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Yoshida R, Ishii H, Morishima I, Tanaka A, Morita Y, Takagi K, Yoshioka N, Hirayama K, Iwakawa N, Tashiro H, Kojima H, Mitsuda T, Hitora Y, Furusawa K, Tsuboi H, Murohara T. Early versus delayed invasive strategy in patients with non-ST-elevation acute coronary syndrome and concomitant congestive heart failure. J Cardiol 2019; 74:320-327. [DOI: 10.1016/j.jjcc.2019.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 02/21/2019] [Accepted: 03/05/2019] [Indexed: 12/28/2022]
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Xu M, Yan L, Xu J, Yang X, Jiang T. Predictors and prognosis for incident in-hospital heart failure in patients with preserved ejection fraction after first acute myocardial infarction: An observational study. Medicine (Baltimore) 2018; 97:e11093. [PMID: 29901624 PMCID: PMC6024188 DOI: 10.1097/md.0000000000011093] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 05/22/2018] [Indexed: 12/14/2022] Open
Abstract
Patients with acute myocardial infarction (AMI) complicated by heart failure with preserved ejection fraction (HFpEF) are likely to have more adverse cardiovascular events and higher mortality. The purpose of this study was to examine the predictors and outcomes in AMI patients complicated by HFpEF.We examined the demographics, clinical data, and clinical outcomes in 405 consecutive subjects who firstly presented with AMI after undergoing emergency percutaneous coronary intervention from January 2013 to June 2016.Three hundred twenty patients and eighty-five patients were classified into the nonheart failure (non-HF) group and HFpEF group, respectively. Patients with HFpEF had higher prevalence of prior hypertension, had higher levels of biomarkers, and had a larger left atrial diameter with a nondilated left ventricle were more likely to develop multivessel disease-vessels and had infarction-related artery located in left anterior descending artery than patients without HF. Moreover, patients with HFpEF had a higher probability of developing the in-hospital incident cardiovascular complications and death than non-HF patients.Two routine biomarkers, levels of hypersensitive C-reactive protein and N-terminal-pro brain natriuretic peptide, and number of diseased-vessels were independent predictors for in-hospital HFpEF incidence in AMI patients with preserved LVEF. AMI patients with HFpEF had a higher probability of in-hospital cardiovascular outcomes and mortality.
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Affiliation(s)
- Mingzhu Xu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou
| | - Lihua Yan
- Department of Thoracic and Cardiovascular Surgery, Nantong First People's hospital, The Second Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Jialiang Xu
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou
| | - Xiangjun Yang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou
| | - Tingbo Jiang
- Department of Cardiology, The First Affiliated Hospital of Soochow University, Suzhou
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Antonelli L, Katz M, Bacal F, Makdisse MRP, Correa AG, Pereira C, Franken M, Fava AN, Serrano Junior CV, Pesaro AEP. Heart failure with preserved left ventricular ejection fraction in patients with acute myocardial infarction. Arq Bras Cardiol 2015; 105:145-50. [PMID: 26039659 PMCID: PMC4559123 DOI: 10.5935/abc.20150055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The prevalence and clinical outcomes of heart failure with preserved left
ventricular ejection fraction after acute myocardial infarction have not
been well elucidated. Objective To analyze the prevalence of heart failure with preserved left ventricular
ejection fraction in acute myocardial infarction and its association with
mortality. Methods Patients with acute myocardial infarction (n = 1,474) were prospectively
included. Patients without heart failure (Killip score = 1), with heart
failure with preserved left ventricular ejection fraction (Killip score >
1 and left ventricle ejection fraction ≥ 50%), and with systolic dysfunction
(Killip score > 1 and left ventricle ejection fraction < 50%) on
admission were compared. The association between systolic dysfunction with
preserved left ventricular ejection fraction and in-hospital mortality was
tested in adjusted models. Results Among the patients included, 1,256 (85.2%) were admitted without heart
failure (72% men, 67 ± 15 years), 78 (5.3%) with heart failure with
preserved left ventricular ejection fraction (59% men, 76 ± 14 years), and
140 (9.5%) with systolic dysfunction (69% men, 76 ± 14 years), with
mortality rates of 4.3%, 17.9%, and 27.1%, respectively (p < 0.001).
Logistic regression (adjusted for sex, age, troponin, diabetes, and body
mass index) demonstrated that heart failure with preserved left ventricular
ejection fraction (OR 2.91; 95% CI 1.35–6.27; p = 0.006) and systolic
dysfunction (OR 5.38; 95% CI 3.10 to 9.32; p < 0.001) were associated
with in-hospital mortality. Conclusion One-third of patients with acute myocardial infarction admitted with heart
failure had preserved left ventricular ejection fraction. Although this
subgroup exhibited more favorable outcomes than those with systolic
dysfunction, this condition presented a three-fold higher risk of death than
the group without heart failure. Patients with acute myocardial infarction
and heart failure with preserved left ventricular ejection fraction
encounter elevated short-term risk and require special attention and
monitoring during hospitalization.
