Document Detail


Heart failure in post-MI patients with persistent IRA occlusion: prevalence, risk factors, and the long-term effect of PCI in the Occluded Artery Trial (OAT).
MedLine Citation:
PMID:  23141853     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The incidence and predictors of heart failure (HF) after myocardial infarction (MI) with modern post-MI treatment have not been well characterized.
METHODS AND RESULTS: A total of 2,201 stable patients with persistent infarct-related artery occlusion >24 hours after MI with left ventricular ejection fraction <50% and/or proximal coronary artery occlusion were randomized to percutaneous intervention plus optimal medical therapy (PCI) or optimal medical therapy (MED) alone. Centrally adjudicated HF hospitalizations for New York Heart Association (NYHA) III/IV HF and mortality were determined in patients with and without baseline HF, defined as a history of HF, Killip Class >I at index MI, rales, S3 gallop, NYHA II at randomization, or NYHA >I before index MI. Long-term follow-up data were used to determine 7-year life-table estimated event rates and hazard ratios. There were 150 adjudicated HF hospitalizations during a mean follow-up of 6 years with no difference between the randomized groups (7.4% PCI vs. 7.5% MED, P = .97). Adjudicated HF hospitalization was associated with subsequent death (44.0% vs. 13.1%, HR 3.31, 99% CI 2.21-4.92, P < .001). Baseline HF (present in 32% of patients) increased the risk of adjudicated HF hospitalization (13.6% vs. 4.7%, HR 3.43, 99% CI 2.23-5.26, P < .001) and death (24.7% vs. 10.8%, HR 2.31, 99% CI 1.71-3.10, P < .001).
CONCLUSIONS: In the overall Occluded Artery Trial (OAT) population, adjudicated HF hospitalizations occurred in 7.5% of subjects and were associated with increased risk of subsequent death. Baseline or prior HF was common in the OAT population and was associated with increased risk of hospitalization and death.
Authors:
Rahul R Jhaveri; Harmony R Reynolds; Stuart D Katz; Raban Jeger; Elzbieta Zinka; Sandra A Forman; Gervasio A Lamas; Judith S Hochman
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of cardiac failure     Volume:  18     ISSN:  1532-8414     ISO Abbreviation:  J. Card. Fail.     Publication Date:  2012 Nov 
Date Detail:
Created Date:  2012-11-12     Completed Date:  2013-08-23     Revised Date:  2013-11-06    
Medline Journal Info:
Nlm Unique ID:  9442138     Medline TA:  J Card Fail     Country:  United States    
Other Details:
Languages:  eng     Pagination:  813-21     Citation Subset:  IM    
Copyright Information:
Copyright © 2012 Elsevier Inc. All rights reserved.
Affiliation:
Cardiovascular Clinical Research Center, Leon Charney Division of Cardiology, New York University School of Medicine, New York, NY 10016, USA.
Data Bank Information
Bank Name/Acc. No.:
ClinicalTrials.gov/NCT00004562
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MeSH Terms
Descriptor/Qualifier:
Aged
Coronary Occlusion / complications,  epidemiology*,  therapy
Female
Follow-Up Studies
Heart Failure / complications,  epidemiology*,  therapy
Humans
Male
Middle Aged
Myocardial Infarction / complications,  epidemiology*,  therapy
Percutaneous Coronary Intervention* / trends
Prevalence
Risk Factors
Time Factors
Treatment Outcome
Grant Support
ID/Acronym/Agency:
U01 HL062509/HL/NHLBI NIH HHS; U01 HL062509/HL/NHLBI NIH HHS; U01 HL062511/HL/NHLBI NIH HHS; U01 HL062511/HL/NHLBI NIH HHS
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