Frequency, patient characteristics, and outcomes of mild-to-moderate heart failure complicating ST-segment elevation acute myocardial infarction: Lessons from 4 international fibrinolytic therapy trials

David Hasdai, Eric J. Topoi, Rakhi Kilaru, Alexander Battler, Robert A. Harrington, Alec Vahanian, E. Magnus Ohman, Christopher B. Granger, Frans Van de Werf, Maarten L. Simoons, Christopher M. O'Connor, David Holmes

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Abstract

Background: There is a paucity of data on the incidence of mild-to-moderate heart failure (HF) complicating ST-segment elevation acute myocardial infarction (MI) and its impact on short-term outcomes. Our objective was to determine the incidence, timing, and consequences of mild-to-moderate HF complicating acute MI. Methods: We examined the occurrence of death or death/recurrent MI (re-MI) in patients enrolled in the Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I), the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO IIb), the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO-III), and Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-II) trials, which examined different fibrinolytic therapies for MI. We excluded patients who had cardiogenic shock (n = 2994) or unknown HF status at all time points (n = 13,716). Of the remaining 61,041 patients, 17,949 patients (29.4%) had HF, 1566 (8.7%) only at baseline, 10,339 (57.6%) only after admission, and 6044 (33.7%) at baseline and after. Results: The incidence of HF was 32.5% in the United States and 26.9% elsewhere. At 30 days, death and death/re-MI occurred in 2% and 4% of patients without HF and 8% and 12% of patients with HF, respectively (2% and 4% of patients with HF only at baseline, 7% and 13% of patients with HF only after baseline, and 10% and 13% of patients with HF at baseline and later). By use of multivariable analyses, the presence of HF was associated with 1.55 times greater risk of dying at 30 days (95% Cl 1.38-1.74) and 2.15 times greater risk of death/re-MI (95% Cl 1.96-2.36). Conclusion: Mild-to-moderate HF is a frequent and ominous complication of MI, especially when it does not resolve or develops after admission.

Original languageEnglish (US)
Pages (from-to)73-79
Number of pages7
JournalAmerican Heart Journal
Volume145
Issue number1
DOIs
StatePublished - Jan 1 2003

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Thrombolytic Therapy
Heart Failure
Myocardial Infarction
Coronary Vessels
ST Elevation Myocardial Infarction
Incidence
Streptokinase
Cardiogenic Shock
Tissue Plasminogen Activator

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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Frequency, patient characteristics, and outcomes of mild-to-moderate heart failure complicating ST-segment elevation acute myocardial infarction : Lessons from 4 international fibrinolytic therapy trials. / Hasdai, David; Topoi, Eric J.; Kilaru, Rakhi; Battler, Alexander; Harrington, Robert A.; Vahanian, Alec; Ohman, E. Magnus; Granger, Christopher B.; Van de Werf, Frans; Simoons, Maarten L.; O'Connor, Christopher M.; Holmes, David.

In: American Heart Journal, Vol. 145, No. 1, 01.01.2003, p. 73-79.

Research output: Contribution to journalArticle

Hasdai, David ; Topoi, Eric J. ; Kilaru, Rakhi ; Battler, Alexander ; Harrington, Robert A. ; Vahanian, Alec ; Ohman, E. Magnus ; Granger, Christopher B. ; Van de Werf, Frans ; Simoons, Maarten L. ; O'Connor, Christopher M. ; Holmes, David. / Frequency, patient characteristics, and outcomes of mild-to-moderate heart failure complicating ST-segment elevation acute myocardial infarction : Lessons from 4 international fibrinolytic therapy trials. In: American Heart Journal. 2003 ; Vol. 145, No. 1. pp. 73-79.
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abstract = "Background: There is a paucity of data on the incidence of mild-to-moderate heart failure (HF) complicating ST-segment elevation acute myocardial infarction (MI) and its impact on short-term outcomes. Our objective was to determine the incidence, timing, and consequences of mild-to-moderate HF complicating acute MI. Methods: We examined the occurrence of death or death/recurrent MI (re-MI) in patients enrolled in the Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I), the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO IIb), the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO-III), and Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-II) trials, which examined different fibrinolytic therapies for MI. We excluded patients who had cardiogenic shock (n = 2994) or unknown HF status at all time points (n = 13,716). Of the remaining 61,041 patients, 17,949 patients (29.4{\%}) had HF, 1566 (8.7{\%}) only at baseline, 10,339 (57.6{\%}) only after admission, and 6044 (33.7{\%}) at baseline and after. Results: The incidence of HF was 32.5{\%} in the United States and 26.9{\%} elsewhere. At 30 days, death and death/re-MI occurred in 2{\%} and 4{\%} of patients without HF and 8{\%} and 12{\%} of patients with HF, respectively (2{\%} and 4{\%} of patients with HF only at baseline, 7{\%} and 13{\%} of patients with HF only after baseline, and 10{\%} and 13{\%} of patients with HF at baseline and later). By use of multivariable analyses, the presence of HF was associated with 1.55 times greater risk of dying at 30 days (95{\%} Cl 1.38-1.74) and 2.15 times greater risk of death/re-MI (95{\%} Cl 1.96-2.36). Conclusion: Mild-to-moderate HF is a frequent and ominous complication of MI, especially when it does not resolve or develops after admission.",
author = "David Hasdai and Topoi, {Eric J.} and Rakhi Kilaru and Alexander Battler and Harrington, {Robert A.} and Alec Vahanian and Ohman, {E. Magnus} and Granger, {Christopher B.} and {Van de Werf}, Frans and Simoons, {Maarten L.} and O'Connor, {Christopher M.} and David Holmes",
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T1 - Frequency, patient characteristics, and outcomes of mild-to-moderate heart failure complicating ST-segment elevation acute myocardial infarction

