Key result
In patients with acute heart failure, undergoing coronary angiography was associated with a lower risk of all-cause death or HF hospitalization (adjusted HR 0.70; 95% CI 0.58–0.85; P<0.001).
Why the study?
Little is known about the characteristics and outcomes of patients undergoing coronary angiography during HF hospitalization, as well as those with coronary stenosis or undergoing coronary revascularization.
Does coronary angiography reduce the composite of all-cause death or HF hospitalization in patients hospitalized for acute heart failure without acute coronary syndrome or prior HF hospitalization?
Cohort (n=2,163)
Does coronary angiography reduce the composite of all-cause death or HF hospitalization in patients hospitalized for acute heart failure without acute coronary syndrome or prior HF hospitalization?
Hazard Ratio: 0.7 (95% CI 0.58–0.85)
p-value: p=<0.001
In patients hospitalized for acute heart failure without ACS, undergoing coronary angiography was associated with a lower risk of all-cause death or HF hospitalization at 1 year, though this group had significantly different baseline characteristics.
Supports further investigation of coronary angiography in acute HF without ACS; should not yet alter clinical practice.
Aims Little is known about the characteristics and outcomes of patients who undergo coronary angiography during heart failure (HF) hospitalization, as well as those with coronary stenosis, and those who underwent coronary revascularization. Methods and results We analysed 2163 patients who were hospitalized for HF without acute coronary syndrome or prior HF hospitalization. We compared patient characteristics and 1 year clinical outcomes according to (i) patients with versus without coronary angiography, (ii) patients with versus without coronary stenosis, and (iii) patients with versus without coronary revascularization. The primary outcome measure was the composite of all-cause death or HF hospitalization. Coronary angiography was performed in 37.0% of patients. In the multivariable logistic regression analysis, factors independently associated with coronary angiography were age < 80 years [adjusted odds ratio (OR) = 1.76, 95% confidence interval (CI) = 1.41–2.20, P < 0.001], men (adjusted OR = 1.28, 95% CI = 1.03–1.59, P = 0.02), diabetes (adjusted OR = 1.27, 95% CI = 1.02–1.60, P = 0.04), no atrial fibrillation or flutter (adjusted OR = 1.45, 95% CI = 1.17–1.82, P < 0.001), no prior device implantation (adjusted OR = 1.81, 95% CI = 1.13–2.91, P = 0.01), current smoking (adjusted OR = 1.40, 95% CI = 1.05–1.87, P = 0.02), no cognitive dysfunction (adjusted OR = 1.90, 95% CI = 1.34–2.69, P < 0.001), ambulatory status (adjusted OR = 2.89, 95% CI = 2.03–4.10, P < 0.001), HF with reduced ejection fraction (adjusted OR = 1.55, 95% CI = 1.24–1.93, P < 0.001), estimated glomerular filtration rate ≥ 30 mL/min/1.73 m2 (adjusted OR = 1.93, 95% CI = 1.45–2.58, P < 0.001), no anaemia (adjusted OR = 1.27, 95% CI = 1.02–1.59, P = 0.04), and no prescription of β-blockers prior to admission (adjusted OR = 1.32, 95% CI = 1.03–1.68, P = 0.03). Patients who underwent coronary angiography had a lower risk of the primary outcome [adjusted hazard ratio (HR) = 0.70, 95% CI = 0.58–0.85, P < 0.001]. Among the patients who underwent coronary angiography, those with coronary stenosis (38.9%) did not have lower risk of the primary outcome measure than those without coronary stenosis (adjusted HR = 0.93, 95% CI = 0.65–1.32, P = 0.68). Among the patients with coronary stenosis, those with coronary revascularization (54.3%) did not have higher risk of the primary outcome measure than those without coronary revascularization (adjusted HR = 1.36, 95% CI = 0.84–2.21, P = 0.22). Conclusions In patients with acute HF, patients who underwent coronary angiography had a lower risk of clinical outcomes and were significantly different from those who did not undergo coronary angiography.
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Seko et al. (2021) conducted a cohort in Acute Heart Failure (n=2,163). Coronary angiography vs. No coronary angiography was evaluated on Composite of all-cause death or heart failure hospitalization (HR 0.70, 95% CI 0.58-0.85, p=<0.001). In patients with acute heart failure, undergoing coronary angiography was associated with a lower risk of all-cause death or HF hospitalization (adjusted HR 0.70; 95% CI 0.58–0.85; P<0.001).
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