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Original research article
Coronary angiography in worsening heart failure: determinants, findings and prognostic implications
  1. João Pedro Ferreira1,2,
  2. Patrick Rossignol1,
  3. Biniyam Demissei3,
  4. Abhinav Sharma4,5,
  5. Nicolas Girerd1,
  6. Stefan D Anker6,
  7. John G Cleland7,
  8. Kenneth Dickstein8,9,
  9. Gerasimos Filippatos10,
  10. Hans L Hillege3,
  11. Chim C Lang11,
  12. Marco Metra12,
  13. Leong L Ng13,
  14. Piotr Ponikowski14,
  15. Nilesh J Samani15,
  16. Dirk J van Veldhuisen3,
  17. Aeilko H Zwinderman16,
  18. Adriaan Voors3,
  19. Faiez Zannad1
  1. 1 INSERM, Centre d’Investigations Cliniques Plurithématique 1433, Université de Lorraine, CHRU de Nancy and F-CRIN INI-CRCT, Nancy, France
  2. 2 Cardiovascular Research and Development Unit, Department of Physiology and Cardiothoracic Surgery, University of Porto, Porto, Portugal
  3. 3 Department of Cardiology, University of Groningen, University Medical Center Groningen, Hanzeplein, Groningen, The Netherlands
  4. 4 Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
  5. 5 Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada
  6. 6 Department of Innovative Clinical Trials, University Medical Centre Göttingen (UMG), Robert-Koch-Straße, Göttingen, Germany
  7. 7 Robertson Centre for Biostatistics and Glasgow Clinical Trials Unit, Glasgow, UK
  8. 8 University of Bergen, Bergen, Norway
  9. 9 Stavanger University Hospital, Stavanger, Norway
  10. 10 Heart Failure Unit, Department of Cardiology, National and Kapodistrian University of Athens, School of Medicine, Athens University Hospital Attikon, Rimini, Athens, Greece
  11. 11 Division of Molecular and Clinical Medicine, Ninewells Hospital and Medical School, University of Dundee, Dundee, UK
  12. 12 University of Brescia, Brescia, Italy
  13. 13 Department of Cardiovascular Sciences, University of Leicester, United Kingdom and Cardiovascular Theme, NIHR Leicester Biomedical Research Centre, Glenfield Hospital, Leicester, UK
  14. 14 Department of Cardiology and Department of Heart Diseases, Centre for Heart Diseases, 4th Military Hospital, Wroclaw Medical University, Wroclaw, Poland
  15. 15 Department of Cardiovascular Sciences, University of Leicester, BHF Cardiovascular Research Centre, Glenfield Hospital, Leicester, UK
  16. 16 Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, Amsterdam, The Netherlands
  1. Correspondence to João Pedro Ferreira, Centre d’Investigation Clinique Inserm, CHU, Université de Lorraine, Institut Lorrain du Coeur et des Vaisseaux 4, rue du Morvan, 54500 Vandœuvre-lès-Nancy, France; jp7ferreira{at}


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.

  • decompensated heart failure
  • coronary angiography
  • acute coronary syndrome
  • outcomes

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  • Contributors All authors contributed to the content of the present manuscript and approved its submission. JPF, AV and FZ designed the study, wrote the manuscript and provided critical appraisal. JPF performed statitical analysis. PR, BD, AS, NG, SDA, JGC, KD, GF, HLH, CCL, MM, LLN, PP, NJS, DJV and AHZ revised the manuscript.

  • Funding This project was funded by a grant from the European Commission (FP7-242209-BIOSTAT-CHF; EudraCT 2010-020808-29).

  • Competing interests None declared.

  • Ethics approval Ethics approval was obtained by each participating institution.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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