Effect of Rosuvastatin on Repeat Heart Failure Hospitalizations The CORONA Trial (Controlled Rosuvastatin Multinational Trial in Heart Failure)

被引：105

作者：

Rogers, Jennifer K. ^{[1
]}

Jhund, Pardeep S. ^{[2
]}

Perez, Ana-Cristina ^{[2
]}

Boehm, Michael ^{[3
]}

Cleland, John G. ^{[4
]}

Gullestad, Lars ^{[5
]}

Kjekshus, John ^{[5
]}

van Veldhuisen, Dirk J. ^{[6
]}

Wikstrand, John ^{[7
]}

Wedel, Hans ^{[8
]}

McMurray, John J. V. ^{[2
]}

Pocock, Stuart J. ^{[1
]}

机构：

[1] London Sch Hyg & Trop Med, London WC1, England

[2] Univ Glasgow, Inst Cardiovasc & Med Sci, BHF Glasgow Cardiovasc Res Ctr, Glasgow G12 8TA, Lanark, Scotland

[3] Univ Klinikum Saarlandes, Homburg, Germany

[4] Hull York Med Sch, Kingston Upon Hull, Yorks, England

[5] Univ Oslo, Rikshosp, Oslo Univ Hosp, N-0027 Oslo, Norway

[6] Univ Med Ctr Groningen, NL-9713 AV Groningen, Netherlands

[7] Gothenburg Univ, Wallenberg Lab Cardiovasc Res, Sahlgrenska Acad, Gothenburg, Sweden

[8] Nord Sch Publ Hlth, Gothenburg, Sweden

来源：

JACC-HEART FAILURE | 2014年 / 2卷 / 03期

基金：

美国国家卫生研究院;

关键词：

heart failure; hospitalizations; statins; RECURRENT EVENTS; REGRESSION; MODEL;

D O I：

10.1016/j.jchf.2013.12.007

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

Objectives This study sought to examine the effect of statin therapy hospitalizations for heart failure (HFH) in patients in the CORONA (Controlled Rosuvastatin Multinational Trial in Heart Failure) trial. Background HFH is an important, frequently recurrent event. Conventional time-to-first event analyses do not take account repeat events. We used a number of statistical approaches to examine the effect of treatment on first and repeat HFH in the CORONA trial. Methods In the CORONA trial, 5,011 patients >= 60 years of age with chronic New York Heart Association functional classes II to IV systolic heart failure resulting from ischemia were randomized to receive rosuvastatin or placebo. Poisson, Andersen-Gill, and negative binomial methods (NB) were used to analyze the effect of rosuvastatin on HFH, and the NB and a parametric joint frailty model (JF) were used to examine this effect while accounting for the competing risk of cardiovascular (CV) death. Rosuvastatin/ placebo rate ratios were calculated, both unadjusted and adjusted. Results A total of 1,291 patients had 1 or more HFH (750 of these had a single HFH only), and there were a total of 2,408 HFHs. The hazard ratio for the conventional time-to-first event analysis for HFH was 0.91 (95% confidence interval [ CI]: 0.82 to 1.02, p = 0.105). In contrast, the NB on repeat hospitalizations gave an unadjusted RR (RR) for HFH of 0.86 (95% CI: 0.75 to 0.99, p = 0.030), adjusted 0.82 (95% CI: 0.72 to 0.92, p = 0.001), and after including CV death as the last event, adjusted RR of 0.85 (95% CI: 0.77 to 0.94, p = 0.001). The JF gave an adjusted RR of 0.82 (95% CI: 0.73 to 0.92, p = 0.001). Similar results were found in analyses of all CV hospitalizations and all-cause hospitalizations. Conclusions When repeat events were included, rosuvastatin was shown to reduce the risk of HFH by approximately 15% to 20%, equating to approximately 76 fewer admissions per 1,000 patients treated over a median 33 months of follow-up. Including repeat events could increase the ability to detect treatment effects in heart failure trials. (J Am Coll Cardiol HF 2014; 2: 289-97) (C) 2014 by the American College of Cardiology Foundation

引用

页码：289 / 297

页数：9

共 18 条

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