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J Am Coll Cardiol, 2002; 40:1389-1394
© 2002 by the American College of Cardiology Foundation
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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{dagger}, Nathan R. Every, MD, MPH, FACC* and Eric R. Bates, MD, FACC{ddagger},*

* Division of Cardiology, Department of Medicine, University of Washington, Seattle, Washington, USA
{dagger} Ovation Research Group, Seattle, Washington, USA
{ddagger} 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


   Abstract
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 Abstract
Methods
 Results
 Discussion
 References
 
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

Left ventricular decompensation complicating acute myocardial infarction (AMI) results in the clinical syndromes of congestive heart failure (CHF) and cardiogenic shock. Although cardiogenic shock has been the focus of several studies (1,2), little attention has been paid to CHF. This complication occurs in approximately 15% to 25% of patients with AMI (3–7) and is associated with an in-hospital mortality rate of 15% to 40% (3–6) and a one-year mortality rate of 25% to 55% (3,6,8). Several studies have described the occurrence of CHF developing after AMI (8–12), particularly in relation to treatment with fibrinolytics (11,12), whereas others have investigated the utility of using the Killip classification (13) as a prognostic indicator of survival after AMI (14–16). However, only a few studies have specifically examined the clinical outcome of patients with AMI presenting with CHF on admission (6,7,13).

The Second National Registry of Myocardial Infarction (NRMI-2) is a multicenter, community-based database of patients presenting with AMI. In this report, we analyzed the NRMI-2 population to determine the incidence and characteristics of CHF complicating AMI and to identify the predictors of hospital outcome.


   Methods
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Results
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Data collection.   The NRMI-2 is a prospective, observational database of consecutive patients admitted to 1,674 participating hospitals throughout the U.S. A total of 772,586 patients were enrolled from June 1994 to March 1998. All treatment decisions were made at the discretion of the treating physicians.

The data collection process used in the study and quality control features have been previously described (17). Patients were included in the registry if they had documented AMI by clinical, electrocardiographic, or serial enzyme level criteria before hospital discharge. Patients transferred out to a non-NRMI hospital were excluded to avoid incomplete or inconsistent data. Patients were included in the present analysis if they: 1) presented within 12 h of symptom onset; 2) had electrocardiographic evidence of AMI including ST-segment elevation or left bundle-branch block; and 3) were admitted in Killip class I, II, or III (i.e., Killip class IV excluded). Congestive heart failure was defined as Killip class II or III. In order to analyze as uniform a population of AMI patients presenting with CHF as possible, we did not include patients with non–ST-segment elevation AMI in this study.

Statistical analysis.   Differences in selected characteristics between patients presenting with CHF and those without were analyzed using chi-square tests for discrete variables and two-tailed t tests for continuous variables. A p value <0.05 indicated statistical significance. The simultaneous effects of CHF and several potential confounding factors on hospital mortality were examined using logistic regression analysis. Using stepwise selection, we entered variables into the multivariate logistic regression model in the following order: 1) presence of CHF on admission and demographic data (age, gender, race); 2) medical history (smoking, diabetes, hypertension, history of angina, history of AMI, history of CHF, prior stroke, prior percutaneous transluminal coronary angioplasty [PTCA], and prior coronary artery bypass graft surgery); 3) presentation characteristics (anterior or septal AMI, posterior or lateral AMI, chest pain at presentation, transferred in); 4) medications within 24 h (aspirin, subcutaneous heparin, intravenous [IV] heparin, angiotensin-converting enzyme [ACE] inhibitor, oral [PO] beta-blocker, IV beta-blocker, calcium-channel blocker, fibrinolytics); and 5) primary reperfusion strategies (fibrinolysis, PTCA). Because so many variables were entered into the multivariate logistic regression model, tests for multicollinearity between variables were performed. A covariance matrix did not demonstrate significant multicollinearity, and tolerance values of all variables in a linear regression model were high, also indicating low multicollinearity. Statistical analyses were performed with SAS software, version 8.02 (SAS Institute, Cary, North Carolina).


