Influence of coronary angiography on the utilization of therapies in patients with acute heart failure syndromes: Findings from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)
Influence of coronary angiography on the utilization of therapies in patients with acute heart failure syndromes: Findings from Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF)
复制标题
DOI：
10.1016/j.ahj.2009.03.011
复制
发表时间：
2009-06-01
影响因子：
4.8
通讯作者：
Gheorghiade, Mihai
中科院分区：
文献类型：
--
作者：
Flaherty, James D.;Rossi, Joseph S.;Gheorghiade, Mihai
大多数因急性心力衰竭综合征（AHFS）住院的患者都有冠状动脉疾病（CAD）的诊断，但很少进行冠状动脉造影。本研究的目的是确定冠状动脉造影对AHFS患者使用治疗药物和早期出院后结局的影响。方法在住院心力衰竭患者中启动救生治疗的有组织计划计划招募了48名，在美国259所学术和社区医院收治的612名AHFS患者中，对所有患者的住院治疗和结局进行了跟踪，出院后的结果在预先规定的10%的样本。结果数据进行了前瞻性收集和分析，根据是否在索引住院期间进行冠状动脉造影术，患者是否有CAD. ResultsOverall，8.7%的患者进行了院内血管造影术。在接受血管造影的CAD患者中，27.5%接受了院内心肌血运重建。在出院时，接受血管造影术的CAD患者更有可能接受阿司匹林治疗（68.9% vs 50.3%，P < .0001），他汀类药物（56.6%对40.6%，P < .0001），β受体阻滞剂（78.6%对67.5%，P < .0001），血管紧张素转换酶抑制剂（64.9%对51.5%，P < .0001）。在AHFS和CAD患者中，在调整多种合并症和患者因素后，出院后60至90天内，使用院内血管造影与死亡率和再住院风险显着降低相关：死亡率（HR 0.31 [95% CI 0.14-0.70]，P = .004）和死亡或再住院（OR 0.65 [95% CI 0.50-0.86]，P = .003）。AHFS和非缺血性病因的基础上的性能inhospitalangiography.Conclusions医院血管造影对AHFS和CAD患者的性能与增加使用阿司匹林，他汀类药物，β-受体阻滞剂，血管紧张素转换酶（ACE）抑制剂和心肌血运重建的患者，这些结果没有显着差异。这与出院后60 - 90天的死亡率、再住院率以及死亡或再住院率显著降低相对应。(Am Heart J 2009; 157：1018-25.）
Background Most patients hospitalized for acute heart failure syndromes (AHFS) carry a diagnosis of coronary artery disease (CAD), but coronary angiography is infrequently performed. This purpose of this study was to determine the influence of coronary angiography on use of therapeutics and early postdischarge outcomes in patients with AHFS.Methods The Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure program enrolled 48,612 patients admitted with AHFS at 259 academic and community hospitals throughout the United States Inhospital treatments and outcomes were tracked in all patients and postdischarge outcomes in a prespecified 10% sample. Outcome data were prospectively collected and analyzed according to whether coronary angiography was performed during the index hospitalization and whether a patient had CAD.Results Overall, 8.7% of all patients underwent inhospital angiography. Among patients with CAD who underwent angiography, 27.5% underwent inhospital myocardial revascularization. At the time of discharge, patients with CAD who underwent angiography were significantly more likely to be receiving aspirin (68.9% vs 50.3%, P < .0001), statins (56.6% vs 40.6%, P < .0001), beta-blockers (78.6% vs 67.5%, P < .0001), and angiotensin-converting enzyme inhibitors (64.9% vs 51.5%, P < .0001). In patients with AHFS and CAD, the use of inhospital angiography was associated with significantly lower mortality and rehospitalization risk in the first 60 to 90 days post hospital discharge after adjustment for multiple comorbidities and patient factors: mortality (HR 0.31 [95% CI 0.14-0.70], P = .004) and death or rehospitalization (OR 0.65 [95% CI 0.50-0.86], P = .003). There were no significant differences in any of these outcomes in patients with AHFS and a nonischemic etiology based the performance of inhospital angiography.Conclusions The performance of inhospital angiography on patients with AHFS and CAD is associated with an increased use of aspirin, statins, beta-blockers, angiotensin-converting enzyme (ACE) inhibitors and myocardial revascularization. This corresponded with significantly lower rates of death, rehospitalization, and death or rehospitalization at 60 to 90 days post discharge. (Am Heart J 2009; 157:1018-25.)