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Angina pectoris identified as a predictor of adverse events in HFpEF
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Researchers have reported an independent association between angina pectoris and increased major adverse CV events in patients with HF with preserved ejection fraction and a history of CAD.
Angina pectoris is a predictor of adverse events in patients with HF with reduced ejection fraction (HFrEF), but the implications in patients with HF with preserved ejection fraction (HFpEF) were previously unknown, according to Robert J. Mentz, MD, of Duke University Medical Center, and colleagues.
The researchers studied 3,517 patients with HFpEF and history of ≥50% stenosis in one or more epicardial coronary vessels who underwent coronary angiography at Duke University Medical Center from 2000 to 2010. Of those, 1,402 patients also had angina pectoris.
Robert J. Mentz
The primary endpoint was a composite of death, MI, revascularization and stroke. Secondary endpoints included death/MI/revascularization, death/MI/stroke, death/MI, death and CV death/CV hospitalization.
Across the entire cohort, the 5-year unadjusted Kaplan-Meier survival rate was 66.3%. Both the primary endpoint and death/MI/revascularization were significantly more common among HFpEF patients with angina pectoris (P<.05 for both). However, the presence of angina pectoris was associated with lower rates of death and death/MI (P<.05 for both) and similar rates of death/MI/stroke and CV death/CV hospitalization (P>.1 for both).
After multivariable adjustment, the risk for major adverse CV events (HR=1.3; 95% CI, 1.17-1.45) and death/MI/revascularization (HR=1.29; 95% CI, 1.15-1.43) remained increased among patients with angina pectoris. The researchers observed no significant difference in risk for other evaluated endpoints according to presence of angina pectoris.
“These results have important clinical applications, given the procedural costs and quality of life implications for revascularization procedures,” Mentz and colleagues concluded. “Previous studies have also suggested that [HFpEF] patients with CAD who present with pulmonary edema tend to have recurrence of pulmonary edema despite revascularization. Thus, a reappraisal of the utility of revascularization in [HFpEF] patients may be warranted, given potential limitations in preventing HF decompensation. Future studies will need to explore whether improved management of [angina pectoris] may reduce revascularization rates.”
Disclosure: Some researchers report receiving research funding from Gilead Sciences.
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