- 作者：Robert J. Mentz ; Samuel Broderick ; Linda K. Shaw ; Mona Fiuzat ; Christopher M. O'Connor
- 关键词：angina pectoris ; heart failure with preserved ejection fraction ; outcomes
- 刊名：Journal of the American College of Cardiology
- 出版年：28 January, 2014
- 年：2014
- 卷：63
- 期：3
- 页码：251-258
- 全文大小：600 K
Objectives
This study investigated the characteristics and outcomes of patients with heart failure with preserved ejection fraction (HFpEF) and angina pectoris (AP).Background
AP is a predictor of adverse events in patients with heart failure with reduced EF. The implications of AP in HFpEF are聽unknown.
Methods
We analyzed HFpEF patients (EF聽鈮?0%) who underwent coronary angiography at Duke University Medical Center聽from 2000 through 2010 with and without AP in the previous 6 weeks. Time to first event was examined using Kaplan-Meier methods for the primary endpoint of death/myocardial infarction (MI)/revascularization/stroke聽(i.e., major adverse cardiac events [MACE]) and secondary endpoints of death/MI/revascularization, death/MI/stroke, death/MI, death, and cardiovascular death/cardiovascular hospitalization.
Results
In the Duke Databank, 3,517 patients met criteria for inclusion and 1,402 (40%) had AP. Those with AP were older聽with more comorbidities and prior revascularization compared with non-AP patients. AP patients more often received beta-blockers, angiotensin-converting enzyme inhibitors, nitrates, and statins (all p聽< 0.05). In unadjusted analysis, AP patients had increased MACE and death/MI/revascularization (both p聽< 0.001), lower rates of death and death/MI (both p聽< 0.05), and similar rates of death/MI/stroke and cardiovascular death/cardiovascular hospitalization (both p > 0.1). After multivariable adjustment, those with AP remained at increased risk for MACE聽(hazard ratio [HR]: 1.30, 95% confidence interval [CI]: 1.17 to 1.45) and death/MI/revascularization (HR:聽1.29, 95% CI: 1.15 to 1.43), but they were at similar risk for other endpoints (p > 0.06).
Conclusions
AP in HFpEF patients with a history of coronary artery disease is common despite medical therapy and is independently associated with increased MACE due to revascularization with similar risk of death, MI, and hospitalization.