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Comparison of Clinical Characteristics and Long-Term Outcomes of Patients With Ischemic Cardiomyopathy With Versus Without Angina Pectoris (from the Duke Databank for Cardiovascular Disease)

Published:February 13, 2012DOI:https://doi.org/10.1016/j.amjcard.2011.12.021
      Myocardial ischemic origin is a significant independent predictor of mortality in patients with heart failure (HF). The implications of angina pectoris (AP) in HF are less well characterized. The aim of this study was to compare the clinical characteristics and outcomes of patients with and without AP in a cohort of patients with reduced ejection fractions and ischemic cardiomyopathy (iCM). Patients who underwent coronary angiography at Duke University Medical Center from January 2000 to September 2009 with ejection fractions <40% and diagnoses of iCM with AP in the previous 6 weeks were compared to similar patients without AP. Time to event was examined using Kaplan-Meier methods for 5 end points: death; death or nonfatal myocardial infarction (MI); death, MI, or revascularization; death or hospitalization; and cardiovascular (CV) death or CV hospitalization. Of 2,376 patients with iCM, 1,412 (59%) had AP. They had more co-morbidities and more previous revascularization than patients without AP. After multivariate adjustment, those with and without AP had similar risks for death (p = 0.32), death or MI (p = 0.15), and death or hospitalization (p = 0.37) (5-year event rates 41% vs 41%, 46% vs 47%, and 87% vs 85%, respectively), but those with AP had lower rates of death, MI, or revascularization (p = 0.01) and higher rates of CV death or CV hospitalization (p = 0.03) (5-year event rates 85% vs 87% and 77% vs 73%, respectively). In conclusion, AP is common in patients with iCM despite medical therapy and previous revascularization and is associated with increased CV death or CV rehospitalization.
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      Reference

        • Lloyd-Jones D.
        • Adams R.
        • Carnethon M.
        • De Simone G.
        • Ferguson T.B.
        • Flegal K.
        • Ford E.
        • Furie K.
        • Go A.
        • Greenlund K.
        • Haase N.
        • Hailpern S.
        • Ho M.
        • Howard V.
        • Kissela B.
        • Kittner S.
        • Lackland D.
        • Lisabeth L.
        • Marelli A.
        • McDermott M.
        • Meigs J.
        • Mozaffarian D.
        • Nichol G.
        • O'Donnell C.
        • Roger V.
        • Rosamond W.
        • Sacco R.
        • Sorlie P.
        • Stafford R.
        • Steinberger J.
        • Thom T.
        • Wasserthiel-Smoller S.
        • Wong N.
        • Wylie-Rosett J.
        • Hong Y.
        Heart disease and stroke statistics—2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee.
        Circulation. 2009; 119: e21-e181
        • Levy D.
        • Kenchaiah S.
        • Larson M.G.
        • Benjamin E.J.
        • Kupka M.J.
        • Ho K.K.
        • Murabito J.M.
        • Vasan R.S.
        Long-term trends in the incidence of and survival with heart failure.
        N Engl J Med. 2002; 347: 1397-1402
        • Felker G.M.
        • Shaw L.K.
        • O'Connor C.M.
        A standardized definition of ischemic cardiomyopathy for use in clinical research.
        J Am Coll Cardiol. 2002; 39: 210-218
        • Bart B.A.
        • Shaw L.K.
        • McCants Jr, C.B.
        • Fortin D.F.
        • Lee K.L.
        • Califf R.M.
        • O'Connor C.M.
        Clinical determinants of mortality in patients with angiographically diagnosed ischemic or nonischemic cardiomyopathy.
        J Am Coll Cardiol. 1997; 30: 1002-1008
        • Adams Jr, K.F.
        • Dunlap S.H.
        • Sueta C.A.
        • Clarke S.W.
        • Patterson J.H.
        • Blauwet M.B.
        • Jensen L.R.
        • Tomasko L.
        • Koch G.
        Relation between gender, etiology and survival in patients with symptomatic heart failure.
        J Am Coll Cardiol. 1996; 28: 1781-1788
        • Likoff M.J.
        • Chandler S.L.
        • Kay H.R.
        Clinical determinants of mortality in chronic congestive heart failure secondary to idiopathic dilated or to ischemic cardiomyopathy.
        Am J Cardiol. 1987; 59: 634-638
        • Franciosa J.A.
        • Wilen M.
        • Ziesche S.
        • Cohn J.N.
