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)

• Published in: European heart journal 2014-12, Vol.35 (48), p.3426-3433
• Main Authors: Badar, Athar A, Perez-Moreno, Ana Cristina, Jhund, Pardeep S, Wong, Chih M, Hawkins, Nathaniel M, Cleland, John G F, van Veldhuisen, Dirk J, Wikstrand, John, Kjekshus, John, Wedel, Hans, Watkins, Stuart, Gardner, Roy S, Petrie, Mark C, McMurray, John J V
• Format: Article
• Language: English
• Subjects: Aged; Angina pectoris; Angina Pectoris - complications; Angina Pectoris - mortality; Angina Pectoris - physiopathology; Cardiac & Cardiovascular Systems; CLINICAL DETERMINANTS; Clinical Medicine; COMET; DISEASE; Female; Fluorobenzenes - administration & dosage; Heart failure; Heart Failure - complications; Heart Failure - drug therapy; Heart Failure - mortality; Humans; Hydroxymethylglutaryl-CoA Reductase Inhibitors - administration & dosage; ISCHEMIC CARDIOMYOPATHY; Kaplan-Meier Estimate; Klinisk medicin; Male; Middle Aged; MORTALITY; PREDICTORS; Pyrimidines - administration & dosage; Reduced ejection fraction; Retrospective Studies; Rosuvastatin Calcium; Stroke Volume - physiology; Sulfonamides - administration & dosage; Treatment Outcome; Ventricular Dysfunction, Left - complications; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehu342

Angina pectoris is common in patients with heart failure and reduced ejection fraction (HF-REF) but its relationship with outcomes has not been well defined. This relationship was investigated further in a retrospective analysis of the Controlled Rosuvastatin Multinational Trial in Heart Failure (CORONA). Four thousand, eight hundred and seventy-eight patients were divided into three categories: no history of angina and no chest pain at baseline (Group A; n = 1240), past history of angina but no chest pain at baseline (Group B; n = 1353) and both a history of angina and chest pain at baseline (Group C; n = 2285). Outcomes were examined using Kaplan-Meier and Cox regression survival analysis. Compared with Group A, Group C had a higher risk of non-fatal myocardial infarction or unstable angina (HR: 2.36, 1.54-3.61; P < 0.001), this composite plus coronary revascularization (HR: 2.54, 1.76-3.68; P < 0.001), as well as HF hospitalization (HR: 1.35, 1.13-1.63; P = 0.001), over a median follow-up period of 33 months. There was no difference in cardiovascular or all-cause mortality. Group B had a smaller increase in risk of coronary events but not of heart failure hospitalization. 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.