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Prognostic value of congestive heart failure history in patients undergoing percutaneous coronary interventions
R D Anderson1, E M Ohman, D R Holmes
1Duke Clinical Research Institute, Durham, North Carolina, USA. Ander040@onyx.mc.duke.edu
Insights
A history of congestive heart failure independently predicts higher mortality after percutaneous coronary interventions. This finding highlights the need for close monitoring of these high-risk patients, especially those with reduced ejection fraction.
Area of Science:
- Cardiology
- Interventional Cardiology
- Prognostics
Background:
- Left ventricular function and congestive heart failure history are known survival predictors in coronary artery disease.
- The independent prognostic value of congestive heart failure history beyond left ventricular function is not well-established.
Purpose of the Study:
- To determine if a history of congestive heart failure provides prognostic information beyond baseline ejection fraction in patients undergoing percutaneous coronary interventions.
Main Methods:
- Data were pooled from four interventional trials and the Duke University database, including 5,260 patients undergoing percutaneous interventions.
- Patients were categorized based on a clinical history of congestive heart failure (334 patients) versus no history (4,926 patients).
Main Results:
- Patients with a congestive heart failure history had significantly higher 30-day and 6-month mortality rates.
- Congestive heart failure history independently predicted intermediate-term mortality, adding prognostic value to ejection fraction.
- Heart failure history did not impact myocardial infarction or revascularization procedures.
Conclusions:
- A clinical history of congestive heart failure is linked to increased early and intermediate-term mortality in patients undergoing percutaneous revascularization.
- Congestive heart failure history offers prognostic insights independent of left ventricular function.
- Close monitoring is recommended for patients with congestive heart failure history undergoing percutaneous intervention, particularly those with low ejection fractions.
Objectives:
We sought to determine the prognostic significance of a history of congestive heart failure above that provided by baseline ejection fraction in patients undergoing percutaneous coronary interventions.
Background:
Left ventricular function is a known predictor of survival in patients with coronary artery disease, as is a history of congestive heart failure. The contribution of heart failure history independent of left ventricular function is unknown.
Methods:
Data were pooled from four interventional trials and the Duke University database. The combined dataset included 5,260 patients undergoing percutaneous interventions, 334 with and 4,926 without a history of heart failure. Patients were defined by the treating physician as having a clinical history of heart failure at the time of enrollment.
Results:
The 30-day and 6-month mortality were higher in patients with a clinical history of congestive heart failure than in those without such a history (2% vs. <1%, p=0.002 at 30 days, 5% vs. 1%, p=0.001 at 6 months). Heart failure history did not influence the incidence of myocardial infarction, use of angioplasty or the use of bypass surgery during follow-up. Multivariable analysis revealed that heart failure history added significantly to ejection fraction in predicting intermediate-term (6-month) mortality (p=0.01). Stepwise logistic regression also revealed heart failure history to be an independent predictor of 6-month mortality (odds risk 1.9, 95% confidence interval 1.1 to 3.5).
Conclusions:
A clinical history of congestive heart failure is associated with increased early and intermediate-term mortality in patients undergoing percutaneous revascularization. Congestive heart failure history appears to provide prognostic information independent of that available from a patient's left ventricular function. These findings suggest that patients with a clinical history of congestive heart failure who undergo a percutaneous intervention should be closely monitored, especially those with the lowest ejection fractions.