Even though angina is typical in patients with stable coronary artery disease (CAD), only a limited amount of information is available on its natural evolution, outcomes, and prevalence in the modern world that has effective drugs for cardiovascular diseases and coronary revascularization procedures are commonly used.
Overall, 32,691 patients diagnosed with stable CAD were enrolled from CLARIFY registry using the prospective observational method. The patient's angina status was mapped every year, especially in patients without incidences of new myocardial infarction or coronary revascularization. Further, using multivariable analysis, changes in angina status in one year were noted on 5-year outcomes.
It was recorded that among the 7212 (22.1%) patients with reported angina, 39.6% did not have angina after a year without coronary revascularization. However, among patients that did not have angina at baseline, it was noted that 2.0-4.8% developed angina every year. In the 5-year follow-up, it was observed that 7773 patients had controlled angina; among these patients, in 11.1%, angina was resolved using high antianginal treatment. In 4.5% of patients, coronary revascularization was performed. However, in 84.4% of patients, angina subsided without any intervention or procedures.
Persistence and occurrence of angina after one year of traditional management were both associated with increased myocardial infarction (MI) or cardiovascular death when compared to patients who did not have angina at baseline (adjusted hazard ratio [HR] 1.32; 95% confidence interval [CI] 1.12 to 1.55 for angina persistence; adjusted HR- 1.37; 95% CI- 1.11 to 1.70 for angina occurrence). However, the risk of MI or cardiovascular death was not high in patients without angina at one year with traditional management or in patients who never had an episode of angina (adjusted HR- 0.97; 95% CI- 0.82−1.15).
Angina that resolves within one year with conservative therapy predicts results similar to those who do not have angina; however, angina that persists or recurs predicts poorer outcomes. Because most patients with angina will have a remission of their symptoms, there is a need for cautious care of stable coronary artery disease.