   Results
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 Abstract
 Methods
 Results
Discussion
 References
 
Baseline characteristics.   A total of 190,518 patients met inclusion criteria; 36,303 (19.1%) had CHF. Baseline patient characteristics are shown in Table 1. Of the patients with CHF, 70.6% were Killip class II and 29.4% were Killip class III. Patients with CHF were more likely to be older and female, and to have a higher prevalence of diabetes, hypertension, prior AMI, and history of CHF. They more often had an anterior or septal AMI and presented later to the hospital than those without CHF. Although there were no clinically significant differences in systolic or diastolic blood pressure, patients with CHF had higher heart rates than those without CHF.


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  		Table 1 Baseline Characteristics

 
Treatment.   Patients presenting with CHF were less likely to receive aspirin, heparin, beta-blockers, and fibrinolytics but were more likely to receive ACE inhibitors and calcium-channel blockers (Table 2). Procedures performed during hospitalization are shown in Table 3. A greater proportion of patients with CHF required supportive interventions, including mechanical ventilation, pacemaker placement, and intra-aortic balloon counterpulsation. Fewer patients with CHF were treated with primary or elective PTCA or surgical revascularization.


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  		Table 2 Medications Within 24h

 

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  		Table 3 Procedures

 
Hospital events.   As shown in Table 4, patients presenting with CHF experienced more adverse clinical outcomes, including recurrent AMI, stroke, second- or third-degree atrioventricular block, ventricular arrhythmias, cardiac rupture, and unexpected cardiac arrest. In-hospital mortality was three times higher for patients with CHF than those without CHF (21.4% vs. 7.2%; p < 0.0005). In addition, length of hospital stay was longer.


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  		Table 4 Hospital events

 
Multivariate analysis.   The logistic regression analysis performed to assess the effect of CHF while adjusting for potential confounding factors is shown in Table 5. Congestive heart failure on admission with AMI was one of the strongest predictors of in-hospital death (adjusted odds ratio [OR] 1.68; 95% confidence interval [CI] 1.62, 1.75), in addition to anterior AMI (adjusted OR 1.85; 95% CI 1.78, 1.92) and older age (adjusted OR 1.58; 95% CI 1.55, 1.61). Treatment with aspirin, PO (but not IV) beta-blockers, and ACE inhibitors were negatively associated with in-hospital death, as was chest pain at presentation. Although risk of in-hospital death was reduced with both fibrinolytics (adjusted OR 0.91; 95% CI 0.87, 0.95) and primary PTCA (adjusted OR 0.67; 95% CI 0.63, 0.72), the latter appeared to impart a stronger survival benefit.


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  		Table 5 Multivariate Logistic Regression Analysis of Predictors of Hospital Death

 

   Discussion
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 Abstract
 Methods
 Results
 Discussion
References
 
CHF complicating AMI.   Drawn from over 1,600 hospitals nationwide, our large study population was a representative sample of patients presenting with CHF complicating AMI in the U.S. in the mid-1990s. Both the incidence of CHF (19%) and distribution of Killip class II (13.5%) and III (5.6%) were similar to those found in older randomized studies of fibrinolytic therapy (3–5). Interestingly, these rates have decreased in more recent trials (18,19), probably reflecting recruitment bias. Patients with CHF were more likely to be older and female, and have a prior history of cardiovascular and comorbid disease (6–9). Furthermore, this patient subgroup was more likely to present with high-risk AMI characteristics including anterior location (20), tachycardia (21), absence of chest pain (22), and longer period from symptom onset to hospital presentation (3).

In their landmark 1967 publication, Killip and Kimball (13) demonstrated increasing hospital mortality with greater degree of CHF severity (i.e., higher Killip class), and their classification has endured as a simple and accurate tool for early risk assessment of patients with AMI (23). Although survival for patients with CHF has improved since 1975 (9), the association between higher Killip class and poorer outcomes has not changed. In our study, Killip class II or III patients were at higher risk for adverse outcomes, including death. Furthermore, CHF on admission was one of the most powerful predictors of in-hospital mortality. In a secondary analysis of the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries (GUSTO-1) trial, Lee et al. (15) found that higher Killip class, in addition to older age, lower systolic blood pressure, tachycardia, and anterior AMI accounted for 90% of the prognostic value found in baseline data.

