Impact of hospitalization for acute coronary events on subsequent mortality in patients with chronic heart failure.
OBJECTIVE
We explored the impact of having a hospital admission for an acute coronary syndrome (ACS) on the subsequent prognosis among patients with chronic heart failure (CHF).


RESULTS
A total of 7599 patients with CHF, New York Heart Association Classes II-IV, were randomly assigned to candesartan or placebo. We assessed the risk of death after a first ACS using time-updated Cox proportional hazard models adjusted for baseline predictors. During a mean follow-up of 3.3 years, 1174 patients experienced at least one ACS. Myocardial infarction (MI) was the first ACS in 442 subjects and unstable angina (UA) in 732. After these events, 219 (49.5%) and 167 (22.8%) patients died during follow-up. The early risk of death was more pronounced after MI: 30.2% died within 30 days compared with 3.6% after UA. After an ACS event, the risk of death declined steadily over time, although 18 months after an MI the risk was still twice that of patients without an ACS.


CONCLUSIONS
Patients with CHF, who develop an ACS, have markedly increased subsequent mortality, particularly in the early phase after an MI.
Abrahamsson
Putte
P
Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. putte.abrahamsson@vgregion.se
Dobson
Joanna
J
Granger
Christopher B
CB
McMurray
John J V
JJ
Michelson
Eric L
EL
Pfeffer
Marc
M
Pocock
Stuart
S
Solomon
Scott D
SD
Yusuf
Salim
S
Swedberg
Karl
K
D054058:Acute Coronary Syndrome / Q000150:complications / Q000401:mortality*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000150:complications / Q000401:mortality; D047228:Angiotensin II Type 1 Receptor Blockers / Q000627:therapeutic use; D001562:Benzimidazoles / Q000627:therapeutic use; D001713:Biphenyl Compounds; D002908:Chronic Disease; D004311:Double-Blind Method; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000188:drug therapy / Q000401:mortality*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality; D011379:Prognosis; D013777:Tetrazoles / Q000627:therapeutic use
D047228:Angiotensin II Type 1 Receptor Blockers; D001562:Benzimidazoles; D001713:Biphenyl Compounds; D013777:Tetrazoles; C081643:candesartan