TY - JOUR
T1 - Coronary artery disease, coronary revascularization, and outcomes in chronic advanced systolic heart failure
AU - Gheorghiade, Mihai
AU - Flaherty, James D.
AU - Fonarow, Gregg C.
AU - Desai, Ravi V.
AU - Lee, Richard
AU - McGiffin, David
AU - Love, Thomas E.
AU - Aban, Inmaculada
AU - Eichhorn, Eric J.
AU - Bonow, Robert O.
AU - Ahmed, Ali
N1 - Funding Information:
Dr. Ahmed is supported by the NIH through grants (R01-HL085561 and R01-HL097047) from the NHLBI and a generous gift from Ms. Jean B. Morris of Birmingham, Alabama.
PY - 2011/8/18
Y1 - 2011/8/18
N2 - Background: 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. Methods: 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. Results: 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). Conclusions: 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.
AB - Background: 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. Methods: 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. Results: 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). Conclusions: 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.
KW - Chronic heart failure
KW - Coronary artery bypass graft
KW - Coronary artery disease
KW - Hospitalization
KW - Mortality
KW - Revascularization
UR - http://www.scopus.com/inward/record.url?scp=79961168560&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=79961168560&partnerID=8YFLogxK
U2 - 10.1016/j.ijcard.2010.04.092
DO - 10.1016/j.ijcard.2010.04.092
M3 - Article
C2 - 20554334
AN - SCOPUS:79961168560
SN - 0167-5273
VL - 151
SP - 69
EP - 75
JO - International Journal of Cardiology
JF - International Journal of Cardiology
IS - 1
ER -