Document Detail

Extent of coronary artery disease as a predictor of outcomes in acute myocardial infarction complicated by heart failure, left ventricular dysfunction, or both.
MedLine Citation:
PMID:  16824854     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Left ventricular systolic dysfunction (LVSD) and heart failure (HF) are powerful predictors of poor outcome after acute myocardial infarction (MI). It is not known, however, whether the extent of coronary artery disease (CAD) independently influences cardiovascular (CV) outcomes in these high-risk patients. METHODS: In the VALIANT, 14703 patients were randomly assigned to receive either captopril monotherapy, valsartan monotherapy, or a valsartan and captopril combination between 0.5 and 10 days after acute MI complicated by LVSD, HF, or both. Cox proportional hazards models were used to evaluate the relation between the extent of CAD (the number of diseased vessels as assessed by angiography) and a range of CV outcomes and all-cause mortality. RESULTS: Coronary angiography data were available on 5742 (40%) of the 14703 randomized patients. Single-vessel disease was reported in 1955 patients (34%), 2-vessel disease in 1598 (28%), and 3-vessel disease in 2189 (38%). For all CV outcomes, the risk increased with the severity of CAD (P for trend < .002). A comparison of single-, 2-, and 3-vessel disease showed that, after adjusting for all known covariates, including revascularization and ejection fraction, 2-vessel disease was associated with a 40% increased hazard (P = .008) and 3-vessel disease was associated with an 85% increased hazard (P < .001) for all-cause mortality. The fully adjusted hazard ratios for death and other CV outcomes increased significantly with increasing extent of CAD. CONCLUSIONS: Increasing extent of CAD, as detected by angiography, is a significant and independent risk factor for adverse CV outcomes after MI complicated by HF, LVSD, or both. The observed risk was apparent even after excluding patients who had undergone revascularization.
Rajesh Janardhanan; Satish Kenchaiah; Eric J Velazquez; Yuhyun Park; John J V McMurray; W Douglas Weaver; Peter V Finn; Harvey D White; Jose A Marin-Neto; Chris O'Connor; Marc A Pfeffer; Robert M Califf; Scott D Solomon;
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  American heart journal     Volume:  152     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2006 Jul 
Date Detail:
Created Date:  2006-07-07     Completed Date:  2006-08-23     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  183-9     Citation Subset:  AIM; IM    
Division of Cardiology, Brigham and Women's Hospital, Boston, MA02115, USA.
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MeSH Terms
Coronary Angiography
Coronary Disease / drug therapy,  pathology*,  radiography
Coronary Vessels / pathology*
Heart Failure / complications*
Middle Aged
Multivariate Analysis
Myocardial Infarction / complications*
Proportional Hazards Models
Randomized Controlled Trials as Topic
Risk Assessment
Risk Factors
Ventricular Dysfunction, Left / complications*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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