National Centre for Global Health, Istituto Superiore di Sanità, Rome, Italy.
Department of Cardio-Thoracic and Vascular Medicine and Surgery, Division of Cardiology, A.O. San Camillo-Forlanini, Rome, Italy.
Int J Cardiol. 2024 Oct 15;413:132369. doi: 10.1016/j.ijcard.2024.132369. Epub 2024 Jul 23.
Coronary artery disease (CAD) is a common underlying cause of de novo heart failure (HF) and is associated with poor outcome despite advances in medical therapy. There are no data clearly supporting coronary angiogram (CVG) and revascularization in this setting.
We analysed a nationwide, comprehensive, and universal administrative database of consecutive patients for the first time admitted in hospital for HF, without a history of CAD, who survived 30 days after index admission from 2015 to 2019 in Italy. Enrolled patients were classified into subjects who did not undergo CVG; those who underwent CVG without coronary revascularization; those who underwent percutaneous coronary intervention (PCI); and those who underwent coronary artery bypass grafting (CABG).
During the study period, 342,090 patients were hospitalized for the first time due to HF and survived 30 days after admission, in Italy. Among them, 30,806 (9.0%) patients underwent CVG without undergoing coronary revascularization, 5855 (1.7%) underwent PCI and 1594 (0.5%) underwent CABG. After adjusting for age, gender and comorbidity, the hazard ratio (HR) for 1-year all-cause mortality in patients undergoing CVG vs no CVG were 0.56 (p < 0.0001), 0.66 (p < 0.0001) and 0.83 (p = 0.020) for CVG, PCI and CABG patients, respectively. When considering the re-hospitalization for HF as the outcome, using death as a competing risk, after multiple corrections, CVG (HR = 0.80; p < 0.0001) and CABG (HR = 0.73; p < 0.0002) were protective versus No CVG, but not PCI (HR = 1.02; p = 0.642).
This study provides evidence that CVG and coronary revascularization may be beneficial for patients with de novo HF.
冠状动脉疾病（CAD）是新发心力衰竭（HF）的常见潜在原因，尽管医学治疗取得了进展，但预后仍然不佳。目前尚无数据明确支持在此情况下进行冠状动脉造影（CVG）和血运重建。
我们首次分析了意大利全国范围内、全面的、通用的行政数据库，该数据库包含了 2015 年至 2019 年期间首次因 HF 住院且无 CAD 病史的患者，这些患者在索引入院后 30 天内存活。纳入的患者分为未进行 CVG 的患者；进行 CVG 但未进行冠状动脉血运重建的患者；进行经皮冠状动脉介入治疗（PCI）的患者；以及进行冠状动脉旁路移植术（CABG）的患者。
在研究期间，意大利有 342090 名患者因 HF 首次住院并在入院后 30 天内存活。其中，30806 名（9.0%）患者进行了 CVG 但未进行冠状动脉血运重建，5855 名（1.7%）进行了 PCI，1594 名（0.5%）进行了 CABG。在校正年龄、性别和合并症后，与未行 CVG 的患者相比，行 CVG 患者的 1 年全因死亡率的风险比（HR）为 0.56（p<0.0001），行 PCI 患者的 HR 为 0.66（p<0.0001），行 CABG 患者的 HR 为 0.83（p=0.020）。当将 HF 再住院作为结局，以死亡为竞争风险时，经多次校正后，CVG（HR=0.80；p<0.0001）和 CABG（HR=0.73；p<0.0002）与无 CVG 相比具有保护作用，但 PCI 无此作用（HR=1.02；p=0.642）。
本研究提供的证据表明，CVG 和冠状动脉血运重建可能有益于新发 HF 患者。
