CLINICAL STUDY: ACUTE MYOCARDIAL INFARCTION
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)
Audrey H. Wu, MD, MPH*,
Lori Parsons, BS ,
Nathan R. Every, MD, MPH, FACC* and
Eric R. Bates, MD, FACC ,*
* Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
Ovation Research Group, Seattle, Washington, USA
Division of Cardiology, Department of Medicine, University of Michigan, Ann Arbor, Michigan, USA
Manuscript received January 20, 2002;
revised manuscript received March 5, 2002,
accepted June 7, 2002.
* Reprint requests and correspondence: Dr. Eric R. Bates, B1-F245 UH, 1500 East Medical Center Drive, Ann Arbor, Michigan 48109, USA.
ebates{at}umich.edu
OBJECTIVES: The purpose of this study was to examine treatment and outcomes in patients admitted to the hospital with acute myocardial infarction (AMI) complicated by congestive heart failure (CHF).
BACKGROUND: Although cardiogenic shock complicating AMI has been studied extensively, the hospital course of patients presenting with CHF is less well established.
METHODS: The Second National Registry of Myocardial Infarction (NRMI-2) was analyzed to determine hospital outcomes for patients with ST-elevation AMI admitted with CHF (Killip classes II or III).
RESULTS: Of 190,518 patients with AMI, 36,303 (19.1%) had CHF on admission. Patients presenting with CHF were older (72.6 ± 12.5 vs. 63.2 ± 13.5 years), more often female (46.8% vs. 32.1%), had longer time to hospital presentation (2.80 ± 2.6 vs. 2.50 ± 2.4 h), and had higher prevalence of anterior/septal AMI (38.8% vs. 33.3%), diabetes (33.1% vs. 19.5%), and hypertension (54.6% vs. 46.1%) (all p < 0.0005). Also, they had longer lengths of stay (8.1 ± 7.1 vs. 6.8 ± 5.3 days, p < 0.00005) and greater risk for in-hospital death (21.4% vs. 7.2%; p < 0.0005). Patients with CHF were less likely to receive aspirin (75.7% vs. 89.0%), heparin (74.6% vs. 91.1%), oral beta-blockers (27.0% vs. 41.7%), fibrinolytics (33.4% vs. 58.0%), or primary angioplasty (8.6% vs. 14.6%), and more likely to receive angiotensin-converting enzyme inhibitors (25.4% vs. 13.0%). Congestive heart failure on admission was one of the strongest predictors of in-hospital death (adjusted odds ratio 1.68; 95% confidence interval 1.62, 1.75).
CONCLUSIONS: Patients with AMI presenting with CHF are at higher risk for adverse in-hospital outcomes. Despite this, they are less likely to be treated with reperfusion therapy and medications with proven mortality benefit.
|
Abbreviations and Acronyms
| | ACE | | angiotensin-converting enzyme | | AMI | | acute myocardial infarction | | CCP | | Cooperative Cardiovascular Project | | CHF | | congestive heart failure | | CI | | confidence interval | | IV | | intravenous | | NRMI-2 | | Second National Registry of Myocardial Infarction | | OR | | odds ratio | | PO | | oral | | PTCA | | percutaneous transluminal coronary angioplasty |
|
This article has been cited by other articles:
|
|
|
|
 
A. A. Alsheikh-Ali, M. H. Al-Mallah, W. Al-Mahmeed, N. Albustani, J. Al Suwaidi, K. Sulaiman, M. Zubaid, and for the Gulf RACE Investigators
Heart failure in patients hospitalized with acute coronary syndromes: observations from the Gulf Registry of Acute Coronary Events (Gulf RACE)
Eur J Heart Fail,
December 1, 2009;
11(12):
1135 - 1142.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Adamopoulos, A. Ahmed, R. Fay, M. Angioi, G. Filippatos, J. Vincent, B. Pitt, F. Zannad, and the EPHESUS Investigators
Timing of eplerenone initiation and outcomes in patients with heart failure after acute myocardial infarction complicated by left ventricular systolic dysfunction: insights from the EPHESUS trial
Eur J Heart Fail,
November 1, 2009;
11(11):
1099 - 1105.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Kumar and C. P. Cannon
Acute Coronary Syndromes: Diagnosis and Management, Part II
Mayo Clin. Proc.,
November 1, 2009;
84(11):
1021 - 1036.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. D. Flaherty, J. J. Bax, L. De Luca, J. S. Rossi, C. J. Davidson, G. Filippatos, P. P. Liu, M. A. Konstam, B. Greenberg, M. R. Mehra, et al.
