title: An international perspective on heart failure and left ventricular systolic dysfunction complicating myocardial infarction: the VALIANT registry.
abstract: 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.
authors.affiliation: 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
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Gary S
authors.initials: GS
authors.lastname: Francis
authors.forename: Paul W
authors.initials: PW
authors.lastname: Armstrong
authors.forename: Phillip E
authors.initials: PE
authors.lastname: Aylward
authors.forename: Rafael
authors.initials: R
authors.lastname: Diaz
authors.forename: Christopher M
authors.initials: CM
authors.lastname: O'Connor
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.forename: Marc
authors.initials: M
authors.lastname: Henis
authors.forename: Lois M
authors.initials: LM
authors.lastname: Rittenhouse
authors.forename: Rakhi
authors.initials: R
authors.lastname: Kilaru
authors.forename: Wiek
authors.initials: W
authors.lastname: van Gilst
authors.forename: Georg
authors.initials: G
authors.lastname: Ertl
authors.forename: Aldo P
authors.initials: AP
authors.lastname: Maggioni
authors.forename: Jiri
authors.initials: J
authors.lastname: Spac
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Weaver
authors.forename: Jean-Lucien
authors.initials: JL
authors.lastname: Rouleau
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
mesh_terms: 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