TY - JOUR
T1 - Influence of coronary artery disease and coronary revascularization status on outcomes in patients with acute heart failure syndromes
T2 - A report from OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure)
AU - Rossi, Joseph S.
AU - Flaherty, James D.
AU - Fonarow, Gregg C.
AU - Nunez, Eduardo
AU - Gattis Stough, Wendy
AU - Abraham, William T.
AU - Albert, Nancy M.
AU - Greenberg, Barry H.
AU - O'Connor, Christopher M.
AU - Yancy, Clyde W.
AU - Young, James B.
AU - Davidson, Charles J.
AU - Gheorghiade, Mihai
N1 - Copyright:
Copyright 2009 Elsevier B.V., All rights reserved.
PY - 2008/12
Y1 - 2008/12
N2 - Background: Coronary artery disease (CAD) is frequent among patients hospitalized with acute heart failure syndromes (AHFS). Aims: To describe the influence of coronary revascularization status on survival in patients with AHFS. Methods and results: OPTIMIZE-HF enrolled 48,612 patients with AHFS from 259 U.S. hospitals. In-hospital data were obtained for all patients and post-discharge 60-90 day follow-up in a pre-specified 10% sample. CAD was associated with higher in-hospital (3.7% vs. 2.9%, OR 1.14, 95% CI 1.00-1.31) and post-discharge mortality (9.2% vs. 6.9%, HR 1.37, 95% CI 1.03-1.81) compared to no CAD. Post-discharge, patients with CAD who were not revascularized had higher mortality compared to patients without CAD (10.6% vs. 6.9%, HR 1.56, 95% CI 1.15-2.11). This association was similar in patients with left ventricular systolic dysfunction (EF < 40%, adjusted HR 1.52, 95% CI 0.98-2.35) and preserved systolic function (EF ≥ 40%, adjusted HR1.58, 95% CI 1.05-2.39). Patients with CAD who were revascularized had similar mortality to patients without CAD (HR 1.06, 95% CI 0.62-1.80 for PSF, HR 1.13, 95% CI 0.71-1.80 for LVSD). Conclusions: In AHFS, patients with CAD have a higher 60-90 day post-discharge mortality compared to no-CAD patients. However, patients with CAD who are revascularized appear to have similar post-discharge mortality when compared to the no-CAD group. This suggests that revascularization status may confer a survival advantage in this high risk population.
AB - Background: Coronary artery disease (CAD) is frequent among patients hospitalized with acute heart failure syndromes (AHFS). Aims: To describe the influence of coronary revascularization status on survival in patients with AHFS. Methods and results: OPTIMIZE-HF enrolled 48,612 patients with AHFS from 259 U.S. hospitals. In-hospital data were obtained for all patients and post-discharge 60-90 day follow-up in a pre-specified 10% sample. CAD was associated with higher in-hospital (3.7% vs. 2.9%, OR 1.14, 95% CI 1.00-1.31) and post-discharge mortality (9.2% vs. 6.9%, HR 1.37, 95% CI 1.03-1.81) compared to no CAD. Post-discharge, patients with CAD who were not revascularized had higher mortality compared to patients without CAD (10.6% vs. 6.9%, HR 1.56, 95% CI 1.15-2.11). This association was similar in patients with left ventricular systolic dysfunction (EF < 40%, adjusted HR 1.52, 95% CI 0.98-2.35) and preserved systolic function (EF ≥ 40%, adjusted HR1.58, 95% CI 1.05-2.39). Patients with CAD who were revascularized had similar mortality to patients without CAD (HR 1.06, 95% CI 0.62-1.80 for PSF, HR 1.13, 95% CI 0.71-1.80 for LVSD). Conclusions: In AHFS, patients with CAD have a higher 60-90 day post-discharge mortality compared to no-CAD patients. However, patients with CAD who are revascularized appear to have similar post-discharge mortality when compared to the no-CAD group. This suggests that revascularization status may confer a survival advantage in this high risk population.
KW - Acute heart failure
KW - Coronary artery disease
KW - Coronary revascularization
KW - Diastolic heart failure
KW - Mortality
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U2 - 10.1016/j.ejheart.2008.09.009
DO - 10.1016/j.ejheart.2008.09.009
M3 - Article
C2 - 19006680
AN - SCOPUS:56449117742
VL - 10
SP - 1215
EP - 1223
JO - European Journal of Heart Failure
JF - European Journal of Heart Failure
SN - 1388-9842
IS - 12
ER -