moretti  2 , Giuseppe Biondi-Zoccai  4 , Marco Mennuni  5 , Davide Capodanno  6 , Marco Lococo  1 , Michael J Lipinski  7 , Fiorenzo Gaita  1
Affiliations
Review

Assessing Risk in Patients with Stable Coronary Disease: When Should We Intensify Care and Follow-Up? Results from a Meta-Analysis of Observational Studies of the COURAGE and FAME Era

Umberto Barbero et al. Scientifica (Cairo). 2016.

Abstract

Background. A large number of clinical and laboratory markers have been appraised to predict prognosis in patients with stable angina, but uncertainty remains regarding which variables are the best predictors of prognosis. Therefore, we performed a meta-analysis of studies in patients with stable angina to assess which variables predict prognosis. Methods. MEDLINE and PubMed were searched for eligible studies published up to 2015, reporting multivariate predictors of major adverse cardiac events (MACE, a composite endpoint of death, myocardial infarction, and revascularization) in patients with stable angina. Study features, patient characteristics, and prevalence and predictors of such events were abstracted and pooled with random-effect methods (95% CIs). Major adverse cardiovascular event (MACE) was the primary endpoint. Results. 42 studies (104,559 patients) were included. After a median follow-up of 57 months, cardiovascular events occurred in 7.8% of patients with MI in 6.2% of patients and need for repeat revascularization (both surgical and percutaneous) in 19.5% of patients. Male sex, reduced EF, diabetes, prior MI, and high C-reactive protein were the most powerful predictors of cardiovascular events. Conclusions. We show that simple and low-cost clinical features may help clinicians in identifying the most appropriate diagnostic and therapeutic approaches within the broad range of outpatients presenting with stable coronary artery disease.

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Figures

Figure 1
Figure 1
Search strategy results.
Figure 2
Figure 2
Incidence of adverse cardiovascular events after a follow-up of 57 months. MACE: major adverse cardiac events.
Figure 3
Figure 3
The most common predictors of subsequent CV events in stable angina patients. Data are reported as OR median value, with lower/upper limit confidence interval.
Figure 4
Figure 4
Effect of length of follow-up (beta 0.07; 0.03–0.09), of optimal medical therapy (0.02; 0.01–0.04), of CABG (0.04; −0.01–−0.06), and of PCI (0.03; 0.02–0.07) on CV events.
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