In-hospital heart failure, first-year ventricular dilatation and 10-year survival after acute myocardial infarction.
BACKGROUND
Little is known about the factors that determine long-term prognosis in patients who have survived the first year after acute myocardial infarction (AMI).


OBJECTIVE
To study the influence of left and right ventricular (LV and RV) dilatation during the first year after AMI on subsequent 10-year survival in comparison with in-hospital heart failure and other established prognostic indices.


METHODS
Radionuclide ventriculography was performed before the era of thrombolysis and post-infarction ACE-inhibition in 57 patients with AMI at hospital discharge and again 1 year later, and compared with survival the ensuing 10 years.


RESULTS
After 1 year significant LV-dilatation (>20%) had occurred in 32 (56%) patients. One year after the re-investigation the mortality in these was 19% vs. 0% in patients without dilatation (P=0.02); after 5 years the difference was 38 vs. 12% (P=0.02), whereafter it declined and became insignificant at 10 years. Neither RV-dilatation, nor LVEF determined at discharge or at the 1-year reinvestigation influenced long-term survival. In contrast, clinical heart failure recorded during the hospital stay had a sustained negative influence on long-term survival.


CONCLUSIONS
Progressive LV dilatation after discharge and clinical heart failure during the hospital stay are both determinants of late survival after AMI, whereas LV ejection fraction at hospital discharge or 1 year later has little, if any, effect on survival beyond 1-year post-AMI.
Gadsbøll
N
N
Department of Internal Medicine C and the Department of Clinical Physiology and Nuclear Medicine, Glostrup Hospital, 2600 Glostrup, University of, Copenhagen, Denmark. ng02@bbh.hosp.dk
Torp-Pedersen
C
C
Høilund-Carlsen
P F
PF
D000328:Adult; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011379:Prognosis; D016016:Proportional Hazards Models; D015635:Radionuclide Ventriculography; D018709:Statistics, Nonparametric; D013318:Stroke Volume; D016019:Survival Analysis