title: Heart failure in post-MI patients with persistent IRA occlusion: prevalence, risk factors, and the long-term effect of PCI in the Occluded Artery Trial (OAT).
abstract: BACKGROUND
  The incidence and predictors of heart failure (HF) after myocardial infarction (MI) with modern post-MI treatment have not been well characterized.
  
  
  RESULTS
  A total of 2,201 stable patients with persistent infarct-related artery occlusion >24 hours after MI with left ventricular ejection fraction <50% and/or proximal coronary artery occlusion were randomized to percutaneous intervention plus optimal medical therapy (PCI) or optimal medical therapy (MED) alone. Centrally adjudicated HF hospitalizations for New York Heart Association (NYHA) III/IV HF and mortality were determined in patients with and without baseline HF, defined as a history of HF, Killip Class >I at index MI, rales, S3 gallop, NYHA II at randomization, or NYHA >I before index MI. Long-term follow-up data were used to determine 7-year life-table estimated event rates and hazard ratios. There were 150 adjudicated HF hospitalizations during a mean follow-up of 6 years with no difference between the randomized groups (7.4% PCI vs. 7.5% MED, P = .97). Adjudicated HF hospitalization was associated with subsequent death (44.0% vs. 13.1%, HR 3.31, 99% CI 2.21-4.92, P < .001). Baseline HF (present in 32% of patients) increased the risk of adjudicated HF hospitalization (13.6% vs. 4.7%, HR 3.43, 99% CI 2.23-5.26, P < .001) and death (24.7% vs. 10.8%, HR 2.31, 99% CI 1.71-3.10, P < .001).
  
  
  CONCLUSIONS
  In the overall Occluded Artery Trial (OAT) population, adjudicated HF hospitalizations occurred in 7.5% of subjects and were associated with increased risk of subsequent death. Baseline or prior HF was common in the OAT population and was associated with increased risk of hospitalization and death.
authors.affiliation: Cardiovascular Clinical Research Center, Leon Charney Division of Cardiology, New York University School of Medicine, New York, NY 10016, USA.
authors.forename: Rahul R
authors.initials: RR
authors.lastname: Jhaveri
authors.forename: Harmony R
authors.initials: HR
authors.lastname: Reynolds
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Katz
authors.forename: Raban
authors.initials: R
authors.lastname: Jeger
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Zinka
authors.forename: Sandra A
authors.initials: SA
authors.lastname: Forman
authors.forename: Gervasio A
authors.initials: GA
authors.lastname: Lamas
authors.forename: Judith S
authors.initials: JS
authors.lastname: Hochman
mesh_terms: D000368:Aged; D054059:Coronary Occlusion / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology* / Q000628:therapy; D062645:Percutaneous Coronary Intervention / Q000639:trends; D015995:Prevalence; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome