BACKGROUND: Coronary artery disease (CAD) is frequent among patients hospitalized with acute heart failure syndromes (AHFS). AIMS: To describe the influence of coronary revascularization status on survival in patients with AHFS. METHODS AND RESULTS: OPTIMIZE-HF enrolled 48,612 patients with AHFS from 259 U.S. hospitals. In-hospital data were obtained for all patients and post-discharge 60-90 day follow-up in a pre-specified 10% sample. CAD was associated with higher in-hospital (3.7% vs. 2.9%, OR 1.14, 95% CI 1.00-1.31) and post-discharge mortality (9.2% vs. 6.9%, HR 1.37, 95% CI 1.03-1.81) compared to no CAD. Post-discharge, patients with CAD who were not revascularized had higher mortality compared to patients without CAD (10.6% vs. 6.9%, HR 1.56, 95% CI 1.15-2.11). This association was similar in patients with left ventricular systolic dysfunction (EF <40%, adjusted HR 1.52, 95% CI 0.98-2.35) and preserved systolic function (EF > or =40%, adjusted HR1.58, 95% CI 1.05-2.39). Patients with CAD who were revascularized had similar mortality to patients without CAD (HR 1.06, 95% CI 0.62-1.80 for PSF, HR 1.13, 95% CI 0.71-1.80 for LVSD). CONCLUSIONS: In AHFS, patients with CAD have a higher 60-90 day post-discharge mortality compared to no-CAD patients. However, patients with CAD who are revascularized appear to have similar post-discharge mortality when compared to the no-CAD group. This suggests that revascularization status may confer a survival advantage in this high risk population.
BACKGROUND:Coronary artery disease (CAD) is frequent among patients hospitalized with acute heart failure syndromes (AHFS). AIMS: To describe the influence of coronary revascularization status on survival in patients with AHFS. METHODS AND RESULTS: OPTIMIZE-HF enrolled 48,612 patients with AHFS from 259 U.S. hospitals. In-hospital data were obtained for all patients and post-discharge 60-90 day follow-up in a pre-specified 10% sample. CAD was associated with higher in-hospital (3.7% vs. 2.9%, OR 1.14, 95% CI 1.00-1.31) and post-discharge mortality (9.2% vs. 6.9%, HR 1.37, 95% CI 1.03-1.81) compared to no CAD. Post-discharge, patients with CAD who were not revascularized had higher mortality compared to patients without CAD (10.6% vs. 6.9%, HR 1.56, 95% CI 1.15-2.11). This association was similar in patients with left ventricular systolic dysfunction (EF <40%, adjusted HR 1.52, 95% CI 0.98-2.35) and preserved systolic function (EF > or =40%, adjusted HR1.58, 95% CI 1.05-2.39). Patients with CAD who were revascularized had similar mortality to patients without CAD (HR 1.06, 95% CI 0.62-1.80 for PSF, HR 1.13, 95% CI 0.71-1.80 for LVSD). CONCLUSIONS: In AHFS, patients with CAD have a higher 60-90 day post-discharge mortality compared to no-CAD patients. However, patients with CAD who are revascularized appear to have similar post-discharge mortality when compared to the no-CAD group. This suggests that revascularization status may confer a survival advantage in this high risk population.
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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 Journal: Int J Cardiol Date: 2010-06-16 Impact factor: 4.164
Authors: Robert J Mentz; Bradley D Allen; Mary J Kwasny; Marvin A Konstam; James E Udelson; Andrew P Ambrosy; Angela J Fought; Muthiah Vaduganathan; Christopher M O'Connor; Faiez Zannad; Aldo P Maggioni; Karl Swedberg; Robert O Bonow; Mihai Gheorghiade Journal: Eur J Heart Fail Date: 2012-09-11 Impact factor: 15.534
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