Current Heart Failure Reports

, Volume 2, Issue 4, pp 174–182

Therapies to prevent heart failure post-myocardial infarction

  • Kevin L. Thomas
  • Eric J. Velazquez
Article

Abstract

Heart failure (HF) is a common complication of myocardial infarction (MI) that carries a poor prognosis when present. HF and/or left ventricular systolic dysfunction (LVSD) occur in approximately 40% of patients who suffer acute MI. The estimated mortality of patients developing HF or LVSD post-MI is 20% to 30%, with that risk varying based on the presence of HF upon initial assessment versus occurring later during the MI hospitalization. Clinical factors and comorbidities associated with post-MI HF include age, diabetes, hypertension, female gender, infarct size, and tachycardia. Factors associated with decreased survival in patients with post-MI HF include Killip class, age, low blood pressure, tachycardia, male gender, and anterior location of MI. Despite extensive data identifying this patient population as high risk, patients with post-MI HF or LVSD are significantly less likely to receive evidence-based medications or revascularization procedures than those without HF. Despite the high prevalence of HF after MI, few studies have examined therapies to prevent it. This review summarizes studies that reported the incidence, risk factors, and outcomes of patients with post-MI HF or LVSD. Additionally, we discuss therapies to prevent post-MI HF and treatment of patients with post-MI HF and/or LVSD.

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References and Recommended Reading

