Jonathan W Cunningham1, Muthiah Vaduganathan1, Brian L Claggett1, Jenine E John1, Akshay S Desai1, Eldrin F Lewis1, Michael R Zile2, Peter Carson3, Pardeep S Jhund4, Lars Kober5, Bertram Pitt6, Sanjiv J Shah7, Karl Swedberg8, Inder S Anand9, Salim Yusuf10, John J V McMurray4, Marc A Pfeffer1, Scott D Solomon11. 1. Brigham and Women's Hospital, Boston, Massachusetts. 2. RHJ Department of Veterans Affairs Medical Center and Medical University of South Carolina, Charleston, South Carolina. 3. Veterans Affairs Medical Center, Washington DC. 4. BHF Cardiovascular Research Centre, University of Glasgow, Glasgow, Scotland, United Kingdom. 5. Rigshospitalet Copenhagen University Hospital, Copenhagen, Denmark. 6. University of Michigan School of Medicine, Ann Arbor, Michigan. 7. Northwestern University Feinberg School of Medicine, Chicago, Illinois. 8. University of Gothenburg, Gothenburg, Sweden. 9. VA Medical Center and University of Minnesota, Minneapolis, Minnesota. 10. Hamilton Health Sciences and McMaster University, Hamilton, Ontario, Canada. 11. Brigham and Women's Hospital, Boston, Massachusetts. Electronic address: ssolomon@rics.bwh.harvard.edu.
Abstract
OBJECTIVES: The authors investigated the relationship between past or incident myocardial infarction (MI) and cardiovascular (CV) events in heart failure with preserved ejection fraction (HFpEF). BACKGROUND: MI and HFpEF share some common risk factors. The prognostic significance of MI in patients with HFpEF is uncertain. METHODS: The authors pooled data from 3 trials-CHARM Preserved (Candesartan Cilexietil in Heart Failure Assessment of Reduction in Mortality and Morbidity), I-Preserve (Irbesartan in Heart Failure With Preserved Systolic Function), and the Americas region of TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) (N = 8,916)-and examined whether MI before or following enrollment independently predicted CV death and heart failure (HF) hospitalization. RESULTS: At baseline, 2,668 patients (30%) had history of MI. Prior MI was independently associated with greater risk of CV death (4.7 vs. 3.5 events/100 patient-years [py], adjusted hazard ratio [HR]: 1.42 [95% confidence interval (CI): 1.23 to 1.64]; p < 0.001). Excess sudden death drove this difference (1.9 vs. 1.2 events/100 py, adjusted HR: 1.55 [95% CI: 1.23 to 1.97]; p < 0.001). There was no difference in HF hospitalization (5.9 vs. 5.5 events/100 py, adjusted HR: 1.05, 95% CI: 0.92 to 1.19) or HF death by prior MI. During follow-up, MI occurred in 336 patients (3.8%). Risk of CV death increased 31-fold in the first 30 days after first post-enrollment MI, and remained 58% higher beyond 1 year after MI. Risk of first or recurrent HF hospitalization increased 2.4-fold after MI. CONCLUSIONS: Prior MI in HFpEF is associated with greater CV and sudden death but similar risk of HF outcomes. Patients with HFpEF who experience MI are at high risk of subsequent CV death and HF hospitalization. These data highlight the importance of primary and secondary prevention of MI in patients with HFpEF. (Candesartan Cilexietil in Heart Failure Assessment of Reduction in Mortality and Morbidity [CHARM Preserved]; NCT00634712; Irbesartan in Heart Failure With Preserved Systolic Function [I-Preserve]; NCT00095238; and Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist [TOPCAT]; NCT00094302).
RCT Entities:
OBJECTIVES: The authors investigated the relationship between past or incident myocardial infarction (MI) and cardiovascular (CV) events in heart failure with preserved ejection fraction (HFpEF). BACKGROUND: MI and HFpEF share some common risk factors. The prognostic significance of MI in patients with HFpEF is uncertain. METHODS: The authors pooled data from 3 trials-CHARM Preserved (Candesartan Cilexietil in Heart Failure Assessment of Reduction in Mortality and Morbidity), I-Preserve (Irbesartan in Heart Failure With Preserved Systolic Function), and the Americas region of TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) (N = 8,916)-and examined whether MI before or following enrollment independently predicted CV death and heart failure (HF) hospitalization. RESULTS: At baseline, 2,668 patients (30%) had history of MI. Prior MI was independently associated with greater risk of CV death (4.7 vs. 3.5 events/100 patient-years [py], adjusted hazard ratio [HR]: 1.42 [95% confidence interval (CI): 1.23 to 1.64]; p < 0.001). Excess sudden death drove this difference (1.9 vs. 1.2 events/100 py, adjusted HR: 1.55 [95% CI: 1.23 to 1.97]; p < 0.001). There was no difference in HF hospitalization (5.9 vs. 5.5 events/100 py, adjusted HR: 1.05, 95% CI: 0.92 to 1.19) or HF death by prior MI. During follow-up, MI occurred in 336 patients (3.8%). Risk of CV death increased 31-fold in the first 30 days after first post-enrollment MI, and remained 58% higher beyond 1 year after MI. Risk of first or recurrent HF hospitalization increased 2.4-fold after MI. CONCLUSIONS: Prior MI in HFpEF is associated with greater CV and sudden death but similar risk of HF outcomes. Patients with HFpEF who experience MI are at high risk of subsequent CV death and HF hospitalization. These data highlight the importance of primary and secondary prevention of MI in patients with HFpEF. (Candesartan Cilexietil in Heart Failure Assessment of Reduction in Mortality and Morbidity [CHARM Preserved]; NCT00634712; Irbesartan in Heart Failure With Preserved Systolic Function [I-Preserve]; NCT00095238; and Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist [TOPCAT]; NCT00094302).
Authors: Gijs van Woerden; Dirk J van Veldhuisen; Olivier C Manintveld; Vanessa P M van Empel; Tineke P Willems; Rudolf A de Boer; Michiel Rienstra; B Daan Westenbrink; Thomas M Gorter Journal: Circ Heart Fail Date: 2021-12-22 Impact factor: 8.790
Authors: Senthil Selvaraj; Deepak L Bhatt; Ph Gabriel Steg; Michael Miller; Eliot A Brinton; Terry A Jacobson; Rebecca A Juliano; Lixia Jiao; Jean-Claude Tardif; Christie M Ballantyne Journal: J Am Heart Assoc Date: 2022-04-04 Impact factor: 6.106
Authors: Kerryn W Reding; Richard K Cheng; Alexi Vasbinder; Roberta M Ray; Ana Barac; Charles B Eaton; Nazmus Saquib; Aladdin H Shadyab; Michael S Simon; Dale Langford; Mary Branch; Bette Caan; Garnet Anderson Journal: JACC CardioOncol Date: 2022-03-15