Coronary Artery Disease Is A Stronger Predictor of All-Cause Mortality Than Left Ventricular Ejection Fraction Among Patients With Newly Diagnosed Heart Failure: Insights From the WDHR.

Autor: Nielsen RR; Department of Cardiology Aarhus University Hospital Aarhus Denmark.; Department of Clinical Medicine Aarhus University, Health Aarhus Denmark., Pryds K; Department of Cardiology Aarhus University Hospital Aarhus Denmark., Olesen KKW; Department of Cardiology Aarhus University Hospital Aarhus Denmark., Mortensen MB; Department of Cardiology Aarhus University Hospital Aarhus Denmark.; Department of Clinical Medicine Aarhus University, Health Aarhus Denmark.; Department of Cardiology Johns Hopkins Baltimore MD., Gyldenkerne C; Department of Cardiology Aarhus University Hospital Aarhus Denmark., Nielsen JC; Department of Cardiology Aarhus University Hospital Aarhus Denmark.; Department of Clinical Medicine Aarhus University, Health Aarhus Denmark., Hindricks G; German Heart Center Charité Berlin Germany., Dagres N; German Heart Center Charité Berlin Germany., Maeng M; Department of Cardiology Aarhus University Hospital Aarhus Denmark.; Department of Clinical Medicine Aarhus University, Health Aarhus Denmark.
Jazyk: angličtina
Zdroj: Journal of the American Heart Association [J Am Heart Assoc] 2024 Jul 16; Vol. 13 (14), pp. e9771. Date of Electronic Publication: 2024 Jul 03.
DOI: 10.1161/JAHA.123.033938
Abstrakt: Background: In patients with newly diagnosed heart failure (HF) and left ventricular ejection fraction (LVEF) <50%, little is known whether LVEF per se or presence of coronary artery disease (CAD) provides independent prognostic information on all-cause mortality.
Methods and Results: Using the WDHR (Western Denmark Heart Registry), we identified 3620 patients with newly diagnosed HF and LVEF 10% to 49% referred for first-time coronary angiography as part of general workup of HF. Patients were stratified by LVEF (10%-35% versus 36%-49%) and presence of CAD. We estimated 10-year all-cause mortality risk and calculated hazard ratios adjusted for relevant comorbidities and risk factors (aHRs). CAD was present in 1592 (44%) patients. Lower LVEF was associated with a relative 15% increased 10-year mortality: 37% for LVEF 36% to 49% versus 42% for LVEF 10% to 35% (aHR, 1.15 [95% CI, 0.99-1.34]). This result did not change when stratified into those with CAD (52% versus 56%; aHR, 1.11 [95% CI, 0.91-1.35]) and those without CAD (27% versus 33%; aHR, 1.24 [95% CI, 0.97-1.57]). In comparison, presence and extent of CAD were associated with a relative 43% increased 10-year mortality (CAD versus no CAD, 55.0% versus 31.5%; aHR, 1.43 [95% CI, 1.25-1.64]). Compared with a matched general population, excess mortality risk was higher for patients with HF and CAD (54.7% versus 26.3%; aHR, 2.10 [95% CI, 1.85-2.39]) versus those with HF and no CAD (31.4% versus 17.2%; aHR, 1.76 [95% CI, 1.52-2.02]).
Conclusions: Among newly diagnosed patients with HF and LVEF <50%, presence and extent of CAD are associated with substantial higher all-cause mortality risk than lower LVEF.
Databáze: MEDLINE
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