Abstract：
BACKGROUND: Coronary artery disease (CAD) is a common underlying cause of de novo heart failure (HF) and is associated with poor outcome despite advances in medical therapy. There are no data clearly supporting coronary angiogram (CVG) and revascularization in this setting.
METHODS: We analysed a nationwide, comprehensive, and universal administrative database of consecutive patients for the first time admitted in hospital for HF, without a history of CAD, who survived 30 days after index admission from 2015 to 2019 in Italy. Enrolled patients were classified into subjects who did not undergo CVG; those who underwent CVG without coronary revascularization; those who underwent percutaneous coronary intervention (PCI); and those who underwent coronary artery bypass grafting (CABG).
RESULTS: During the study period, 342,090 patients were hospitalized for the first time due to HF and survived 30 days after admission, in Italy. Among them, 30,806 (9.0%) patients underwent CVG without undergoing coronary revascularization, 5855 (1.7%) underwent PCI and 1594 (0.5%) underwent CABG. After adjusting for age, gender and comorbidity, the hazard ratio (HR) for 1-year all-cause mortality in patients undergoing CVG vs no CVG were 0.56 (p < 0.0001), 0.66 (p < 0.0001) and 0.83 (p = 0.020) for CVG, PCI and CABG patients, respectively. When considering the re-hospitalization for HF as the outcome, using death as a competing risk, after multiple corrections, CVG (HR = 0.80; p < 0.0001) and CABG (HR = 0.73; p < 0.0002) were protective versus No CVG, but not PCI (HR = 1.02; p = 0.642).
CONCLUSIONS: This study provides evidence that CVG and coronary revascularization may be beneficial for patients with de novo HF.
METHODS: We analysed a nationwide, comprehensive, and universal administrative database of consecutive patients for the first time admitted in hospital for HF, without a history of CAD, who survived 30 days after index admission from 2015 to 2019 in Italy. Enrolled patients were classified into subjects who did not undergo CVG; those who underwent CVG without coronary revascularization; those who underwent percutaneous coronary intervention (PCI); and those who underwent coronary artery bypass grafting (CABG).
RESULTS: During the study period, 342,090 patients were hospitalized for the first time due to HF and survived 30 days after admission, in Italy. Among them, 30,806 (9.0%) patients underwent CVG without undergoing coronary revascularization, 5855 (1.7%) underwent PCI and 1594 (0.5%) underwent CABG. After adjusting for age, gender and comorbidity, the hazard ratio (HR) for 1-year all-cause mortality in patients undergoing CVG vs no CVG were 0.56 (p < 0.0001), 0.66 (p < 0.0001) and 0.83 (p = 0.020) for CVG, PCI and CABG patients, respectively. When considering the re-hospitalization for HF as the outcome, using death as a competing risk, after multiple corrections, CVG (HR = 0.80; p < 0.0001) and CABG (HR = 0.73; p < 0.0002) were protective versus No CVG, but not PCI (HR = 1.02; p = 0.642).
CONCLUSIONS: This study provides evidence that CVG and coronary revascularization may be beneficial for patients with de novo HF.
摘要：
背景：冠状动脉疾病（CAD）是新发心力衰竭（HF）的常见潜在原因，尽管药物治疗取得了进展，但与不良预后相关。在这种情况下，没有明确支持冠状动脉造影（CVG）和血运重建的数据。
方法：我们分析了全国范围内的，全面,以及首次住院的连续患者的通用管理数据库，没有CAD的历史，从2015年到2019年，他在意大利的指数录取后存活了30天。纳入的患者分为未接受CVG的受试者；接受CVG但未进行冠状动脉血运重建的受试者；接受经皮冠状动脉介入治疗（PCI）的受试者；以及接受冠状动脉旁路移植术（CABG）的受试者。
结果：在研究期间，342,090例患者因HF首次住院，并在入院后30天存活，在意大利。其中,30,806例（9.0％）患者接受了CVG而未接受冠状动脉血运重建，5855（1.7%）行PCI，1594（0.5%）行CABG。在调整了年龄之后,性别和合并症，CVG与无CVG患者1年全因死亡率的风险比（HR）为0.56（p<0.0001），CVG为0.66（p<0.0001）和0.83（p=0.020），PCI和CABG患者，分别。当考虑心力衰竭的再住院作为结果时，将死亡作为一种竞争风险，经过多次修正,与无CVG相比，CVG（HR=0.80；p<0.0001）和CABG（HR=0.73；p<0.0002）具有保护性，但不是PCI（HR=1.02；p=0.642）。
结论：本研究提供了CVG和冠状动脉血运重建术可能对新发HF患者有益的证据。
方法：我们分析了全国范围内的，全面,以及首次住院的连续患者的通用管理数据库，没有CAD的历史，从2015年到2019年，他在意大利的指数录取后存活了30天。纳入的患者分为未接受CVG的受试者；接受CVG但未进行冠状动脉血运重建的受试者；接受经皮冠状动脉介入治疗（PCI）的受试者；以及接受冠状动脉旁路移植术（CABG）的受试者。
结果：在研究期间，342,090例患者因HF首次住院，并在入院后30天存活，在意大利。其中,30,806例（9.0％）患者接受了CVG而未接受冠状动脉血运重建，5855（1.7%）行PCI，1594（0.5%）行CABG。在调整了年龄之后,性别和合并症，CVG与无CVG患者1年全因死亡率的风险比（HR）为0.56（p<0.0001），CVG为0.66（p<0.0001）和0.83（p=0.020），PCI和CABG患者，分别。当考虑心力衰竭的再住院作为结果时，将死亡作为一种竞争风险，经过多次修正,与无CVG相比，CVG（HR=0.80；p<0.0001）和CABG（HR=0.73；p<0.0002）具有保护性，但不是PCI（HR=1.02；p=0.642）。
结论：本研究提供了CVG和冠状动脉血运重建术可能对新发HF患者有益的证据。