        Survival in men with severe chronic left ventricular failure due to either coronary heart disease or idiopathic dilated cardiomyopathy.
        Am J Cardiol. 1983; 51: 831-836
        • Mullens W.
        • Abrahams Z.
        • Skouri H.N.
        • Taylor D.O.
        • Starling R.C.
        • Francis G.S.
        • Young J.B.
        • Tang W.H.
        Prognostic evaluation of ambulatory patients with advanced heart failure.
        Am J Cardiol. 2008; 101: 1297-1302
        • O'Connor C.M.
        • Abraham W.T.
        • Albert N.M.
        • Clare R.
        • Gattis Stough W.
        • Gheorghiade M.
        • Greenberg B.H.
        • Yancy C.W.
        • Young J.B.
        • Fonarow G.C.
        Predictors of mortality after discharge in patients hospitalized with heart failure: an analysis from the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF).
        Am Heart J. 2008; 156: 662-673
        • Fraker Jr, T.D.
        • Fihn S.D.
        • Gibbons R.J.
        • Abrams J.
        • Chatterjee K.
        • Daley J.
        • Deedwania P.C.
        • Douglas J.S.
        • Ferguson Jr, T.B.
        • Gardin J.M.
        • O'Rourke R.A.
        • Williams S.V.
        • Smith Jr, S.C.
        • Jacobs A.K.
        • Adams C.D.
        • Anderson J.L.
        • Buller C.E.
        • Creager M.A.
        • Ettinger S.M.
        • Halperin J.L.
        • Hunt S.A.
        • Krumholz H.M.
        • Kushner F.G.
        • Lytle B.W.
        • Nishimura R.
        • Page R.L.
        • Riegel B.
        • Tarkington L.G.
        • Yancy C.W.
        2007 chronic angina focused update of the ACC/AHA 2002 guidelines for the management of patients with chronic stable angina: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines Writing Group to Develop the Focused Update of the 2002 Guidelines for the Management of Patients With Chronic Stable Angina.
        J Am Coll Cardiol. 2007; 50: 2264-2274
        • Juul-Moller S.
        • Edvardsson N.
        • Jahnmatz B.
        • Rosen A.
        • Sorensen S.
        • Omblus R.
        • The Swedish Angina Pectoris Aspirin Trial (SAPAT) Group
        Double-blind trial of aspirin in primary prevention of myocardial infarction in patients with stable chronic angina pectoris.
        Lancet. 1992; 340: 1421-1425
        • Fox K.M.
        • Mulcahy D.
        • Findlay I.
        • Ford I.
        • Dargie H.J.
        • The TIBET Study Group
        The Total Ischaemic Burden European Trial (TIBET).
        Eur Heart J. 1996; 17: 96-103
        • Rehnqvist N.
        • Hjemdahl P.
        • Billing E.
        • Bjorkander I.
        • Eriksson S.V.
        • Forslund L.
        • Held C.
        • Nasman P.
        • Wallen N.H.
        Effects of metoprolol vs verapamil in patients with stable angina pectoris.
        Eur Heart J. 1996; 17: 76-81
        • Hjemdahl P.
        • Eriksson S.V.
        • Held C.
        • Forslund L.
        • Nasman P.
        • Rehnqvist N.
        Favourable long term prognosis in stable angina pectoris: an extended follow up of the Angina Prognosis Study in Stockholm (APSIS).
        Heart. 2006; 92: 177-182
        • Poole-Wilson P.A.
        • Lubsen J.
        • Kirwan B.A.
        • van Dalen F.J.
        • Wagener G.
        • Danchin N.
        • Just H.
        • Fox K.A.
        • Pocock S.J.
        • Clayton T.C.
        • Motro M.
        • Parker J.D.
        • Bourassa M.G.
        • Dart A.M.
        • Hildebrandt P.
        • Hjalmarson A.
        • Kragten J.A.
        • Molhoek G.P.
        • Otterstad J.E.
        • Seabra-Gomes R.
        • Soler-Soler J.
        • Weber S.
        Effect of long-acting nifedipine on mortality and cardiovascular morbidity in patients with stable angina requiring treatment (ACTION trial): randomised controlled trial.
        Lancet. 2004; 364: 849-857
        • Boden W.E.
        • O'Rourke R.A.
        • Teo K.K.
        • Hartigan P.M.
        • Maron D.J.
        • Kostuk W.J.
        • Knudtson M.
