CLINICAL CHARACTERISTICS AND LONG-TERM OUTCOME OF PATIENTS IN WHOM CONGESTIVE-HEART-FAILURE DEVELOPS AFTER THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - DEVELOPMENT OF A PREDICTIVE MODEL

Ischemic heart disease is the most common cause of congestive heart fa ilure, which often begins after acute myocardial infarction. To better delineate the clinical characteristics and outcomes of patients in wh om congestive heart failure develops after acute myocardial infarction in the thrombolytic era, we prospectively evaluated patients enrolled in six of the TAMI trials. The study cohort comprised 1619 consecutiv e patients who had at least 1 mm of ST-segment elevation in two contig uous electrocardiographic leads within 6 hours of the onset of acute m yocardial infarction and who received intravenous thrombolytic therapy . We prospectively collected clinical characteristics, baseline demogr aphics, acute and 1-week angiographic variables, and in-hospital and 1 -year outcome data. We performed stepwise multivariable regression ana lysis to determine the noninvasive and Invasive predictors of the deve lopment of in-hospital congestive heart failure. Congestive heart fail ure developed in 301 patients in the hospital (19% of 1521 patients ad mitted were not in heart failure). These patients were likely to be ol der and female, have diabetes mellitus and previous myocardial infarct ion, and have an anterior wall myocardial infarction. On acute angiogr aphy, they had lower ejection fractions and a higher incidence of mult ivessel disease. Patency at 90 minutes was lower in the patients with congestive heart failure, and acute mitral regurgitation occurred in 1 .6% versus 0.21% of patients without congestive heart failure. Patient s with congestive heart failure had higher mortality, more in-hospital complications, and longer hospitalizations. At 1-year follow up, 21% of the patients in whom congestive heart failure developed had died ve rsus 5% in the group without congestive heart failure. Predictors of n ew congestive heart failure included increased age, anterior wall myoc ardial infarction, tower pulse pressure and systolic blood pressure, d iabetes mellitus, and the presence of rales on admission. The acute an giographic variables of reduced ejection fraction, increased number of diseased vessels, and attempted percutaneous intervention improved th e concordance of the predictive model by 6%. Congestive heart failure remains a common clinical problem after acute myocardial infarction an d is associated with a twofold increase in in-hospital morbidity and a fourfold increase in in-hospital and 1-year mortality. The developmen t of congestive heart failure in the hospital can be predicted from no ninvasive and invasive baseline characteristics. We present a simple t able to predict congestive heart failure from baseline characteristics and invasive information.