Complete revascularization with PCI is not always achieved in patients with ischemic HF. Therefore, this study aimed to elucidate the prognostic impact of residual coronary stenosis (RS) after ...percutaneous coronary intervention (PCI) in patients with ischemic heart failure (HF).
We analyzed a total of 1307 patients with symptomatic HF and a history of PCI registered in our Chronic Heart Failure Analysis and Registry in the Tohoku District-2 (CHART-2) Study. RS that was defined as the presence of ≥70% luminal stenosis in major coronary arteries at the last coronary angiography.
Among the study population, 851 patients (65.1%) had RS. During a median follow-up period of 3.2 years, patients with RS had higher all-cause mortality than those without it even after propensity score matching (21.9 vs. 11.6%, log-rank P = 0.027). Multivariable Cox hazard analysis also showed the negative impact of RS on all-cause death in ischemic HF patients hazard ratio (HR):1.62, 95% confidence interval (CI): 1.07–2.46, P = 0.024. Importantly, when divided all subjects into three subgroups by left ventricular ejection fraction (LVEF) LVEF < 40% (HFrEF), LVEF 40–49% (HFmrEF), and LVEF ≥ 50% (HFpEF), inverse probability of treatment weighted method provided a similar result that RS after PCI was an independent risk factor for death in the HFpEF HR(95%CI); 1.94(1.22–3.09), P < 0.01 and HFmrEF 4.47(1.13–14.98), P < 0.01 groups, but not in the HFrEF group 1.20(0.59–2.43), P = 0.62.
These results indicate that RS after PCI could aggravate long-term prognosis of ischemic HF patients with moderate- to well-preserved EF, but not those with reduced EF.
•Prognostic impact of residual coronary stenosis after PCI in HF patients was examined.•Residual coronary stenosis was significantly associated with higher all-cause mortality.•Those findings were documented in those with HFpEF and HFmrEF, but not HFrEF.
Several studies have reported that C-reactive protein (CRP), an inflammatory biomarker, predicts cardiovascular events independently of low-density lipoprotein cholesterol levels. However, no study ...examined whether temporal changes in CRP levels are associated with clinical events in patients with previous myocardial infarction (MI).
We examined 2184 consecutive patients with previous MI and CRP data at baseline in the Chronic Heart Failure Registry and Analysis in the Tohoku district-2 (CHART-2) Study. During the median 6.4 years follow-up, 592 all-cause, 245 cardiovascular, and 273 non-cardiovascular deaths occurred. Patients with CRP ≥ 2.0 mg/L at baseline had significantly increased incidence of all-cause (hazard ratio (HR) 1.68, P < 0.001) and non-cardiovascular death (HR 1.86, P < 0.001), compared with those with CRP < 2.0 mg/L. Temporal changes in CRP levels were associated with prognosis; among patients with CRP ≥ 2.0 mg/L at baseline, those with CRP ≥ 2.0 mg/L at 1-year had significantly increased incidence of all-cause (HR 2.12, P < 0.001), cardiovascular (HR 2.31, P < 0.001), and non-cardiovascular death (HR 2.29, P < 0.001). Among patients with CRP < 2.0 mg/L at baseline, those with CRP ≥ 2.0 mg/L at 1-year had significantly increased incidence of all-cause (HR 1.76, P < 0.001) and cardiovascular death (HR 2.10, P = 0.001). These results remained significant after adjusted with the inverse probability of treatment weighted models using propensity sore. Furthermore, as compared with patients with CRP < 2.0 mg/L at both baseline and 1-year, those with CRP ≥ 2.0 mg/L at both baseline and 1-year had increased incidence of all-cause, cardiovascular, and non-cardiovascular death.
These results provide the evidence that temporal increases in CRP levels are associated with increased clinical events in patients with previous MI.
•We assessed the association between temporal changes in CRP levels and prognosis.•Elevated CRP levels were associated with worse outcomes.•Persistent inflammation is associated with increased mortality.
