RT Journal Article
SR Electronic
T1 Coronary angiography in worsening heart failure: determinants, findings and prognostic implications
JF Heart
JO Heart
FD BMJ Publishing Group Ltd and British Cardiovascular Society
SP 606
OP 613
DO 10.1136/heartjnl-2017-311750
VO 104
IS 7
A1 Ferreira, João Pedro
A1 Rossignol, Patrick
A1 Demissei, Biniyam
A1 Sharma, Abhinav
A1 Girerd, Nicolas
A1 Anker, Stefan D
A1 Cleland, John G
A1 Dickstein, Kenneth
A1 Filippatos, Gerasimos
A1 Hillege, Hans L
A1 Lang, Chim C
A1 Metra, Marco
A1 Ng, Leong L
A1 Ponikowski, Piotr
A1 Samani, Nilesh J
A1 van Veldhuisen, Dirk J
A1 Zwinderman, Aeilko H
A1 Voors, Adriaan
A1 Zannad, Faiez
YR 2018
UL http://heart.bmj.com/content/104/7/606.abstract
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.