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Influence of coronary artery disease and coronary revascularization status on outcomes in patients with acute heart failure syndromes: A report from OPTIMIZE‐HF (Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) *
Author(s) -
Rossi Joseph S.,
Flaherty James D.,
Fonarow Gregg C.,
Nunez Eduardo,
Gattis Stough Wendy,
Abraham William T.,
Albert Nancy M.,
Greenberg Barry H.,
O'Connor Christopher M.,
Yancy Clyde W.,
Young James B.,
Davidson Charles J.,
Gheorghiade Mihai
Publication year - 2008
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1016/j.ejheart.2008.09.009
Subject(s) - medicine , coronary artery disease , cardiology , revascularization , heart failure , myocardial infarction
Background: Coronary artery disease (CAD) is frequent among patients hospitalized with acute heart failure syndromes (AHFS). Aims: To describe the influence of coronary revascularization status on survival in patients with AHFS. Methods and results: OPTIMIZE‐HF enrolled 48,612 patients with AHFS from 259 U.S. hospitals. In‐hospital data were obtained for all patients and post‐discharge 60–90 day follow‐up in a pre‐specified 10% sample. CAD was associated with higher in‐hospital (3.7% vs. 2.9%, OR 1.14, 95% CI 1.00–1.31) and post‐discharge mortality (9.2% vs. 6.9%, HR 1.37, 95% CI 1.03–1.81) compared to no CAD. Post‐discharge, patients with CAD who were not revascularized had higher mortality compared to patients without CAD (10.6% vs. 6.9%, HR 1.56, 95% CI 1.15–2.11). This association was similar in patients with left ventricular systolic dysfunction (EF <40%, adjusted HR 1.52, 95% CI 0.98–2.35) and preserved systolic function (EF ≥40%, adjusted HR1.58, 95% CI 1.05–2.39). Patients with CAD who were revascularized had similar mortality to patients without CAD (HR 1.06, 95% CI 0.62–1.80 for PSF, HR 1.13, 95% CI 0.71–1.80 for LVSD). Conclusions: In AHFS, patients with CAD have a higher 60–90 day post‐discharge mortality compared to no‐CAD patients. However, patients with CAD who are revascularized appear to have similar post‐discharge mortality when compared to the no‐CAD group. This suggests that revascularization status may confer a survival advantage in this high risk population.