Acute heart failure syndromes in patients with coronary artery disease early assessment and treatment.
J. Am. Coll. Cardiol.,
January 20, 2009;
53(3):
254 - 263.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. A. Ezekowitz, P. Kaul, J. A. Bakal, P. W. Armstrong, R. C. Welsh, and F. A. McAlister
Declining in-hospital mortality and increasing heart failure incidence in elderly patients with first myocardial infarction.
J. Am. Coll. Cardiol.,
January 6, 2009;
53(1):
13 - 20.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. M. Santoro, N. Carrabba, A. Migliorini, G. Parodi, and R. Valenti
Acute heart failure in patients with acute myocardial infarction treated with primary percutaneous coronary intervention
Eur J Heart Fail,
August 1, 2008;
10(8):
780 - 785.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
N. M. Albert and C. Lewis
Recognizing and Managing Asymptomatic Left Ventricular Dysfunction: After Myocardial Infarction
Crit. Care Nurse,
April 1, 2008;
28(2):
20 - 37.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Guazzi, R. Arena, and M. D. Guazzi
Evolving changes in lung interstitial fluid content after acute myocardial infarction: mechanisms and pathophysiological correlates
Am J Physiol Heart Circ Physiol,
March 1, 2008;
294(3):
H1357 - H1364.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Zeller, D. Masson, M. Farnier, L. Lorgis, V. Deckert, J.-P. Pais de Barros, C. Desrumaux, P. Sicard, J. Grober, D. Blache, et al.
High Serum Cholesteryl Ester Transfer Rates and Small High-Density Lipoproteins Are Associated With Young Age in Patients With Acute Myocardial Infarction
J. Am. Coll. Cardiol.,
November 13, 2007;
50(20):
1948 - 1955.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. J. Nicholls, Z. Wang, R. Koeth, B. Levison, B. DelFraino, V. Dzavik, O. W. Griffith, D. Hathaway, J. A. Panza, S. E. Nissen, et al.
Metabolic Profiling of Arginine and Nitric Oxide Pathways Predicts Hemodynamic Abnormalities and Mortality in Patients With Cardiogenic Shock After Acute Myocardial Infarction
Circulation,
November 13, 2007;
116(20):
2315 - 2324.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
F. Najafi, A. J. Dobson, M. Hobbs, and K. Jamrozik
Temporal trends in the frequency and longer-term outcome of heart failure complicating myocardial infarction
Eur J Heart Fail,
September 1, 2007;
9(9):
879 - 885.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
V. Dzavik, G. Cotter, H. R. Reynolds, J. H. Alexander, K. Ramanathan, A. L. Stebbins, D. Hathaway, M. E. Farkouh, E. M. Ohman, D. A. Baran, et al.
Effect of nitric oxide synthase inhibition on haemodynamics and outcome of patients with persistent cardiogenic shock complicating acute myocardial infarction: a phase II dose-ranging study
Eur. Heart J.,
May 1, 2007;
28(9):
1109 - 1116.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. C. Smith Jr, T. E. Feldman, J. W. Hirshfeld Jr, A. K. Jacobs, M. J. Kern, S. B. King III, D. A. Morrison, W. W. O'Neill, H. V. Schaff, P. L. Whitlow, et al.
ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention)
J. Am. Coll. Cardiol.,
January 3, 2006;
47(1):
216 - 235.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. C. Smith Jr, T. E. Feldman, J. W. Hirshfeld Jr, A. K. Jacobs, M. J. Kern, S. B. King III, D. A. Morrison, W. W. O'Neill, H. V. Schaff, P. L. Whitlow, et al.
ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention--Summary Article: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI Writing Committee to Update the 2001 Guidelines for Percutaneous Coronary Intervention)
Circulation,
January 3, 2006;
113(1):
156 - 175.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. P. Wharton Jr, E. C. Keeley, C. L. Grines, T. P. Wharton Jr, E. C. Keeley, and C. L. Grines
The Case for Community Hospital Angioplasty
Circulation,
November 29, 2005;
112(22):
3509 - 3534.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. F. Hernandez, E. J. Velazquez, S. D. Solomon, R. Kilaru, R. Diaz, C. M. O'Connor, G. Ertl, A. P. Maggioni, J.-L. Rouleau, W. van Gilst, et al.
Left Ventricular Assessment in Myocardial Infarction: The VALIANT Registry
Arch Intern Med,
October 10, 2005;
165(18):
2162 - 2169.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. E. Szummer, S. D. Solomon, E. J. Velazquez, R. Kilaru, J. McMurray, J.-L. Rouleau, K. W. Mahaffey, A. P. Maggioni, R. M. Califf, M. A. Pfeffer, et al.
Heart failure on admission and the risk of stroke following acute myocardial infarction: the VALIANT registry
Eur. Heart J.,
October 2, 2005;
26(20):
2114 - 2119.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Elsasser and C. W. Hamm
Percutaneous coronary intervention guidelines: new aspects for the interventional treatment of acute coronary syndromes
Eur. Heart J. Suppl.,
October 1, 2005;
7(suppl_K):
K5 - K9.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Bonnefoy, P. G. Steg, S. Chabaud, P.-Y. Dubien, F. Lapostolle, F. Boudet, J.-M. Lacroute, F. Dissait, G. Vanzetto, A. Leizorowicz, et al.
Is primary angioplasty more effective than prehospital fibrinolysis in diabetics with acute myocardial infarction? Data from the CAPTIM randomized clinical trial
Eur. Heart J.,
September 1, 2005;
26(17):
1712 - 1718.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. Pitt, H. White, J. Nicolau, F. Martinez, M. Gheorghiade, M. Aschermann, D. J. van Veldhuisen, F. Zannad, H. Krum, R. Mukherjee, et al.
Eplerenone Reduces Mortality 30 Days After Randomization Following Acute Myocardial Infarction in Patients With Left Ventricular Systolic Dysfunction and Heart Failure
J. Am. Coll. Cardiol.,
August 2, 2005;
46(3):
425 - 431.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Zeller, P. G. Steg, J. Ravisy, Y. Laurent, L. Janin-Manificat, I. L'Huillier, J.-C. Beer, A. Oudot, G. Rioufol, H. Makki, et al.
Prevalence and Impact of Metabolic Syndrome on Hospital Outcomes in Acute Myocardial Infarction
Arch Intern Med,
May 23, 2005;
165(10):
1192 - 1198.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R Weir and J J V McMurray
Treatments that improve outcome in the patient with heart failure, left ventricular systolic dysfunction, or both after acute myocardial infarction
Heart,
May 1, 2005;
91(suppl_2):
ii17 - ii20.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, S. Silber, P. Albertsson, F. F. Aviles, P. G. Camici, A. Colombo, C. Hamm, E. Jorgensen, J. Marco, J.-E. Nordrehaug, et al.
Guidelines for Percutaneous Coronary Interventions: The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology
Eur. Heart J.,
April 2, 2005;
26(8):
804 - 847.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. S. Weintraub, Z. Zhang, E. M. Mahoney, P. Kolm, J. A. Spertus, J. Caro, J. Ishak, R. Goldberg, J. Tooley, R. Willke, et al.
