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).
BACKGROUND
Coronary artery disease (CAD) is frequent among patients hospitalized with acute heart failure syndromes (AHFS).


OBJECTIVE
To describe the influence of coronary revascularization status on survival in patients with AHFS.


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 > or =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.
Rossi
Joseph S
JS
Northwestern University, Chicago, Illinois, United States.
Flaherty
James D
JD
Fonarow
Gregg C
GC
Nunez
Eduardo
E
Gattis Stough
Wendy
W
Abraham
William T
WT
Albert
Nancy M
NM
Greenberg
Barry H
BH
O'Connor
Christopher M
CM
Yancy
Clyde W
CW
Young
James B
JB
Davidson
Charles J
CJ
Gheorghiade
Mihai
M
D000208:Acute Disease; D000368:Aged; D016001:Confidence Intervals; D003324:Coronary Artery Disease / Q000401:mortality / Q000503:physiopathology*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology*; D054144:Heart Failure, Diastolic / Q000503:physiopathology; D054143:Heart Failure, Systolic / Q000503:physiopathology; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization; D016017:Odds Ratio; D011379:Prognosis; D016730:Program Development; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left