title: Impact of concomitant heart failure on outcomes in patients undergoing percutaneous coronary interventions: analysis of the Melbourne Interventional Group registry.
abstract: OBJECTIVE
  The presence of heart failure (HF) is an established risk factor for adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). The aim of this study was to determine the prevalence and impact of concomitant HF on major outcomes in contemporary PCI practice.
  
  
  RESULTS
  We analysed 5006 consecutive PCIs (2004-2006) enrolled in the Melbourne Interventional Group registry. Baseline characteristics, in-hospital, 30-day, and 12-month outcomes of patients with a history of HF (n = 189, 3.8%) were compared with patients without HF (n = 4817, 96.2%). Patients with a history of HF were older (mean age 72.9 ± 9.8 vs. 64.3 ± 12 years, P < 0.01) and had higher rates of diabetes (37.0 vs. 23.5%, P < 0.01), renal dysfunction (Cr > 200 μmol/L; 16.5 vs. 3.9%, P < 0.01), multi-vessel disease (79.8 vs. 58.7%, P < 0.01), and presentation with cardiogenic shock (4.8 vs. 2.1%, P = 0.02). At 12 months, patients with HF had higher overall mortality (13.7 vs. 3.5%, P < 0.01) and rates of HF admission (10.4 vs. 2.0%, P < 0.01). Independent predictors of recurrent HF admission included history of HF [odds ratio (OR) 2.2, 95% confidence interval (CI) 1.2-4.2, P < 0.01] and renal dysfunction (OR 2.5, 95% CI 1.4-4.4, P < 0.01). At 12 months, patients with HF had lower rates of statin (73.9 vs. 89.2%, P < 0.01) and beta-blocker use (55.6 vs. 59.0%, P < 0.01). Angiotensin-converting enzyme-inhibitor/angiotensin receptor blocker use was also relatively low in HF patients (79.6%).
  
  
  CONCLUSIONS
  While the overall incidence of HF in patients undergoing PCI is low, underutilization of HF therapies may contribute to an increased likelihood of subsequent re-admission and increased mortality.
authors.affiliation: Department of Cardiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
authors.forename: Ken J
authors.initials: KJ
authors.lastname: Lu
authors.forename: Bryan P
authors.initials: BP
authors.lastname: Yan
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Ajani
authors.forename: William M
authors.initials: WM
authors.lastname: Wilson
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Duffy
authors.forename: Ronen
authors.initials: R
authors.lastname: Gurvitch
authors.forename: David J
authors.initials: DJ
authors.lastname: Clark
authors.forename: Angela
authors.initials: A
authors.lastname: Brennan
authors.forename: Christopher
authors.initials: C
authors.lastname: Reid
authors.forename: Nick
authors.initials: N
authors.lastname: Andrianopoulos
authors.forename: Henry
authors.initials: H
authors.lastname: Krum
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D001315:Australia; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000628:therapy*; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012042:Registries; D016896:Treatment Outcome