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CLINICAL STUDIES

Prognostic value of congestive heart failure history in patients undergoing percutaneous coronary interventions

R. David Anderson, MD^*, E. Magnus Ohman, MD^*, David R. Holmes, Jr., MD, Robert A. Harrington, MD^*, Gregory W. Barsness, MD, Nancy M. Wildermann, BS^*, Harry R. Phillips, MD^*, Eric J. Topol, MD and Robert M. Califf, MD^*

^* Duke Clinical Research Institute, Durham, North Carolina, USA
Mayo Clinic, Rochester, Minnesota, USA
Cleveland Clinic Foundation, Cleveland, Ohio, USA

Manuscript received January 27, 1998; revised manuscript received May 27, 1998, accepted June 4, 1998.

Address for correspondence: Dr. R. David Anderson, P.O. Box 3850, Duke University Medical Center, Durham, North Carolina 27710
Ander040{at}onyx.mc.duke.edu

Objectives. We sought to determine the prognostic significance of a history of congestive heart failure above that provided by baseline ejection fraction in patients undergoing percutaneous coronary interventions.

Background. Left ventricular function is a known predictor of survival in patients with coronary artery disease, as is a history of congestive heart failure. The contribution of heart failure history independent of left ventricular function is unknown.

Methods. Data were pooled from four interventional trials and the Duke University database. The combined dataset included 5,260 patients undergoing percutaneous interventions, 334 with and 4,926 without a history of heart failure. Patients were defined by the treating physician as having a clinical history of heart failure at the time of enrollment.

Results. The 30-day and 6-month mortality were higher in patients with a clinical history of congestive heart failure than in those without such a history (2% vs. <1%, p = 0.002 at 30 days, 5% vs. 1%, p = 0.001 at 6 months). Heart failure history did not influence the incidence of myocardial infarction, use of angioplasty or the use of bypass surgery during follow-up. Multivariable analysis revealed that heart failure history added significantly to ejection fraction in predicting intermediate-term (6-month) mortality (p = 0.01). Stepwise logistic regression also revealed heart failure history to be an independent predictor of 6-month mortality (odds risk 1.9, 95% confidence interval 1.1 to 3.5).

Conclusions. A clinical history of congestive heart failure is associated with increased early and intermediate-term mortality in patients undergoing percutaneous revascularization. Congestive heart failure history appears to provide prognostic information independent of that available from a patient’s left ventricular function. These findings suggest that patients with a clinical history of congestive heart failure who undergo a percutaneous intervention should be closely monitored, especially those with the lowest ejection fractions.

Abbreviations and Acronyms   CAVEAT = Coronary Angioplasty Versus Excisional Atherectomy Trial   CHF = congestive heart failure   EF = ejection fraction   NHLBI = National Heart, Lung and Blood Institute   PBC = Perfusion Balloon Catheter Study Group

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