Natural history and outcomes of medically treated coronary artery disease: insights from reconstructed individual patient data of 29 randomized trials.

BACKGROUND

The natural history of medically treated chronic CAD remains unclear. The current study pools evidence from randomized controlled trials to examine the natural progression and long-term outcomes in the population with chronic CAD.

METHODS

Medline, Embase, and Cochrane databases were searched in March 2024 to identify relevant randomized-controlled trials (RCTs) reporting long-term outcomes for chronic CAD individuals on guideline-directed medical therapy (GDMT). A single-arm meta-analysis of proportions and means was performed on the baseline characteristics, primary and secondary endpoints. Individual patient data were reconstructed from Kaplan-Meier estimates published in the included RCTs for all-cause mortality and myocardial infarction (MI).

RESULTS

A total of 29 trials, comprising 51,275 individuals with medically treated chronic CAD, were included. The pooled incidence rates for all-cause mortality, MI and cardiac death were 19.3 (95%CI, 18.0-20.7), 30.0 (95%CI, 27.6-32.6), and 8.6 (95%CI, 5.8-12.7) per 1000 person-years, respectively. Incremental risks in all-cause mortality and MI in chronic CAD were observed across time, at one (0.8% and 2.6%), two (2.0% and 2.3%), three (3.3% and 7.5%), four (4.9% and 5.0%) and five years (10.5% and 8.4%), respectively. The rates of angina and coronary revascularization were 76.1 (95%CI, 31.6 to 183.4) and 37.3 (95%CI, 25.1 to 55.2) events per 1000 person-years.

CONCLUSION

The reconstructed individual patient data meta-analysis of patients with chronic CAD over 185,455 person-years highlights that the natural progression of chronic CAD is far from stable, with cardiovascular risks more than doubling at ≥ 5 years of follow-up.