Search

Aims: In Europe, global data on guideline adherence, geographic variations, and determinants of clinical events in patients with chronic coronary syndrome (CCS) remain suboptimal. The European Society of Cardiology (ESC) EURObservational Research Programme (EORP) Chronic Ischemic Cardiovascular Disease Long-Term (CICD-LT) registry is a prospective European registry, and was designed to describe the profile, management, and outcomes of patients with CCS across the ESC countries., Methods and Results: We aimed to investigate clinical events at 1-year follow-up from the ESC EORP CICD-LT registry.One-year outcomes of 6655 patients from the 9174 recruited in this European registry were analysed. Overall, 168 patients (2.5%) died, mostly from cardiovascular (CV) causes (n = 97, 1.5%). Northern Europe had the lowest CV mortality rate, while southern Europe had the highest (0.5 vs. 2.0%, P = 0.04). Women had a higher rate of CV mortality compared with men (2.0 vs. 1.3%, P = 0.02). During follow-up, 1606 patients (27.1%) were hospitalized at least once, predominantly for CV indications (n = 1220, 20.6%). Among the population with measured low-density lipoprotein-cholesterol level at 1 year, 1434 patients (66.5%) were above the recommended target. Age, history of atrial fibrillation, previous stroke, liver disease, chronic obstructive pulmonary disease or asthma, increased serum creatinine, and impaired left ventricular function were associated with an increased risk of CV death or hospitalization., Conclusion: In the CICD registry, the majority of patients with CCS have uncontrolled CV-risk factors. The 1-year mortality rate is low, but these patients are frequently hospitalized for CV causes. Early identification of comorbidities may represent an opportunity for enhanced care and better outcomes., Competing Interests: Conflict of interest: M.Ke. reports research grants from institut servier, federation francaise de cardiologie, and consulting fees from Bayer, Kiniksa, Sanofi, and Servier. F.C. reports personal fees from Novo Nordisk, personal fees from MSD, personal fees from Pfizer, personal fees from Mundipharma, personal fees from Eli Lilly, personal fees from Boehringer Ingelheim, personal fees from AstraZeneca, personal fees from BMS, outside the submitted work. R.F. reports personal fees from Servier International, grants and personal fees from Novartis, personal fees from Merck Serono, personal fees from Boehringer Ingelheim, personal fees from Sun Pharma, personal fees from Lupin, personal fees from Doc Generici, personal fees from Pfizer, personal fees from Spa Prodotti Antibiotici, outside the submitted work; and Director of Art Research and Science S.r.l. J.L.G., H.R., E.K., and C.L. have nothing to disclose. A.P.M. reports personal fees from Bayer, personal fees from Fresenius, personal fees from Novartis, outside the submitted work. P.G.S. reports grants and personal fees from Bayer/Janssen, grants and personal fees from Merck, grants and personal fees from Sanofi, grants and personal fees from Amarin, personal fees from Amgen, personal fees from Bristol Myers Squibb, personal fees from Boehringer Ingelheim, personal fees from Pfizer, personal fees from Novartis, personal fees from Regeneron, personal fees from Lilly, personal fees from AstraZeneca, grants and personal fees from Servier, outside the submitted work. L.T. reports personal fees from Servier, personal fees from CVie Therapeutics, outside the submitted work; M.V. reports personal fees from AstraZeneca, grants and personal fees from Terumo, personal fees from Alvimedica/CID, personal fees from Abbott Vascular, personal fees from Daiichi Sankyo, personal fees from Opsens, personal fees from Bayer, personal fees from CoreFlow, personal fees from Idorsia Pharmaceuticals Ltd, personal fees from Department Klinische Forschung, Universität Basel, personal fees from Vifor, personal fees from Bristol Myers Squib SA, personal fees from iVascular, personal fees from Medscape, outside the submitted work. C.P.G. reports non-financial support from Bayer, grants, personal fees, and non-financial support from Bristol Myers Squib, personal fees and non-financial support from Novartis, personal fees and non-financial support from AstraZeneca, personal fees from Vifor Pharma, grants from Abbot, personal fees from Daiichi Sankyo, outside the submitted work. M.Ko. reports personal fees from Novartis, Servier, MSD, Sanofi, AstraZeneca, TORRENT, Amgen, Bayer, outside the submitted work., (© The Author(s) 2022. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Aim Chronic ischaemic cardiovascular disease (CICD) remains a leading cause of morbidity and mortality worldwide. The CICD Pilot Registry enrolled 2420 patients across 10 European Society of Cardiology countries prospectively to describe characteristics, management strategies and clinical outcomes in this setting. We report here the six-month outcomes. Methods and results From the overall population, 2203 patients were analysed at six months. Fifty-eight patients (2.6%) died after inclusion; 522 patients (23.7%) experienced all-cause hospitalisation or death. The rate of prescription of angiotensin-converting enzyme inhibitors, beta-blockers and aspirin was mildly decreased at six months (all P < 0.02). Patients who experienced all-cause hospitalisation or death were older, more often had a history of non-ST-segment elevation myocardial infarction, of chronic kidney disease, peripheral revascularisation and/or chronic obstructive pulmonary disease than those without events. Independent predictors of all-cause mortality/hospitalisation were age (hazard ratio (HR) 1.17, 95% confidence interval (CI) 1.07-1.27) per 10 years, and a history of previous peripheral revascularisation (HR 1.45, 95% CI 1.03-2.03), chronic kidney disease (HR 1.31, 95% CI 1.0-1.68) or chronic obstructive pulmonary disease (HR 1.42, 95% CI 1.06-1.91, all P < 0.05). We observed a higher rate of events in eastern, western and northern countries compared to southern countries and in cohort 1. Conclusion In this contemporary European registry of CICD patients, the rate of severe clinical outcomes at six months was high and was influenced by age, heart rate and comorbidities. The medical management of this condition remains suboptimal, emphasising the need for larger registries with long-term follow-up. Ad-hoc programmes aimed at implementing guidelines adherence and follow-up procedures are necessary, in order to improve quality of care and patient outcomes.

Aims: The aims of the study are to compare the outcome with and without major bleeding and to identify the independent correlates of major bleeding complications and mortality in patients described in the ATOLL study., Methods: The ATOLL study included 910 patients randomly assigned to either 0.5 mg/kg intravenous enoxaparin or unfractionated heparin before primary percutaneous coronary intervention. Incidence of major bleeding and ischemic end points was assessed at 1 month, and mortality, at 1 and 6 months. Patients with and without major bleeding complication were compared. A multivariate model of bleeding complications at 1 month and mortality at 6 months was realized. Intention-to-treat and per-protocol analyses were performed., Results: The most frequent bleeding site appears to be the gastrointestinal tract. Age >75 years, cardiac arrest, and the use of insulin or >1 heparin emerged as independent correlates of major bleeding at 1 month. Patients presenting with major bleeding had significantly higher rates of adverse ischemic complications. Mortality at 6 months was higher in bleeders. Major bleeding was found to be one of the independent correlates of 6-month mortality. The addition or mixing of several anticoagulant drugs was an independent factor of major bleeding despite the predominant use of radial access., Conclusions: This study shows that major bleeding is independently associated with poor outcome, increasing ischemic events, and mortality in primary percutaneous coronary intervention performed mostly with radial access., (Copyright © 2015 Elsevier Inc. All rights reserved.)