T2 - Lessons from 4 international fibrinolytic therapy trials

AU - Hasdai, David

AU - Topoi, Eric J.

AU - Kilaru, Rakhi

AU - Battler, Alexander

AU - Harrington, Robert A.

AU - Vahanian, Alec

AU - Ohman, E. Magnus

AU - Granger, Christopher B.

AU - Van de Werf, Frans

AU - Simoons, Maarten L.

AU - O'Connor, Christopher M.

AU - Holmes, David

PY - 2003/1/1

Y1 - 2003/1/1

N2 - Background: There is a paucity of data on the incidence of mild-to-moderate heart failure (HF) complicating ST-segment elevation acute myocardial infarction (MI) and its impact on short-term outcomes. Our objective was to determine the incidence, timing, and consequences of mild-to-moderate HF complicating acute MI. Methods: We examined the occurrence of death or death/recurrent MI (re-MI) in patients enrolled in the Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I), the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO IIb), the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO-III), and Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-II) trials, which examined different fibrinolytic therapies for MI. We excluded patients who had cardiogenic shock (n = 2994) or unknown HF status at all time points (n = 13,716). Of the remaining 61,041 patients, 17,949 patients (29.4%) had HF, 1566 (8.7%) only at baseline, 10,339 (57.6%) only after admission, and 6044 (33.7%) at baseline and after. Results: The incidence of HF was 32.5% in the United States and 26.9% elsewhere. At 30 days, death and death/re-MI occurred in 2% and 4% of patients without HF and 8% and 12% of patients with HF, respectively (2% and 4% of patients with HF only at baseline, 7% and 13% of patients with HF only after baseline, and 10% and 13% of patients with HF at baseline and later). By use of multivariable analyses, the presence of HF was associated with 1.55 times greater risk of dying at 30 days (95% Cl 1.38-1.74) and 2.15 times greater risk of death/re-MI (95% Cl 1.96-2.36). Conclusion: Mild-to-moderate HF is a frequent and ominous complication of MI, especially when it does not resolve or develops after admission.

AB - Background: There is a paucity of data on the incidence of mild-to-moderate heart failure (HF) complicating ST-segment elevation acute myocardial infarction (MI) and its impact on short-term outcomes. Our objective was to determine the incidence, timing, and consequences of mild-to-moderate HF complicating acute MI. Methods: We examined the occurrence of death or death/recurrent MI (re-MI) in patients enrolled in the Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I), the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO IIb), the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO-III), and Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-II) trials, which examined different fibrinolytic therapies for MI. We excluded patients who had cardiogenic shock (n = 2994) or unknown HF status at all time points (n = 13,716). Of the remaining 61,041 patients, 17,949 patients (29.4%) had HF, 1566 (8.7%) only at baseline, 10,339 (57.6%) only after admission, and 6044 (33.7%) at baseline and after. Results: The incidence of HF was 32.5% in the United States and 26.9% elsewhere. At 30 days, death and death/re-MI occurred in 2% and 4% of patients without HF and 8% and 12% of patients with HF, respectively (2% and 4% of patients with HF only at baseline, 7% and 13% of patients with HF only after baseline, and 10% and 13% of patients with HF at baseline and later). By use of multivariable analyses, the presence of HF was associated with 1.55 times greater risk of dying at 30 days (95% Cl 1.38-1.74) and 2.15 times greater risk of death/re-MI (95% Cl 1.96-2.36). Conclusion: Mild-to-moderate HF is a frequent and ominous complication of MI, especially when it does not resolve or develops after admission.

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