Document Detail


Coronary artery disease, coronary revascularization, and outcomes in chronic advanced systolic heart failure.
MedLine Citation:
PMID:  20554334     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Associations between coronary artery disease (CAD) and outcomes in systolic heart failure (HF) and that between coronary artery bypass graft (CABG) surgery and outcomes in patients with HF and CAD have not been examined using propensity-matched designs.
METHODS: Of the 2707 patients with advanced chronic systolic HF in the Beta-Blocker Evaluation of Survival Trial (BEST), 1593 had a history of CAD, of whom 782 had prior CABG. Using propensity scores for CAD we assembled a cohort of 458 pairs of CAD and no-CAD patients. Propensity scores for prior CABG in those with CAD were used to assemble 500 pairs of patients with and without CABG. Matched patients were balanced on 68 baseline characteristics.
RESULTS: All-cause mortality occurred in 33% and 24% of matched patients with and without CAD respectively, during 26 months of median follow-up (hazard ratio {HR} when CAD was compared with no-CAD, 1.41; 95% confidence interval {CI}, 1.11-1.81; P=0.006). HR's (95% CIs) for CAD-associated cardiovascular mortality, HF mortality, and sudden cardiac death (SCD) were 1.53 (1.17-2.00; P=0.002), 1.44 (0.92-2.25; P=0.114) and 1.76 (1.21-2.57; P=0.003) respectively. CAD had no association with hospitalization. Among matched patients with HF and CAD, all-cause mortality occurred in 32% and 39% of those with and without prior CABG respectively (HR for CABG, 0.77; 95% CI, 0.62-0.95; P=0.015).
CONCLUSIONS: In patients with advanced chronic systolic HF, CAD is associated with increased mortality, and in those with CAD, prior CABG seems to be associated with reduced all-cause mortality but not SCD.
Authors:
Mihai Gheorghiade; James D Flaherty; Gregg C Fonarow; Ravi V Desai; Richard Lee; David McGiffin; Thomas E Love; Inmaculada Aban; Eric J Eichhorn; Robert O Bonow; Ali Ahmed
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2010-06-16
Journal Detail:
Title:  International journal of cardiology     Volume:  151     ISSN:  1874-1754     ISO Abbreviation:  Int. J. Cardiol.     Publication Date:  2011 Aug 
Date Detail:
Created Date:  2011-08-05     Completed Date:  2012-08-10     Revised Date:  2014-09-18    
Medline Journal Info:
Nlm Unique ID:  8200291     Medline TA:  Int J Cardiol     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  69-75     Citation Subset:  IM    
Copyright Information:
Published by Elsevier Ireland Ltd.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Chronic Disease
Coronary Artery Bypass / mortality*
Coronary Artery Disease / mortality*,  surgery*
Death, Sudden, Cardiac / epidemiology
Female
Heart Failure, Systolic / mortality*,  surgery*
Hospitalization / statistics & numerical data
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Myocardial Revascularization / mortality*
Severity of Illness Index
Treatment Outcome
Grant Support
ID/Acronym/Agency:
R01 HL085561/HL/NHLBI NIH HHS; R01 HL085561-04/HL/NHLBI NIH HHS; R01-HL085561/HL/NHLBI NIH HHS; R01-HL097047/HL/NHLBI NIH HHS
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