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Temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease
AIMS: Ischaemic coronary artery disease (CAD) remains the leading cause of mortality globally due to sudden death and heart failure (HF). Invasive coronary angiography (CAG) is the gold standard for evaluating the presence and severity of CAD. Our objective was to assess temporal trends in CAG utili...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9065869/ https://www.ncbi.nlm.nih.gov/pubmed/35261201 http://dx.doi.org/10.1002/ehf2.13875 |
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author | Bollano, Entela Redfors, Björn Rawshani, Araz Venetsanos, Dimitrios Völz, Sebastian Angerås, Oskar Ljungman, Charlotta Alfredsson, Joakim Jernberg, Tomas Råmunddal, Truls Petursson, Petur Smith, J. Gustav Braun, Oscar Hagström, Henrik Fröbert, Ole Erlinge, David Omerovic, Elmir |
author_facet | Bollano, Entela Redfors, Björn Rawshani, Araz Venetsanos, Dimitrios Völz, Sebastian Angerås, Oskar Ljungman, Charlotta Alfredsson, Joakim Jernberg, Tomas Råmunddal, Truls Petursson, Petur Smith, J. Gustav Braun, Oscar Hagström, Henrik Fröbert, Ole Erlinge, David Omerovic, Elmir |
author_sort | Bollano, Entela |
collection | PubMed |
description | AIMS: Ischaemic coronary artery disease (CAD) remains the leading cause of mortality globally due to sudden death and heart failure (HF). Invasive coronary angiography (CAG) is the gold standard for evaluating the presence and severity of CAD. Our objective was to assess temporal trends in CAG utilization, patient characteristics, and prognosis in HF patients undergoing CAG at a national level. METHODS AND RESULTS: We used data from the Swedish Coronary Angiography and Angioplasty Registry. Data on all patients undergoing CAG for HF indication in Sweden between 2000 and 2018 were collected and analysed. Long‐term survival was estimated with multivariable Cox proportional hazards regression adjusted for differences in patient characteristics. In total, 22 457 patients (73% men) with mean age 64.2 ± 11.3 years were included in the study. The patients were increasingly older with more comorbidities over time. The number of CAG specifically for HF indication increased by 5.5% per calendar year (P < 0.001). No such increase was seen for indications angina pectoris and ST‐elevation myocardial infarction. A normal CAG or non‐obstructive CAD was reported in 63.2% (HF‐NCAD), and 36.8% had >50% diameter stenosis in one or more coronary arteries (HF‐CAD). The median follow‐up time was 3.6 years in HF‐CAD and 5 years in HF‐NCAD. Age and sex‐adjusted survival improved linearly by 1.3% per calendar year in all patients. Compared with HF‐NCAD, long‐term mortality was higher in HF‐CAD patients. The risk of death increased with the increasing severity of CAD. Compared with HF‐NCAD, the risk estimate in patients with a single‐vessel disease was higher [hazard ratio (HR) 1.3; 95% confidence interval (CI) 1.20–1.41; P < 0.001], a multivessel disease without the involvement of left main coronary artery (HR 1.72; 95% CI 1.58–1.88; P < 0.001), and with left main disease (HR 2.02; 95% CI 1.88–2.18; P < 0.001). The number of HF patients undergoing revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) increased by 7.5% (P < 0.001) per calendar year. The majority (53.4%) of HF‐CAD patients were treated medically, while a minority (46.6%) were referred for revascularization with PCI or CABG. Compared with patients treated with PCI, the proportion of patients treated medically or with CABG decreased substantially (P < 0.001). CONCLUSIONS: Over 18 years, the number of patients with HF undergoing CAG has increased substantially. Expanded utilization of CAG increased the number of HF patients treated with percutaneous coronary intervention and coronary artery bypass surgery. Long‐term survival improved in all HF patients despite a steady increase of elderly patients with comorbidities. |
format | Online Article Text |
