Key result
HFrEF in cardiorenal-metabolic syndrome is associated with a ~58% 5-year MACE rate versus no HF.
Why the study?
Heart failure in patients with cardiorenal-metabolic syndrome worsens prognosis and increases recurrent events, but risks after primary PCI across HF phenotypes were unclear.
Does the phenotype of heart failure affect the risk of major cardiovascular events or repeated coronary interventions after percutaneous coronary intervention in patients with cardio-renal-metabolic syndrome?
Cohort (n=131)
No
Does the phenotype of heart failure affect the risk of major cardiovascular events or repeated coronary interventions after percutaneous coronary intervention in patients with cardio-renal-metabolic syndrome?
In patients with cardio-renal-metabolic syndrome undergoing percutaneous coronary intervention, the presence of HFrEF is associated with the worst long-term prognosis and highest risk of recurrent coronary events compared to other heart failure phenotypes or no heart failure.
HFrEF phenotype flags higher MACE risk in cardiorenal-metabolic syndrome; leaves open whether targeted interventions improve outcomes.
Background. Patients with cardio-renal-metabolic syndrome (CRMS) have a high risk of cardiovascular mortality due to the combination of heart failure, chronic kidney disease, and endocrine diseases, as well as a high risk of coronary heart disease and complications from systemic atherosclerosis. The presence of heart failure in such patients worsens the prognosis and increases the likelihood of repeated cardiovascular events. Aim: To study the risk of major cardiovascular events or the need for repeated coronary interventions after primary percutaneous coronary intervention in patients with cardio-renal-metabolic syndrome, depending on the phenotype of heart failure. Materials and Methods. The study included 131 patients undergoing examination and percutaneous coronary intervention for CAD. The average age of the patients was 58.3±0.5 years, 81 (61.8%) of them were male. CRMS was defined as a combination of heart failure, chronic kidney disease stage ≥3A, and type 2 diabetes. Patients were divided into 4 groups depending on the presence of heart failure: clinical group 1 - patients with CRMS and heart failure with preserved ejection fraction (n=36); clinical group 2 – patients with CRMS and heart failure with mildly reduced LVEF (n=33); clinical group 3 - patients with CRMS and heart failure with reduced ejection fraction (n=32); a comparison group with type 2 diabetes, chronic kidney disease, and no signs of heart failure (stage A) (n=30). Results. Heart failure patients with reduced ejection fraction had the highest percentage of those who reached the end point during the five-year follow-up. The group of patients without heart failure showed the best results in interventional treatment. The main reason for the recurrence of coronary heart disease was restenosis in a previously implanted coronary stent or the appearance of significant stenosis in new locations. Conclusion. The phenotype of heart failure with reduced left ventricular ejection fraction in patients with cardiorenal-metabolic syndrome is associated with a worse prognosis after percutaneous coronary intervention, since the patients have a higher risk of new coronary artery stenosis.
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G. B. Mankovsky (2024) conducted a cohort in Cardiorenal-metabolic syndrome and coronary artery disease (n=131). Heart failure with reduced ejection fraction (HFrEF) vs. No heart failure, or heart failure with preserved or mildly reduced ejection fraction was evaluated on Major cardiovascular events or need for repeated coronary interventions (cardiovascular death, acute myocardial infarction, restenosis, or new significant stenosis) (p=<0.05). The phenotype of heart failure with reduced ejection fraction in patients with cardiorenal-metabolic syndrome was associated with a significantly higher 5-year rate of major cardiovascular events (58.1%) compared to patients without heart failure (16.7%).
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