Coronary angiography in worsening heart failure: determinants, findings and prognostic implications

Ferreira, J. P. et al. (2018) Coronary angiography in worsening heart failure: determinants, findings and prognostic implications. Heart, 104(7), pp. 606-613. (doi: 10.1136/heartjnl-2017-311750) (PMID:28798192)

Abstract

Objectives: Coronary angiography is regularly performed in patients with worsening signs and/or symptoms of heart failure (HF). However, little is known on the determinants, findings and associated clinical outcomes of coronary angiography performed in patients with worsening HF. Methods: The BIOSTAT-CHF (a systems BIOlogy Study to TAilored Treatment in Chronic Heart Failure) programme enrolled 2516 patients with worsening symptoms and/or signs of HF, either hospitalised or in the outpatient setting. All patients were included in the present analysis. Results: Of the 2516 patients included, 315 (12.5%) underwent coronary angiography within the 30 days after the onset of worsening symptoms and/or signs of HF. Subjects who underwent angiography were more often observed as inpatients, had more often an overt acute coronary syndrome, had higher troponin I levels, were younger and had better renal function (all p≤0.01). Patients who underwent coronary angiography had a lower risk of the primary outcome of death and/or HF hospitalisation (adjusted HR=0.71, 95% CI 0.57 to 0.89, p=0.003) and death (adjusted HR=0.59, 95% CI 0.43 to 0.80, p=0.001). Among the patients who underwent coronary angiography, those with a coronary stenosis (39%) had a worse prognosis than those without stenosis (adjusted HR for the primary outcome=1.71, 95% CI 1.10 to 2.64, p=0.016). Conclusions: Coronary angiography was performed in <13% of patients with symptoms and/or signs of worsening HF. These patients were remarkably different from those who did not undergo coronary angiography and had a lower risk of subsequent events. The presence of coronary stenosis on coronary angiography was associated with a worse prognosis.

• Item Type: Articles
• Additional Information: This project was funded by a grant from the European Commission (FP7- 242209-BIOSTAT-CHF; EudraCT 2010-020808-29).
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Cleland, Professor John
• Authors: Ferreira, J. P., Rossignol, P., Demissei, B., Sharma, A., Girerd, N., Anker, S. D., Cleland, J. G., Dickstein, K., Filippatos, G., Hillege, H. L., Lang, C. C., Metra, M., Ng, L. L., Ponikowski, P., Samani, N. J., van Veldhuisen, D. J., Zwinderman, A. H., Voors, A., and Zannad, F.
• Subjects: R Medicine > R Medicine (General)
• College/School: College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Robertson Centre
• Journal Name: Heart
• Publisher: BMJ Publishing Group
• ISSN: 1355-6037
• ISSN (Online): 1468-201X
• Published Online: 10 August 2017
• Copyright Holders: Copyright © 2017 The Authors
• First Published: First published in Heart 104(7): 606-613
• Publisher Policy: Reproduced in accordance with the publisher copyright policy