期刊
EUROPEAN JOURNAL OF HEART FAILURE
卷 15, 期 1, 页码 61-68出版社
WILEY
DOI: 10.1093/eurjhf/hfs139
关键词
Heart failure; Coronary artery disease; Outcomes; Hospitalization
资金
- Otsuka, Inc., Rockville, Maryland
- Center for Cardiovascular Innovation, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Otsuka
- JNJ
- Amgen
- Trevena
- AstraZeneca
- Servier
Data on the prognosis of heart failure (HF) patients with coronary artery disease (CAD) have been conflicting. We describe the clinical characteristics and mode-specific outcomes of HF patients with reduced ejection fraction (EF) and documented CAD in a large randomized trial. EVEREST was a prospective, randomized trial of vasopressin-2 receptor blockade, in addition to standard therapy, in 4133 patients hospitalized with worsening HF and reduced EF. Patients were classified as having CAD based on patient-reported myocardial infarction (MI) or coronary revascularization. We analysed the characteristics and outcomes [all-cause mortality and cardiovascular (CV) mortality/HF hospitalization] of patients with and without documented CAD. All events were centrally adjudicated. Documented CAD was present in 2353 patients (57). Patients with CAD were older and had more co-morbidities compared with those without CAD. Patients with CAD were more likely to receive a beta-blocker, but less likely to receive an angiotensin-converting enzyme (ACE) inhibitor or aldosterone antagonist (P 0.01). After risk adjustment, patients with documented CAD had similar mortality [hazard ratio (HR) 1.12, 95 confidence interval (CI) 0.971.30], but were at an increased risk for CV mortality/HF hospitalization (HR 1.25, 95 CI 1.121.41) due to an increased risk for HF hospitalization (HR 1.26, 95 CI 1.101.44). Patients with CAD had increased HF- and MI-related events, but similar rates of sudden cardiac death. Documented CAD in patients hospitalized for worsening HF with reduced EF was associated with a higher burden of co-morbidities, lower use of HF therapies (except beta-blockers), and increased HF hospitalization, while all-cause mortality was similar.
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