title: Coronary artery disease and outcome in acute congestive heart failure.
abstract: OBJECTIVE
  To quantify the prognostic impact of coronary artery disease (CAD) on patients with acute heart failure (HF).
  
  
  METHODS
  Prospective cohort study of 217 consecutive patients presenting with acute HF to the emergency department. Treatment, hospitalisation, the use of revascularisation procedures, and survival were observed during follow up of up to three years.
  
  
  RESULTS
  CAD was present in 153 patients (71%). Patients with and without CAD were similar with respect to age and sex. Although adequate HF treatment was initiated more rapidly among patients with CAD, their initial outcomes including hospitalisation rate, time to discharge, and total treatment cost were significantly worse. Moreover, despite higher use of angiotensin converting enzyme inhibitors and beta blockers during follow up, patients with CAD had a significantly lower survival rate. Cumulative survival at 720 days was 48.7% of patients with CAD as compared with 76.4% of patients without CAD (p = 0.0004). In Cox regression analysis the presence of CAD increased the risk of death by more than 250% (hazard ratio 2.57, 95% confidence interval 1.50 to 4.39, p = 0.001). This strong association persisted after multivariate adjustments. The use of coronary angiography and coronary revascularisation procedures was low, both at initial presentation and during follow up.
  
  
  CONCLUSIONS
  CAD is a strong and independent predictor of mortality among patients with acute HF. Whether, for example, less restrictive use of revascularisation procedures in this elderly HF population can improve the outcome for patients with CAD warrants further study.
authors.affiliation: Department of Internal Medicine, University of Basel, University Hospital, Basel, Switzerland.
authors.forename: L
authors.initials: L
authors.lastname: Purek
authors.forename: K
authors.initials: K
authors.lastname: Laule-Kilian
authors.forename: A
authors.initials: A
authors.lastname: Christ
authors.forename: T
authors.initials: T
authors.lastname: Klima
authors.forename: M E
authors.initials: ME
authors.lastname: Pfisterer
authors.forename: A P
authors.initials: AP
authors.lastname: Perruchoud
authors.forename: C
authors.initials: C
authors.lastname: Mueller
mesh_terms: D000208:Acute Disease; D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications* / Q000401:mortality; D004812:Epidemiologic Methods; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization / Q000401:mortality; D011379:Prognosis