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Angina pectoris may increase adverse events in patients with HFpEF

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Patients with HF with preserved ejection fraction appear to be at increased risk for major adverse CV events if they also have angina pectoris, researchers reported in a new study.

Robert J. Mentz

Robert J. Mentz, MD, of Duke University Medical Center, and colleagues investigated the outcomes and characteristics of patients with HF with preserved ejection fraction (HFpEF) and angina pectoris. They analyzed all patients with HFpEF who underwent coronary angiography at Duke University Medical Center from 2000 to 2010 (n=3,517). Forty percent of those patients had angina pectoris.

The primary endpoint was a composite of death, MI, revascularization and stroke. Secondary endpoints included death plus the following composites: death/MI/revascularization, death/MI/stroke, death/MI and CV death/CV hospitalization. Median follow-up was 4 years.

According to the researchers, a major factor of poorer outcomes among patients with both HFpEF and angina pectoris was the increased incidence of revascularization. In an unadjusted analysis, patients with angina pectoris had increased incidence of the primary outcome and of death/MI/revascularization (P<.001 for both) compared with patients without angina pectoris. However, the angina pectoris group had lower rates of death and death/MI (both P<.05) and similar rates of death/MI/stroke and CV death/CV hospitalization (both P<.1).

After multivariable adjustment, patients with angina pectoris were still at increased risk for the primary outcome (HR=1.3; 95% CI, 1.17-1.45) and for death/MI/revascularization (HR=1.29; 95% CI, 1.15-1.43) compared with those without angina pectoris. There was no difference between the two groups in the other outcomes (P>.06).

Patients with angina pectoris were older, had more comorbidities and had undergone more prior revascularization procedures than those without angina pectoris. They were also more likely to receive beta-blockers, ACE inhibitors, nitrates and statins (all P<.05).

“[Angina pectoris] was an independent predictor of major adverse cardiac events driven by increased revascularization, but was not associated with increased risk for death, MI, stroke or rehospitalization,” Mentz and colleagues wrote. “Potentially, by targeting angina symptoms with presently available medical therapies, the morbidity related to repeat revascularizations in HFpEF patients could be reduced.”

For this study, HFpEF was defined as patients with NYHA class II to IV symptoms and ejection fraction ≥50% in the 2 weeks before index catheterization. Angina pectoris was defined as chest pain in the 6 weeks before index catheterization.

For more information:

Mentz RJ. J Am Coll Cardiol. 2013;doi:10.1016/j.jacc.2013.09.039.

Disclosure: Three researchers report receiving research funding from Gilead Sciences.