Clinical Characteristics and Outcomes of Patients with Ischemic Cardiomyopathy (ICM) and Angina: Findings from the Duke Cardiovascular Database

BackgroundIschemic etiology is a significant independent predictor of mortality in patients with heart failure (HF). We compared the clinical characteristics and outcomes of ICM patients with and without angina in a cohort of HF patients with systolic dysfunction.MethodsPatients undergoing coronary angiography at Duke University Medical Center from January 2000 to September 2009 with systolic HF (EF < 40%) and a diagnosis of ICM (≥ 1 coronary vessel with significant disease) + angina in the previous 6 weeks were compared to similar patients without angina. Time to event was examined using Kaplan-Meier Methods for all-cause mortality (ACM), ACM + non-fatal myocardial infarction (NFMI), ACM + rehospitalization (rehosp) and CV death + CV rehosp.ResultsOf the 2,526 patients with ICM, 59% had angina. They had more comorbidities and more prior revascularization than asymptomatic patients (Table 1). Both groups had high prescription rates of anti-platelets, statins and beta-blockers. Symptomatic patients had similarly high event rates for mortality, NFMI and rehospitalization compared to those without angina (Table 2).ConclusionTable 1Baseline characteristics for ICM patients with and without angina*ParameterTotal Cohort (n = 2526)ICM + angina (N = 1487)ICM without angina (N = 1039)P-valueAge, yr65 (55,73)64 (55,73)65 (56,73)0.19Male7474740.82Black2221240.02Hx HTN717367<0.01Hx DM3536340.20Hx HLD606652<0.01Hx PVD1314110.03Hx Smoking576251<0.01Hx MI6768660.32Hx PCI404335<0.01Hx CABG2626260.90NYHS III/IV252230<0.013 vessel disease545751<0.01ASA9292910.26Beta-blocker9090900.82ACE-I/ARB8382850.04Clopidogre 1505345<0.01Statin7576730.12∗Presented as % for categorical variables and by the medians and first and third quartiles for continuous variables. Open table in a new tab Table 2Event rates (%) for ICM Patients with and without angina.OutcomeSymptom BurdenTime6 mos1 yr3 yr7 yrP-valueDeathNo Angina12173254Angina101529500.04Death/MINo Angina14203658Angina121834550.08Death/RehospNo Angina48597690Angina465979920.34CV Death/CV RehospNo Angina22294056Angina232943580.18 Open table in a new tab BackgroundIschemic etiology is a significant independent predictor of mortality in patients with heart failure (HF). We compared the clinical characteristics and outcomes of ICM patients with and without angina in a cohort of HF patients with systolic dysfunction. Ischemic etiology is a significant independent predictor of mortality in patients with heart failure (HF). We compared the clinical characteristics and outcomes of ICM patients with and without angina in a cohort of HF patients with systolic dysfunction. MethodsPatients undergoing coronary angiography at Duke University Medical Center from January 2000 to September 2009 with systolic HF (EF < 40%) and a diagnosis of ICM (≥ 1 coronary vessel with significant disease) + angina in the previous 6 weeks were compared to similar patients without angina. Time to event was examined using Kaplan-Meier Methods for all-cause mortality (ACM), ACM + non-fatal myocardial infarction (NFMI), ACM + rehospitalization (rehosp) and CV death + CV rehosp. Patients undergoing coronary angiography at Duke University Medical Center from January 2000 to September 2009 with systolic HF (EF < 40%) and a diagnosis of ICM (≥ 1 coronary vessel with significant disease) + angina in the previous 6 weeks were compared to similar patients without angina. Time to event was examined using Kaplan-Meier Methods for all-cause mortality (ACM), ACM + non-fatal myocardial infarction (NFMI), ACM + rehospitalization (rehosp) and CV death + CV rehosp. ResultsOf the 2,526 patients with ICM, 59% had angina. They had more comorbidities and more prior revascularization than asymptomatic patients (Table 1). Both groups had high prescription rates of anti-platelets, statins and beta-blockers. Symptomatic patients had similarly high event rates for mortality, NFMI and rehospitalization compared to those without angina (Table 2). Of the 2,526 patients with ICM, 59% had angina. They had more comorbidities and more prior revascularization than asymptomatic patients (Table 1). Both groups had high prescription rates of anti-platelets, statins and beta-blockers. Symptomatic patients had similarly high event rates for mortality, NFMI and rehospitalization compared to those without angina (Table 2). ConclusionTable 1Baseline characteristics for ICM patients with and without angina*ParameterTotal Cohort (n = 2526)ICM + angina (N = 1487)ICM without angina (N = 1039)P-valueAge, yr65 (55,73)64 (55,73)65 (56,73)0.19Male7474740.82Black2221240.02Hx HTN717367<0.01Hx DM3536340.20Hx HLD606652<0.01Hx PVD1314110.03Hx Smoking576251<0.01Hx MI6768660.32Hx PCI404335<0.01Hx CABG2626260.90NYHS III/IV252230<0.013 vessel disease545751<0.01ASA9292910.26Beta-blocker9090900.82ACE-I/ARB8382850.04Clopidogre 1505345<0.01Statin7576730.12∗Presented as % for categorical variables and by the medians and first and third quartiles for continuous variables. Open table in a new tab Table 2Event rates (%) for ICM Patients with and without angina.OutcomeSymptom BurdenTime6 mos1 yr3 yr7 yrP-valueDeathNo Angina12173254Angina101529500.04Death/MINo Angina14203658Angina121834550.08Death/RehospNo Angina48597690Angina465979920.34CV Death/CV RehospNo Angina22294056Angina232943580.18 Open table in a new tab ∗Presented as % for categorical variables and by the medians and first and third quartiles for continuous variables.