European Heart Journal Advance Access originally published online on June 21, 2005
European Heart Journal 2005 26(20):2114-2119; doi:10.1093/eurheartj/ehi352
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Heart failure on admission and the risk of stroke following acute myocardial infarction: the VALIANT registry
1Department of Cardiology, Karolinska University Hospital Huddinge, Stockholm, Sweden
2Brigham and Women's Hospital, Boston, MA, USA
3Division of Cardiology, Department of Medicine, Duke University Medical Center and Duke Clinical Research Institute, Durham, NC, USA
4University of Glasgow, Glasgow, UK
5University of Toronto, Ontario, Canada
6Italian Association of Hospital Cardiologists Research Center, Florence, Italy
7Green Lane Cardiovascular Service, Auckland City Hospital, Private Bag 92 024, Auckland 1003, New Zealand
Received 22 October 2004; revised 11 February 2005; accepted 28 April 2005; online publish-ahead-of-print 21 June 2005.
* Corresponding author. Tel: +64 9 307 4949 ext. 23669; fax: +64 9 307 4949 ext. 23670. E-mail address: harveyw{at}adhb.govt.nz
This paper was guest edited by Prof. Freek W.A. Verheugt, University Medical Center Nijmegen, The Netherlands
Aims We sought to assess the relative contribution of heart failure (HF) on admission for an acute myocardial infarction (MI) to the subsequent in-hospital stroke risk.
Methods and results The VALsartan In Acute myocardial iNfarcTion (VALIANT) registry enrolled 5573 consecutive MI patients at 84 international sites from 1999 to 2001. We calculated odds ratios (ORs) for stroke and adjusted for baseline characteristics, Killip Class, and risk factors for stroke, such as diabetes and prior HF.
In-hospital stroke occurred in 81 (1.5%) patients. HF was present on admission in 38% of patients who developed a stroke and in 24% who did not (P=0.001). Older age (OR 1.03 increase/year, 95% confidence interval (CI) 1.01–1.04), Killip Class III (OR 1.66, CI 0.86–3.19) or IV (OR 4.85, CI 1.69–13.93), history of hypertension (OR 1.73, CI 1.06–2.82), and history of stroke (OR 1.89, CI 1.06–3.37) were more common in patients who had in-hospital stroke. In-hospital mortality in patients with and without stroke was 27.2 and 6.5%, respectively (P<0.001).
Conclusion Patients with stroke after MI have a dismal prognosis. The presence of HF on admission for an acute MI increases in-hospital stroke risk. HF treatments may modify the risk of stroke.
Key Words: Stroke • Risk factors • Myocardial infarction
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