Patients with chronic coronary syndrome (CCS) currently have overall a relatively low rate of long-term ischaemic events but some high risk subsets of patient still experience a worse prognosis such as polyarterial disease patients. Cigarette smoking and diabetes mellitus are strongly associated with polyarterial disease and may be associated with an additional increase in ischaemic outcomes.

We aimed to determine the 5-year ischaemic risk of CCS outpatients according to arterial disease phenotype as well as diabetic and smoking status.

We analyzed data from 32,703 consecutive CCS outpatients enrolled in the prospective observational CLARIFY registry. Subsets of patients were compared according to their vascular phenotypes: Coronary artery disease (CAD) alone, CAD with peripheral artery disease (PAD) or cerebrovascular disease (CVD) (CAD+1), CAD with CVD and PAD (CAD+2) and according to their diabetic and smoking status. The primary outcome was a composite of cardiovascular death, myocardial infarction or stroke, adjusted by age, sex and geographic origin at 5 years.

The 5-year primary outcome event rate was 9.5% overall (95% confidence interval (CI) 9.3–9.7) increasing according to the number of diseased arterial beds: from 8.4% (95% CI 8.1–8.7) in patients with CAD alone to 17.4% (95% CI 16.9–17.8) for CAD+2 patients (P<0.001). Subgroup analyzes according to diabetes and smoking status revealed an even greater variation of the primary outcome event rate ranging from 7% (95% CI 6.5–7.6) in non-diabetic, non-smoking CAD alone patients to 20.3% (95% CI 19.1–21.4) in diabetics and smokers CAD+2 patients (Fig. 1).

CCS patients with polyarterial disease are a heterogeneous group of patients, in which the ischaemic risk varies not only according to the number of arterial beds involvement, but also according to smoking and diabetes status. These findings highlighted a very vulnerable population of CCS patients.