Adjunctive drug therapy.   Aspirin and beta-blockers have been demonstrated in randomized trials to improve survival in patients with AMI (24,25), as has ACE inhibitor therapy for patients with CHF complicating AMI (26,27). We found that AMI patients presenting with CHF are at high risk for adverse hospital outcomes, but despite their poor prognosis, they are less aggressively treated with potentially life-saving medications. In multivariate analysis, treatment with ACE inhibitor, aspirin, and PO beta-blocker therapy provided the strongest protection against in-hospital death in this high-risk population. Despite this marked benefit, 25% of these high-risk patients did not receive aspirin, and three-quarters did not receive beta-blockers or ACE inhibitors. Additionally, patients presenting with CHF were more likely to receive calcium-channel blockers, which do not have proven clinical benefit for patients with AMI and are an American College of Cardiology/American Heart Association (ACC/AHA) class III indication for patients with CHF (28). In our analysis, treatment with calcium-channel blockers had a neutral effect on hospital mortality.

Easily administered medications such as aspirin, beta-blockers, and ACE inhibitors have always been underused in the treatment of patients with AMI. In 1992, only 38% of hospitalized patients with AMI were treated with beta-blockers (29). In hospitalized Medicare patients with AMI, approximately 80% received aspirin, 45% received beta-blockers, and less than 60% received ACE inhibitors, even when contraindications were absent (30). Other large studies have found similar suboptimal usage rates of these medications for patients with AMI (31,32).

The reasons behind underuse of potentially life-saving medications in our patient population are not entirely clear and are probably multifactorial. Possible contributors include care providers’ overestimation of potential side effects (such as hypotension) or unawareness of current standards of care, lack of hospital protocols to ensure that treatment is consistent with evidence-based guidelines, or non-clinical factors such as patient gender and race or geographic variation that may influence treatment decisions (29,31). Although the presence of transient CHF, pulmonary edema, reduced left ventricular ejection fraction, or higher Killip class is associated with lack of beta-blocker therapy (33,34), the risk of worsening heart failure with initiation of beta-blocker therapy may be overstated. Among AMI patients with a known history of CHF, clinical heart failure was precipitated in only 15% (35), and these patients benefited from treatment with a greater reduction in absolute mortality (36,37). Even patients with severe left ventricular dysfunction demonstrate long-term mortality benefit from beta-blocker treatment (34). More recently, a large multicenter trial demonstrated a 29% risk reduction for the combined end point of all-cause mortality and non-fatal AMI in patients with left ventricular dysfunction randomized to treatment with the beta-blocker carvedilol after AMI (38). The ACE inhibitors have been an ACC/AHA class I indication for patients with CHF since 1996 (28). Further investigation of potential barriers to optimal care of patients with CHF complicating AMI is warranted.

Reperfusion therapy.   This study confirmed the previous observation that patients with AMI presenting with CHF are less likely to undergo primary reperfusion, either with fibrinolysis or PTCA, than Killip class I patients (6,7). Although one small randomized study showed survival benefit after fibrinolysis in patients presenting with CHF (39), others have not (5), and it has not conclusively been shown that this subgroup of patients benefits from fibrinolysis (40). In this study, the largest report on patients with CHF complicating AMI, there was a small (9%) reduction in relative risk of mortality that was statistically significant. The failure of fibrinolytic therapy to dramatically decrease mortality in patients who present with CHF could be explained by physiologically more significant left ventricular dysfunction, lower reperfusion rates, associated mechanical complications (such as mitral regurgitation), or completed infarction (40). We found that the risk of in-hospital mortality was reduced more by primary PTCA than by fibrinolysis. Similar favorable results have been observed with primary PTCA in cardiogenic shock (1,2,40) and in Killip class II or III patients (41), presumably due to improved infarct artery patency. DeGeare and co-workers (42) reported lower than expected in-hospital mortality rates of 2.4%, 7.0%, and 19.2% for 2,654 patients undergoing primary percutaneous coronary intervention in Killip class I, II, and III, respectively. However, further investigation is needed to clarify whether primary PTCA is superior to fibrinolytic therapy for patients with AMI complicated by CHF.