  1. 1.
    American Heart Association: Heart disease and stroke statistics. http://www.americanheart.org/presenter. jhtml?identifier=3018163. Accessed September 9, 2005.Google Scholar
  2. 2.
    Gheorghiade M, Bonow RO: Chronic heart failure in the United States: a manifestation of coronary artery disease. Circulation 1998, 97:282–289.PubMedGoogle Scholar
  3. 3.
    Steg PG, Goldberg RJ, Gore JM, et al.: Baseline characteristics, management practices, and in-hospital outcomes of patients hospitalized with acute coronary syndromes in the Global Registry of Acute Coronary Events (GRACE). Am J Cardiol 2002, 90:358–363. This large international registry of ACS patients provided new important information regarding the incidence of acute HF across all ischemic syndromes, including NSTEMI (15.6%), STEMI (15.7%), and unstable angina patients (8.2%).PubMedCrossRefGoogle Scholar
  4. 4.
    Bart BA, Shaw LK, McCants CB Jr, et al.: Clinical determinants of mortality in patients with angiographically diagnosed ischemic or nonischemic cardiomyopathy. J Am Coll Cardiol 1997, 30:1002–1008.PubMedCrossRefGoogle Scholar
  5. 5.
    Hellermann JP, Goraya TY, Jacobsen SJ, et al.: Incidence of heart failure after myocardial infarction: is it changing over time? Am J Epidemiology 2003, 157:1101–1107.CrossRefGoogle Scholar
  6. 6.
    Hellermann JP, Jacobsen SJ, Redfield MM, et al.: Heart failure after myocardial infarction: clinical presentation and survival. Eur J Heart Fail 2005, 7:119–125.PubMedCrossRefGoogle Scholar
  7. 7.
    Roger VL, Weston SA, Redfield MM, et al.: Trends in heart failure incidence and survival in a community-based population. JAMA 2004, 292:344–350.PubMedCrossRefGoogle Scholar
  8. 8.
    Lewis EF, Moye LA, Rouleau JL, et al.: Predictors of late development of heart failure in stable survivors of myocardial infarction: the CARE study. J Am Coll Cardiol 2003, 42:1446–1453.PubMedCrossRefGoogle Scholar
  9. 9.
    Moss AJ, Benhorin J: Prognosis and management after a first myocardial infarction. N Engl J Med 1990, 322:743–753.PubMedCrossRefGoogle Scholar
  10. 10.
    Ho KK, Pinsky JL, Kannel WB, Levy D: The epidemiology of heart failure: the Framingham Study. J Am Coll Cardiol 1993, 22:6A-13A.PubMedCrossRefGoogle Scholar
  11. 11.
    Ali AS, Rybicki BA, Alam M, et al.: Clinical predictors of heart failure in patients with first acute myocardial infarction. Am Heart J 1999, 138:1133–1139.PubMedCrossRefGoogle Scholar
  12. 12.
    Cohn JN, Ferrari R, Sharpe N: Cardiac remodeling—concepts and clinical implications: a consensus paper from an international forum on cardiac remodeling. Behalf of an International Forum on Cardiac Remodeling. J Am Coll Cardiol 2000, 35:569–582.PubMedCrossRefGoogle Scholar
  13. 13.
    Braunwald E, Kloner RA: The stunned myocardium: prolonged, post ischemic ventricular dysfunction. Circulation 1982, 66:1146–1149.PubMedGoogle Scholar
  14. 14.
    Kober L, Torp-Pedersen C, Pedersen OD, et al.: Importance of congestive heart failure and interaction of congestive heart failure and left ventricular systolic function on prognosis in patients with acute myocardial infarction. Am J Cardiol 1996, 78:1124–1128.PubMedGoogle Scholar
  15. 15.
    Warnowicz MA, Parker H, Cheitlin MD: Prognosis of patients with acute pulmonary edema and normal ejection fraction after acute myocardial infarction. Circulation 1983, 67:330–334.PubMedGoogle Scholar
  16. 16.
    Persson H, Linder-Klingsell E, Eriksson SV, Erhardt L: Heart failure after myocardial infarction: the importance of diastolic dysfunction. A prospective clinical and echocardiographic study. Eur Heart J 1995, 16:496–505.PubMedGoogle Scholar
  17. 17.
    Aronow WS: Heart failure complicating acute myocardial infarction. Clin Geriatr Med 2000, 16:535–548.PubMedCrossRefGoogle Scholar
  18. 18.
    Stone GW, Griffin B, Shah PK, et al.: Prevalence of unsuspected mitral regurgitation and left ventricular diastolic dysfunction in patients with coronary artery disease and acute pulmonary edema associated with normal or depressed left ventricular systolic function. Am J Cardiol 1991, 67:37–41.PubMedCrossRefGoogle Scholar
  19. 19.
