Persistence of the prognostic importance of left ventricular systolic function and heart failure after myocardial infarction: 17-year follow-up of the TRACE register.
OBJECTIVE
Left ventricular systolic function and presence of heart failure (HF) are important prognostic factors and dictate future therapeutic strategies after myocardial infarction (MI). We evaluated persistence of the prognostic importance of left ventricular dysfunction and HF in consecutive MI patients screened for entry in the Trandolopril Cardiac Evaluation Registry (TRACE) study.


RESULTS
The study population comprised 6676 MI patients screened for entry into the TRACE study, a double-blind, randomized, parallel group, placebo-controlled study of trandolapril vs. placebo in patients with left ventricular dysfunction after MI. In unadjusted analysis, patients with reduced left ventricular function and HF continued to show increased mortality. Landmark analysis and Cox proportional-hazards models showed that wall motion index (WMI) was a significant prognostic factor until 10 years of follow-up with hazard ratios ranging between 0.74 [confidence interval (CI) 0.71-0.78] and 0.90 (CI 0.82-0.98) associated with a 12% improvement in left ventricular ejection fraction (0.4 WMI units). The prognostic significance of HF persisted for 8 years with hazard ratios between 1.47 (CI 1.21-1.78) and 2.62 (95% CI 2.30-2.98) for the first 8 years.


CONCLUSIONS
When assessed during the index MI, WMI and HF carry prognostic information for up to 10 years.
Kümler
Thomas
T
Department of Cardiology, Copenhagen University Hospital Gentofte, Niels Andersens Vej 65, 2900 Hellerup, Denmark. tkumler@dadlnet.dk
Gislason
Gunnar Hilmar
GH
Køber
Lars
L
Torp-Pedersen
Christian
C
D000368:Aged; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D016001:Confidence Intervals; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology / Q000503:physiopathology*; D006352:Heart Ventricles / Q000473:pathology*; D006801:Humans; D007211:Indoles / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology; D011379:Prognosis; D016016:Proportional Hazards Models; D012042:Registries; D012189:Retrospective Studies; D012307:Risk Factors; D013599:Systole; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000188:drug therapy / Q000209:etiology* / Q000503:physiopathology
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D007211:Indoles; C052035:trandolapril