An international perspective on heart failure and left ventricular systolic dysfunction complicating myocardial infarction: The VALIANT registry

Eric J. Velazquez, Gary S. Francis, Paul W. Armstrong, Phillip E. Aylward, Rafael Diaz, Christopher M. O'Connor, Harvey D. White, Marc Henis, Lois M. Rittenhouse, Rakhi Kilaru, Wiek Van Gilst, Georg Ertl, Aldo P. Maggioni, Jiri Spac, W. Douglas Weaver, Jean Lucien Rouleau, John J.V. McMurray, Marc A. Pfeffer, Robert M. Califf

Research output: Contribution to journalArticlepeer-review

101 Citations (Scopus)

Abstract

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. 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. 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.

Original languageEnglish
Pages (from-to)1911-1919
Number of pages9
JournalEuropean Heart Journal
Volume25
Issue number21
DOIs
Publication statusPublished - 1 Nov 2004
Externally publishedYes

Keywords

  • Heart failure
  • Killip class
  • Left ventricular dysfunction
  • Myocardial infarction
  • Prognosis

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