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Affiliation(s)
| | - Marcelo Katz
- Hospital Israelita Albert Einstein, São Paulo, SP, BR
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4
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Koracevic GP. Beneficial metabolic effects of insulin infusion may be jeopardized by volume overload. Am J Emerg Med 2014; 32:383-4. [DOI: 10.1016/j.ajem.2013.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 12/03/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022] Open
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Shah RV, Holmes D, Anderson M, Wang TY, Kontos MC, Wiviott SD, M. Scirica B. Risk of Heart Failure Complication During Hospitalization for Acute Myocardial Infarction in a Contemporary Population. Circ Heart Fail 2012; 5:693-702. [DOI: 10.1161/circheartfailure.112.968180] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Patients with acute myocardial infarction (MI) complicated by heart failure (HF) are subject to higher mortality during the index hospitalization. Early risk prediction and intervention may help prevent HF-related morbidity and mortality.
Methods and Results—
We examined 77 675 ST-elevation MI and 110 128 non-ST-elevation patients with MI without cardiogenic shock or HF at presentation treated at 609 hospitals in Acute Coronary Treatment and Intervention Outcomes Network Registry (ACTION) Registry-Get With The Guidelines between January 1, 2007, and March 31, 2011. Logistic regression identified patient characteristics associated with development of in-hospital HF. Overall, 3.8% of patients with MI developed in-hospital HF, which was associated with higher mortality in both ST-elevation MI and non-ST elevation MI. In multivariable logistic regression, left ventricular ejection fraction ≤30%, prior HF, diabetes mellitus, female sex, ST-elevation MI, and hypertension (all
P
<0.005) were independently associated with in-hospital HF. Patients who developed HF during non-ST-elevation MI were more likely to be medically managed without catheterization (30% versus 13% with HF,
P
<0.0001) or had longer delays to surgical or percutaneous revascularization. Patients with ST-elevation MI and HF were less likely to receive primary percutaneous coronary revascularization (84% versus 79% with HF,
P
<0.0001), and more likely to receive thrombolytic therapy (14% versus 11%;
P
=0.0001).
Conclusions—
Patients with MI who develop HF during hospitalization have a higher risk clinical profile and greater mortality, but may be less likely to receive revascularization in a timely fashion. Targeting these highest risk patients may improve outcome post-MI.
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Affiliation(s)
- Ravi V. Shah
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.V.S.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (D.H., M.A., T.Y.W.); Virginia Commonwealth University, Department of Cardiology, Richmond, VA (M.C.K.); TIMI, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.W.); TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard
| | - DaJuanicia Holmes
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.V.S.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (D.H., M.A., T.Y.W.); Virginia Commonwealth University, Department of Cardiology, Richmond, VA (M.C.K.); TIMI, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.W.); TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard
| | - Monique Anderson
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.V.S.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (D.H., M.A., T.Y.W.); Virginia Commonwealth University, Department of Cardiology, Richmond, VA (M.C.K.); TIMI, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.W.); TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard
| | - Tracy Y. Wang
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.V.S.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (D.H., M.A., T.Y.W.); Virginia Commonwealth University, Department of Cardiology, Richmond, VA (M.C.K.); TIMI, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.W.); TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard
| | - Michael C. Kontos
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.V.S.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (D.H., M.A., T.Y.W.); Virginia Commonwealth University, Department of Cardiology, Richmond, VA (M.C.K.); TIMI, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.W.); TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard
| | - Stephen D. Wiviott
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.V.S.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (D.H., M.A., T.Y.W.); Virginia Commonwealth University, Department of Cardiology, Richmond, VA (M.C.K.); TIMI, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.W.); TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard
| | - Benjamin M. Scirica
