ESC Heart Failure (Feb 2022)

Coronary angiography in patients with acute heart failure: from the KCHF registry

  • Yuta Seko,
  • Takefumi Kishimori,
  • Takao Kato,
  • Takeshi Morimoto,
  • Hidenori Yaku,
  • Yasutaka Inuzuka,
  • Yodo Tamaki,
  • Neiko Ozasa,
  • Masayuki Shiba,
  • Erika Yamamoto,
  • Yusuke Yoshikawa,
  • Yugo Yamashita,
  • Takeshi Kitai,
  • Ryoji Taniguchi,
  • Moritake Iguchi,
  • Kazuya Nagao,
  • Takafumi Kawai,
  • Akihiro Komasa,
  • Ryusuke Nishikawa,
  • Yuichi Kawase,
  • Takashi Morinaga,
  • Mamoru Toyofuku,
  • Yutaka Furukawa,
  • Kenji Ando,
  • Kazushige Kadota,
  • Yukihito Sato,
  • Koichiro Kuwahara,
  • Takeshi Kimura,
  • for the KCHF Study Investigators

DOI
https://doi.org/10.1002/ehf2.13716
Journal volume & issue
Vol. 9, no. 1
pp. 531 – 544

Abstract

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Abstract 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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