Epidemiology of myocardial infarction in France: Therapeutic and prognostic implications of heart failure during the acute phase

Background The aim of this study was to assess the 1-year outcome of acute myocardial infarction, in current practice, according io the presence or ab sence oi heart failure. This was an epidemiologic, prospective survey invol ving 2152 patients recruited in November 1995 from 312 French coronary care units. Methods and Results All consecutive patients admitted within 48 hours for c onfirmed acute myocardial infarction to the participating centers in Novemb er, 1995 were included. For each patient, baseline parameters, as well as c linical course and therapeutic treatment during the first 5 days, were coll ected. For the purpose of this study, the diagnosis of heart failure requir ed a left ventricular ejection fraction less than or equal to 35% and/or a Killip class >1. During the 1-year follow-vp, date and cause of death were recorded. Kaplan-Meier survival curves were analyzed with the log rank test . Cox multivariate analyses were used to assess the independent prognostic factors among 5-day survivors. Fight hundred twenty-one (38%) patients exhi bited heart failure during the first 5 days after myocardial infarction. Pa tients with heart failure were 10 years older and were more likely to be hy pertensive or diabetic; use of primary revascularization (33% vs 47%, P < . 001) and beta-blockers (40% vs 79%, P < .007) was less frequent, whereas pr escription of angiotensin-converting enzyme (ACE) inhibitors was enhanced ( 56% vs 41%, P < .001). Mortality rate was strongly related to both left ven tricular ejection fraction (P < .007) and Killip class (P < .001). One-year mortality rate was 39.7% in patients with heart failure compared with 7.1% in patients without heart failure (P < .001). A significant reduction in m ortality rates was observed with beta-blockers (risk ratio 0.63 [0.45 to 0. 89], P = .01) and ACE inhibitors (risk ratio 0.73 [0.54 to 0.99], P = .04). It was more pronounced in patients with heart Failure. Conclusions Results of this French observational survey are in line with pr evious epidemiologic studies and with major therapeutic trials. Patients wi th heart failure after acute myocardial infarction constitute a high-risk g roup. They appear to derive a greater benefit from treatment with both beta -blockers and ACE inhibitors than from each class on its own.