Intermittent claudication as a predictor of outcome in patients with ischaemic systolic heart failure: analysis of the Controlled Rosuvastatin Multinational Trial in Heart Failure trial (CORONA)

Inglis, S. C. et al. (2010) Intermittent claudication as a predictor of outcome in patients with ischaemic systolic heart failure: analysis of the Controlled Rosuvastatin Multinational Trial in Heart Failure trial (CORONA). European Journal of Heart Failure, 12(7), pp. 698-705. (doi:10.1093/eurjhf/hfq070)

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Abstract

To examine the relationship between baseline intermittent claudication and outcomes in patients enrolled in the Controlled Rosuvastatin Multinational Trial in Heart Failure trial (CORONA). Intermittent claudication is an independent predictor of worse outcome in coronary heart disease, but its prognostic importance in heart failure (HF) is unknown. Patients aged >= 60 years with NYHA class II-IV, low ejection fraction HF of ischaemic aetiology were enrolled in CORONA. Rosuvastatin did not reduce the primary outcome or all-cause mortality. To determine whether intermittent claudication was an independent predictor of clinical outcomes, a three-step multivariable model was built: (i) demographic/clinical variables, (ii) biochemical measures added, (iii) high-sensitivity C-reactive protein and N-terminal pro B-type natriuretic-peptide added. Of the 5011 patients, 637 (12.7%) had intermittent claudication at baseline. Patients with intermittent claudication were more likely to be male (83 vs. 75%), be a current smoker (19 vs. 9%), and have diabetes mellitus (36 vs. 29%) relative to those without intermittent claudication. Over a median 33-month follow-up, 2168 patients died or were hospitalized for HF. Patients with intermittent claudication had an increased risk of death (any cause) (adjusted hazard ratio 1.36, 95% CI 1.19-1.56, P < 0.0001), death from worsening HF (1.35, 1.03-1.77, P = 0.028), sudden death (1.24, 1.00-1.54, P = 0.05), and risk of non-fatal or fatal myocardial infarction (time to first event 1.67, 1.24-2.27, P < 0.001). In the full multivariable model, intermittent claudication remained an independent predictor of most outcomes evaluated. Intermittent claudication is a relatively common symptom in ischaemic HF and an independent predictor of worse outcome

Item Type:Articles
Keywords:Aetiology aged ASPIRIN ATHEROSCLEROSIS C-REACTIVE PROTEIN Chronic heart failure Coronary heart disease CORONARY-HEART-DISEASE DEATH DESIGN diabetes Diabetes mellitus DIABETES-MELLITUS DISEASE EJECTION FRACTION ENGLAND FAILURE FOLLOW-UP HEART heart disease Heart failure HEART-DISEASE HEART-FAILURE INCREASED RISK INFARCTION MELLITUS MODEL MORTALITY Myocardial infarction MYOCARDIAL-INFARCTION outcome OUTCOMES PATIENT patients PERIPHERAL ARTERIAL-DISEASE Peripheral artery disease PREVALENCE PROTEIN RANDOMIZED-TRIAL RATIO RISK ROSUVASTATIN Scotland smoker STENOSIS sudden death SUDDEN-DEATH SYSTEM SYSTEMS Systolic heart failure THERAPY TRIAL VARIABLES VASCULAR-DISEASE WARFARIN/ASPIRIN
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:McMurray, Professor John and Inglis, Dr Sally
Authors: Inglis, S. C., McMurray, J. J. V., Bohm, M., Schaufelberger, M., van Veldhuisen, D. J., Lindberg, M., Dunselman, P., Hjalmarson, A., Kjekshus, J., Waagstein, F., Wedel, H., and Wikstrand, J.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
College of Medical Veterinary and Life Sciences
Journal Name:European Journal of Heart Failure
ISSN:1388-9842

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