Cost-Effectiveness of Eplerenone Compared With Placebo in Patients With Myocardial Infarction Complicated by Left Ventricular Dysfunction and Heart Failure
Circulation,
March 8, 2005;
111(9):
1106 - 1113.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. J. Velazquez, G. S. Francis, P. W. Armstrong, P. E. Aylward, R. Diaz, C. M. O'Connor, H. D. White, M. Henis, L. M. Rittenhouse, R. Kilaru, et al.
An international perspective on heart failure and left ventricular systolic dysfunction complicating myocardial infarction: the VALIANT registry
Eur. Heart J.,
November 1, 2004;
25(21):
1911 - 1919.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Kashani, R. P. Giugliano, E. M. Antman, D. A. Morrow, C. M. Gibson, S. A. Murphy, and E. Braunwald
Severity of heart failure, treatments, and outcomes after fibrinolysis in patients with ST-elevation myocardial infarction
Eur. Heart J.,
October 1, 2004;
25(19):
1702 - 1710.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Di Donato, A. Frigiola, M. Benhamouda, and L. Menicanti
Safety and Efficacy of Surgical Ventricular Restoration in Unstable Patients With Recent Anterior Myocardial Infarction
Circulation,
September 14, 2004;
110(11_suppl_1):
II-169 - II-173.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. I. Larsen and K. Dickstein
BNP in acute coronary syndromes: the heart expresses its suffering
Eur. Heart J.,
August 1, 2004;
25(15):
1284 - 1286.
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. De Luca, A. W.J. van't Hof, M.-J. de Boer, J. C.A. Hoorntje, A.T. M. Gosselink, J.-H. E. Dambrink, J. P. Ottervanger, F. Zijlstra, and H. Suryapranata
Impaired Myocardial Perfusion Is a Major Explanation of the Poor Outcome Observed in Patients Undergoing Primary Angioplasty for ST-Segment-Elevation Myocardial Infarction and Signs of Heart Failure
Circulation,
March 2, 2004;
109(8):
958 - 961.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. J. Velazquez and M. A. Pfeffer
Acute Heart Failure Complicating Acute Coronary Syndromes: A Deadly Intersection
Circulation,
February 3, 2004;
109(4):
440 - 442.
[Full Text]
[PDF]
|
|
|
|
|
|
|
P. G. Steg, O. H. Dabbous, L. J. Feldman, A. Cohen-Solal, M.-C. Aumont, J. Lopez-Sendon, A. Budaj, R. J. Goldberg, W. Klein, F. A. Anderson Jr, et al.
Determinants and Prognostic Impact of Heart Failure Complicating Acute Coronary Syndromes: Observations From the Global Registry of Acute Coronary Events (GRACE)
Circulation,
February 3, 2004;
109(4):
494 - 499.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Cohen, G. F. Gensini, F. Maritz, E. P. Gurfinkel, K. Huber, A. Timerman, M. Krzeminska-Pakula, J. Santopinto, C. Hecquet, L. Vittori, et al.
Prospective Evaluation of Clinical Outcomes After Acute ST-Elevation Myocardial Infarction in Patients Who Are Ineligible for Reperfusion Therapy: Preliminary Results From the TETAMI Registry and Randomized Trial
Circulation,
October 21, 2003;
108(90161):
III-14 - 21.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Cohen, G. F. Gensini, F. Maritz, E. P. Gurfinkel, K. Huber, A. Timerman, M. Krzeminska-Pakula, N. Danchin, H. D. White, J. Santopinto, et al.
The safety and efficacy of subcutaneous enoxaparin versus intravenous unfractionated heparin and tirofiban versus placebo in the treatment of acute ST-segment elevation myocardial infarction patients ineligible for reperfusion (TETAMI): A randomized trial
J. Am. Coll. Cardiol.,
October 15, 2003;
42(8):
1348 - 1356.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Patients with AMI Complicated by CHF Are at Very High Risk
Journal Watch Emergency Medicine,
December 30, 2002;
2002(1230):
4 - 4.
[Full Text]
|
|
|
|