    Hellermann JP, Jacobsen SJ, Reeder GS, et al.: Heart failure after myocardial infarction: prevalence of preserved left ventricular systolic function in the community. Am Heart J 2003, 145:742–748. This study of patients with acute MI demonstrated that 30% of post-MI HF patients had preserved systolic function.PubMedCrossRefGoogle Scholar
  20. 20.
    Moller JE, Brendorp B, Ottesen M, et al.: Congestive heart failure with preserved left ventricular systolic function after acute myocardial infarction: clinical and prognostic implications. Eur J Heart Fail 2003, 5:811–819.PubMedCrossRefGoogle Scholar
  21. 21.
    Pfeffer MA, Braunwald E, Moye LA, et al.: Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. N Engl J Med 1992, 327:669–677.PubMedCrossRefGoogle Scholar
  22. 22.
    Pfeffer MA, McMurray JJ, Velazquez EJ, et al.: Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both. N Engl J Med 2003, 349:1893–1906. Large randomized controlled study that showed that valsartan, 160 mg twice a day, was as effective as captopril in patients with an acute MI, HF, and/or LVSD. The combination of an ACE/ARB did not improve survival over monotherapy with captopril.PubMedCrossRefGoogle Scholar
  23. 23.
    McDonagh TA, Morrison CE, Lawrence A, et al.: Symptomatic and asymptomatic left-ventricular systolic dysfunction in an urban population. Lancet 1997, 350:829–833.PubMedCrossRefGoogle Scholar
  24. 24.
    Spencer FA, Meyer TE, Goldberg RJ, et al.: Twenty year trends (1975-1995) in the incidence, in-hospital and long-term death rates associated with heart failure complicating acute myocardial infarction: a community-wide perspective. J Am Coll Cardiol 1999, 34:1378–1387. Large registry of MI patients that showed that the incidence of post-MI HF was decreasing along with inhospital mortality rates; however, 1-year mortality rates were largely unchanged.PubMedCrossRefGoogle Scholar
  25. 25.
    Velazquez EJ, Francis GS, Armstrong PW, et al.: An international perspective on heart failure and left ventricular systolic dysfunction complicating myocardial infarction: the VALIANT registry. Eur Heart J 2004, 25:1911–1919. This paper reported results on a large international registry of patients with acute MI, LVSD, and/or HF. The incidence of HF was 42%, and patients with HF and/or LVSD were less likely to be treated with evidence-based therapies.PubMedCrossRefGoogle Scholar
  26. 26.
    Hellermann JP, Jacobsen SJ, Gersh BJ, et al.: Heart failure after myocardial infarction: a review. Am J Med 2002, 113:324–330. This is a systematic review of 33 clinical studies of patients with acute MI. This review identified the heterogeneity in the incidence of post-MI heart failure by study design.PubMedCrossRefGoogle Scholar
  27. 27.
    Rosamond WD, Chambless LE, Folsom AR, et al.: Trends in the incidence of myocardial infarction and in mortality due to coronary heart disease, 1987 to 1994. N Engl J Med 1998, 339:861–867.PubMedCrossRefGoogle Scholar
  28. 28.
    Spencer FA, Meyer TE, Gore JM, Goldberg RJ: Heterogeneity in the management and outcomes of patients with acute myocardial infarction complicated by heart failure: the National Registry of Myocardial Infarction. Circulation 2002, 105:2605–2610.PubMedCrossRefGoogle Scholar
  29. 29.
    O’Connor CM, Hathaway WR, Bates ER, et al.: Clinical characteristics and long-term outcome of patients in whom congestive heart failure develops after thrombolytic therapy for acute myocardial infarction: development of a predictive model. Am Heart J 1997, 133:663–673.PubMedCrossRefGoogle Scholar
  30. 30.
    Kober L, Torp-Pedersen C, Ottesen M, et al.: Influence of gender on short- and long-term mortality after acute myocardial infarction. TRACE study group. Am J Cardiol 1996, 77:1052–1056.PubMedCrossRefGoogle Scholar
  31. 31.
    Kober L, Torp-Pedersen C, Ottesen M, et al.: Influence of age on the prognostic importance of left ventricular dysfunction and congestive heart failure on long-term survival after acute myocardial infarction. TRACE Study Group. Am J Cardiol 1996, 78:158–162.PubMedCrossRefGoogle Scholar
  32. 32.
    Killip T III, Kimball JT: Treatment of myocardial infarction in a coronary care unit. A two year experience with 250 patients. Am J Cardiol 1967, 20:457–464.PubMedCrossRefGoogle Scholar
  33. 33.
