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)
What is the relationship between current angina symptoms and outcomes in patients with heart failure and reduced ejection fraction (HF-REF)?
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.
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.
The authors concluded that patients with HF-REF and ongoing angina are at an increased risk of acute coronary syndrome and HF hospitalization.
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.
Keywords: Fluorobenzenes, Myocardial Infarction, Acute Coronary Syndrome, Angina, Unstable, Heart Failure, Pyrimidines, Stroke Volume, Survival Analysis, Hospitalization, Sulfonamides
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