Copyright © 2004 by the European Society of Cardiology.
Clinical research
An international perspective on heart failure and left ventricular systolic dysfunction complicating myocardial infarction: the VALIANT registry
a Division of Cardiology, Department of Medicine, Duke University Medical Center and Duke Clinical Research Institute, P.O. Box 17969, Durham, NC 27715, USA
b The Cleveland Clinic Foundation, Cleveland, OH, USA
c University of Alberta, Edmonton, Alberta, Canada
d Flinders Medical Centre, Bedford Park, South Australia
e Estudios Cardiologicos, Latinoamerica, Santa Fe, Argentina
f Green Lane Hospital, Auckland, New Zealand
g Medical Pharmaceutical Consultants, Randolph, NJ, USA
h Rijksuniversiteit Groningen, Groningen, The Netherlands
i Medizinische Universitätsklinik, Würzburg, Germany
j ANMCO Research Center, Florence, Italy
k Faculty Hospital of St. Anna, Brno, Czech Republic
l Henry Ford Hospital, Detroit, MI, USA
m University of Toronto, Ont., Canada
n University of Glasgow, Glasgow, UK
o Brigham and Women's Hospital, Boston, MA, USA
Received October 2, 2003; revised July 20, 2004; accepted August 5, 2004 * Corresponding author. Tel.: +1 919 668 8041; fax: +1 919 668 7169 (E-mail: velaz002{at}dcri.duke.edu).
AIMS: We analysed the contemporary incidence, outcomes, and predictors of heart failure (HF) and/or left ventricular systolic dysfunction (LVSD) before discharge in patients with acute myocardial infarction (MI).
The baseline presence of HF or LVSD, or its development during hospitalisation, increases short- and long-term risk after MI, yet its incidence, predictors, and outcomes have not been well described in a large, international, general MI population.
METHODS AND RESULTS: The VALIANT registry included 5573 consecutive MI patients at 84 hospitals in nine countries from 1999 to 2001. A multivariable logistic survival model was constructed using baseline variables to determine the adjusted mortality risk for those with in-hospital HF and/or LVSD. Baseline variables were also tested for associations with in-hospital HF and/or LVSD.
Of the 5566 patients analysed, 42% had HF and/or LVSD during hospitalisation. Their in-hospital mortality rate was 13.0% compared with 2.3% for those without HF and/or without LVSD. After adjustment for other baseline risk factors, in-hospital HF and/or LVSD carried a hazard ratio for in-hospital mortality of 4.12 (95% confidence interval: 3.08–5.56). Patients with HF and/or LVSD also had disproportionately higher rates of other cardiovascular events.
CONCLUSIONS: HF and/or LVSD is common in the general contemporary MI population and precedes 80.3% of all in-hospital deaths after MI. Survivors of early MI-associated HF and/or LVSD have more complications, longer hospitalisations, and are more likely to die during hospitalisation. Although baseline variables can identify MI patients at highest risk for HF and/or LVSD, such patients are less likely to receive indicated procedures and medical therapies.
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