- From the Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA (R.V.S.); Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC (D.H., M.A., T.Y.W.); Virginia Commonwealth University, Department of Cardiology, Richmond, VA (M.C.K.); TIMI, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA (S.D.W.); TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard
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Steinberg BA, Zhao X, Heidenreich PA, Peterson ED, Bhatt DL, Cannon CP, Hernandez AF, Fonarow GC. Trends in patients hospitalized with heart failure and preserved left ventricular ejection fraction: prevalence, therapies, and outcomes. Circulation 2012; 126:65-75. [PMID: 22615345 DOI: 10.1161/circulationaha.111.080770] [Citation(s) in RCA: 614] [Impact Index Per Article: 51.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Heart failure with preserved ejection fraction (EF) is a common syndrome, but trends in treatments and outcomes are lacking. METHODS AND RESULTS We analyzed data from 275 hospitals in Get With the Guidelines-Heart Failure from January 2005 to October 2010. Patients were stratified by EF as reduced EF (EF <40% [HF-reduced EF]), borderline EF (40%≤EF<50% [HF-borderline EF]), or preserved (EF ≥50% [HF-preserved EF]). Using multivariable models, we examined trends in therapies and outcomes. Among 110 621 patients, 50% (55 083) had HF-reduced EF, 14% (15 184) had HF-borderline EF, and 36% (40 354) had HF-preserved EF. From 2005 to 2010, the proportion of hospitalizations for HF-preserved EF increased from 33% to 39% (P<0.0001). In multivariable analyses, use of angiotensin-converting enzyme inhibitors/angiotensin receptor blockers at discharge decreased in all EF groups, and β-blocker use increased. Patients with HF-preserved EF less frequently achieved blood pressure control (adjusted odds ratio, 0.44 versus HF-reduced EF; P<0.001) and were more likely discharged to skilled nursing (adjusted odds ratio, 1.16 versus HF-reduced EF; P<0.001). In-hospital mortality for HF-preserved EF decreased from 3.32% in 2005 to 2.35% in 2010 (adjusted odds ratio, 0.89 per year; P=0.01) but was stable for patients with HF-reduced EF (3.03%-2.83%; adjusted odds ratio, 0.93 per year; P=0.10). CONCLUSIONS Hospitalization for HF-preserved EF is increasing relative to HF-reduced EF. Although in-hospital mortality for patients with HF-preserved EF declined over the study period, an important opportunity remains for identifying evidence-based therapies in patients with HF-preserved EF.
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Huang D, Cheng JWM. Pharmacologic management of heart failure with preserved ejection fraction. Ann Pharmacother 2010; 44:1933-45. [PMID: 21098754 DOI: 10.1345/aph.1p372] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To provide an overview of heart failure with preserved ejection fraction (HFPEF), as well as its pathophysiology, diagnosis, and clinical evidence regarding its pharmacologic management. DATA SOURCES Peer-reviewed articles were identified from MEDLINE, International Pharmaceutical Abstracts, and Current Contents (all 1966-August 2010) using the search terms heart failure with preserved ejection fraction, diastolic dysfunction, diastolic heart failure, angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), digoxin, β-blockers, calcium-channel blockers, and vasodilators. Citations from available articles were also reviewed for additional references. STUDY SELECTION AND DATA EXTRACTION Fourteen published manuscripts relating to pharmacologic management of HFPEF were identified. DATA SYNTHESIS The prevalence of HFPEF has continued to increase. Compared to heart failure with left ventricular systolic dysfunction, HFPEF has been largely understudied. Unlike in the management of heart failure with left ventricular systolic dysfunction, ACE inhibitors, ARBs, β-blockers, and aldosterone antagonists did not demonstrate mortality benefit in HFPEF, with the exception of one small study evaluating the use of propranolol. However, this study enrolled a small number of patients with recent history of myocardial infarction, which limited the generalizability of the results. Most of the current evidence centers on morbidity benefits and symptom reduction. One study showed that treatment with candesartan reduced hospital admissions in this population of patients. Management of HFPEF still focuses on optimally managing underlying diseases (eg, hypertension). CONCLUSIONS Much remains to be learned about the appropriate pharmacologic management of patients with HFPEF. Hypertension is in most cases the predominant contributor to its development and progression. For this reason, antihypertensive treatment, including ACE inhibitors, ARBs, β-blockers, and calcium-channel blockers, has been evaluated and is recommended to control the disease in this patient population, although these agents have not demonstrated significant benefit beyond blood pressure control. Further research into the pathophysiology of HFPEF may contribute to identifying the most optimal agent in managing this disease.
