Poor prognosis of Japanese patients with chronic heart failure following myocardial infarction--comparison with nonischemic cardiomyopathy.
BACKGROUND
Myocardial infarction (MI) is one of the major etiologies of chronic heart failure (CHF) in Japan.


RESULTS
The prognoses of CHF patients after MI (n=283) were investigated by comparing them with those of CHF patients with nonischemic cardiomyopathy (NICM, n=310) from the CHF registry (CHART; n=1,154). The Kaplan-Meier (KM) analyses revealed that the 3-year all-cause mortality was significantly higher in the MI cohort compared with the NICM cohort (29.0% vs 12.4%, p<0.0005). Age/gender/treatment-adjusted KM analysis revealed significant differences only in the cohorts with preserved left ventricular ejection fraction (LVEF), defined as LVEF >45%, or in less symptomatic patients (New York Heart Association I or II). Multivariate Cox regression analysis showed that beta-blocker (BB) was associated with a significant reduction in mortality from cardiac causes, and either angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB) was significantly related to the improvement of survival in the MI cohort (adjusted hazard ratio: 0.222 and 0.497, p<0.05), even though these medicines were used significantly less often in the MI cohort.


CONCLUSIONS
Underlying MI has a significant impact on the survival of Japanese CHF patients, especially those with preserved LVEF or with fewer symptoms. The appropriate expansion of ACEI/ARB or BB therapy might be necessary to improve their survival.
Shiba
Nobuyuki
N
Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan. shiba@cardio.med.tohoku.ac.jp
Watanabe
Jun
J
Shinozaki
Tsuyoshi
T
Koseki
Yoshito
Y
Sakuma
Masahito
M
Kagaya
Yutaka
Y
Shirato
Kunio
K
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D000369:Aged, 80 and over; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D009202:Cardiomyopathies / Q000401:mortality; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000188:drug therapy / Q000209:etiology / Q000401:mortality*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D011379:Prognosis; D012044:Regression Analysis; D013318:Stroke Volume; D016019:Survival Analysis
D000319:Adrenergic beta-Antagonists; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors