Janssen Scientific Affairs, LLC, Titusville, NJ, USA.
STATinMED Research, Plano, TX, USA.
BMC Cardiovasc Disord. 2019 Jan 15;19(1):19. doi: 10.1186/s12872-018-0991-1.
Coronary artery disease accelerates heart failure progression, leading to poor prognosis and a substantial increase in morbidity and mortality. This study was aimed to assess the impact of coronary artery disease on all-cause mortality, myocardial infarction (MI), and ischemic stroke (IS) among hospitalized newly-diagnosed heart failure (HF) patients with left ventricular systolic dysfunction (LVSD).
This retrospective cohort study included Medicare patients (aged ≥65 years) with ≥1 inpatient heart failure claim (index date = discharge date) during 01JAN2007-31DEC2013. Patients were required to have continuous enrollment for ≥1-year pre-index date (baseline: 1-year pre-index period) without a prior heart failure claim (in the 1 year pre-index prior to the index hospital admission); follow-up ran from the index date to death, disenrollment from the health plan, or the end of the study period, whichever occurred first. HF with LVSD patients, identified with diagnosis codes of systolic dysfunction (excluding baseline atrial fibrillation), were stratified based on prevalent coronary artery disease at baseline into coronary artery disease and non-coronary artery disease cohorts. Main outcomes were occurrence of major adverse cardiovascular events including all-cause mortality, myocardial infarction, and ischemic stroke. Propensity score matching (PSM) was used to balance patient characteristics. Kaplan-Meier curves of ACM and cumulative incidence distribution of MI/IS were presented.
Of 22,230 HF with LVSD patients, 15,827 (71.2%) had coronary artery disease and were overall more likely to be younger (79.8 vs 80.9 years), male (49.6% vs. 35.6%), white (86.2% vs 81.4%), with more prevalent comorbidities including hypertension (80.7% vs 74.3%), hyperlipidemia (67.7% vs 46.7%), and diabetes (46.3% vs 35.8%) (all p < 0.0001). After propensity score matching, cohorts included 5792 patients each. The coronary artery disease cohort had significantly higher cumulative incidence of myocardial infarction and ischemic stroke at the end of 7-year follow-up vs non-coronary artery disease (myocardial infarction = 50.0% vs 18.0%; ischemic stroke = 23.3% vs 18.7%; all p < 0.0001). Follow-up all-cause mortality rates were similar between the two cohorts.
HF with LVSD patients with coronary artery disease had significantly higher incidence of ischemic stroke and myocardial infarction, but similar all-cause mortality compared to those without coronary artery disease.
冠状动脉疾病会加速心力衰竭的进展，导致预后不良，并大幅增加发病率和死亡率。本研究旨在评估冠状动脉疾病对伴有左心室收缩功能障碍（LVSD）的新诊断心力衰竭（HF）住院患者全因死亡率、心肌梗死（MI）和缺血性卒中（IS）的影响。
本回顾性队列研究纳入了 Medicare 患者（年龄≥65 岁），他们在 2007 年 1 月 1 日至 2013 年 12 月 31 日期间至少有一次住院 HF 就诊（索引日期=出院日期）。患者需在索引日期前至少 1 年（基线：索引前 1 年）连续参保，且在索引住院前的 1 年中没有 HF 就诊（在索引住院前的 1 年内）；随访从索引日期开始，至死亡、退出健康计划或研究结束，以先发生者为准。LVSD 的 HF 患者，根据收缩功能障碍的诊断代码（不包括基线心房颤动），按基线时是否存在已确诊的冠状动脉疾病分为冠状动脉疾病和非冠状动脉疾病队列。主要结局为全因死亡率、心肌梗死和缺血性卒中的发生。采用倾向评分匹配（PSM）来平衡患者特征。Kaplan-Meier 曲线用于显示 ACM 的生存情况，累积发生率分布用于显示 MI/IS 的发生情况。
在 22230 例伴有 LVSD 的 HF 患者中，15827 例（71.2%）存在冠状动脉疾病，且总体上更年轻（79.8 岁 vs 80.9 岁）、男性（49.6% vs 35.6%）、白人（86.2% vs 81.4%）、更常见合并症，包括高血压（80.7% vs 74.3%）、高血脂（67.7% vs 46.7%）和糖尿病（46.3% vs 35.8%）（均 P<0.0001）。经过倾向评分匹配后，每个队列包括 5792 例患者。与非冠状动脉疾病队列相比，冠状动脉疾病队列在 7 年随访结束时心肌梗死和缺血性卒中的累积发生率更高（心肌梗死=50.0% vs 18.0%；缺血性卒中=23.3% vs 18.7%；均 P<0.0001）。两组的全因死亡率随访结果相似。
伴有 LVSD 的 HF 患者如果存在冠状动脉疾病，其发生缺血性卒中和心肌梗死的风险显著增加，但全因死亡率与无冠状动脉疾病的患者相似。
