Relationship between angina pectoris and outcomes in patients with heart failure and reduced ejection fraction: an analysis of the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA)

Abstract

Patients with HF-REF and ongoing angina are at an increased risk of acute coronary syndrome and HF hospitalization. Whether these patients would benefit from more aggressive medical therapy or percutaneous revascularization is not known and merits further investigation.

Importance of Angina in Patients With Coronary Disease, Heart Failure, and Left Ventricular Systolic Dysfunction

“…Other analyses, in populations with less robust evidence of CAD, suggest that angina is associated with a worse outcome (14), but this may be because angina is a marker confirming the presence of CAD. The reasons why angina does not predict a mortality benefit from CABG are uncertain, and cannot be determined from the current study.…”

“…For each model, candidate variables were pre-specified, using either clinical experience or previously reported risk factors (4,5,14). The primary analysis was on the basis of the intention-to-treat principle.…”

Clinical characteristics and outcomes of patients with angina and heart failure in the CHARM (Candesartan in Heart Failure Assessment of Reduction in Mortality and Morbidity) Programme

“…The reported prevalence of angina pectoris varies widely in previous studies—from 11% to 75% in patients with HF‐REF and from 4% to 50% in those with HF‐PEF, although these proportions do not take account of aetiology or presence of underlying CAD . In our study of over 5000 patients with an ischaemic aetiology, 72% of patients with HF‐REF had a history of angina (with current angina in 28% of patients) and 79% of patients with HF‐PEF had a history of angina (current in 36%).…”

“…Seventy per cent of patients with current angina and HF‐REF were in NYHA class III or IV compared with only 62% of patients with previous angina and 58% with no history of angina—a finding consistent with a recent analysis of CORONA. In CORONA, patients with current angina had worse NYHA class despite higher LVEFs and lower NT‐proBNP levels . CHARM allows us to build a more detailed clinical profile of this patient group.…”

“…In the Controlled Rosuvastatin Multinational Trial in Heart Failure trial (CORONA), patients with HF and reduced ejection fraction (HF‐REF) and current angina experienced greater functional limitation [as quantified by New York Heart Association (NYHA) class] and were more likely to experience acute coronary syndromes (ACS) than patients without a history of angina pectoris. These patients were also more likely to be hospitalized for HF but had similar survival to those without angina . Even less is known about the prevalence and prognostic importance of angina in patients with HF and preserved ejection fraction (HF‐PEF), which has only been examined in a retrospective analysis of the Duke database.…”