Modifiable Risk Factors and Residual Risk Following Coronary Revascularization
Objective: To ensure compliance with optimal secondary prevention strategies and document the residual risk of patients following revascularization, we established a postrevascularization clinic for risk-factor optimization at 1 year, with outcomes recorded in a web-based registry. Although coronary...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-12-01
|
| Series: | Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S254245482100134X |
| _version_ | 1798026763438129152 |
|---|---|
| author | Trevor Simard, MD Richard G. Jung, PhD Pietro Di Santo, MD David T. Harnett, MD, MSc Omar Abdel-Razek, MD F. Daniel Ramirez, MD, MSc Pouya Motazedian, MD Simon Parlow, MD Alisha Labinaz, BSc Robert Moreland, MD Jeffrey Marbach, MBBS, MS Anthony Poulin, MD Amos Levi, MD Kamran Majeed, MD Paul Boland, MD, PhD Etienne Couture, MD Kiran Sarathy, MD Steven Promislow, MD Juan J. Russo, MD Aun Yeong Chong, MD Derek So, MD Michael Froeschl, MD Alexander Dick, MD Marino Labinaz, MD Michel Le May, MD David R. Holmes, Jr., MD Benjamin Hibbert, MD, PhD |
| author_facet | Trevor Simard, MD Richard G. Jung, PhD Pietro Di Santo, MD David T. Harnett, MD, MSc Omar Abdel-Razek, MD F. Daniel Ramirez, MD, MSc Pouya Motazedian, MD Simon Parlow, MD Alisha Labinaz, BSc Robert Moreland, MD Jeffrey Marbach, MBBS, MS Anthony Poulin, MD Amos Levi, MD Kamran Majeed, MD Paul Boland, MD, PhD Etienne Couture, MD Kiran Sarathy, MD Steven Promislow, MD Juan J. Russo, MD Aun Yeong Chong, MD Derek So, MD Michael Froeschl, MD Alexander Dick, MD Marino Labinaz, MD Michel Le May, MD David R. Holmes, Jr., MD Benjamin Hibbert, MD, PhD |
| author_sort | Trevor Simard, MD |
| collection | DOAJ |
| description | Objective: To ensure compliance with optimal secondary prevention strategies and document the residual risk of patients following revascularization, we established a postrevascularization clinic for risk-factor optimization at 1 year, with outcomes recorded in a web-based registry. Although coronary revascularization can reduce ischemia, medical treatment of coronary artery disease (CAD) remains the cornerstone of ongoing risk reduction. While standardized referral pathways and protocols for revascularization are prevalent and well studied, post-revascularization care is often less formalized. Patients and Methods: The University of Ottawa Heart Institute is a tertiary-care center providing coronary revascularization services. From 2015 to 2019, data were prospectively recorded in the CAPITAL revascularization registry, and patient-level procedural, clinical, and outcome data are collected in the year following revascularization. Major adverse cardiovascular event (MACE) was defined as death, myocardial infarction, unplanned revascularization, or cerebrovascular accident. Kaplan-Meier curves were generated to evaluate time-to-event data for clinical outcomes by risk-factor management, and comparisons were performed using log-rank tests and reported by hazard ratio (HR) and 95% confidence intervals (CIs). Results: A cohort of 4147 patients completed 1-year follow-up after revascularization procedure that included 3462 undergoing percutaneous coronary intervention (PCI), 589 undergoing coronary artery bypass graft (CABG), and 96 undergoing both PCI and CABG. In the year following revascularization (median follow-up 13.3 months—interquartile range [IQR]: 11.9-16.5) 11% of patients experienced MACE, with female patients being disproportionately at risk. Moreover, 47.7% of patients had ≥2 risk factors (diabetes, dyslipidemia, overweight, active smoker) at the time of follow-up, with 45.0% of patients with diabetes failing to achieve target hemoglobin (Hb) A1c, 54.8% of smokers continuing to smoke, and 27.1% of patients failing to achieve guideline-directed lipid targets. Conclusion: Patients who have undergone revascularization procedures remain at elevated risk for MACE, and inadequately controlled risk factors are prevalent in follow-up. This highlights the need for aggressive secondary prevention strategies and implementation of programs to optimize postrevascularization care. |
| first_indexed | 2024-04-11T18:40:38Z |
| format | Article |
| id | doaj.art-6b289dc2bcfd4552b2c9a6a2d127349c |
| institution | Directory Open Access Journal |
| issn | 2542-4548 |
| language | English |
| last_indexed | 2024-04-11T18:40:38Z |
| publishDate | 2021-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| spelling | doaj.art-6b289dc2bcfd4552b2c9a6a2d127349c2022-12-22T04:08:59ZengElsevierMayo Clinic Proceedings: Innovations, Quality & Outcomes2542-45482021-12-015611381152Modifiable Risk Factors and Residual Risk Following Coronary RevascularizationTrevor Simard, MD0Richard G. Jung, PhD1Pietro Di Santo, MD2David T. Harnett, MD, MSc3Omar Abdel-Razek, MD4F. Daniel Ramirez, MD, MSc5Pouya Motazedian, MD6Simon Parlow, MD7Alisha Labinaz, BSc8Robert Moreland, MD9Jeffrey Marbach, MBBS, MS10Anthony Poulin, MD11Amos Levi, MD12Kamran Majeed, MD13Paul Boland, MD, PhD14Etienne Couture, MD15Kiran Sarathy, MD16Steven Promislow, MD17Juan J. Russo, MD18Aun Yeong Chong, MD19Derek So, MD20Michael Froeschl, MD21Alexander Dick, MD22Marino Labinaz, MD23Michel Le May, MD24David R. Holmes, Jr., MD25Benjamin Hibbert, MD, PhD26CAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MinnesotaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Hôpital Cardiologique du Haut-Lévêque, CHU Bordeaux, Bordeaux-Pessac, France; L’Institut de Rythmologie et Modélisation Cardiaque (LIRYC), Université de Bordeaux, Bordeaux-Pessac, FranceCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cardiology, Royal Perth Hospital, Perth, Western Australia; School of Medicine, University of Western Australia, Perth, Western AustraliaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, CanadaDepartment of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, MinnesotaCAPITAL Research