Relationship Between Angina Pectoris and Outcomes in Patients With Heart Failure and Reduced Ejection Fraction: An Analysis of the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA)

Study Questions:

What is the relationship between current angina symptoms and outcomes in patients with heart failure and reduced ejection fraction (HF-REF)?

Methods:

This was a retrospective analysis of the CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure) trial. A total of 4,878 patients were divided into three categories: no history of angina and no chest pain at baseline (Group A; n = 1,240), past history of angina but no chest pain at baseline (Group B; n = 1,353), and both a history of angina and chest pain at baseline (Group C; n = 2,285). Outcomes were examined using Kaplan–Meier and Cox regression survival analysis.

Results:

Compared with Group A, Group C had a higher risk of nonfatal myocardial infarction or unstable angina (hazard ratio [HR], 2.36; 1.54–3.61; p < 0.001), this composite plus coronary revascularization (HR, 2.54; 1.76–3.68; p < 0.001), as well as HF hospitalization (HR, 1.35; 1.13–1.63; p = 0.001), over a median follow-up of 33 months. There was no difference in cardiovascular or all-cause mortality. Group B had a smaller increase in risk of coronary events, but not of HF hospitalization.

Conclusions:

The authors concluded that patients with HF-REF and ongoing angina are at an increased risk of acute coronary syndrome and HF hospitalization.

Perspective:

This study suggests that angina is a common symptom in patients with HF-REF, and is associated with worse functional status, increased risk of acute coronary events, and HF hospitalization. These findings highlight the potential for anti-ischemic and anti-infarction strategies to improve symptoms and outcomes in HF, but this concept needs to be tested in randomized controlled trials.

Clinical Topics: Acute Coronary Syndromes, Heart Failure and Cardiomyopathies, Statins, Acute Heart Failure

Keywords: Fluorobenzenes, Myocardial Infarction, Acute Coronary Syndrome, Angina, Unstable, Heart Failure, Pyrimidines, Stroke Volume, Survival Analysis, Hospitalization, Sulfonamides


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