Original Article
Temporal Changes in Characteristics, Treatment and Outcomes of Heart Failure Patients Undergoing Percutaneous Coronary Intervention Findings From Melbourne Interventional Group Registry

https://doi.org/10.1016/j.hlc.2018.03.030Get rights and content

Background

Limited data exist on whether outcomes of patients with heart failure (HF) undergoing percutaneous coronary intervention (PCI) have improved over time. The purpose of this study was to assess temporal trends in patient characteristics, treatment and outcomes of patients with HF undergoing PCI.

Methods

Using data from the Melbourne Interventional Group (MIG), we evaluated temporal trends of procedure volume, major adverse cardiac events (MACE; a composite of all-cause mortality, myocardial infarction and target vessel revascularisation) and rates of cardiovascular readmission, all-cause death and cardiovascular death in consecutive patients with HF undergoing PCI. Change over time was assessed by Box-Jenkins autoregressive integrated moving average (ARIMA) models.

Results

Data from 1,604 patients were analysed. In our cohort, there were no significant changes in the number of procedures performed annually and patient characteristics between January 2005 and December 2014. Optimal use of HF therapy has improved over the study period. Planned clopidogrel therapy of more than 12 months increased in tandem with increasing use of drug-eluting stents (DES). Procedural success was high (≥90%). However, the rates of MACE, cardiovascular readmission, all-cause death and cardiovascular death remained unchanged throughout the study period.

Conclusions

Clinical outcomes in HF patients undergoing PCI have remained unchanged despite improvement in medical technology and contemporary therapeutic measures.

Introduction

Coronary artery disease is the most common cause of heart failure (HF) in the developed world, associated with over 60% of cases [1], [2]. The presence and extent of coronary artery disease may augment the progression of HF, leading to higher mortality among ischaemic compared with non-ischaemic HF patients [3].

Revascularisation is advocated to improve ventricular function and prognosis for patients with ischaemic cardiomyopathy [4], and there is an increasing number of patients with left ventricular dysfunction referred for revascularisation [5]. Both pre-existing HF and the development of de novo HF as a complication of acute myocardial infarction (AMI) are associated with poorer outcomes [6], [7].

To date, limited data exist on temporal trends of HF patients undergoing percutaneous coronary intervention (PCI). Importantly, the impact of changing medical technology and contemporary therapeutic measures on this high risk subset of patients has not been described. To appropriately align efforts towards reducing long-term mortality and morbidity of HF patients who undergo PCI, it is crucial to understand temporal changes in this population.

The Melbourne Interventional Group (MIG) is a clinical registry that captures data pertaining to PCI at six major public hospitals in Victoria, Australia. It provided an opportunity to explore the prevalence and outcomes in the subset of patients with HF. In this study we sought to examine temporal trends in patient characteristics, treatment and outcomes among HF patients undergoing PCI over a period of 10 years.

Section snippets

Study Design and Patient Population

Data were drawn from the MIG registry, which has previously been described in detail [8]. In brief, MIG collects data pertaining to PCI and outcomes at six major public hospitals in Melbourne, Australia. The registry, which currently has enrolled over 25,000 patients, documents demographic, clinical and procedural characteristics of all patients undergoing PCI and captures information about medications and outcomes at 30 days and 12 months. These include rehospitalisation and its causes, death

Results

Table 1, Table 2 summarise patient and procedural characteristics for the cohort. A total of 1,604 HF patients (7.1% of the overall cohort) were included in the MIG registry between 2005 and 2014. Overall, patients had a weighted mean age of 70.2 years, 71% were male, 68% had a history of smoking and 64.4% had no or mild HF symptoms (i.e. New York Heart Association [NYHA] functional class I and II). In addition, 78.5% were hypertensive, 74.6% were dyslipidaemic and 71.7% were overweight/obese

Discussion

We described temporal changes in patient characteristics, treatment and outcomes of HF patients undergoing PCI over a time period of 10 years in the Australian public hospital setting. Our group has previously reported trends in baseline characteristics and outcomes among overall patients enrolled in the MIG registry [12]. As anticipated, patients with HF in the registry were elderly, with multiple diseased coronary vessels and co-morbidities. There was greater use of drug eluting stents and

Limitations

Several limitations in our study warrant mention. Our analyses are descriptive and do not provide causal explanations for the observations. The ARIMA models may be limited by the operational characteristics of the four sites studied and may not be representative of other centres. However, all sites under consideration are large, tertiary referral institutions and perform high volumes of PCI. Separate subgroup analyses based on important clinical characteristics such as acute/chronic HF,

Conclusion

In conclusion, we found that the temporal changes in patient characteristics, treatment and outcomes of patients with HF undergoing PCI enrolled in the MIG registry remained relatively stable from 2005 to 2014. We predict that these trends would persist over the short-term.

Acknowledgements

KLC receives a PhD scholarship from the Ministry of Education, Malaysia. This work was supported by a NHMRC Program Grant (1092642) awarded to CMR. CMR is supported by a Research Fellowship (1045862) from the National Health and Medical Research Council of Australia (NHMRC). IH is supported by a National Health and Medical Research Council Early Career Fellowship (1113314). SJD’s work is supported by NHMRC grants.

Sources of Funding

The Melbourne Interventional Group acknowledges funding from Abbott, Astra-Zeneca, Biotronik, Boston Scientific, Bristol-Myers Squibb, Cordis Johnson & Johnson, CSL, Medtronic, MSD, Pfizer, Sanofi-Aventis, Servier, Schering-Plough, and The Medicines Company. The funding bodies had no role in the design and conduct of the study, the collection, management, analysis and interpretation of the data, or the preparation, review, or approval of the manuscript.

Conflict of Interest

The authors have no conflicts of interest

References (32)

  • R.S.B. Beanlands et al.

    F-18-Fluorodeoxyglucose positron emission tomography imaging-assisted management of patients with severe left ventricular dysfunction and suspected coronary disease: a randomized, controlled trial (PARR-2)

    J Am Coll Cardiol

    (2007)
  • M. Gheorghiade et al.

    Navigating the crossroads of coronary artery disease and heart failure

    Circulation

    (2006)
  • G.M. Felker et al.

    Underlying causes and long-term survival in patients with initially unexplained cardiomyopathy

    N Engl J Med

    (2000)
  • J.G.F. Cleland et al.

    The heart failure revascularisation trial (HEART)

    Eur J Heart Fail

    (2011)
  • K.J. Lu et al.

    Impact of concomitant heart failure on outcomes in patients undergoing percutaneous coronary interventions: analysis of the Melbourne Interventional Group registry

    Eur J Heart Fail

    (2011)
  • U. Helfenstein

    Box-Jenkins modelling in medical research

    Stat Methods Med Res

    (1996)
  • View full text