Anker Nanna, Olesen Kevin K W, Thrane Pernille G, Gyldenkerne Christine, Mortensen Martin B, Nielsen Roni R, Løgstrup Brian B, Würtz Morten, Nielsen Jens C, Maeng Michael
Department of Cardiology Aarhus University Hospital Aarhus Denmark.
Department of Clinical Medicine Aarhus University Aarhus Denmark.
J Am Heart Assoc. 2025 May 6;14(9):e037915. doi: 10.1161/JAHA.124.037915. Epub 2025 Apr 16.
Assessment of coronary artery disease (CAD) in patients with heart failure and reduced left ventricular ejection fraction (HFrEF) varies between countries and there are only limited data on the long-term impact of CAD in these patients. We examined the association between CAD and mortality in patients with HFrEF undergoing coronary angiography.
Using Danish registries, we identified patients with HFrEF (EF ≤40%) undergoing coronary angiography from 2003 to 2016. We estimated 10-year cumulative incidence proportions and adjusted hazard ratios (aHR) for all-cause death, comparing patients with HFrEF with CAD with patients with HFrEF without CAD. Both groups were further compared with an age- and sex-matched general population cohort in a 1:5 ratio. We included 3294 patients with HFrEF, of whom 1436 (44%) had CAD, as well as 16 365 matched general population individuals. Median follow-up was 5.3 years. Patients with HFrEF with CAD had higher 10-year mortality than patients with HFrEF without CAD (55% versus 33%; aHR, 1.38 [95% CI, 1.19-1.59]). These estimates were consistent across ages, whereas greater extent of CAD was associated with higher mortality (<0.01). Compared with the matched general population, the 10-year excess mortality was 29% for patients with HFrEF with CAD (55% versus 26%; aHR, 2.18 [95% CI, 1.92-2.48]), and 15% for patients with HFrEF without CAD (33% versus 17%; aHR, 1.87 [95% CI, 1.63-2.14]).
Presence and extent of CAD are strongly associated with all-cause mortality in patients with HFrEF and, when compared with a matched general population, presence of CAD doubles excess mortality. This highlights the importance of CAD assessment for prognostication in patients with HFrEF.
心力衰竭且左心室射血分数降低（HFrEF）患者的冠状动脉疾病（CAD）评估在不同国家存在差异，而且关于CAD对这些患者长期影响的数据有限。我们研究了接受冠状动脉造影的HFrEF患者中CAD与死亡率之间的关联。
利用丹麦登记处的数据，我们确定了2003年至2016年期间接受冠状动脉造影的HFrEF（射血分数≤40%）患者。我们估计了全因死亡的10年累积发病率比例和调整后的风险比（aHR），将患有CAD的HFrEF患者与未患CAD的HFrEF患者进行比较。两组患者还以1:5的比例与年龄和性别匹配的普通人群队列进行了进一步比较。我们纳入了3294例HFrEF患者，其中1436例（44%）患有CAD，以及16365例匹配的普通人群个体。中位随访时间为5.3年。患有CAD的HFrEF患者的10年死亡率高于未患CAD的HFrEF患者（55%对33%；aHR，1.38[95%CI，1.19 - 1.59]）。这些估计在各年龄段均一致，而CAD程度越高，死亡率越高（<0.01）。与匹配的普通人群相比，患有CAD的HFrEF患者的10年超额死亡率为29%（55%对26%；aHR，2.18[95%CI，1.92 - 2.48]），未患CAD的HFrEF患者为15%（33%对17%；aHR，1.87[95%CI，1.63 - 2.14]）。
CAD的存在和程度与HFrEF患者的全因死亡率密切相关，与匹配的普通人群相比，CAD的存在使超额死亡率翻倍。这突出了CAD评估对HFrEF患者预后的重要性。
