on April 14, 2009
Published online before print April 14, 2009, doi: 10.1161/CIRCHEARTFAILURE.108.820696
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Original Article |
Predictors of Heart Failure in Patients with Stable Coronary Artery Disease: A PEACE Study
1 Brigham and Women's Hospital, Boston, MA;
2 George Washington University, Washington, D.C. and Rockville, MD;
3 Mediterranean Institute for Transplantation and Advanced Specialized Therapies, Palermo, Italy;
4 Astra Zeneca, Wilmington, DE;
5 AMNCO Foundation, Florence, Italy;
6 University of Texas Health Science Center, San Antonio, TX;
7 Montreal General Hospital, McGill University Health Center, Montreal, Quebec, Canada;
8 University of Manitoba, Winnipeg, Manitoba, Canada;
9 Mayo Clinic, Rochester, MN;
10 University of Montreal, Montreal, Canada
11 E-mail: eflewis{at}partners.org
Background—Heart failure (HF) is a disease commonly associated with coronary artery disease (CAD). Most risk models for HF development have focused on acute myocardial infarction (MI) patients. The prevention of events with angiotensin-converting enzyme inhibition (PEACE) population enabled the development of a risk model to predict HF in patients with stable CAD and preserved ejection fraction.
Methods and Results—In the 8290 PEACE patients without pre-existing HF, new-onset HF hospitalizations and fatal HF were assessed over a median follow-up of 4.8 years. Covariates were evaluated and maintained in the Cox regression multivariable model using backward selection if p<0.05. A risk score was developed and converted to an integer-based scoring system. Among the PEACE population (age 64±8, female 18%, prior MI 55%), there were 268 cases of fatal and non-fatal HF. Twelve characteristics were associated with increased risk of HF along with several baseline medications, including older age, history of hypertension, and diabetes. Randomization to trandolapril independently reduced risk of HF. There was no interaction between trandolapril treatment and other risk factors for HF. The risk score (range 0-21) demonstrated excellent discriminatory power (c-statistic 0.80). Risk of HF ranged from 1.75% in patients with a risk score of 0 to 33% in patients with risk score
16.
Conclusion—Among patients with stable CAD and preserved EF, traditional and newer factors were independently associated with increased risk of HF. Trandolopril decreased the risk of HF in these patients with preserved EF.
Key Words: atherosclerosis • drugs • heart failure • risk factors