Northwestern University, Chicago, IL, United States.
Int J Cardiol. 2011 Aug 18;151(1):69-75. doi: 10.1016/j.ijcard.2010.04.092. Epub 2010 Jun 16.
Associations between coronary artery disease (CAD) and outcomes in systolic heart failure (HF) and that between coronary artery bypass graft (CABG) surgery and outcomes in patients with HF and CAD have not been examined using propensity-matched designs.
Of the 2707 patients with advanced chronic systolic HF in the Beta-Blocker Evaluation of Survival Trial (BEST), 1593 had a history of CAD, of whom 782 had prior CABG. Using propensity scores for CAD we assembled a cohort of 458 pairs of CAD and no-CAD patients. Propensity scores for prior CABG in those with CAD were used to assemble 500 pairs of patients with and without CABG. Matched patients were balanced on 68 baseline characteristics.
All-cause mortality occurred in 33% and 24% of matched patients with and without CAD respectively, during 26 months of median follow-up (hazard ratio {HR} when CAD was compared with no-CAD, 1.41; 95% confidence interval {CI}, 1.11-1.81; P=0.006). HR's (95% CIs) for CAD-associated cardiovascular mortality, HF mortality, and sudden cardiac death (SCD) were 1.53 (1.17-2.00; P=0.002), 1.44 (0.92-2.25; P=0.114) and 1.76 (1.21-2.57; P=0.003) respectively. CAD had no association with hospitalization. Among matched patients with HF and CAD, all-cause mortality occurred in 32% and 39% of those with and without prior CABG respectively (HR for CABG, 0.77; 95% CI, 0.62-0.95; P=0.015).
In patients with advanced chronic systolic HF, CAD is associated with increased mortality, and in those with CAD, prior CABG seems to be associated with reduced all-cause mortality but not SCD.
目前尚未采用倾向评分匹配设计来研究冠状动脉疾病（CAD）与收缩性心力衰竭（HF）患者结局之间的关系，以及冠状动脉旁路移植术（CABG）与 CAD 合并 HF 患者结局之间的关系。
在 Beta-Blocker Evaluation of Survival Trial（BEST）中，2707 例晚期慢性收缩性 HF 患者中，1593 例有 CAD 病史，其中 782 例有既往 CABG 病史。我们使用 CAD 的倾向评分，将 CAD 和非 CAD 患者组成一个队列，共 458 对。使用 CAD 患者的既往 CABG 倾向评分，将 500 对有和无 CABG 的患者组成一个队列。匹配患者在 68 个基线特征上达到平衡。
在中位随访 26 个月期间，CAD 患者的全因死亡率为 33%，非 CAD 患者为 24%（CAD 患者与非 CAD 患者相比，风险比[HR]为 1.41；95%置信区间[CI]，1.11-1.81；P=0.006）。CAD 相关心血管死亡率、HF 死亡率和心源性猝死（SCD）的 HR（95%CI）分别为 1.53（1.17-2.00；P=0.002）、1.44（0.92-2.25；P=0.114）和 1.76（1.21-2.57；P=0.003）。CAD 与住院无关。在合并 CAD 的 HF 患者中，既往 CABG 的患者全因死亡率为 32%，无 CABG 的患者为 39%（CABG 的 HR 为 0.77；95%CI，0.62-0.95；P=0.015）。
在晚期慢性收缩性 HF 患者中，CAD 与死亡率增加相关，在 CAD 患者中，既往 CABG 似乎与全因死亡率降低相关，但与 SCD 无关。
