Related Experiment Video
Updated: Oct 1, 2025
Reduction in Left Ventricular Wall Stress and Improvement in Function in Failing Hearts using Algisyl-LVR
Published on: April 8, 2013
Vericiguat in patients with coronary artery disease and heart failure with reduced ejection fraction
Clara Saldarriaga1, Dan Atar2, Amanda Stebbins3
1Department of Cardiology, University of Antioquia, CardioVID Clinic, Medellín, Colombia.
Insights
Coronary artery disease (CAD) worsens outcomes in heart failure with reduced ejection fraction (HFrEF). Vericiguat demonstrated benefits for cardiovascular death or HF hospitalization, irrespective of CAD presence in HFrEF patients.
Area of Science:
- Cardiology
- Heart Failure Research
- Ischemic Heart Disease
Background:
- Coronary artery disease (CAD) is a significant comorbidity associated with poorer prognoses in patients with heart failure (HF).
- Patients with heart failure with reduced ejection fraction (HFrEF) and CAD often present with more complex clinical profiles and higher event rates.
- Understanding the impact of CAD on HF outcomes and treatment efficacy is crucial for optimizing patient management.
Purpose of the Study:
- To characterize patients with HFrEF and worsening HF who also have CAD.
- To evaluate the treatment effect of vericiguat on cardiovascular death or HF hospitalization (CVD/HFH) in patients with HFrEF, specifically examining if this effect differs based on the presence of CAD.
Main Methods:
- A post hoc analysis of the VICTORIA trial was conducted.
- Patients with HFrEF and worsening HF were categorized based on the presence or absence of CAD (defined by prior myocardial infarction, PCI, or CABG).
- Cox proportional hazards models were used to assess the primary endpoint of CVD/HFH, with subgroup analyses performed for CAD status.
Main Results:
- Patients with CAD (n=2704) were older, more frequently male and diabetic, and had lower GFR compared to those without CAD (n=2344).
- The incidence of CVD/HFH was significantly higher in patients with CAD (40.6/100 patient-years) compared to those without (30.1/100 patient-years).
- Vericiguat reduced CVD/HFH in both groups, with no significant interaction effect observed between vericiguat treatment and CAD status (interaction p=0.78).
Conclusions:
- Concomitant CAD is associated with increased risks of cardiovascular death and HF hospitalization in patients with HFrEF and worsening HF.
- Vericiguat provides a consistent clinical benefit in reducing CVD/HFH for patients with HFrEF, regardless of whether they have underlying coronary artery disease.
Aims:
Coronary artery disease (CAD) portends worse outcomes in heart failure (HF). We aimed to characterize patients with CAD and worsening HF with reduced ejection fraction (HFrEF) and evaluate post hoc whether vericiguat treatment effect varied according to CAD.
Methods And Results:
Cox proportional hazards were generated for the primary endpoint of cardiovascular death or HF hospitalization (CVD/HFH). CAD was defined as previous myocardial infarction, percutaneous coronary intervention, or coronary artery bypass grafting. Of 5048 patients in VICTORIA with available data on CAD status, 2704 had CAD and were older, were more frequently male, diabetic, and had a lower glomerular filtration rate than those without CAD (all p <0.0001). Use of implantable cardioverter defibrillators and cardiac resynchronization therapy (CRT) was higher in patients with versus without CAD (33.5% vs. 21.1%; p <0.0001 and 16.3% vs. 12.8%; p = 0.0006). The primary endpoint of CVD/HFH was higher in those with versus without CAD (40.6 vs. 30.1/100 patient-years; adjusted hazard ratio [HR] 1.23; p <0.001) as was all-cause mortality (17.9% vs. 12.7%; adjusted HR 1.32; p <0.001). The primary outcome of CVD/HFH associated with vericiguat in patients with or without CAD was 38.8 versus 27.6 per 100 patient-years and for placebo was 42.6 versus 32.7 per 100 patient-years (interaction p = 0.78).
Conclusion:
In this post hoc study, CAD was associated with more CVD and HFH in patients with HFrEF and worsening HF. Vericiguat was beneficial and safe regardless of concomitant CAD.
Related Concept Videos
01:30Heart Failure V: Medical Management
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:22Heart Failure Drugs: β-Blockers
01:26Heart Failure Drugs: Inotropic Agents
01:22Heart Failure Drugs: Diuretics
01:18Treatment for Pulmonary Arterial Hypertension: Endothelin Receptor Antagonists
ETs are synthesized through a complex sequence of enzymatic steps, primarily involving an enzyme referred to as endothelin-converting enzyme...