Influence of coronary artery disease and coronary revascularization status on outcomes in patients with acute heart failure syndromes: A report from OPTIMIZE-HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure)

Joseph S. Rossi, James D. Flaherty, Gregg C. Fonarow*, Eduardo Nunez, Wendy Gattis Stough, William T. Abraham, Nancy M. Albert, Barry H. Greenberg, Christopher M. O'Connor, Clyde W. Yancy, James B. Young, Charles J. Davidson, Mihai Gheorghiade

*Corresponding author for this work

Research output: Contribution to journalArticle

50 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1215-1223
Number of pages9
JournalEuropean Journal of Heart Failure
Volume10
Issue number12
DOIs
StatePublished - Dec 1 2008

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Keywords

  • Acute heart failure
  • Coronary artery disease
  • Coronary revascularization
  • Diastolic heart failure
  • Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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