Revascularization in patients with heart failure

Tsuyuki, Ross T.; Shrive, Fiona M.; Galbraith, P. Diane; Knudtson, Merril L.; Graham, Michelle M.
August 2005
CMAJ: Canadian Medical Association Journal;8/15/2006, Vol. 175 Issue 4, p361
Academic Journal
Background: Although practice guidelines recommend coronary revascularization for patients with heart failure, the evidence to support this recommendation is weak. The objective of our study was to determine the association of coronary revascularization with survival in patients who have had heart failure. Methods: Data were obtained from the Alberta Provincial Project for Outcomes Assessment in Coronary Heart Disease (APPROACH), a clinical outcome--monitoring initiative that has captured data on all patients undergoing cardiac catheterization in the province of Alberta since 1995. Our study included data from patients with a history of heart failure and with documented coronary artery disease; patients with normal coronary arteries or prior coronary artery bypass grafting (CABG) were excluded. We constructed survival curves and adjusted them by the corrected group prognosis method (incorporating all clinical variables in APPROACH). Propensity scores were used to account for clinical characteristics that could influence the decision to revascularize. Results: A total of 2538 patients (mean age 68 yr, standard deviation [SD] 11 yr, 31% female) underwent revascularization; 1690 patients (mean age 69 [SD 11] yr, 34% female) did not. Crude 1-year mortality was 11.8% among patients who underwent revascularization, compared with 21.6% among those who did not. Adjusted survival curves diverged early and continued up to 7 years of follow-up (hazard ratio 0.50, 95% confidence interval 0.44-0.57). Propensity scores showed improved survival with revascularization across all quintiles of likelihood of revascularization. Interpretation: This new evidence lends support to practice guidelines, which recommend revascularization in patients with heart failure and coronary disease.


Related Articles

  • Early invasive strategy in elderly patients with non- ST elevation acute coronary syndrome: comparison with younger patients regarding 30 day and long term outcome. Liistro, F.; Angioli, P.; Falsini, G.; Ducci, K.; Baldassarre, S.; Burali, A.; Bolognese, L. // Heart;Oct2005, Vol. 91 Issue 10, p1284 

    Objectives: To evaluate an early invasive strategy in elderly patients with non-ST elevation acute coronary syndrome (ACS). Methods: All consecutive patients admitted with a diagnosis of non-ST elevation ACS from June 2002 to February 2004 were enrolled in this registry. Clinical outcome was...

  • Anomalous Coronary Arteries from the Opposite Coronary Sinus: Similar Long-term Outcomes from Medical or Surgical Treatment. Boyle, Andrew J. // Clinical Cardiology Alert;Mar2011, Vol. 30 Issue 3, p23 

    The article discusses a study by R. A. Krasuski and colleagues which evaluated the benefit of surgery on patients with anomalous coronary arteries that arise from the opposite sinus (ACAOS), especially with inter-arterial course (IAC) between the aorta and the pulmonary artery. The author...

  • Safety and efficacy of femoral artery closure with the FemoSeal® device after coronary angiography using a 7 French sheath. Wanitschek, MM; Suessenbacher, A; Dörler, J; Pachinger, O; Moes, N; Alber, HF // Perfusion;Sep2011, Vol. 26 Issue 5, p447 

    Post-cardiac catheterization femoral artery hemostasis can be accomplished with several mechanisms, including the FemoSeal® hemostasis device which has been designed and approved for closure of 6 French (F) arterial puncture sites. The aim of this study was to investigate whether the...

  • Coronary rotational atherectomy in patients with unsuccessful classical angioplasty -- in-hospital and six-month follow-up. Wojtczak, Marcin; Kubler, Piotr; Jankowska, Ewa A.; Telichowski, Artur; Zimoch, Wojciech; Banasiak, Waldemar; Ponikowski, Piotr; Reczuch, Krzysztof; Ferenc, Mirosław // Advances in Interventional Cardiology;2012, Vol. 8 Issue 2, p85 

    Background: The data regarding follow-up of high-risk patients after coronary rotational atherectomy (RA) are poor. Aim: The aim of this study was to evaluate the in-hospital and 6-month outcome of patients with uncrossable or undilatable lesions who were treated with RA. Material and methods:...

  • 2014 ESC/EACTS Guidelines on myocardial revascularization. Kolh, Philippe; Windecker, Stephan; Alfonso, Fernando; Collet, Jean-Philippe; Cremer, Jochen; Falk, Volkmar; Filippatos, Gerasimos; Hamm, Christian; Head, Stuart J.; Jüni, Peter; Kappetein, A. Pieter; Kastrati, Adnan; Knuuti, Juhani; Landmesser, Ulf; Laufer, Günther; Neumann, Franz-Josef; Richter, Dimitrios J.; Schauerte, Patrick; Sousa Uva, Miguel; Stefanini, Giulio G. // European Journal of Cardio-Thoracic Surgery;Oct2014, Vol. 46 Issue 4, p517 

    The article presents the European Society of Cardiology/European Association for Cardio-Thoracic Surgery (ESC/EASC) guidelines on myocardial revascularization therapy post-SYNTAX. Featured in the guidelines are the approach to calculate the SYNTAX score and the risk models to assess outcomes as...

  • Drug-Eluting Stents � Pushing the Envelope beyond the Labels? Carrozza, Joseph P. // New England Journal of Medicine;1/24/2008, Vol. 358 Issue 4, p405 

    The author reflects on the controversial use of drug-eluting stents for patients with coronary heart disease. The use of drug-eluting stents became somewhat default with most of the indications being off-label until data suggested a higher rate of patients with thrombotic occlusion who used the...

  • Impact of heart failure on outcome after percutaneous coronary intervention: is it the patient or the intervention? Vlaar, Pieter J.; de Smet, Bart J.G.L. // European Journal of Heart Failure;Apr2011, Vol. 13 Issue 4, p364 

    No abstract available.

  • Health-related quality of life in patients with coronary artery disease after coronary revascularization. Tasić, Ivan; Lazarević, Gordana; Stojanović, Miomir; Kostić, Svetlana; Rihter, Marija; Djordjević, Dragan; Simonović, Dejan; Vulić, Dušan; Stefanović, Vladisav // Central European Journal of Medicine;Oct2013, Vol. 8 Issue 5, p618 

    The aim of this study was to investigate the quality of life (HRQoL) in coronary artery disease(CAD) patients, admitted for rehabilitation within 3 months after an acute coronary event, in relation to treatment strategy [conservative treatment without revascularization (WR), percutaneous...

  • Long term outcome in patients with silent versus symptomatic ischaemia during dobutamine stress echocardiography. Biagini, E.; Schinkel, A. F. L.; Bax, J. J.; Rizzello, V.; van Domburg, R. T.; Krenning, B. J.; Bountioukos, M.; Pedone, C.; Vourvouri, E. C.; Rapezzi, C.; Branzi, A.; Roelandt, J. R. T. C.; Poldermans, D. // Heart;Jun2005, Vol. 91 Issue 6, p737 

    Objectives: To compare the long term prognosis of patients having silent versus symptomatic ischaemia during dobutamine stress echocardiography (DSE). Design: Observational study. Setting: Tertiary referral centre. Patients: 931 patients who experienced stress induced myocardial ischaemia during...


Read the Article


Sign out of this library

Other Topics