Invasive Coronary Angiography Early in Ischemic Heart Failure

Study Overview
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Brief Summary
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To compare the outcomes of patients with acute heart failure who undergo early coronary angiography vs. usual care

Official Title
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Invasive Coronary Angiography Early in Ischemic Heart Failure (ICE-HF)

Conditions
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Acute Heart Failure

Intervention / Treatment
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* Procedure: Coronary angiography


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Adult patients with acute heart failure, hospitalized in Ontario, Canada, with evidence of possible ischemic heart disease, defined as at least one of: a) prior myocardial infarction, b) troponin elevation, or c) angina. Exclusion Criteria: Recent myocardial infarction Coronary angiogram or revascularization within previous 3 months before admission Nonresidents of Ontario, invalid health card number HF diagnosed after admission Admission BNP or NT-proBNP not diagnostic of HF Died within 14 days of admission Palliative within 6 months prior to hospital admission Elevated creatinine concentration Documented anaphylactic contrast allergy Ischemic or hemorrhagic stroke within 3 months prior to admission Highest category of Hospital Frailty Risk Score Active severe bleeding at time of hospital admission Absolute platelet count < 20 Metastatic cancer

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Early angiography<br>Patients admitted to hospital with acute heart failure undergoing coronary angiography within 14 days of hospital admission | Procedure: Coronary angiography<br>* Coronary angiogram performed either in hospital or post-discharge, within 14 days after initial hospital presentation with heart failure<br>* Other names: Diagnostic coronary angiography;|
| Control<br>Patients admitted to hospital with acute heart failure not undergoing coronary angiography within 14 days | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| All-cause mortality | Death from any cause after 14 days in landmark analysis | 2 years | 
| Cardiovascular mortality | Death due to cardiovascular causes after 14 days in landmark analysis | 2 years | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| All-cause hospital readmission | Readmissions for all causes after 14 days or hospital discharge in landmark analysis | 2 years | 
| Heart failure readmission | Readmissions for heart failure after 14 days or hospital discharge in landmark analysis | 2 years | 
| Readmission for myocardial infarction | Readmissions for myocardial infarction after 14 days or hospital discharge in landmark analysis | 2 years | 
| Rates of revascularization | Coronary revascularization with CABG surgery or PCI procedure | 90 days | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Myocardial infarction, Heart failure, Coronary angiography, Invasive strategy, Troponin