Patterns and outcomes of revascularization in patients with heart failure and/or left ventricular systolic dysfunction following acute myocardial infarction: observations from the VALIANT registry

Tang, W.H.W., Velazquez, E.J., Kilaru, R., Maroo, A., White, H., Kober, L., Rouleau, J.L., McMurray, J.J.V. , Califf, R.M. and Francis, G.S. (2004) Patterns and outcomes of revascularization in patients with heart failure and/or left ventricular systolic dysfunction following acute myocardial infarction: observations from the VALIANT registry. Journal of Cardiac Failure, 10(4), S104. (doi: 10.1016/j.cardfail.2004.06.321)

Abstract

Background: Data regarding patterns and outcomes of in-hospital revascularization (IHR) following acute myocardial infarction (MI) in patients with heart failure (HF) and/or left ventricular systolic dysfunction (LVSD) in the contemporary era are limited. Methods: From the VALIANT Registry (n = 5,566), clinical characteristics and in-hospital outcomes of patients presenting with acute MI were followed prospectively. Multivariable logistic analysis was performed to determine independent predictors for in-hospital mortality. Results: In the HF/LVSD cohort, 42% of patients underwent IHR compared with 58% in the non-HF/LVSD cohort (p<0.001). Patients with HF/LVSD who underwent IHR were more likely to have undergone coronary angiography upon admission compared with those without IHR (88.7% vs 31%, p<0.001, 69.5% for non-HF/LVSD cohort). Among those with IHR in the HF/LVSD cohort, 75% underwent coronary angioplasty. Patients with HF/LVSD who underwent IHR were more likely to be younger and male, even though they had less cardiovascular history or co-morbidities. Despite having a greater predilection for cardiogenic shock or hypotension at presentation, patients with HF/LVSD who underwent IHR had lower in-hospital event rates (see Table). IHR was an independent predictor of survival in patients with HF/LVSD, although in-hospital event rates remained higher than that in the non-HF/LVSD cohort except for recurrent angina/ischemia. Conclusions: In this contemporary registry, patients with HF/LVSD after acute MI were less likely to be revascularized and had poorer in-hospital clinical outcomes. However, in-hospital revascularization in this high-risk subset of patients was associated with an equivalent relative reduction and greater absolute reduction in in-hospital mortality.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: McMurray, Professor John
• Authors: Tang, W.H.W., Velazquez, E.J., Kilaru, R., Maroo, A., White, H., Kober, L., Rouleau, J.L., McMurray, J.J.V., Califf, R.M., and Francis, G.S.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: Journal of Cardiac Failure
• Publisher: Elsevier
• ISSN: 1071-9164
• ISSN (Online): 1532-8414