IMPORTANCE OF CONGESTIVE-HEART-FAILURE AND INTERACTION OF CONGESTIVE-HEART-FAILURE AND LEFT-VENTRICULAR SYSTOLIC FUNCTION ON PROGNOSIS IN PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION

Left ventricular (LV) systolic function and congestive heart failure ( CHF) are important predictors of long-term mortality after acute myoca rdial infarction. The importance of transient CHF and the interaction of CHF and LV function on prognosis has not been studied in detail pre viously. In the TRAndolapril Cardiac Evaluation Study, 6,676 consecuti ve patients with acute myocardial infarction 1 to 6 days earlier had L V systolic function quantified as wall motion index (echocardiography) , which is closely correlated to LV ejection fraction, To study the in teraction of CHF and wall motion index on long-term mortality, separat e analyses were performed in patients with different levels of LV func tion. Risk ratio (95% confidence intervals [CI]) were determined from proportional hazard models subgrouped by wall motion index or CHF adju sted for age and gender. Heart failure was separated into transient or persistent. Wall motion index and CHF are correlated. Furthermore, th ere is an interaction between wall motion index and CHF, The prognosti c importance of wall motion index depends on whether patients have CHF or not: the risk ratio associated with decreasing 1 wail motion index unit is 3.0 (2.6 to 3.4) in patients with CHF, and 2.2 (1.7 to 2.9) i n patients without CHF when adjusted for age and gender. Similarly, th e prognostic importance of CHF depends on the level of wall motion ind ex: the risk ratio associated with CHF is 3.9 (1.8 to 8.3) when the wa ll motion index is <0.8 and 1.9 (1.5 to 2.3) when the wall motion inde x is >1.6. Transient CHF is an independent risk factor (risk ratio 1.5 , confidence interval [CI] 1.3 to 1.8) although milder than persistent CHF (risk ratio 2.8, CI 2.5 to 3.2). (C) 1996 by Excerpta Medica, Inc .