Worsening of heart failure during hospital course of an unselected cohort of 2507 patients with myocardial infarction is a factor of poor prognosis: the PRIMA study

Worsening of heart failure in patients with myocardial infarction is seldom studied, elderly patients often are not included, and multivariate analysi s is uncommon. The prospective PRIMA study (Prise en charge de l'Infarctus du Myocarde Aigu; management of acute myocardial infarction) sought to dete rmine the incidence of worsening heart failure, its risk factors, and its p rognostic importance in patients with myocardial infarction, regardless of age and hospital facilities, in the 'real world' in a region in France, usi ng multivariate analysis. Data were prospectively collected in all patients with myocardial infarction admitted in all hospitals in three departments in the Rhone-Alpes region in France between 1 September 1993 and 31 January 1995. Among the 2507 patients included, 33% were in Killip classes II-IV a t admission. After exclusion of patients with admission Killip class IV, 41 6 patients (17% of the cohort, 24% of women and 14% of men) had worsening o f Killip class during the first 5 days. In-hospital mortality (overall, 14% ) increased dramatically with Killip class at admission (9% in class I, 62% in class IV) and with worsening of Killip class during the first 5 days (3 6.5 vs. 8.5% if no worsening). In multivariate analysis, older age, diabete s mellitus and anterior Q-wave myocardial infarction were significant predi ctors of Killip class at admission and of its worsening; Killip class >I at admission was a significant predictor of Killip-class worsening. The signi ficant predictors of in-hospital mortality were older age, Killip class III at admission and worsening of Killip class during the first 5 days. This l arge, unselected cohort revealed that, among patients with myocardial infar ction, heart failure and its worsening are frequent, especially in the elde rly, and dramatically worsen the in-hospital mortality. (C) 2001 European J ournal of Cardiology. All rights reserved.