Article

Coronary artery disease, coronary revascularization, and outcomes in chronic advanced systolic heart failure.

Northwestern University, Chicago, IL, United States.
International journal of cardiology (impact factor: 7.08). 08/2011; 151(1):69-75. DOI:10.1016/j.ijcard.2010.04.092 pp.69-75
Source: PubMed

ABSTRACT Associations between coronary artery disease (CAD) and outcomes in systolic heart failure (HF) and that between coronary artery bypass graft (CABG) surgery and outcomes in patients with HF and CAD have not been examined using propensity-matched designs.
Of the 2707 patients with advanced chronic systolic HF in the Beta-Blocker Evaluation of Survival Trial (BEST), 1593 had a history of CAD, of whom 782 had prior CABG. Using propensity scores for CAD we assembled a cohort of 458 pairs of CAD and no-CAD patients. Propensity scores for prior CABG in those with CAD were used to assemble 500 pairs of patients with and without CABG. Matched patients were balanced on 68 baseline characteristics.
All-cause mortality occurred in 33% and 24% of matched patients with and without CAD respectively, during 26 months of median follow-up (hazard ratio {HR} when CAD was compared with no-CAD, 1.41; 95% confidence interval {CI}, 1.11-1.81; P=0.006). HR's (95% CIs) for CAD-associated cardiovascular mortality, HF mortality, and sudden cardiac death (SCD) were 1.53 (1.17-2.00; P=0.002), 1.44 (0.92-2.25; P=0.114) and 1.76 (1.21-2.57; P=0.003) respectively. CAD had no association with hospitalization. Among matched patients with HF and CAD, all-cause mortality occurred in 32% and 39% of those with and without prior CABG respectively (HR for CABG, 0.77; 95% CI, 0.62-0.95; P=0.015).
In patients with advanced chronic systolic HF, CAD is associated with increased mortality, and in those with CAD, prior CABG seems to be associated with reduced all-cause mortality but not SCD.

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Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

26 months
 
68 baseline characteristics
 
95% confidence interval {CI}
 
all-cause mortality
 
Associations
 
Beta-Blocker Evaluation
 
CAD-associated cardiovascular mortality
 
chronic systolic HF
 
coronary artery bypass graft
 
coronary artery disease
 
hazard ratio {HR}
 
HF mortality
 
no-CAD
 
no-CAD patients
 
prior CABG
 
propensity scores
 
propensity-matched designs
 
sudden cardiac death
 
Survival Trial
 
systolic heart failure