Study limitations.   Although the NRMI-2 registry includes more than 1,600 hospitals throughout the U.S., participating hospitals may not be entirely representative of all hospitals in the country. Registry hospitals have been shown to be larger, more likely to be affiliated with a medical school, more likely to be certified by the Joint Commission on Accreditation of Health Care Organizations, and more likely to have facilities for cardiac catheterization and cardiac surgery than non-registry hospitals (17). However, a recent analysis found that the NRMI-2 registry compared favorably with the Cooperative Cardiovascular Project (CCP), a large national registry which employs very rigorous data collection methods, with regard to demographic, past medical, procedural, and medication use data (43).

A second limitation of our analysis is that NRMI-2 is an observational registry rather than a randomized treatment trial, and thus CHF was defined by chart-abstracted Killip class. Killip class in NRMI-2 has not been externally validated. In the recent comparison with the CCP, CHF complicating AMI during hospitalization was under-reported in NRMI-2 (43). However, if NRMI-2 also under-reported CHF on admission, any differences between patients presenting with CHF versus those without would be attenuated rather than falsely exaggerated. Also, NRMI-2 did not include data on the different mechanisms of CHF in patients with AMI, so their impact on management and outcomes cannot be determined.

Conclusion.   Our study demonstrates that patients presenting with AMI complicated by CHF are at high risk for hospital mortality and adverse outcomes. Despite their increased risk, these patients are less frequently treated with medications with proven mortality benefit or with primary reperfusion strategies. Further study to determine and overcome barriers to treatment with aspirin, beta-blockers, and ACE inhibitors in this high-risk group of patients is warranted. In addition, primary PTCA appears to be associated with greater mortality benefit than fibrinolytics, a finding that merits further investigation with prospective clinical trials. Early identification of patients with CHF and aggressive targeting of this patient population for medical treatment and reperfusion therapy may reduce hospital mortality and adverse events.


   Footnotes
 
This study was supported by Genentech, Inc.


   References
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 Abstract
 Methods
 Results
 Discussion
 References
 

