Coronary angiography in worsening heart failure: determinants, findings, and prognostic implications

Introduction: Coronary angiography is regularly performed in patients with worsening signs and/or symptoms of heart failure (HF). However, little is known on the determinants, findings, and associated clinical outcomes of coronary angiography performed in patients with worsening HF.

Methods: The BIOSTAT-CHF (A systems BIOlogy Study to TAilored Treatment in Chronic Heart Failure) program enrolled 2516 patients with worsening symptoms and/or signs of HF, either hospitalized or in the out-patient setting. All patients were included in the present analysis.

Results: Of the 2516 patients included, 315 (12.5%) underwent coronary angiography within the 30 days after the onset of worsening symptoms and/or signs of HF. Subjects who underwent angiography were younger, more often conducted on inpatients, had more often an overt acute coronary syndrome, had higher troponin I levels, were younger, and had better renal function (all p≤0.01). Only 35% (n=54) of patients with an ACS (n=155) underwent coronary angiography. Patients who underwent coronary angiography had a lower risk of the primary outcome of death and/or HF hospitalization (adjusted HR=0.71, 95%CI=0.57-0.89; p=0.003) and death (adjusted HR=0.59, 95%CI=0.43-0.80, p=0.001). Among the patients who underwent coronary angiography, those with a coronary stenosis (39%) had a worse prognosis than those without stenosis (adjusted HR for the primary outcome=1.71, 95%CI=1.10-2.64, p =0.016).

Conclusions: Coronary angiography was performed in <13% of patients with symptoms and/or signs of worsening heart failure. Coronary angiography appears to be underutilized among patients who present with an ACS and HF. Strategies to optimize the use of coronary angiography among eligible patients may represent an opportunity to improve outcomes.