Early coronary angiography improves cardiovascular outcomes in patients with acute heart failure: Study
Canada: Early coronary angiography during acute heart failure (HF) hospitalization is associated with lower HF readmissions, cardiovascular death, all-cause mortality, show results from a recent study. Further, it is associated with higher rates of coronary revascularization in acute HF patients with possible ischemia.
Heart failure is a major global health burden, impacts about 26 million people worldwide and its prevalence continues to increase. Acute HF hospitalization which has 1-year mortality of 25–40%, contributes to a substantial component of this burden. Coronary artery disease is a key risk factor for HF development and is identified as the primary etiology in 66% of the cases. CAD presence in HF predicts a worse prognosis. While guidelines suggest considering an ischaemic etiology in any episode of acute HF, there is no standard approach for identifying patients requiring investigation. Therefore, the decision to pursue diagnostic coronary angiography is a considerable challenge in acute HF. The presence of ischemic signs and symptoms (including troponin elevation and chest pain) generally guides the decision but these features are common in hospitalized HF patients.
Against the above background, Leah B Kosyakovsky, Department of Medicine, University of Toronto, Toronto, ON, Canada, and colleagues aimed to determine the association of early coronary angiography during acute HF hospitalization with 2-year mortality, cardiovascular death, HF readmissions, and coronary revascularization in a two-stage sampling process.
For this purpose, acute HF patients presenting to 70 emergency departments in Ontario between April 2010 to March 2013 were identified. Using administrative databases, the researchers determined whether they underwent early coronary angiography within 14 days after presentation. After clinical record review, a cohort was defined with acute ischaemic HF as patients with at least one factor suggesting underlying ischaemic heart disease, including previous myocardial infarction, troponin elevation, or angina on presentation.
The researchers then oversampled patients undergoing angiography. Of 7239 patients with acute HF, 2994 met inclusion criteria (median age 75 years; 40.9% women).
Key findings of the study include:
- Early angiography was performed in 52.3% of the patients and was associated with lower all-cause mortality [hazard ratio (HR) 0.74], cardiovascular death (HR 0.72), and HF readmissions (HR 0.84) after IPTW.
- Those undergoing early angiography experienced higher rates of percutaneous coronary intervention (HR 2.58) and coronary artery bypass grafting (HR 2.94) within 2 years.
"While randomized trial evidence is required to validate these results, this study suggests that early coronary angiography may benefit patients with acute HF and potential underlying ischaemia, supporting the need for an evidence-based clinical framework for the diagnosis and assessment of CAD in the acute HF population," wrote the authors.
Reference:
The study titled, "Early invasive coronary angiography and acute ischaemic heart failure outcomes," is published in the European Heart Journal.
DOI: https://academic.oup.com/eurheartj/advance-article/doi/10.1093/eurheartj/ehab423/6331345