Group, Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada; Correspondence: Address to Benjamin Hibbert, MD, PhD, University of Ottawa Heart Institute, 40 Ruskin Street, Room H4238, Ottawa, Ontario K1Y 4W7, CanadaObjective: To ensure compliance with optimal secondary prevention strategies and document the residual risk of patients following revascularization, we established a postrevascularization clinic for risk-factor optimization at 1 year, with outcomes recorded in a web-based registry. Although coronary revascularization can reduce ischemia, medical treatment of coronary artery disease (CAD) remains the cornerstone of ongoing risk reduction. While standardized referral pathways and protocols for revascularization are prevalent and well studied, post-revascularization care is often less formalized. Patients and Methods: The University of Ottawa Heart Institute is a tertiary-care center providing coronary revascularization services. From 2015 to 2019, data were prospectively recorded in the CAPITAL revascularization registry, and patient-level procedural, clinical, and outcome data are collected in the year following revascularization. Major adverse cardiovascular event (MACE) was defined as death, myocardial infarction, unplanned revascularization, or cerebrovascular accident. Kaplan-Meier curves were generated to evaluate time-to-event data for clinical outcomes by risk-factor management, and comparisons were performed using log-rank tests and reported by hazard ratio (HR) and 95% confidence intervals (CIs). Results: A cohort of 4147 patients completed 1-year follow-up after revascularization procedure that included 3462 undergoing percutaneous coronary intervention (PCI), 589 undergoing coronary artery bypass graft (CABG), and 96 undergoing both PCI and CABG. In the year following revascularization (median follow-up 13.3 months—interquartile range [IQR]: 11.9-16.5) 11% of patients experienced MACE, with female patients being disproportionately at risk. Moreover, 47.7% of patients had ≥2 risk factors (diabetes, dyslipidemia, overweight, active smoker) at the time of follow-up, with 45.0% of patients with diabetes failing to achieve target hemoglobin (Hb) A1c, 54.8% of smokers continuing to smoke, and 27.1% of patients failing to achieve guideline-directed lipid targets. Conclusion: Patients who have undergone revascularization procedures remain at elevated risk for MACE, and inadequately controlled risk factors are prevalent in follow-up. This highlights the need for aggressive secondary prevention strategies and implementation of programs to optimize postrevascularization care.http://www.sciencedirect.com/science/article/pii/S254245482100134X |
| spellingShingle | Trevor Simard, MD Richard G. Jung, PhD Pietro Di Santo, MD David T. Harnett, MD, MSc Omar Abdel-Razek, MD F. Daniel Ramirez, MD, MSc Pouya Motazedian, MD Simon Parlow, MD Alisha Labinaz, BSc Robert Moreland, MD Jeffrey Marbach, MBBS, MS Anthony Poulin, MD Amos Levi, MD Kamran Majeed, MD Paul Boland, MD, PhD Etienne Couture, MD Kiran Sarathy, MD Steven Promislow, MD Juan J. Russo, MD Aun Yeong Chong, MD Derek So, MD Michael Froeschl, MD Alexander Dick, MD Marino Labinaz, MD Michel Le May, MD David R. Holmes, Jr., MD Benjamin Hibbert, MD, PhD Modifiable Risk Factors and Residual Risk Following Coronary Revascularization Mayo Clinic Proceedings: Innovations, Quality & Outcomes |
| title | Modifiable Risk Factors and Residual Risk Following Coronary Revascularization |
| title_full | Modifiable Risk Factors and Residual Risk Following Coronary Revascularization |
| title_fullStr | Modifiable Risk Factors and Residual Risk Following Coronary Revascularization |
| title_full_unstemmed | Modifiable Risk Factors and Residual Risk Following Coronary Revascularization |
| title_short | Modifiable Risk Factors and Residual Risk Following Coronary Revascularization |
| title_sort | modifiable risk factors and residual risk following coronary revascularization |
| url | http://www.sciencedirect.com/science/article/pii/S254245482100134X |
| work_keys_str_mv | AT trevorsimardmd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT richardgjungphd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT pietrodisantomd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT davidtharnettmdmsc modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT omarabdelrazekmd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT fdanielramirezmdmsc modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT pouyamotazedianmd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT simonparlowmd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT alishalabinazbsc modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT robertmorelandmd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT jeffreymarbachmbbsms modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT anthonypoulinmd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT amoslevimd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT kamranmajeedmd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT paulbolandmdphd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT etiennecouturemd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT kiransarathymd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT stevenpromislowmd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT juanjrussomd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT aunyeongchongmd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT dereksomd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT michaelfroeschlmd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT alexanderdickmd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT marinolabinazmd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT michellemaymd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT davidrholmesjrmd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization AT benjaminhibbertmdphd modifiableriskfactorsandresidualriskfollowingcoronaryrevascularization |