PT  - JOURNAL ARTICLE
AU  - João Pedro Ferreira
AU  - Patrick Rossignol
AU  - Biniyam Demissei
AU  - Abhinav Sharma
AU  - Nicolas Girerd
AU  - Stefan D Anker
AU  - John G Cleland
AU  - Kenneth Dickstein
AU  - Gerasimos Filippatos
AU  - Hans L Hillege
AU  - Chim C Lang
AU  - Marco Metra
AU  - Leong L Ng
AU  - Piotr Ponikowski
AU  - Nilesh J Samani
AU  - Dirk J van Veldhuisen
AU  - Aeilko H Zwinderman
AU  - Adriaan Voors
AU  - Faiez Zannad
TI  - Coronary angiography in worsening heart failure: determinants, findings and prognostic implications
AID  - 10.1136/heartjnl-2017-311750
DP  - 2017 Aug 10
TA  - Heart
PG  - heartjnl-2017-311750
4099  - http://heart.bmj.com/content/early/2017/08/10/heartjnl-2017-311750.short
4100  - http://heart.bmj.com/content/early/2017/08/10/heartjnl-2017-311750.full
AB  - 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.