April 15, 2009Open Access
Predictors of Heart Failure in Patients With Stable Coronary Artery Disease
Key Result
A novel risk score demonstrated excellent discriminatory power (c-statistic 0.80) for predicting heart failure in patients with stable coronary artery disease and preserved ejection fraction.
Study Design
Type
RCT (n=8,290)
Structured PICO
What are the predictors of heart failure in patients with stable coronary artery disease and preserved ejection fraction?
P
Population
8,290 patients with stable coronary artery disease and preserved ejection fraction, without preexisting heart failure (mean age 64+/-8, 18% female, 55% prior myocardial infarction) from the Prevention of Events with Angiotensin-Converting Enzyme Inhibition population.
I
Intervention
Development of a clinical risk score (and trandolapril treatment from the original trial)
O
Outcome
New-onset heart failure hospitalizations and fatal heart failurecomposite
A newly developed risk score accurately predicts the development of heart failure in patients with stable coronary artery disease and preserved ejection fraction.
Abstract
BACKGROUND: Heart failure (HF) is a disease commonly associated with coronary artery disease. Most risk models for HF development have focused on patients with acute myocardial infarction. The Prevention of Events with Angiotensin-Converting Enzyme Inhibition population enabled the development of a risk model to predict HF in patients with stable coronary artery disease and preserved ejection fraction. METHODS AND RESULTS: In the 8290, Prevention of Events with Angiotensin-Converting Enzyme Inhibition patients without preexisting HF, new-onset HF hospitalizations, and fatal HF were assessed over a median follow-up of 4.8 years. Covariates were evaluated and maintained in the Cox regression multivariable model using backward selection if Por=16. CONCLUSIONS: Among patients with stable coronary artery disease and preserved ejection fraction, traditional and newer factors were independently associated with increased risk of HF. Trandolopril decreased the risk of HF in these patients with preserved ejection fraction.