INFLUENCE OF AGE ON THE PROGNOSTIC IMPORTANCE OF LEFT-VENTRICULAR DYSFUNCTION AND CONGESTIVE-HEART-FAILURE ON LONG-TERM SURVIVAL AFTER ACUTE MYOCARDIAL-INFARCTION

The aim of this study was to assess the importance of congestive heart failure and left ventricular (LV) systolic dysfunction after an acute myocardial infarction (AMI) on long-term mortality in different age g roups. A total of 7,001 consecutive enzyme-confirmed AMIs (6,676 patie nts) were screened for entry into the TRAndolapril Cardiac Evaluation (TRACE) study. Medical history, echocardiographic estimation of LV sys tolic function determined as wall motion index, infarct complications, and survival were documented for ail patients. To study the importanc e of congestive heart failure and wall motion index independent of age , we performed Cox proportional-hazard models in 4 different age strat a (less than or equal to 55 years, 56 to 65 years, 56 to 75 years, and >75 years). Patients in these strata had 1-year mortality Kites of 5% , 11%, 21%, and 32%, respectively. Three-year mortality rates were 11% , 20%, 34%, and 55%, respectively. The risk ratios (and 95% confidence limits) associated with congestive heart failure in the same 4 age st rata were 1.9 (1.3 to 2.9), 2.8 (2.1 to 3.7), 1.8 (1.5 to 2.2) and 1.8 (1.5 to 2.2), respectively. The risk ratios associated with decreasin g wall motion index were 6.5 (3.6 to 11.4), 3.3 (2.3 to 4.6), 2.7 (2.2 to 3.4), and 2.1 (1.7 to 2.6), respectively. In absolute percentages, there was an excess 3-year mortality associated with congestive heart failure in the 4 age strata of 14%, 24%, 25%, and 28%, respectively. The absolute excess in 3-year mortality associated with LV systolic dy sfunction in the 4 age strata wets 15%, 19%, 25%, and 21%, respectivel y. Thus, the relative importance of LV systolic dysfunction and conges tive heart failure diminished with increasing age. However, the absolu te excess mortality associated with congestive heart failure and LV sy stolic dysfunction was more pronounced in the elderly than in the youn g.