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


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.
Velazquez
Eric J
EJ
Division of Cardiology, Department of Medicine, Duke University Medical Center and Duke Clinical Research Institute, P.O. Box 17969, Durham, NC 27715, USA. velaz002@dcri.duke.edu
Francis
Gary S
GS
Armstrong
Paul W
PW
Aylward
Phillip E
PE
Diaz
Rafael
R
O'Connor
Christopher M
CM
White
Harvey D
HD
Henis
Marc
M
Rittenhouse
Lois M
LM
Kilaru
Rakhi
R
van Gilst
Wiek
W
Ertl
Georg
G
Maggioni
Aldo P
AP
Spac
Jiri
J
Weaver
W Douglas
WD
Rouleau
Jean-Lucien
JL
McMurray
John J V
JJ
Pfeffer
Marc A
MA
Califf
Robert M
RM
D005260:Female; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000453:epidemiology / Q000401:mortality; D012042:Registries; D018487:Ventricular Dysfunction, Left / Q000453:epidemiology / Q000209:etiology* / Q000401:mortality