    Steg PG, Dabbous OH, Feldman LJ, et al.: Determinants and prognostic impact of heart failure complicating acute coronary syndromes: observations from the Global Registry of Acute Coronary Events (GRACE). Circulation 2004, 109:494–499.PubMedCrossRefGoogle Scholar
  34. 34.
    Wu AH, Parsons L, Every NR, Bates ER: Hospital outcomes in patients presenting with congestive heart failure complicating acute myocardial infarction: a report from the Second National Registry of Myocardial Infarction (NRMI-2). J Am Coll Cardiol 2002, 40:1389–1394.PubMedCrossRefGoogle Scholar
  35. 35.
    Wood DA: Preventing clinical heart failure: the rationale and scientific evidence. Heart 2002, 88(Suppl 2):ii15-ii22. This is one of the few papers that discusses the rationale for preventive strategies for HF and/or LVSD after MI.PubMedGoogle Scholar
  36. 36.
    Stone PH, Raabe DS, Jaffe AS, et al.: Prognostic significance of location and type of myocardial infarction: independent adverse outcome associated with anterior location. J Am Coll Cardiol 1988, 11:453–463.PubMedCrossRefGoogle Scholar
  37. 37.
    Exner DV, Dries DL, Waclawiw MA, et al.: Beta-adrenergic blocking agent use and mortality in patients with asymptomatic and symptomatic left ventricular systolic dysfunction: a post hoc analysis of the Studies of Left Ventricular Dysfunction. J Am Coll Cardiol 1999, 33:916–923.PubMedCrossRefGoogle Scholar
  38. 38.
    Vantrimpont P, Rouleau JL, Wun CC, et al.: Additive beneficial effects of beta-blockers to angiotensin-converting enzyme inhibitors in the Survival and Ventricular Enlargement (SAVE) Study. SAVE Investigators. J Am Coll Cardiol 1997, 29:229–236.PubMedCrossRefGoogle Scholar
  39. 39.
    Yusuf S, Sleight P, Pogue J, et al.: Effects of an angiotensinconverting-enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The Heart Outcomes Prevention Evaluation Study Investigators. N Engl J Med 2000, 342:145–153. This study demonstrated that the use of the ACE inhibitor ramipril decreased cardiovascular events including HF in high-risk patients.PubMedCrossRefGoogle Scholar
  40. 40.
    Kjekshus J, Pedersen TR, Olsson AG, et al.: The effects of simvastatin on the incidence of heart failure in patients with coronary heart disease. J Card Fail 1997, 3:249–254.PubMedCrossRefGoogle Scholar
  41. 41.
    Moser M, Hebert PR: Prevention of disease progression, left ventricular hypertrophy and congestive heart failure in hypertension treatment trials. J Am Coll Cardiol 1996, 27:1214–1218.PubMedCrossRefGoogle Scholar
  42. 42.
    Yu CM, Chau E, Sanderson JE, et al.: Tissue Doppler echocardiographic evidence of reverse remodeling and improved synchronicity by simultaneously delaying regional contraction after biventricular pacing therapy in heart failure. Circulation 2002, 105:438–445.PubMedCrossRefGoogle Scholar
  43. 43.
    The Acute Infarction Ramipril Efficacy (AIRE) Study Investigators: Effect of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure. Lancet 1993, 342:821–828.Google Scholar
  44. 44.
    Kober L, Torp-Pedersen C, Carlsen JE, et al.: A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction. Trandolapril Cardiac Evaluation (TRACE) Study Group. N Engl J Med 1995, 333:1670–1676.PubMedCrossRefGoogle Scholar
  45. 45.
    Flather MD, Yusuf S, Kober L, et al.: Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients. ACE-Inhibitor Myocardial Infarction Collaborative Group. Lancet 2000, 355:1575–1581.PubMedCrossRefGoogle Scholar
  46. 46.
    Dargie HJ: Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet 2001, 357:1385–1390. This is the only large randomized controlled trial to show that beta blockers (carvedilol) in post-MI patients with HF or LVSD decrease mortality.PubMedCrossRefGoogle Scholar
  47. 47.
    Dickstein K, Kjekshus J: Effects of losartan and captopril on mortality and morbidity in high-risk patients after acute myocardial infarction: the OPTIMAAL randomised trial. Optimal Trial in Myocardial Infarction with Angiotensin II Antagonist Losartan. Lancet 2002, 360:752–760.PubMedCrossRefGoogle Scholar
  48. 48.
    Pitt B, Zannad F, Remme WJ, et al.: The effect of spironolactone on morbidity and mortality in patients with severe heart failure. Randomized Aldactone Evaluation Study Investigators. N Engl J Med 1999, 341:709–717.PubMedCrossRefGoogle Scholar
  49. 49.
