BACKGROUND:Evaluation of the residual risk in patient with chronic coronary syndrome is challenging in daily practice. Several types of events (myocardial infarction, ischemic stroke, bleeding, and heart failure [HF]) may occur, and their impact on subsequent mortality is unclear in the era of modern evidence-based pharmacotherapy.METHODS:CORONOR (Suivi d’une cohorte de patients Coronariens stables en région Nord-pas-de-Calais) is a prospective multicenter cohort that enrolled 4184 consecutive unselected outpatients with chronic coronary syndrome. We analyzed the incidence, correlates, and impact of ischemic events (a composite of myocardial infarction and ischemic stroke), major bleeding (Bleeding Academic Research Consortium 3 or higher), and hospitalization for HF on subsequent patient mortality.RESULTS:During follow-up (median, 4.9 years), 677 patients (16.5%) died. The 5-year cumulative incidences (death as competing event) of ischemic events, major bleeding, and HF hospitalization were 6.3% (5.6%–7.1%), 3.1% (2.5%–3.6%), and 8.1% (7.3%–9%), respectively. Ischemic events, major bleeding, and HF hospitalization were each associated with all-cause mortality. Major bleeding and hospitalization for HF were associated with the highest mortality rates in the postevent period (42.4%/y and 34.7%/y, respectively) compared with incident ischemic events (13.1%/y). The age- and sex-adjusted hazard ratios for all-cause mortality were 3.57 (95% CI, 2.77–4.61), 9.88 (95% CI, 7.55–12.93), and 8.60 (95% CI, 7.15–10.35) for ischemic events, major bleeding, and hospitalization for HF, respectively (all P<0.001).CONCLUSIONS:Hospitalization for HF has become both the most frequent and one of the most ominous events among patients with chronic coronary syndrome. Although less frequent, major bleeding is strongly associated with worse patient survival. Secondary prevention should not be limited to preventing ischemic events. Minimizing bleeding and preventing HF may be at least as important.

中文翻译：

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慢性冠状动脉综合征患者缺血性大出血和心力衰竭事件的发生率和预后影响的比较：来自 CORONOR 登记处的见解

背景：评估慢性冠状动脉综合征患者的残余风险在日常实践中具有挑战性。几种类型的事件（心肌梗死、缺血性中风、出血和心力衰竭 [HF]）可能会发生，在现代循证药物治疗时代，这些事件对随后死亡率的影响尚不清楚。北加来海峡地区冠状动脉稳定患者队列）是一项前瞻性多中心队列，纳入了 4184 名连续未经选择的慢性冠状动脉综合征门诊患者。我们分析了缺血性事件（心肌梗死和缺血性中风的复合）、大出血（出血学术研究联盟 3 级或更高级别）以及心衰住院对后续患者死亡率的发生率、相关性和影响。 结果：在随访期间（中位数，4.9 年），677 名患者（16.5%）死亡。缺血事件、大出血和心衰住院的 5 年累计发生率（死亡作为竞争事件）分别为 6.3% (5.6%–7.1%)、3.1% (2.5%–3.6%) 和 8.1% (7.3%–7.3%)。 9%），分别。缺血事件、大出血和心衰住院均与全因死亡率相关。与缺血性事件（13.1%/年）相比，大出血和心衰住院与事件后死亡率最高（分别为 42.4%/年和 34.7%/年）相关。缺血性全因死亡率的年龄和性别调整后风险比分别为 3.57 (95% CI, 2.77–4.61)、9.88 (95% CI, 7.55–12.93) 和 8.60 (95% CI, 7.15–10.35)。事件、大出血和心力衰竭住院（均P <0.001）。 结论：心力衰竭住院已成为慢性冠状动脉综合征患者中最常见的事件，也是最不祥的事件之一。尽管发生率较低，但大出血与患者生存率较差密切相关。二级预防不应仅限于预防缺血事件。尽量减少出血和预防心力衰竭可能至少同样重要。