Do patients with heart failure appropriately undergo invasive procedures post-myocardial infarction? Results from a prospective multicentre study.
BACKGROUND
The degree of adherence to guideline recommendations that patients following myocardial infarction (MI) with congestive heart failure (CHF) undergo early angiography, and angioplasty if indicated, is unknown.


METHODS
We prospectively evaluated the use of invasive procedures in patients with segment-elevation myocardial infarction (STEMI), non-STEMI and CHF, admitted in 1 month to 16 Australian hospitals.


RESULTS
Of 475 post-MI patients (248 (52.2%) with STEMI), 112 (23.6%) had CHF, (57 (23.0%) with STEMI). Patients with CHF, compared with those without CHF, were older (67.8 vs 63.2 years; P = 0.002) and were more often women (34 vs 24%, P = 0.03), but had similar rates of other risk factors. Compared with post-MI patients without CHF, patients with CHF had fewer invasive procedures: angiography 72.3% versus 85.1% (P = 0.002) and angioplasty 33.9% versus 52.9% (P < 0.001) (12 (2.5%) patients underwent coronary surgery in-hospital); and among STEMI patients (angiography 72.3% CHF vs 89.5% no CHF [P < 0.001]; angioplasty 50.9% CHF vs 69.1% no CHF [P = 0.011]); these differences remained significant after adjustment for clinical covariates. Of the 121 (25.5%) post-MI patients aged > or =75 years, compared with those <75 years, the frequencies of angiography and angioplasty procedures were 66.1% versus 87.6% (P < 0.001) and 33.9% versus 53.4% (P < 0.001), respectively; 66% of the elderly with, and without, CHF had angiography.


CONCLUSIONS
The presence of CHF post-MI resulted in lower rates of use of angiography and angioplasty, which was not explained by lower procedure rates in the elderly. As these guideline-recommended procedures may improve survival in patients with CHF post-MI, future strategies should aim to enhance their use.
Tobing
D
D
Liverpool Hospital and South West Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia.
French
J
J
Varigos
J
J
Meehan
A
A
Billah
B
B
Krum
H
H
D000368:Aged; D000800:Angioplasty, Balloon / Q000706:statistics & numerical data; D000933:Antifibrinolytic Agents / Q000627:therapeutic use; D017023:Coronary Angiography / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D011446:Prospective Studies; D016896:Treatment Outcome
D000933:Antifibrinolytic Agents