Influence of cerebral stroke on life prognosis of patients with stable coronary heart disease according to the data of CHD PROGNOSIS registry

Abstract

Objective: to assess how cerebral stroke (CS) in patient’s history affectы length life of patients with stable coronary heart disease (СHD), included in the СHD PROGNOSIS registry.Materials and methods. We analyzed the data of patients from CHD PROGNOSIS registry who underwent coronary angiography and confirmed CHD diagnosis (n = 541, including 432 men and 109 women) during the reference hospitalization in the National Medical Research Center for Therapy and Preventive Medicine of the Ministry of Health of Russia from 01 / 01 / 2004 to 31 / 12 / 2007. The average age of men and women was 57.5 ± 0.4 and 60.9 ± 0.9 years, respectively. During reference hospitalization, we took into account CS / transient ischemic attack in anamnesis (retrospective part) and frequency of reaching endpoints (general and cardiovascular mortality, myocardial infarction and CS after 4 and 7 years of follow-up (prospective part). In case of 4-year observation, therapy response was 89 %, in case of 7-year observation – 93 %.Results. Twenty (3.7 %) patients had CS or transient ischemic attack in anamnesis at reference hospitalization, 284 (52.5 %) patients suffered myocardial infarction (p < 0.001). There were revealed differences in patients with coronary artery disease, which cannot be detected in the anamnesis by age, sex, presence of comorbid burden, arterial hypertension and diabetes mellitus, non-cardiological diseases, smoking frequency. The relative risk of death from all causes at 4- and 7-year follow-up was 3.3 and 2.4 times higher, respectively (p < 0.05). Patients with CS in anamnesis demonstrated 25 and 45 % overall mortality in 4 and 7 years, their cardiovascular mortality was 25 and 35 %, respectively. Patients without CS in medical history demonstrated 9 and 18 % overall mortality after 4 and 7 years of follow-up, cardiovascular mortality was 8 and 12 %, respectively (intergroup differences are statistically significant at p < 0.05–0.01).Conclusion. It was noted that patients with CHD and CS in anamnesis were older, percent of women among them was higher, they more often suffered from grade II–III hypertension and diabetes mellitus, had more comorbidities, but smoked less often. CS in anamnesis significantly worsened the medium-term and long-term life prognosis for patients with CHD, increasing overall and cardiovascular mortality.