From the BHF Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (A.A.B., A.C.P.-M., P.S.J., A.P.T.B., R.S.G., M.C.P., J.J.V.M.); Scottish National Advanced Heart Failure Service, Golden Jubilee National Hospital, Glasgow, United Kingdom (A.A.B., R.S.G., M.C.P.); Division of Cardiology, University of British Columbia, Vancouver, Canada (N.M.H.); Veterans Affairs Medical Center and University of Minnesota, Minneapolis (I.S.A.); Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada (R.S.M.); Pitié-Salpêtrière Hospital, Paris, France (M.K.); Ralph H. Johnson Veterans Affairs Medical Center and Medical University of South Carolina, Charleston (M.R.Z.); and Georgetown University and Washington DC Veterans Affairs Medical Center (P.E.C.).
Circ Heart Fail. 2015 Jul;8(4):717-24. doi: 10.1161/CIRCHEARTFAILURE.114.002024. Epub 2015 Jun 11.
BACKGROUND: The aim of our study was to investigate the relationship between coronary artery disease (CAD), angina, and clinical outcomes in patients with heart failure and preserved ejection fraction enrolled in the irbesartan in patients with heart failure and preserved systolic function (I-Preserve) trial. METHODS AND RESULTS: The mean follow-up period for the 4128 patients enrolled in I-Preserve was 49.5 months. Patients were divided into 4 mutually exclusive groups according to history of CAD and angina: patients with no history of CAD or angina (n=2008), patients with no history of CAD but a history of angina (n=649), patients with a history of CAD but no angina (n=468), and patients with a history of CAD and angina (n=1003); patients with no known CAD or angina were the reference group. After adjustment for other prognostic variables using Cox proportional-hazard models, patients with CAD but no angina were found to be at higher risk of all-cause mortality (hazard ratio [HR], 1.58 [1.22-2.04]; P<0.01) and sudden death (HR, 2.12 [1.33-3.39]; P<0.01), compared with patients with no CAD or angina. Patients with CAD and angina were also at higher risk of all-cause mortality (HR, 1.29 [1.05-1.59]; P=0.02) and sudden death (HR, 1.83 [1.24-2.69]; P<0.01) compared with the same reference group and had the highest risk of unstable angina or myocardial infarction (HR, 5.84 [3.43-9.95]; P<0.01). CONCLUSIONS: Patients with heart failure and preserved ejection fraction and CAD are at higher risk of all-cause mortality and sudden death when compared with those without CAD. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT00095238.
背景：我们的研究目的是探讨冠心病（CAD）、心绞痛与射血分数保留的心力衰竭患者临床结局之间的关系，该研究纳入了心力衰竭且射血分数保留的伊贝沙坦治疗研究（I-Preserve）中的患者。
方法和结果：共纳入 4128 例 I-Preserve 患者，平均随访时间为 49.5 个月。根据 CAD 和心绞痛的病史，将患者分为 4 个互斥组：无 CAD 或心绞痛病史（n=2008）、无 CAD 但有心绞痛病史（n=649）、有 CAD 但无心绞痛病史（n=468）和有 CAD 及心绞痛病史（n=1003）；无已知 CAD 或心绞痛的患者为参照组。使用 Cox 比例风险模型对其他预后变量进行调整后，发现无 CAD 但有心绞痛病史的患者全因死亡率（风险比[HR]，1.58[1.22-2.04]；P<0.01）和猝死（HR，2.12[1.33-3.39]；P<0.01）的风险高于无 CAD 或心绞痛的患者。有 CAD 和心绞痛病史的患者全因死亡率（HR，1.29[1.05-1.59]；P=0.02）和猝死（HR，1.83[1.24-2.69]；P<0.01）的风险也高于参照组，且不稳定型心绞痛或心肌梗死的风险最高（HR，5.84[3.43-9.95]；P<0.01）。
结论：与无 CAD 的患者相比，射血分数保留的心力衰竭且合并 CAD 的患者全因死亡率和猝死风险更高。
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