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)

Abstract

Background The incidence and predictors of heart failure (HF) post myocardial infarction (MI) with modern post-MI treatment have not been well characterized. Methods and Results 2201 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 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 prior to 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=0.97). Adjudicated HF hospitalization was associated with subsequent death (44.0% vs. 13.1%, HR 3.31, 99% CI 2.21–4.92, p<0.001). 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<0.001) and death (24.7% vs. 10.8%, HR 2.31, 99% CI 1.71–3.10, p<0.001). Conclusions In the overall 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.

Relationship Between No/Slow Reflow Phenomenon in Acute Myocardial Infarction Patients After Percutaneous Coronary Intervention and Inflammatory Response

“…The goal of the treatment for AMI patients is to restore the blood perfusion of myocardial tissue in a rapid and complete way, to avoid the further progression of necrotic myocardial cells against cardiac pump failure. So PCI is the preferred therapy for the reconstruction of infarction related artery and restoration of reperfusion [7,8]. The occurrence of no/slow reflow phenomenon may exert a certain influence upon the prognosis of patients, but controversy remains over its mechanism of occurrence.…”

Health outcomes after myocardial infarction: A population study of 56 million people in England

“…Indeed, the majority of studies of new onset disease following MI focussed only on short-term recurrent MI, bleeding, or stroke [12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] (literature review S1 Text and S1 Table ). Short-and long-term heart failure incidence following MI has been studied extensively [27][28][29][30][31][32]-but estimates vary widely (14% to 36%) [33]. While studies reporting the determinants of heart failure account for confounding and competing risk of death-absolute risk was commonly reported without adjustment, which is prone to bias and lacks generalisability [3,[34][35][36].…”