id | pubmed-9065869 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-90658692022-05-04 Temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease Bollano, Entela Redfors, Björn Rawshani, Araz Venetsanos, Dimitrios Völz, Sebastian Angerås, Oskar Ljungman, Charlotta Alfredsson, Joakim Jernberg, Tomas Råmunddal, Truls Petursson, Petur Smith, J. Gustav Braun, Oscar Hagström, Henrik Fröbert, Ole Erlinge, David Omerovic, Elmir ESC Heart Fail Original Articles AIMS: Ischaemic coronary artery disease (CAD) remains the leading cause of mortality globally due to sudden death and heart failure (HF). Invasive coronary angiography (CAG) is the gold standard for evaluating the presence and severity of CAD. Our objective was to assess temporal trends in CAG utilization, patient characteristics, and prognosis in HF patients undergoing CAG at a national level. METHODS AND RESULTS: We used data from the Swedish Coronary Angiography and Angioplasty Registry. Data on all patients undergoing CAG for HF indication in Sweden between 2000 and 2018 were collected and analysed. Long‐term survival was estimated with multivariable Cox proportional hazards regression adjusted for differences in patient characteristics. In total, 22 457 patients (73% men) with mean age 64.2 ± 11.3 years were included in the study. The patients were increasingly older with more comorbidities over time. The number of CAG specifically for HF indication increased by 5.5% per calendar year (P < 0.001). No such increase was seen for indications angina pectoris and ST‐elevation myocardial infarction. A normal CAG or non‐obstructive CAD was reported in 63.2% (HF‐NCAD), and 36.8% had >50% diameter stenosis in one or more coronary arteries (HF‐CAD). The median follow‐up time was 3.6 years in HF‐CAD and 5 years in HF‐NCAD. Age and sex‐adjusted survival improved linearly by 1.3% per calendar year in all patients. Compared with HF‐NCAD, long‐term mortality was higher in HF‐CAD patients. The risk of death increased with the increasing severity of CAD. Compared with HF‐NCAD, the risk estimate in patients with a single‐vessel disease was higher [hazard ratio (HR) 1.3; 95% confidence interval (CI) 1.20–1.41; P < 0.001], a multivessel disease without the involvement of left main coronary artery (HR 1.72; 95% CI 1.58–1.88; P < 0.001), and with left main disease (HR 2.02; 95% CI 1.88–2.18; P < 0.001). The number of HF patients undergoing revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) increased by 7.5% (P < 0.001) per calendar year. The majority (53.4%) of HF‐CAD patients were treated medically, while a minority (46.6%) were referred for revascularization with PCI or CABG. Compared with patients treated with PCI, the proportion of patients treated medically or with CABG decreased substantially (P < 0.001). CONCLUSIONS: Over 18 years, the number of patients with HF undergoing CAG has increased substantially. Expanded utilization of CAG increased the number of HF patients treated with percutaneous coronary intervention and coronary artery bypass surgery. Long‐term survival improved in all HF patients despite a steady increase of elderly patients with comorbidities. John Wiley and Sons Inc. 2022-03-08 /pmc/articles/PMC9065869/ /pubmed/35261201 http://dx.doi.org/10.1002/ehf2.13875 Text en © 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes. |
spellingShingle | Original Articles Bollano, Entela Redfors, Björn Rawshani, Araz Venetsanos, Dimitrios Völz, Sebastian Angerås, Oskar Ljungman, Charlotta Alfredsson, Joakim Jernberg, Tomas Råmunddal, Truls Petursson, Petur Smith, J. Gustav Braun, Oscar Hagström, Henrik Fröbert, Ole Erlinge, David Omerovic, Elmir Temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease |
title | Temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease |
title_full | Temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease |
title_fullStr | Temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease |
title_full_unstemmed | Temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease |
title_short | Temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease |
title_sort | temporal trends in characteristics and outcome of heart failure patients with and without significant coronary artery disease |
topic | Original Articles |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9065869/ https://www.ncbi.nlm.nih.gov/pubmed/35261201 http://dx.doi.org/10.1002/ehf2.13875 |
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