Heart failure post-myocardial infarction in the new millennium: how often does it occur, can we predict it, and what are the consequences?

Purpose: Patients (pts) with acute myocardial infarction (MI) complicated by pulmonary edema and/or depressed ejection fraction (EF) are at heightened risk for chronic heart failure (HF) and/or death. We utilized the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial experience to determine predictors of cardiovascular (CV) death and/or HF in high-risk MI pts undergoing modern therapy. Methods: VALIANT enrolled 14,703 pts with MI complicated by Killip class ≥2 and/or reduced EF between 0.5 and 10 days post-MI randomized to valsartan, captopril, or combination (median follow-up 24.7 months). Cox proportional hazards model was used to determine predictors of CV death and/or hospitalization for HF requiring intravenous therapy. Results: CV death occurred in 2484 (16.9%) pts, HF hospitalization in 2388 (16.2%), and 3992 (27%) died from CV cause and/or developed HF. Of the 2388 with HF hospitalization, 880 (36.9%) subsequently died. The most powerful independent predictors of HF and/or CV death were older age, higher baseline heart rate and diabetes mellitus (Table). There were no differences in outcomes between pts randomized to valsartan, captopril, or combination. Also, 73% (n = 10,711) neither developed HF nor died from CV causes. Conclusion: Even among high-risk MI pts, the majority did not develop HF or die from CV causes. Age, diabetes, and rapid heart rate remain significant predictors of CV death and/or HF hospitalization. Mortality is twice as high among pts hospitalized for HF