Abstract 13855: Invasive Versus Conservative Strategy For Stable Coronary Artery Disease In Patients With Heart Failure

Abstract

Introduction: Patients with stable ischemic heart disease (SIHD) and intermediate to high-risk stress tests with underlying heart failure (HF) are at increased risk for cardiovascular death, nonfatal myocardial infarction, or hospitalization for unstable angina and HF. In this patient population, the decision to pursue an early invasive strategy versus continuing medical management remains unclear. To evaluate this conundrum further, we performed a retrospective analysis. Method: We followed 308 SIHD patients with both reduced and preserved ejection fraction HF for a period of at least 16 months. All patients were classified as intermediate to high-risk based on their nuclear stress test results. They were further divided based on whether they underwent an initial invasive strategy versus medical management. A multivariable Cox regression analysis was performed to compare the primary outcome of all-cause mortality and cardiac mortality between the two groups. Results: Patients undergoing an initial invasive strategy were younger (70.64 ± 10.94 vs. 73.7 ± 12.04 years, P = 0.021), with a positive family history (24.4% vs 13.3%, p=0.023) and more likely to have high-risk nuclear stress tests (53.3% vs. 35.9%, p = 0.004) and prior percutaneous coronary intervention (35.0% vs. 23.4%, p =0.04) compared to the medical therapy group. Peripheral Vascular Disease (PVD) was more common in medical treatment group (35.2% vs.17.8%, p=0.001). During follow-up, all-cause death was 19.4% (n=35) vs. 33.6% (n=43), and cardiac death was 3.3% (n=6) vs.15.6% (n=20) in the invasive and medical therapy groups respectively. There was no difference in the all-cause mortality between the two groups, but cardiac mortality was noted to be lower in the invasive strategy group (Figure 1 & 2). Conclusions: In our patient population with SIHD and HF, pursuing an early invasive strategy provided cardiac mortality benefit when compared to conservative medical therapy.