  1. Bates ER, Moscucci M. Post-infarction cardiogenic shock. Brown DL. Cardiac Intensive Care. Philadelphia: W.B. Saunders; 1998. p. 215–227
  2. SHOCK InvestigatorsHochman JS, Sleeper LA, Webb JG, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. N Engl J Med. 1999;341:625–634[Abstract/Free Full Text]
  3. Gruppo Italiano per lo Studio della Streptochinasi nell’Infarto Miocardico (GISSI). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet. 1986;1:397–402[CrossRef][Medline]
  4. Gruppo Italiano per lo Studio della Sopravivenza nell’Infarto Miocardico. GISSI-2: a factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12,490 patients with acute myocardial infarction. Lancet. 1990;336:65–71[Medline]
  5. The International Study Group. In-hospital mortality and clinical course of 20,891 patients with suspected acute myocardial infarction randomised between alteplase and streptokinase with or without heparin. Lancet. 1990;336:71–75[CrossRef][Medline]
  6. Rott D, Behar S, Gottlieb S, Boyko V, Hod H. Usefulness of the Killip classification for early risk stratification of patients with acute myocardial infarction in the 1990s compared with those treated in the 1980s. Am J Cardiol. 1997;80:859–864[CrossRef][Medline]
  7. Miller WL, Wright RS, Grill JP, Kopecky SL. Improved survival after acute myocardial infarction in patients with advanced Killip class. Clin Cardiol. 2000;23:751–758[Medline]
  8. Emanuelsson H, Karlson BW, Herlitz J. Characteristics and prognosis of patients with acute myocardial infarction in relation to occurrence of congestive heart failure. Eur Heart J. 1994;15:761–768[Abstract/Free Full Text]
  9. 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[Abstract/Free Full Text]
  10. Ali AS, Rybicki BA, Alam M, et al. Clinical predictors of heart failure in patients with first acute myocardial infarction. Am Heart J. 1999;138:1133–1199[CrossRef][Medline]
  11. 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[CrossRef][Medline]
  12. Gilon D, Leitersdorf I, Gotsman MS, Zahger D, Sapoznikov D, Weiss AT. Reduction of congestive heart failure symptoms by very early fibrinolytic therapy in acute myocardial infarction: a long-term follow-up. Am Heart J. 2000;139:1096–1100[CrossRef][Medline]
  13. Killip T, 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[CrossRef][Medline]
  14. Fresco C, Carinci F, Maggioni AP, et al. Very early assessment of risk for in-hospital death among 11,483 patients with acute myocardial infarction. Am Heart J. 1999;138:1058–1064[CrossRef][Medline]
  15. GUSTO-I InvestigatorsLee KL, Woodlief LH, Topol EJ, et al. Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction: results from an international trial of 41,021 patients. Circulation. 1995;91:1659–1668[Abstract/Free Full Text]
  16. Morrow DA, Antman EM, Parsons L, et al. Application of the TIMI risk score for ST-elevation MI in the National Registry of Myocardial Infarction 3. JAMA. 2001;286:1356–1359[Abstract/Free Full Text]
  17. Rogers WJ, Bowlby LJ, Chandra NC, et al. Treatment of myocardial infarction in the United States (1990 to 1993): observations from the National Registry of Myocardial Infarction. Circulation. 1994;90:2103–2114[Abstract/Free Full Text]
  18. The GUSTO V Investigators. Reperfusion therapy for acute myocardial infarction with fibrinolytic therapy or combination reduced fibrinolytic therapy and platelet glycoprotein IIb/IIIa inhibition: the GUSTO V randomised trial. Lancet. 2001;357:1905–1914[CrossRef][Medline]
  19. The ASSENT-3 Investigators. Efficacy and safety of tenecteplase in combination with enoxaparin, abciximab, or unfractionated heparin: the ASSENT-3 randomised trial in acute myocardial infarction. Lancet. 2001;358:605–613[CrossRef][Medline]
  20. MILIS GroupStone 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[Abstract]
  21. Crimm A, Severance HW, Coffey K, McKinnis R, Wagner GS, Califf RM. Prognostic significance of isolated sinus tachycardia during first three days of acute myocardial infarction. Am J Med. 1984;76:983–988[CrossRef][Medline]
  22. Canto JG, Shlipak MG, Rogers WJ, et al. Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain. JAMA. 2000;283:3223–3229[Abstract/Free Full Text]
  23. Werns SW, Bates ER. The enduring value of Killip classification. Am Heart J. 1999;137:213–215[CrossRef][Medline]
  24. Second International Study of Infarct Survival (ISIS-2) Collaborative Group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction. Lancet. 1988;2:349–360[Medline]
  25. Yusuf S, Peto R, Lewis J, Collins R, Sleight P. Beta blockade during and after myocardial infarction: an overview of the randomized trials. Prog Cardiovasc Dis. 1985;27:335–371[Medline]
  26. 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[Medline]
  27. 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. Lancet. 2000;355:1575–1581[CrossRef][Medline]
  28. Ryan TJ, Anderson JL, Antman EM, et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Acute Myocardial Infarction). J Am Coll Cardiol. 1996;28:1328–1428[CrossRef][Medline]
  29. Pashos CL, Normand SL, Garfinkle JB, Newhouse JP, Epstein AM, McNeil BJ. Trends in the use of drug therapies in patients with acute myocardial infarction: 1988 to 1992. J Am Coll Cardiol. 1994;23:1023–1030[Abstract]
  30. Ellerbeck EF, Jencks SF, Radford MJ, et al. Quality of care for Medicare patients with acute myocardial infarction: a four state pilot study from the Cooperative Cardiovascular Project. JAMA. 1995;273:1509–1514[Abstract]
