Abstract 12951: Predictors of Incident Heart Failure in Patients with Stable Coronary Heart Disease
Background: Coronary heart disease (CHD) is a major cause of heart failure (HF). Availability of risk prediction models for HF in CHD patients that include both clinical parameters and biomarkers is limited. We aimed to develop such a model in patients with stable CHD.
Method: The LIPID study recruited 9014 patients with myocardial infarction or hospitalisation for unstable angina 3-36 months previously. They were randomised to receive pravastatin 40mg daily or placebo and had a median of 6 years follow-up. All patients with a NYHA class>1 at baseline were excluded (n=858). A Cox proportional hazards model was used to determine independent predictors of a first HF event (HF hospitalisation or death). The c-statistic and net reclassification improvement (NRI) were used to assess the predictive usefulness of models containing only clinical parameters and after addition of novel biomarkers.
Results: Among the 8156 patients, median age was 62 years (IQR 55-67 years) and 84% were male. Overall 653 (8%) patients experienced a heart failure event during follow-up. Older age, history of claudication or diabetes mellitus, LDL>100mg/dl, heart rate >70bpm and several baseline medications (ACEI, digoxin, nitrates, and diuretics) were associated with increased risk of HF. However aspirin reduced the risk by 22% (HR 0.78, 95%CI 0.63-0.96). Among 7017 patients with biomarkers there was an increased risk of developing HF with higher troponin I (>0.018 v 0.006 ng/ml) (HR 1.91, 95% CI 1.52-2.38), higher cystatin C (>0.93 v 50.29 pg/ml (HR 1.94, 95%CI 1.61-2.32), higher hsCRP (>4.8 v 273 v ≤112) ng/ml (HR 1.48, 95%CI 1.13-1.94). The addition of all of these biomarkers to the clinical risk model improved the model c-statistic from 0.74 to 0.78 and NRI was 19.5% using predicted 5-year risk categories of ≤5, 5-10, 10-20 and >20%.
Conclusion: Incident heart failure was predicted by age, diabetes, history of claudication, elevated LDL-C and heart rate>70 per minute. The addition of a multi-biomarker panel markedly improved discrimination and risk classification for heart failure, which may significantly enhance clinical management of patients with stable CHD.
- © 2013 by American Heart Association, Inc.