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Affiliation(s)
- Dana Huang
- Massachusetts College of Pharmacy and Health Sciences, Boston, MA Pharmaceuticals, Wayne, NJ, USA
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Scirica BM, Morrow DA, Bode C, Ruzyllo W, Ruda M, Oude Ophuis AJM, Lopez-Sendon J, Swedberg K, Ogorek M, Rifai N, Lukashevich V, Maboudian M, Cannon CP, McCabe CH, Braunwald E. Patients with acute coronary syndromes and elevated levels of natriuretic peptides: the results of the AVANT GARDE-TIMI 43 Trial. Eur Heart J 2010; 31:1993-2005. [PMID: 20558431 DOI: 10.1093/eurheartj/ehq190] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
AIMS Elevated natriuretic peptides (NPs) are associated with an increased cardiovascular risk following acute coronary syndromes (ACSs). However, the therapeutic implications are still undefined. We hypothesized that early inhibition of renin-angiotensin-aldosterone system (RAAS) in patients with preserved left ventricular function but elevated NPs but following ACS would reduce haemodynamic stress as reflected by a greater reduction NP compared with placebo. METHODS AND RESULTS AVANT GARDE-TIMI 43 trial, a multinational, double-blind trial, randomized 1101 patients stabilized after ACS without clinical evidence of heart failure or left ventricular function <or=40% but with an increased level of NP 3-10 days after admission to aliskiren, valsartan, their combination, and placebo. The primary endpoint was the change in NT-proBNP from baseline to Week 8. NT-proBNP declined significantly in each treatment arm, including placebo, by Week 8, though there were no differences in the reduction between treatment strategies (42% in placebo, 44% in aliskiren, 39% in valsartan, and 36% in combination arm). Although several subgroups had higher baseline levels of NP and greater reductions over the study period, there were no differences among treatment groups in any subgroup. There were no differences in clinical outcomes but there were more adverse events, including serious events and adverse events leading to early study drug discontinuation, in patients treated with active therapy. CONCLUSION In this study of a high-risk population with elevated levels of NPs but relatively preserved systolic function and no evidence of heart failure following ACS, there was no evidence for a benefit of early initiation of inhibition of RAAS with valsartan, aliskiren, or their combination compared with placebo with respect to a reduction in NP over 8 weeks of therapy. Moreover, adverse events were reported more frequently in patients assigned to active therapy.
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Affiliation(s)
- Benjamin M Scirica
- TIMI Study Group, Cardiovascular Division, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, USA.
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Factors related to in-hospital heart failure are very different for unstable angina and non-ST elevation myocardial infarction. Heart Vessels 2009; 24:399-405. [DOI: 10.1007/s00380-008-1141-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 12/19/2008] [Indexed: 10/20/2022]
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Relation Between Global Left Ventricular Longitudinal Strain Assessed with Novel Automated Function Imaging and Biplane Left Ventricular Ejection Fraction in Patients with Coronary Artery Disease. J Am Soc Echocardiogr 2008; 21:1244-50. [PMID: 18992675 DOI: 10.1016/j.echo.2008.08.010] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Indexed: 11/22/2022]
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Giugliano RP, Braunwald E. The Year in Non–ST-Segment Elevation Acute Coronary Syndrome. J Am Coll Cardiol 2008; 52:1095-103. [DOI: 10.1016/j.jacc.2008.07.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2008] [Revised: 07/01/2008] [Accepted: 07/01/2008] [Indexed: 11/29/2022]
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Kontos MC, Jamal S, Tatum JL, Ornato JP, Jesse RL. Predictive power of systolic function and congestive heart failure in patients with patients admitted for chest pain without ST elevation in the troponin era. Am Heart J 2008; 156:329-35. [PMID: 18657664 DOI: 10.1016/j.ahj.2008.03.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Accepted: 03/11/2008] [Indexed: 12/22/2022]
Abstract
BACKGROUND Impaired systolic function and congestive heart failure (CHF) are powerful predictors of adverse outcomes in patients with myocardial infarction (MI). However, there are little data in which both of these variables were assessed in heterogenous patients admitted from the emergency department for exclusion of ischemia. METHODS Consecutive patients admitted for MI exclusion who had ejection fraction (EF) measured were included. Systolic dysfunction was defined as EF <40%. Congestive heart failure was diagnosed based on clinical or x-ray evidence in the first 24 hours. Multivariate analysis was used to determine predictors of 30-day and 1-year mortality. RESULTS Of the 4,343 consecutive patients admitted, 3,682 (85%) had EF assessed (including 97% of the troponin I [TnI]-positive patients) and were included. One-year unadjusted mortality was 9.5%, but in the presence of systolic dysfunction or CHF, it increased to 22% and 26%, respectively. The most important multivariate predictors of 30-day and 1-year mortality were similar and included CHF (OR for 1-year mortality 2.5, 95% CI 1.9-3.4), TnI elevations (OR 2.0, 95% CI 1.5-2.6), and severe renal failure (OR 5.2, 95% CI 3.7-7.2). Systolic dysfunction was predictive of 1 year (OR 1.9, 95% CI 1.4-2.5) but not 30-day mortality. Results were similar in the 3,018 patients who were troponin-negative. CONCLUSIONS Congestive heart failure is an independent predictor of both short- and long-term mortality in patients admitted for MI exclusion. In contrast, systolic dysfunction predicts long-term but not short-term mortality. One cannot be used as a surrogate for the other.
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