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Importance of Nonobstructive Coronary Artery Disease in the Prognosis of Patients With Heart Failure
Juarez R Braga1, Peter C Austin2, Heather J Ross3
1Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
Insights
Nonobstructive coronary artery disease (CAD) in heart failure (HF) patients increases the risk of cardiovascular death and all-cause mortality. This finding highlights the prognostic significance of nonobstructive CAD beyond normal coronary arteries in HF management.
Area of Science:
- Cardiology
- Cardiovascular Research
- Heart Failure Research
Background:
- Heart failure (HF) patients are often classified as ischemic or nonischemic.
- The nonischemic category inaccurately groups patients with normal coronary arteries and those with nonobstructive coronary artery disease (CAD).
- This binary classification obscures the distinct prognostic implications of nonobstructive CAD.
Purpose of the Study:
- To investigate the prognostic significance of nonobstructive coronary artery disease (CAD) in patients with heart failure (HF).
- To differentiate the outcomes of patients with nonobstructive CAD from those with normal coronary arteries and obstructive CAD.
- To clarify the role of nonobstructive CAD as a distinct category in HF etiology.
Main Methods:
- A cohort of 12,814 patients with HF and reduced ejection fraction was analyzed.
- Patients were categorized into three groups: normal coronary arteries, nonobstructive CAD, and obstructive CAD.
- Outcomes, including a composite of cardiovascular death, myocardial infarction, stroke, or HF hospitalization, were evaluated using administrative databases.
Main Results:
- Nonobstructive CAD was identified in 17.6% of the study population.
- Patients with nonobstructive CAD had a significantly increased risk of the primary composite outcome (HR: 1.17) compared to those with normal coronary arteries.
- Nonobstructive CAD was independently associated with higher risks of cardiovascular death (HR: 1.82) and all-cause mortality (HR: 1.18).
Conclusions:
- Nonobstructive coronary artery disease (CAD) is an independent predictor of adverse outcomes in patients with heart failure (HF) and reduced ejection fraction.
- The presence of nonobstructive CAD confers an increased hazard for the composite cardiovascular outcome and all-cause mortality.
- These findings underscore the importance of recognizing nonobstructive CAD as a distinct prognostic factor in HF management.
Objectives:
This study sought to examine the prognostic significance of nonobstructive coronary artery disease (CAD) in patients with heart failure (HF), as a distinct category apart from those with normal coronary arteries.
Background:
Individuals with HF are often dichotomized into ischemic versus nonischemic categories according to the underlying etiology. This binary classification creates a heterogeneous group, combining individuals with nonobstructive CAD with those with normal coronary arteries under the nonischemic label.
Methods:
A cohort of individuals with HF and reduced ejection fraction undergoing invasive coronary angiography was examined and linked to administrative databases for outcomes evaluation. Patients were divided into those with normal coronary arteries, nonobstructive disease, and obstructive disease. The primary outcome was the composite of cardiovascular death, nonfatal acute myocardial infarction, nonfatal stroke, or HF hospitalization.
Results:
Of 12,814 individuals, 2,656 (20.7%) had normal coronary arteries, 2,254 (17.6%) had nonobstructive CAD, and 7,904 (61.7%) had obstructive CAD. The risk of the primary outcome was increased in the nonobstructive group (hazard ratio [HR]: 1.17; 95% confidence interval [CI]: 1.04 to 1.32; p = 0.01) relative to those with normal coronary arteries. Nonobstructive CAD was associated with an increased hazard of cardiovascular death (HR: 1.82; 95% CI: 1.27 to 2.62; p = 0.001) and death of any cause (HR: 1.18; 95% CI: 1.05 to 1.33; p = 0.005). There were no significant differences in the rate of acute myocardial infarction, stroke, or HF hospitalization.
Conclusions:
Among HF patients with reduced ejection fraction, the presence of nonobstructive CAD was independently associated with an increased hazard of the primary composite outcome and death of any cause.
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