• Eric J Velazquez, Gary S Francis, Paul W Armstrong, Phillip E Aylward, Rafael Diaz, Christopher M O'Connor, Harvey D White, Marc Henis, Lois M Rittenhouse, Rakhi Kilaru, Wiek van Gilst, Georg Ertl, Aldo P Maggioni, Jiri Spac, W Douglas Weaver, Jean-Lucien Rouleau, John J V McMurray, Marc A Pfeffer, Robert M Califf, and VALIANT registry.
• Division of Cardiology, Department of Medicine, Duke University Medical Center and Duke Clinical Research Institute, P.O. Box 17969, Durham, NC 27715, USA. velaz002@dcri.duke.edu
• Eur. Heart J. 2004 Nov 1; 25 (21): 1911-9.

AimsWe analysed the contemporary incidence, outcomes, and predictors of heart failure (HF) and/or left ventricular systolic dysfunction (LVSD) before discharge in patients with acute myocardial infarction (MI). The baseline presence of HF or LVSD, or its development during hospitalisation, increases short- and long-term risk after MI, yet its incidence, predictors, and outcomes have not been well described in a large, international, general MI population.Methods And ResultsThe VALIANT registry included 5573 consecutive MI patients at 84 hospitals in nine countries from 1999 to 2001. A multivariable logistic survival model was constructed using baseline variables to determine the adjusted mortality risk for those with in-hospital HF and/or LVSD. Baseline variables were also tested for associations with in-hospital HF and/or LVSD. Of the 5566 patients analysed, 42% had HF and/or LVSD during hospitalisation. Their in-hospital mortality rate was 13.0% compared with 2.3% for those without HF and/or without LVSD. After adjustment for other baseline risk factors, in-hospital HF and/or LVSD carried a hazard ratio for in-hospital mortality of 4.12 (95% confidence interval: 3.08-5.56). Patients with HF and/or LVSD also had disproportionately higher rates of other cardiovascular events.ConclusionsHF and/or LVSD is common in the general contemporary MI population and precedes 80.3% of all in-hospital deaths after MI. Survivors of early MI-associated HF and/or LVSD have more complications, longer hospitalisations, and are more likely to die during hospitalisation. Although baseline variables can identify MI patients at highest risk for HF and/or LVSD, such patients are less likely to receive indicated procedures and medical therapies.

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