Heart failure on admission and the risk of stroke following acute myocardial infarction: the VALIANT registry.
OBJECTIVE
We sought to assess the relative contribution of heart failure (HF) on admission for an acute myocardial infarction (MI) to the subsequent in-hospital stroke risk.


RESULTS
The VALsartan In Acute myocardial iNfarcTion (VALIANT) registry enrolled 5573 consecutive MI patients at 84 international sites from 1999 to 2001. We calculated odds ratios (ORs) for stroke and adjusted for baseline characteristics, Killip Class, and risk factors for stroke, such as diabetes and prior HF. In-hospital stroke occurred in 81 (1.5%) patients. HF was present on admission in 38% of patients who developed a stroke and in 24% who did not (P=0.001). Older age (OR 1.03 increase/year, 95% confidence interval (CI) 1.01-1.04), Killip Class III (OR 1.66, CI 0.86-3.19) or IV (OR 4.85, CI 1.69-13.93), history of hypertension (OR 1.73, CI 1.06-2.82), and history of stroke (OR 1.89, CI 1.06-3.37) were more common in patients who had in-hospital stroke. In-hospital mortality in patients with and without stroke was 27.2 and 6.5%, respectively (P<0.001).


CONCLUSIONS
Patients with stroke after MI have a dismal prognosis. The presence of HF on admission for an acute MI increases in-hospital stroke risk. HF treatments may modify the risk of stroke.
Department of Cardiology, Karolinska University Hospital Huddinge, Stockholm, Sweden.
Karolina E
KE
Szummer
Scott D
SD
Solomon
Eric J
EJ
Velazquez
Rakhi
R
Kilaru
John
J
McMurray
Jean-Lucien
JL
Rouleau
Kenneth W
KW
Mahaffey
Aldo P
AP
Maggioni
Robert M
RM
Califf
Marc A
MA
Pfeffer
Harvey D
HD
White
D000368:Aged; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D006439:Hemodynamics; D017052:Hospital Mortality; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D015425:Myocardial Reperfusion / Q000379:methods; D011379:Prognosis; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology