Coronary artery disease, coronary revascularization, and outcomes in chronic advanced systolic heart failure

Area of Science:

• Cardiology
• Heart Failure Research
• Clinical Outcomes

Background:

• Coronary artery disease (CAD) and coronary artery bypass graft (CABG) surgery outcomes in systolic heart failure (HF) patients lack propensity-matched study designs.
• Previous research has not adequately explored the combined impact of CAD and CABG on HF patient prognosis.

Purpose of the Study:

• To investigate the association between CAD and outcomes in patients with advanced chronic systolic HF.
• To examine the impact of prior CABG surgery on mortality in HF patients with CAD.

Main Methods:

• Utilized data from the Beta-Blocker Evaluation of Survival Trial (BEST) on 2707 advanced chronic systolic HF patients.
• Employed propensity score matching to create balanced cohorts for CAD vs. no-CAD and for prior CABG vs. no-CABG in HF patients.
• Matched 458 pairs of CAD and no-CAD patients, and 500 pairs of patients with and without prior CABG, balancing 68 baseline characteristics.

Main Results:

• Coronary artery disease (CAD) was associated with a 41% increase in all-cause mortality (HR 1.41, P=0.006) in systolic heart failure (HF) patients.
• CAD significantly increased cardiovascular mortality (HR 1.53, P=0.002) and sudden cardiac death (HR 1.76, P=0.003), but not HF mortality (P=0.114) or hospitalizations.
• In HF patients with CAD, prior coronary artery bypass graft (CABG) surgery was associated with a 23% reduction in all-cause mortality (HR 0.77, P=0.015).

Conclusions:

• Coronary artery disease (CAD) is linked to elevated mortality in patients with advanced chronic systolic heart failure (HF).
• Prior coronary artery bypass graft (CABG) surgery in these patients may offer a survival benefit, reducing all-cause mortality but not sudden cardiac death.