title: Extent of coronary artery disease as a predictor of outcomes in acute myocardial infarction complicated by heart failure, left ventricular dysfunction, or both.
abstract: BACKGROUND
  Left ventricular systolic dysfunction (LVSD) and heart failure (HF) are powerful predictors of poor outcome after acute myocardial infarction (MI). It is not known, however, whether the extent of coronary artery disease (CAD) independently influences cardiovascular (CV) outcomes in these high-risk patients.
  
  
  METHODS
  In the VALIANT, 14703 patients were randomly assigned to receive either captopril monotherapy, valsartan monotherapy, or a valsartan and captopril combination between 0.5 and 10 days after acute MI complicated by LVSD, HF, or both. Cox proportional hazards models were used to evaluate the relation between the extent of CAD (the number of diseased vessels as assessed by angiography) and a range of CV outcomes and all-cause mortality.
  
  
  RESULTS
  Coronary angiography data were available on 5742 (40%) of the 14703 randomized patients. Single-vessel disease was reported in 1955 patients (34%), 2-vessel disease in 1598 (28%), and 3-vessel disease in 2189 (38%). For all CV outcomes, the risk increased with the severity of CAD (P for trend < .002). A comparison of single-, 2-, and 3-vessel disease showed that, after adjusting for all known covariates, including revascularization and ejection fraction, 2-vessel disease was associated with a 40% increased hazard (P = .008) and 3-vessel disease was associated with an 85% increased hazard (P < .001) for all-cause mortality. The fully adjusted hazard ratios for death and other CV outcomes increased significantly with increasing extent of CAD.
  
  
  CONCLUSIONS
  Increasing extent of CAD, as detected by angiography, is a significant and independent risk factor for adverse CV outcomes after MI complicated by HF, LVSD, or both. The observed risk was apparent even after excluding patients who had undergone revascularization.
authors.affiliation: Division of Cardiology, Brigham and Women's Hospital, Boston, MA02115, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Janardhanan
authors.forename: Satish
authors.initials: S
authors.lastname: Kenchaiah
authors.forename: Eric J
authors.initials: EJ
authors.lastname: Velazquez
authors.forename: Yuhyun
authors.initials: Y
authors.lastname: Park
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: W Douglas
authors.initials: WD
authors.lastname: Weaver
authors.forename: Peter V
authors.initials: PV
authors.lastname: Finn
authors.forename: Harvey D
authors.initials: HD
authors.lastname: White
authors.forename: Jose A
authors.initials: JA
authors.lastname: Marin-Neto
authors.forename: Chris
authors.initials: C
authors.lastname: O'Connor
authors.forename: Marc A
authors.initials: MA
authors.lastname: Pfeffer
authors.forename: Robert M
authors.initials: RM
authors.lastname: Califf
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000473:pathology*; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications*; D011379:Prognosis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D018487:Ventricular Dysfunction, Left / Q000150:complications*