| Related Articles |
Heart Failure with Preserved Ejection Fraction: Comparison of Patients With and Without Angina Pectoris (From the Duke Databank for Cardiovascular Disease).
J Am Coll Cardiol. 2013 Oct 10;
Authors: Mentz RJ, Broderick S, Shaw LK, Fiuzat M, O'Connor CM
Abstract
OBJECTIVES: We aimed to investigate the characteristics and outcomes of patients with heart failure with preserved ejection fraction (HFpEF) and angina pectoris (AP).
BACKGROUND: AP is a predictor of adverse events in patients with heart failure with reduced EF. The implications of AP in HFpEF are unknown.
METHODS: We analyzed HFpEF patients (EF≥50%) who underwent coronary angiography at Duke University Medical Center from 2000-2010 with and without AP in the previous 6 weeks. Time to first event was examined using Kaplan-Meier methods for the primary endpoint of death/myocardial infarction (MI)/revascularization/stroke (i.e., MACE) and secondary endpoints of death/MI/revascularization, death/MI/stroke, death/MI, death and cardiovascular death/cardiovascular hospitalization.
RESULTS: In the Duke Databank, 3517 patients met criteria for inclusion and 1402 (40%) had AP. Those with AP were older with more comorbidities, and prior revascularization vs. non-AP patients. AP patients more often received beta-blockers, ACE-inhibitors, nitrates, and statins (all P<0.05). In unadjusted analysis, AP patients had increased MACE and death/MI/revascularization (both P <0.001), lower rates of death and death/MI (both P<0.05), and similar rates of death/MI/stroke and cardiovascular death/cardiovascular hospitalization (both P>0.1). After multivariable adjustment, those with AP remained at increased risk for MACE (Hazard Ratio [HR] 1.30; 95% Confidence Interval [CI], 1.17-1.45) and death/MI/revascularization (HR 1.29; 95% CI, 1.15-1.43), but were at similar risk for other endpoints (P>0.06).
CONCLUSIONS: AP in HFpEF patients with a history of coronary artery disease is common despite medical therapy and is independently associated with increased MACE due to revascularization with similar risk of death, MI, and hospitalization.
PMID: 24161322 [PubMed - as supplied by publisher]