Coronary Artery Disease and Angina in HFpEF | Journal Scan

Study Questions:

What is the relationship between coronary artery disease (CAD), angina, and clinical outcomes in patients with heart failure and preserved ejection fraction (HFpEF)?

Methods:

For the purposes of this retrospective analysis from the I-Preserve (Heart Failure and Preserved Systolic Function) trial, patients with a history of CAD were defined as those with a history of previous myocardial infarction, percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), or a primary ischemic etiology, as defined by investigators. The mean follow-up period for the 4,128 patients enrolled in I-Preserve was 49.5 months. Patients were divided into four mutually exclusive groups according to history of CAD and angina: patients with no history of CAD or angina (n = 2,008), patients with no history of CAD but a history of angina (n = 649), patients with a history of CAD but no angina (n = 468), and patients with a history of CAD and angina (n = 1,003); patients with no known CAD or angina were the reference group.

Results:

After adjustment for other prognostic variables using Cox proportional-hazard models, patients with CAD but no angina were found to be at higher risk of all-cause mortality (hazard ratio [HR], 1.58 [1.22-2.04]; p < 0.01) and sudden death (HR, 2.12 [1.33-3.39]; p < 0.01), compared with patients with no CAD or angina. Patients with CAD and angina were also at higher risk of all-cause mortality (HR, 1.29 [1.05-1.59]; p = 0.02) and sudden death (HR, 1.83 [1.24-2.69]; p < 0.01) compared with the same reference group, and had the highest risk of unstable angina or myocardial infarction (HR, 5.84 [3.43-9.95]; p < 0.01).

Conclusions:

The authors concluded that patients with HFpEF and CAD are at higher risk of all-cause mortality and sudden death when compared with those without CAD.

Perspective:

This retrospective study reports that among patients with HFpEF randomized in the I-Preserve trial, patients with a history of CAD were at higher risk of death from any cause, which was driven by a higher rate of sudden death in particular. Furthermore, patients with CAD and HFpEF have evidence of more advanced HF, whereas patients with angina and HFpEF experience poorer quality of life, irrespective of the underlying etiology. These findings appear to suggest that specific interventions such as coronary revascularization or ICD therapy may improve outcomes in some groups of patients with HFpEF, but needs to be tested in prospective randomized trials.

Clinical Topics: Cardiac Surgery, Heart Failure and Cardiomyopathies, Invasive Cardiovascular Angiography and Intervention, Atherosclerotic Disease (CAD/PAD), Aortic Surgery, Cardiac Surgery and Heart Failure, Cardiac Surgery and SIHD, Acute Heart Failure, Interventions and Coronary Artery Disease

Keywords: Angina Pectoris, Angina, Unstable, Biphenyl Compounds, Coronary Artery Bypass, Coronary Artery Disease, Coronary Disease, Death, Sudden, Follow-Up Studies, Heart Failure, Myocardial Infarction, Percutaneous Coronary Intervention, Proportional Hazards Models, Prospective Studies, Retrospective Studies, Tetrazoles


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