© 2008 European Society of Cardiology
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)
a Northwestern University Chicago, Illinois, United States
b University of California—Los Angeles Medical Center Los Angeles, California, United States
c GlaxoSmithKline Philadelphia, Pennsylvania, United States
d Duke University Medical Center, Durham, and Department of Clinical Research, Campbell University School of Pharmacy Research Triangle Park, North Carolina, United States
e The Ohio State University, Columbus Ohio, United States
f George M. and Linda H. Kaufman Center for Heart Failure, Cleveland Clinic Foundation Cleveland, Ohio, United States
g University of California San Diego—Hillcrest Medical Center San Diego, California, United States
h Duke University Medical Center/Duke Clinical Research Institute Durham, North Carolina, United States
i Baylor Heart and Vascular Institute, Baylor University Medical Center Dallas, Texas, United States
* Corresponding author. UCLA Division of Cardiology, 10833 LeConte Avenue, Los Angeles, CA, 90095-1679, United States. Tel.: +1 310 206 9112; fax: +1 310 206 9111. E-mail address: gfonarow{at}mednet.ucla.edu (G.C. Fonarow).
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Abstract |
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Background: Coronary artery disease (CAD) is frequent among patients hospitalized with acute heart failure syndromes (AHFS).
Aims: To describe the influence of coronary revascularization status on survival in patients with AHFS.
Methods and 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 
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.
Key Words: Acute heart failure • Coronary artery disease • Coronary revascularization • Diastolic heart failure • Mortality
Received July 7, 2008; Revised August 27, 2008; Accepted September 25, 2008