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European Heart Journal Advance Access originally published online on February 28, 2008
European Heart Journal 2008 29(6):748-756; doi:10.1093/eurheartj/ehn062
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2008. For permissions please email: journals.permissions@oxfordjournals.org

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

Eldrin F. Lewis1,*, Eric J. Velazquez2, Scott D. Solomon1, Anne S. Hellkamp2, John J.V. McMurray3, Jasmine Mathias2, Jean-Lucien Rouleau4, Aldo P. Maggioni5, Karl Swedberg6, Lars Kober7, Harvey White8, Anthony J. Dalby9, Gary S. Francis10, Faiez Zannad11, Robert M. Califf2 and Marc A. Pfeffer1

1 Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, 75 Francis Street, Boston, MA 02115, USA
2 Duke University Medical Center, Duke Clinical Research Institute, Durham, NC, USA
3 Western Infirmary, Glasgow, UK
4 Montreal Heart Institute, Montreal, Quebec, Canada
5 ANMCO Research Center, Florence, Italy
6 Sahlgrenska University Hospital-Ostra, Goteborg, Sweden
7 Rigshospitalet, Copenhagen, Denmark
8 Auckland City Hospital, Auckland, New Zealand
9 Milpark Hospital, Johannesburg, South Africa
10 Cleveland Clinic Foundation, Cleveland, OH, USA
11 Hopital Jeanne d’Arc, Dommartin-Les-Toul, France

Received 28 August 2007; revised 18 January 2008; accepted 23 January 2008; online publish-ahead-of-print 28 February 2008.

* Corresponding author. Tel: +1 617 525 7057, Fax: +1 617 582 6027, Email: eflewis{at}partners.org

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 ~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.

Key Words: Myocardial infarction • Heart failure • Hospitalization • Predictors • Mortality


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