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Association between the diagnostic classification of newly diagnosed coronary artery disease and future heart failure
Brent A Williams1, Stephen Voyce2, James C Blankenship3
1Cardiovascular Institute, Allegheny Health Network, Pittsburgh.
Insights
Initial myocardial infarction (MI) and acute coronary artery disease (CAD) presentations significantly increase early heart failure risk. However, among stable patients, MI remains the highest long-term risk factor, not acute presentation.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- Coronary artery disease (CAD) initial clinical manifestations vary widely, impacting future health outcomes.
- Understanding the link between initial CAD diagnosis and subsequent heart failure is crucial for patient management.
Purpose of the Study:
- To quantify the association between different initial diagnostic classifications of CAD and the risk of developing heart failure.
- To differentiate short-term and long-term heart failure risks based on initial CAD presentation.
Main Methods:
- Retrospective analysis of electronic health records from a single healthcare system.
- Classification of newly diagnosed CAD into mutually exclusive categories: MI, CAD with CABG, CAD with PCI, CAD only, unstable angina, and stable angina.
- Definition of acute CAD presentation based on hospital admission; identification of new heart failure post-CAD diagnosis.
Main Results:
- Among 28,693 patients, 47% had acute presentations and 26% had MI. MI and unstable angina classifications, along with acute presentation, were linked to the highest 30-day heart failure risk.
- In stable, heart failure-free patients followed for 7.4 years, initial MI and CAD with CABG were associated with increased long-term heart failure risk.
- Initial acute CAD presentation was not associated with increased long-term heart failure risk.
Conclusions:
- Nearly 50% of initial CAD diagnoses involve hospitalization, posing a high risk for early heart failure.
- Myocardial infarction remains the primary diagnostic classification associated with the highest long-term heart failure risk in stable CAD patients.
- Initial acute presentation of CAD does not correlate with increased long-term heart failure risk.
Objective:
The first clinical manifestation of coronary artery disease (CAD) varies widely from unheralded myocardial infarction (MI) to mild, incidentally detected disease. The primary objective of this study was to quantify the association between different initial CAD diagnostic classifications and future heart failure.
Methods:
This retrospective study incorporated the electronic health record of a single integrated health care system. Newly diagnosed CAD was classified into a mutually exclusive hierarchy as MI, CAD with coronary artery bypass graft (CABG), CAD with percutaneous coronary intervention, CAD only, unstable angina, and stable angina. An acute CAD presentation was defined when the diagnosis was associated with a hospital admission. New heart failure was identified after the CAD diagnosis.
Results:
Among 28 693 newly diagnosed CAD patients, initial presentation was acute in 47% and manifested as MI in 26%. Within 30 days of CAD diagnosis, MI [hazard ratio (HR) = 5.1; 95% confidence interval: 4.1-6.5] and unstable angina (3.2; 2.4-4.4) classifications were associated with the highest heart failure risk (compared to stable angina), as was acute presentation (2.9; 2.7-3.2). Among stable, heart failure-free CAD patients followed on average 7.4 years, initial MI (adjusted HR = 1.6; 1.4-1.7) and CAD with CABG (1.5; 1.2-1.8) were associated with higher long-term heart failure risk, but an initial acute presentation was not (1.0; 0.9-1.0).
Conclusion:
Nearly 50% of initial CAD diagnoses are associated with hospitalization, and these patients are at high risk of early heart failure. Among stable CAD patients, MI remained the diagnostic classification associated with the highest long-term heart failure risk, however, having an initial acute CAD presentation was not associated with long-term heart failure.
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