CARDIOVASCULAR MEDICINE

Coronary artery disease and outcome in acute congestive heart failure

L Purek, K Laule-Kilian, A Christ, T Klima, M E Pfisterer, A P Perruchoud, C Mueller

University of Basel, University Hospital, Department of Internal Medicine, Basel, Switzerland

Correspondence to:
Professor Dr Christian Mueller
Medizinische Klinik A, Universitätsklinik, Petersgraben 4, CH-4031 Basel, Switzerland; chmueller{at}uhbs.ch

Objectives: To quantify the prognostic impact of coronary artery disease (CAD) on patients with acute heart failure (HF).

Design: Prospective cohort study of 217 consecutive patients presenting with acute HF to the emergency department. Treatment, hospitalisation, the use of revascularisation procedures, and survival were observed during follow up of up to three years.

Results: CAD was present in 153 patients (71%). Patients with and without CAD were similar with respect to age and sex. Although adequate HF treatment was initiated more rapidly among patients with CAD, their initial outcomes including hospitalisation rate, time to discharge, and total treatment cost were significantly worse. Moreover, despite higher use of angiotensin converting enzyme inhibitors and ß blockers during follow up, patients with CAD had a significantly lower survival rate. Cumulative survival at 720 days was 48.7% of patients with CAD as compared with 76.4% of patients without CAD (p = 0.0004). In Cox regression analysis the presence of CAD increased the risk of death by more than 250% (hazard ratio 2.57, 95% confidence interval 1.50 to 4.39, p = 0.001). This strong association persisted after multivariate adjustments. The use of coronary angiography and coronary revascularisation procedures was low, both at initial presentation and during follow up.

Conclusion: CAD is a strong and independent predictor of mortality among patients with acute HF. Whether, for example, less restrictive use of revascularisation procedures in this elderly HF population can improve the outcome for patients with CAD warrants further study.

Abbreviations: ACE, angiotensin converting enzyme; BASEL, B-type natriuretic peptide for the acute shortness of breath evaluation; BNP, B-type natriuretic peptide; CAD, coronary artery disease; HF, heart failure; TACTICS-TIMI 18, treat angina with Aggrastat and determine cost of therapy with an invasive or conservative strategy-thrombolysis in myocardial infarction 18

Keywords: coronary artery disease; acute heart failure; mortality; revascularisation

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