Predictors of the first heart failure hospitalization in patients who are stable survivors of myocardial infarction complicated by pulmonary congestion and/or left ventricular dysfunction: a VALIANT study

TY - JOUR

T1 - Predictors of the first heart failure hospitalization in patients who are stable survivors of myocardial infarction complicated by pulmonary congestion and/or left ventricular dysfunction: a VALIANT study

AU - Lewis, Eldrin F

AU - Velazquez, Eric J

AU - Solomon, Scott D

AU - Hellkamp, Anne S

AU - McMurray, John J V

AU - Mathias, Jasmine

AU - Rouleau, Jean-Lucien

AU - Maggioni, Aldo P

AU - Swedberg, Karl

AU - Køber, Lars Valeur

AU - White, Harvey

AU - Dalby, Anthony J

AU - Francis, Gary S

AU - Zannad, Faiez

AU - Califf, Robert M

AU - Pfeffer, Marc A

N1 - Keywords: Adolescent; Adult; Aged; Female; Heart Failure; Hospitalization; Humans; Male; Middle Aged; Myocardial Infarction; Pulmonary Edema; Risk Assessment; Risk Factors; Ventricular Dysfunction, Left

PY - 2008

Y1 - 2008

N2 - AIMS: We sought to assess the incidence of and prognostic factors for heart failure (HF) hospitalization among survivors of high-risk acute myocardial infarction (MI). METHODS AND RESULTS: We assessed the risk of an initial hospitalization for HF in 11 040 stable MI patients (no major non-fatal cardiovascular events or deaths within 45 days of randomization) without a prior history of HF enrolled in the VALIANT trial. Multivariable models were developed to identify independent predictors of HF and HF or cardiovascular death. Of 11 040 stable post-MI patients, 1139 (10.3%) developed HF during the median 25-month follow-up at a rate of approximately 3.4% per year. Most patients, 824 (72.3%), did not have a symptomatic recurrent MI between randomization and the onset of HF. The most important predictors of HF were older age, antecedent diabetes, prior MI before index MI, and reduced renal function. HF markedly increased the risk of death [HR(hazard ratio) 8.22; 95% CI(confidence interval), 7.49-9.01]. CONCLUSION: HF post high risk-MI occurs in a time-dependent fashion and is usually not directly related to re-infarction. Patients who experience HF beyond the acute phase have increased mortality. Long-term survivors of high-risk MI should be followed closely and treated aggressively beyond the acute MI period.

AB - AIMS: We sought to assess the incidence of and prognostic factors for heart failure (HF) hospitalization among survivors of high-risk acute myocardial infarction (MI). METHODS AND RESULTS: We assessed the risk of an initial hospitalization for HF in 11 040 stable MI patients (no major non-fatal cardiovascular events or deaths within 45 days of randomization) without a prior history of HF enrolled in the VALIANT trial. Multivariable models were developed to identify independent predictors of HF and HF or cardiovascular death. Of 11 040 stable post-MI patients, 1139 (10.3%) developed HF during the median 25-month follow-up at a rate of approximately 3.4% per year. Most patients, 824 (72.3%), did not have a symptomatic recurrent MI between randomization and the onset of HF. The most important predictors of HF were older age, antecedent diabetes, prior MI before index MI, and reduced renal function. HF markedly increased the risk of death [HR(hazard ratio) 8.22; 95% CI(confidence interval), 7.49-9.01]. CONCLUSION: HF post high risk-MI occurs in a time-dependent fashion and is usually not directly related to re-infarction. Patients who experience HF beyond the acute phase have increased mortality. Long-term survivors of high-risk MI should be followed closely and treated aggressively beyond the acute MI period.

U2 - 10.1093/eurheartj/ehn062

DO - 10.1093/eurheartj/ehn062

M3 - Journal article

C2 - 18308687

SN - 0195-668X

VL - 29

SP - 748

EP - 756

JO - European Heart Journal

JF - European Heart Journal

IS - 6

ER -