Abstract 14315: Invasive versus Conservative Strategy for Stable Coronary Artery Disease in Patients With Asymptomatic Heart Failure With Reduced Ejection Fraction

Abstract

Introduction: In asymptomatic heart failure patients with reduced ejection fraction (HFrEF), an ischemia evaluation is part of the routine diagnostic work up. Nonetheless, in asymptomatic HFrEF patients with stable ischemic heart disease (SIHD) and intermediate to high-risk findings on nuclear perfusion study, the decision to pursue conservative medical therapy versus an early invasive strategy remains debatable. To address this conundrum, we performed a retrospective analysis. Method: A total of 451 patients with SIHD and HFrEF were followed for at least 16 months. All patients were classified as intermediate to high-risk based on their nuclear stress test results. Patients were subsequently dichotomized into two groups depending on whether they underwent an initial invasive approach versus continuing conservative medical therapy. A multivariable Cox regression analysis was performed to compare the primary outcome of all-cause mortality between the two groups. Results: Patients undergoing an initial invasive strategy were younger (68.3 ± 11.5 vs 71.3 ± 11.8 years, P = 0.001) and more likely to have a prior percutaneous coronary intervention (PCI, 50% ± 25.9% vs. 35% ± 13.6%, P = 0.001) compared to the medical therapy group. On multivariable analysis, after adjusting for demographics and confounding factors, there was no difference in all-cause mortality between the two groups (p= 0.120, Figure ). An older age with a prior history of a PCI or a cerebrovascular accident (CVA) were independent predictors of mortality while a history of never smoking was associated with a mortality benefit. Conclusions: In asymptomatic HFrEF patients with SIHD with intermediate to high-risk findings on nuclear stress testing, an initial invasive strategy has no significant mortality benefit when compared to medical therapy. An older age, history of prior PCI or CVA predicted mortality while never smoking provided a mortality benefit.