University of Lille, Inserm, CHU of Lille, Institut Pasteur, Lille, France.
Hôpital Privé Le Bois, Lille, France.
J Card Fail. 2018 Dec;24(12):815-822. doi: 10.1016/j.cardfail.2018.09.013. Epub 2018 Oct 5.
We lack recent data on the incidence, correlates, and prognosis associated with heart failure (HF) development in patients with stable coronary artery disease (CAD). Here, we analyzed HF development in a contemporary population of outpatients with stable CAD.
Of 4184 unselected outpatients with stable CAD (ie, myocardial infarction [MI] and/or coronary revascularization >1 year earlier) included in the multicenter CORONOR registry, we identified 3871 patients with no history of hospitalization for HF at inclusion and followed 3785 (98%) of them for 5 years. During follow-up, 211 patients were hospitalized for HF (5-year cumulative incidence 5.7%) and 163 patients had incident MIs. Independent predictors of hospitalization for HF were older age, lower left ventricular ejection fraction (LVEF), atrial fibrillation, higher body mass index, diabetes mellitus, history of hypertension, angina at inclusion, and multivessel CAD. Most hospitalizations for HF (62.6%) occurred in patients with LVEF ≥50% at inclusion, and most (92.4%) were not preceded by an incident MI. Hospitalization for HF was a powerful predictor of mortality (adjusted hazard ratio 5.97, 95% confidence interval 4.55-7.83; P < .0001). After hospitalization for HF, mortality rates were similar in patients with LVEFs ≥50% and <50% at hospitalization.
Outpatients with stable CAD were frequently hospitalized for HF, and HF was associated with high mortality. Most HF hospitalizations were associated with preserved LVEF at inclusion and were not preceded by an incident MI.
我们缺乏有关稳定型冠状动脉疾病（CAD）患者心力衰竭（HF）发展相关发病率、相关性和预后的最新数据。在这里，我们分析了当代稳定型 CAD 门诊患者中 HF 的发展情况。
在多中心 CORONOR 注册研究中，纳入了 4184 例未经选择的稳定型 CAD 门诊患者（即心肌梗死[MI]和/或冠状动脉血运重建术>1 年前），其中 3871 例患者在纳入时无 HF 住院史，对其中 3785 例（98%）患者进行了 5 年随访。随访期间，211 例患者因 HF 住院（5 年累积发生率 5.7%），163 例患者发生 MI。HF 住院的独立预测因素为年龄较大、左心室射血分数（LVEF）较低、心房颤动、体重指数较高、糖尿病、高血压病史、纳入时心绞痛和多血管 CAD。HF 住院的大多数（62.6%）发生在纳入时 LVEF≥50%的患者中，且大多数（92.4%）没有发生 MI 事件。HF 住院是死亡的强有力预测因素（调整后的危险比 5.97，95%置信区间 4.55-7.83；P<0.0001）。HF 住院后，LVEF≥50%和<50%的患者死亡率相似。
稳定型 CAD 的门诊患者常因 HF 住院，HF 与高死亡率相关。大多数 HF 住院与纳入时 LVEF 保留有关，且没有发生 MI 事件。
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