    Weir R, McMurray JJ: Treatments that improve outcome in the patient with heart failure, left ventricular systolic dysfunction, or both after acute myocardial infarction. Heart 2005, 91(Suppl 2):ii17-ii48.PubMedCrossRefGoogle Scholar
  50. 50.
    Pitt B, Remme W, Zannad F, et al.: Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction. N Engl J Med 2003, 348:1309–1321. A large randomized controlled trial that showed the selective aldosterone blocker eplerenone provided a 15% relative risk reduction in all causes of mortality in patients with acute myocardial infarction complicated by left ventricular dysfunction and HF or diabetes. These patients were treated with excellent background therapy.PubMedCrossRefGoogle Scholar
  51. 51.
    Solomon SD, Zelenkofske S, McMurray JJ, et al.: Sudden death in patients with myocardial infarction and left ventricular dysfunction, heart failure, or both. N Engl J Med 2005, 352:2581–2588. This paper documented that the highest risk of sudden death in patients with acute MI complicated by LVSD and/or HF is during the first 30 days and that the risk of sudden death increases with decreasing ejection fraction.PubMedCrossRefGoogle Scholar
  52. 52.
    Hohnloser SH, Kuck KH, Dorian P, et al.: Prophylactic use of an implantable cardioverter-defibrillator after acute myocardial infarction. N Engl J Med 2004, 351:2481–2488. This randomized controlled trial failed to show a survival benefit for patients treated with prophylactic ICD implantation after a recent MI.PubMedCrossRefGoogle Scholar
  53. 53.
    ACE Inhibitor Myocardial Infarction Collaborative Group: Indications for ACE inhibitors in the early treatment of acute myocardial infarction: systematic overview of individual data from 100,000 patients in randomized trials. Circulation 1998, 97:2202–2212.Google Scholar
  54. 54.
    First International Study of Infarct Survival Collaborative Group: Randomised trial of intravenous atenolol among 16,027 cases of suspected acute myocardial infarction: ISIS-1. Lancet 1986, 2:57–66.Google Scholar
  55. 55.
    Yusuf S, Zhao F, Mehta SR, et al.: Effect of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med 2001, 345:494–502.PubMedCrossRefGoogle Scholar
  56. 56.
    Kashani A, Giugliano RP, Antman EM, et al.: Severity of heart failure, treatments, and outcomes after fibrinolysis in patients with ST-elevation myocardial infarction. Eur Heart J 2004, 25:1702–1710.PubMedCrossRefGoogle Scholar
  57. 57.
    Pashos CL, Normand SL, Garfinkle JB, et al.: Trends in the use of drug therapies in patients with acute myocardial infarction: 1988 to 1992. J Am Coll Cardiol 1994, 23:1023–1030.PubMedCrossRefGoogle Scholar
  58. 58.
    McGovern PG, Pankow JS, Shahar E, et al.: Recent trends in acute coronary heart disease—mortality, morbidity, medical care, and risk factors. The Minnesota Heart Survey Investigators. N Engl J Med 1996, 334:884–890.PubMedCrossRefGoogle Scholar
  59. 59.
    The Norwegian Multicenter Study Group: Timolol-induced reduction in mortality and reinfarction in patients surviving acute myocardial infarction. N Engl J Med 1981, 304:801–807.CrossRefGoogle Scholar
  60. 60.
    Guidry UC, Evans JC, Larson MG, et al.: Temporal trends in event rates after Q-wave myocardial infarction: the Framingham Heart Study. Circulation 1999, 100:2054–2059.PubMedGoogle Scholar
  61. 61.
    Kober L, Torp-Pedersen C, Jorgensen S, et al.: Changes in absolute and relative importance in the prognostic value of left ventricular systolic function and congestive heart failure after acute myocardial infarction. TRACE Study Group. Trandolapril Cardiac Evaluation. Am J Cardiol 1998, 81:1292–1297.PubMedCrossRefGoogle Scholar
  62. 62.
    The GUSTO Investigators: An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993, 329:673–682.CrossRefGoogle Scholar
  63. 63.
    Hasdai D, Behar S, Wallentin L, et al.: A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin; the Euro Heart Survey of Acute Coronary Syndromes (Euro Heart Survey ACS). Eur Heart J 2002, 23:1190–1201.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc 2005

Authors and Affiliations

  • Kevin L. Thomas
  • Eric J. Velazquez
    • 1
  1. 1.Duke University Medical CenterDurhamUSA

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