  31. Pilote L, Califf RM, Sapp S, et al. Regional variation across the United States in the management of acute myocardial infarction. N Engl J Med. 1995;333:565–572[Abstract/Free Full Text]
  32. McGovern PG, Pankow JS, Shahar E, et al. Recent trends in acute coronary heart disease: mortality, morbidity, medical care, and risk factors. N Engl J Med. 1996;334:884–890[Abstract/Free Full Text]
  33. Viskin S, Kitzis I, Lev E, et al. Treatment with beta-adrenergic blocking agents after myocardial infarction: from randomized trials to clinical practice. J Am Coll Cardiol. 1995;25:1327–1332[Abstract]
  34. Gottlieb SS, McCarter RJ, Vogel RA. Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med. 1998;339:489–497[Abstract/Free Full Text]
  35. Beta-blocker Heart Attack Trial Research Group. A randomized trial of propranolol in patients with acute myocardial infarction. II. Morbidity results. JAMA. 1983;250:2814–2819[Abstract]
  36. Chadda K, Goldstein S, Byington R, Curb JD. Effect of propranolol after acute myocardial infarction in patients with congestive heart failure. Circulation. 1986;73:503–510[Abstract/Free Full Text]
  37. Multicenter Diltiazem Post-Infarction Research GroupLichstein E, Hager WD, Gregory JJ, Fleiss JL, Rolnitzky LM, Bigger JT. Relation between beta-adrenergic blocker use, various correlates of left ventricular function and the chance of developing congestive heart failure. J Am Coll Cardiol. 1990;16:1327–1332[Abstract]
  38. The CAPRICORN Investigators. Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial. Lancet. 2001;357:1385–1390[CrossRef][Medline]
  39. Simoons ML, Vos J, Tijssen JGP, et al. Long-term benefit of early fibrinolytic therapy in patients with acute myocardial infarction: 5-year follow-up of a trial conducted by Interuniversity Cardiology Institute of the Netherlands. J Am Coll Cardiol. 1989;14:1609–1615[Abstract]
  40. Bates ER, Topol EJ. Limitations of thrombolytic therapy for acute myocardial infarction complicated by congestive heart failure and cardiogenic shock. J Am Coll Cardiol. 1991;18:1077–1084[Abstract]
  41. Working Group on Intensive Cardiac Care, Israel Heart SocietyRott D, Behar S, Leor J, et al. Effect on survival of acute myocardial infarction in Killip Classes II or III patients undergoing invasive coronary procedures. Am J Cardiol. 2001;88:618–623[CrossRef][Medline]
  42. DeGeare VS, Boura JA, Grines LL, O’Neill WW, Grines CL. Predictive value of the Killip classification in patients undergoing primary percutaneous coronary intervention for acute myocardial infarction. Am J Cardiol. 2001;87:1035–1038[CrossRef][Medline]
  43. Every NR, Frederick PD, Robinson M, Sugarman J, Bowlby L, Barron HV. A comparison of the National Registry of Myocardial Infarction 2 with the Cooperative Cardiovascular Project. J Am Coll Cardiol. 1999;33:1886–1894[Abstract/Free Full Text]



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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.
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 CirculationHome page
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.
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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.
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 Arch Intern MedHome page
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]

Home page
 Eur Heart JHome page
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]

Home page
 Eur Heart J SupplHome page
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]

Home page
 Eur Heart JHome page
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]

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 J Am Coll CardiolHome page
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.
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Home page
 Arch Intern MedHome page
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]

Home page
 HeartHome page
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]

Home page
 Eur Heart JHome page
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.
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 CirculationHome page
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]

Home page
 Eur Heart JHome page
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]

Home page
 Eur Heart JHome page
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]

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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]

Home page
 Eur Heart JHome page
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.
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Home page
 CirculationHome page
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.
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 CirculationHome page
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.
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 CirculationHome page
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.
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 CirculationHome page
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.
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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.
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 JWatch Emergency Med.Home page
Patients with AMI Complicated by CHF Are at Very High Risk
Journal Watch Emergency Medicine, December 30, 2002; 2002(1230): 4 - 4.
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