Risk of Stroke in Chronic Heart Failure Patients Without Atrial Fibrillation: Analysis of the Controlled Rosuvastatin in Multinational Trial Heart Failure (CORONA) and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza Cardiaca-Heart Failure (GISSI-HF) Trials.

Abstract

BACKGROUND:

Our aim was to describe the incidence and predictors of stroke in patients who have heart failure without atrial fibrillation (AF).

METHODS AND RESULTS:

We pooled 2 contemporary heart failure trials, the Controlled Rosuvastatin in Multinational Trial Heart Failure (CORONA) and the Gruppo Italiano per lo Studio della Sopravvivenza nell'Insufficienza cardiaca-Heart Failure trial (GISSI-HF). Of the 9585 total patients, 6054 did not have AF. Stroke occurred in 165 patients (4.7%) with AF and in 206 patients (3.4%) without AF (rates 16.8/1000 patient-years and 11.1/1000 patient-years, respectively). Using Cox proportional-hazards models, we identified the following independent predictors of stroke in patients without AF (ranked by χ(2) value): age (hazard ratio, 1.34; 95% confidence interval, 1.18-1.63 per 10 years), New York Heart Association class (1.60, 1.21-2.12 class III/IV versus II), diabetes mellitus treated with insulin (1.87, 1.22-2.88), body mass index (0.74, 0.60-0.91 per 5 kg/m(2) up to 30), and previous stroke (1.81, 1.19-2.74). N-terminal pro B-type natriuretic peptide (available in 2632 patients) was also an independent predictor of stroke (hazard ratio, 1.31; 1.11-1.57 per log unit) when added to this model. With the use of a risk score formulated from these predictors, we found that patients in the upper third of risk had a rate of stroke that approximated the risk in patients with AF.

CONCLUSIONS:

A small number of demographic and clinical variables identified a subset of patients who have heart failure without AF at a high risk of stroke.

• Authors: Azmil H Abdul-Rahim, Ana-Cristina Perez, Rachael L Fulton, Pardeep S Jhund, Roberto Latini, Gianni Tognoni, John Wikstrand, John Kjekshus, Gregory Y H Lip, Aldo P Maggioni, Luigi Tavazzi, Kennedy R Lees, John J V McMurray, Investigators of the Controlled Rosuvastatin Multinational Study in Heart Failure (CORONA), GISSI-Heart Failure (GISSI-HF) Committees and Investigators
• Journal: Circulation (Circulation) Vol. 131 Issue 17 Pg. 1486-94; discussion 1494 (Apr 28 2015) ISSN: 1524-4539 [Electronic] United States
• PMID: 25810334 (Publication Type: Journal Article, Meta-Analysis, Research Support, Non-U.S. Gov't)
• Copyright: © 2015 American Heart Association, Inc.

Chemical References

• Benzimidazoles
• Biomarkers
• Biphenyl Compounds
• Cardiovascular Agents
• Fatty Acids, Omega-3
• Fluorobenzenes
• Hydroxymethylglutaryl-CoA Reductase Inhibitors
• Peptide Fragments
• Pyrimidines
• Sulfonamides
• Tetrazoles
• pro-brain natriuretic peptide (1-76)
• Natriuretic Peptide, Brain
• Rosuvastatin Calcium
• candesartan

Topics

• Adult
• Aged
• Aged, 80 and over
• Atrial Fibrillation (etiology)
• Benzimidazoles (therapeutic use)
• Biomarkers (blood)
• Biphenyl Compounds
• Cardiovascular Agents (therapeutic use)
• Diabetes Mellitus, Type 1 (complications)
• Fatty Acids, Omega-3 (therapeutic use)
• Female
• Fluorobenzenes (therapeutic use)
• Follow-Up Studies
• Heart Failure (complications, drug therapy)
• Humans
• Hydroxymethylglutaryl-CoA Reductase Inhibitors (therapeutic use)
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Natriuretic Peptide, Brain (blood)
• Peptide Fragments (blood)
• Proportional Hazards Models
• Pyrimidines (therapeutic use)
• Randomized Controlled Trials as Topic
• Risk Factors
• Rosuvastatin Calcium
• Stroke (epidemiology, etiology, prevention & control)
• Stroke Volume
• Sulfonamides (therapeutic use)
• Tetrazoles (therapeutic use)