Results from the CLARIFY study presented Sept. 3 during ESC Congress 2019 provide helpful information for characterizing the spectrum of patients with chronic coronary syndrome (CCS) – information that could help inform future management of this patient population, as well as future studies, researchers said.

The study, which was also published in the European Heart Journal, looked at 32,703 patients with CCS from 45 middle- to high-income countries enrolled in the prospective observational CLARIFY registry between November 2009 and June 2010. The primary outcome was cardiovascular death or nonfatal myocardial infarction (MI) over five years.

Overall findings showed the primary outcome occurred in 8.0 percent of patients. Using a Cox proportional hazards model, Emmanuel Sorbets, MD, PhD, et al., identified several main independent predictors of the primary outcome, including prior hospitalization for heart failure, current smoking, atrial fibrillation, living in Central/South America, prior MI, prior stroke, diabetes, current angina and peripheral artery disease.

Additionally, researchers noted that prescription rates of evidence-based secondary prevention therapies were high. They also highlighted substantial variations in clinical profiles across geographical regions. For example, patients in the Middle East had the lowest rates of current heart failure symptoms and lower extremity artery disease, along with the highest body mass index and highest prevalence of diabetes. In contrast, patients from Asia had the lowest prevalence of prior MI, the highest rate of prior PCI, the highest rate of stroke, and the smallest body mass index and use of statins. Central and South America had the lowest rate of current smokers, prior stroke or angina, but the highest rate of hypertension.

Among the study limitations, CLARIFY reflects only middle- or high-income countries, making it impossible to extrapolate findings to large and important regions such as Africa and Asia where access to more advanced medical care is limited. Yet, Sorbets and colleagues say their findings are important given the substantial changes in the profile of CCS over the last decades.

Clinical Topics: Cardiovascular Care Team, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Interventions and Coronary Artery Disease, Interventions and Imaging, Angiography, Nuclear Imaging

Keywords: ESC 19, ESC Congress, Coronary Artery Disease, Myocardial Infarction, Angiography, Percutaneous Coronary Intervention

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