        • Dada M.
        • Casperson P.
        • Harris C.L.
        • Chaitman B.R.
        • Shaw L.
        • Gosselin G.
        • Nawaz S.
        • Title L.M.
        • Gau G.
        • Blaustein A.S.
        • Booth D.C.
        • Bates E.R.
        • Spertus J.A.
        • Berman D.S.
        • Mancini G.B.
        • Weintraub W.S.
        Optimal medical therapy with or without PCI for stable coronary disease.
        N Engl J Med. 2007; 356: 1503-1516
        • Velazquez E.J.
        • Lee K.L.
        • Deja M.A.
        • Jain A.
        • Sopko G.
        • Marchenko A.
        • Ali I.S.
        • Pohost G.
        • Gradinac S.
        • Abraham W.T.
        • Yii M.
        • Prabhakaran D.
        • Szwed H.
        • Ferrazzi P.
        • Petrie M.C.
        • O'Connor C.M.
        • Panchavinnin P.
        • She L.
        • Bonow R.O.
        • Rankin G.R.
        • Jones R.H.
        • Rouleau J.L.
        Coronary-artery bypass surgery in patients with left ventricular dysfunction.
        N Engl J Med. 2011; 364: 1607-1616
        • Jabbour S.
        • Young-Xu Y.
        • Graboys T.B.
        • Blatt C.M.
        • Goldberg R.J.
        • Bedell S.E.
        • Bilchik B.Z.
        • Lown B.
        • Ravid S.
        Long-term outcomes of optimized medical management of outpatients with stable coronary artery disease.
        Am J Cardiol. 2004; 93: 294-299
        • Mozaffarian D.
        • Bryson C.L.
        • Spertus J.A.
        • McDonell M.B.
        • Fihn S.D.
        Anginal symptoms consistently predict total mortality among outpatients with coronary artery disease.
        Am Heart J. 2003; 146: 1015-1022
        • Harris P.J.
        • Lee K.L.
        • Harrell Jr, F.E.
        • Behar V.S.
        • Rosati R.A.
        Outcome in medically treated coronary artery disease.
        Circulation. 1980; 62: 718-726
        • Boyle C.A.
        • Decoufle P.
        National sources of vital status information: extent of coverage and possible selectivity in reporting.
        Am J Epidemiol. 1990; 131: 160-168
        • Douglas P.S.
        • Ginsburg G.S.
        The evaluation of chest pain in women.
        N Engl J Med. 1996; 334: 1311-1315
        • Canto J.G.
        • Fincher C.
        • Kiefe C.I.
        • Allison J.J.
        • Li Q.
        • Funkhouser E.
        • Centor R.M.
        • Selker H.P.
        • Weissman N.W.
        Atypical presentations among Medicare beneficiaries with unstable angina pectoris.
        Am J Cardiol. 2002; 90: 248-253
        • Campeau L.
        The Canadian Cardiovascular Society grading of angina pectoris revisited 30 years later.
        Can J Cardiol. 2002; 18: 371-379
        • Mahe I.
        • Chassany O.
        • Grenard A.S.
        • Caulin C.
        • Bergmann J.F.
        Defining the role of calcium channel antagonists in heart failure due to systolic dysfunction.
        Am J Cardiovasc Drugs. 2003; 3: 33-41
        • Kloner R.A.
        • Shook T.
        • Przyklenk K.
        • Davis V.G.
        • Junio L.
        • Matthews R.V.
        • Burstein S.
        • Gibson M.
        • Poole W.K.
        • Cannon C.P.
        • McCabe C.H.
        • Braunwald E.
        • TIMI 4 investigators
        Previous angina alters in-hospital outcome in TIMI 4.
        Circulation. 1995; 91: 37-45
        • Abete P.
        • Ferrara N.
        • Cacciatore F.
        • Madrid A.
        • Bianco S.
        • Calabrese C.
        • Napoli C.
        • Scognamiglio P.
        • Bollella O.
        • Cioppa A.
        • Longobardi G.
        • Rengo F.
        Angina-induced protection against myocardial infarction in adult and elderly patients: a loss of preconditioning mechanism in the aging heart?.
        J Am Coll Cardiol. 1997; 30: 947-954
        • Fang J.
        • Mensah G.A.
        • Croft J.B.
        • Keenan N.L.
        Heart failure-related hospitalization in the U.S. 1979 to 2004.
        J Am Coll Cardiol. 2008; 52: 428-434