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

• Published in: Heart (British Cardiac Society) Vol. 104; no. 7; pp. 606 - 613
• Main Authors: Ferreira, João Pedro, Rossignol, Patrick, Demissei, Biniyam, Sharma, Abhinav, Girerd, Nicolas, Anker, Stefan D, Cleland, John G, Dickstein, Kenneth, Filippatos, Gerasimos, Hillege, Hans L, Lang, Chim C, Metra, Marco, Ng, Leong L, Ponikowski, Piotr, Samani, Nilesh J, van Veldhuisen, Dirk J, Zwinderman, Aeilko H, Voors, Adriaan, Zannad, Faiez
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01.04.2018
• Subjects: Acute coronary syndromes; Aged; Angina pectoris; Cardiology; Cardiovascular disease; Coronary Angiography - adverse effects; Coronary Angiography - methods; Coronary Stenosis - diagnosis; Coronary Stenosis - epidemiology; Coronary vessels; Disease Progression; Etiology; Europe - epidemiology; Female; Heart failure; Heart Failure - diagnosis; Heart Failure - epidemiology; Heart Failure - physiopathology; Hospitalization - statistics & numerical data; Humans; Male; Medical imaging; Middle Aged; Outcome and Process Assessment (Health Care); Outpatients - statistics & numerical data; Patients; Peptides; Prognosis; Stents; Symptom Assessment - methods; Time Factors; Variables; Italy; Northern Europe; acute coronary syndrome; outcomes; coronary angiography; decompensated heart failure
• ISSN: 1355-6037; 1468-201X; 1468-201X
• DOI: 10.1136/heartjnl-2017-311750

ObjectivesCoronary 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.MethodsThe 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.ResultsOf 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).ConclusionsCoronary 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.