Carbohydrate Antigen 125-Guided Therapy Superior to Standard of Care in Heart Failure

CA 125 in Acute Heart Failure
CA 125 in Acute Heart Failure
Carbohydrate antigen 125 strategy significantly reduced death and acute heart failure readmissions.

Carbohydrate antigen 125-guided therapy (CA125-strategy) was superior compared to standard of care in reducing death and acute heart failure readmission, according to results from the CHANCE-HF (Carbohydrate Antigen 125-guided Therapy in Acute Heart Failure) trial.

Julio Núñez, MD, of Hospital Clínico Universitario in Valenica, Spain, and colleagues conducted a prospective multicenter randomized trial to compare the CA125-strategy and standard of care after hospitalization for acute heart failure. Their findings were published in JACC: Heart Failure.

“In recent years, CA125, a widely available biomarker used for ovarian cancer monitoring, has emerged as a potential surrogate of fluid retention and inflammation activity in AHF [acute heart failure],” the authors wrote. “Published data has shown that high levels of this glycoprotein, which is present in up to two-thirds of patients hospitalized for AHF, correlate with the severity of AHF and relate to morbidity and mortality.”

After discharge for acute heart failure, 380 patients (mean age: 73.7 ± 11.1 years; 44.2% female) were randomly assigned to receive CA125-strategy (n=187) or standard of care (n=193).

The primary end point was a 1-year composite of death and acute heart failure readmission. Secondary end points included the composite of 1-year death or readmission for any cause, all-cause mortality and the number of days out of the hospital, recurrent hospitalizations, worsening heart failure episodes not requiring hospitalization, and depiction of CA125 and natriuretic peptides’ trajectories during follow-up.

Patients who were in the CA125-strategy group had more ambulatory visits compared to those in the standard of care group (5.97 vs 5.23 visits/person-years, respectively; incidence rate ratio [IRR]: 1.14; P=.003). There was no difference in prescription frequencies for many therapeutic agents between groups. However, statins were more frequently prescribed in the CA125-strategy group, both at randomization (82.4% vs 53.4%; P<.001) and at the trial end (78.1% vs 41.5%; P<.001).

For the primary end point, CA125-strategy significantly reduced the proportion of events (35.3% vs 43.5%; P=.101). In addition, on average, patients in the CA125-strategy had 30 days more time free of events in a 1-year framework.

The composite of death and/or any rehospitalization occurred in 44.9% of CA125-strategy patients vs 50.3% of standard of care patients (P=.297), whereas there were no differences in all-cause mortality and days alive and out of hospital between the 2 arms.

Rate of recurrent acute heart failure and all-cause hospitalizations were significantly reduced using the CA125-strategy (85 vs 165 recurrent heart failure events; IRR: 0.49; 95% confidence interval [CI]: 0.28-0.82; P=.008 and 132 vs 202 all-cause hospitalizations; IRR: 0.61; 95% CI: 0.39-0.96; P=.033).

“Larger studies are needed to confirm our results and define the real clinical impact of the CA125-guided therapy after an episode of AHF,” researchers concluded.


Núñez J, Llàcer P, Bertomeu-González V, et al; for the CHANCE-HF Investigators. Carbohydrate antigen 125-guided therapy in acute heart failure (CHANCE-HF). A randomized study. JACC Heart Fail. 2016. doi:10.1016/j.jchf.2016.06.007.