Predictors of late development of heart failure in stable survivors of myocardial infarction - The CARE study
Predictors of late development of heart failure in stable survivors of myocardial infarction - The CARE study
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DOI：
10.1016/s0735-1097(03)01057-x
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发表时间：
2003-10-15
影响因子：
24
通讯作者：
Pfeffer, MA
中科院分区：
文献类型：
--
作者：
Lewis, EF;Moye, LA;Pfeffer, MA
目的：我们试图确定心肌梗死（MI）长期幸存者心力衰竭（HF）发展的预测因素。背景：现代急性心肌梗死护理策略导致幸存者中未来非致命事件（包括心衰）风险增加的比例增加。方法：我们评估了3860名无心衰病史的稳定型心衰患者发生心衰的风险，这些患者被纳入胆固醇与复发事件（CARE）试验，中位时间为心肌梗死后10个月。在5年的观察中，评估了发生或未发生心衰的患者的基线特征。结果共有243例（6.3%）患者以1.3%/年的速度线性发展为HF。心力衰竭的发展显著增加死亡风险（风险比10.2,95%置信区间7.7 ~ 13.5）。57例HF患者（23.5%）在入组和HF发病之间有复发性心肌梗死，风险增加了5倍。HF最重要的预测因子是年龄和左心室射血分数。其他预测因素包括糖尿病、高血压史、既往心肌梗死和基线心率。每周适度运动三次或三次以上与心衰风险降低30%独立相关。结论：心肌梗死后心力衰竭的发生具有时间依赖性，通常不是可检测到的中期心肌梗死的直接后果。与其他心肌梗死幸存者相比，迟发性心衰患者的死亡风险增加了10倍。基线特征可以对随后HF的高风险患者进行风险分层。(C) 2003年由美国心脏病学会基金会发布。
OBJECTIVES We sought to determine the predictors of heart failure (HF) development in long-term survivors of myocardial infarction (MI).BACKGROUND Modern strategies of acute MI care have resulted in an increasing proportion of survivors at heightened risk of future non-fatal events, including HF.METHODS We assessed the risk of developing HF in 3,860 stable MI patients without a previous history of HF, who were enrolled in the Cholesterol And Recurrent Events (CARE) trial a median of 10 months post MI. Baseline characteristics of patients who did or did not develop HF during the five years of observation were assessed.RESULTS A total of 243 patients (6.3%) developed HF in a linear pattern at a rate of 1.3%/year. Heart failure development markedly increased the risk of death (hazard ratio 10.2, 95% confidence interval 7.7 to 13.5). Fifty-seven patients (23.5%) who developed HF had a recurrent MI between enrollment and the onset of HF, increasing the risk fivefold. The most important predictors of HF were age and left ventricular ejection fraction. Other predictors included diabetes, history of hypertension, previous MI, and baseline heart rate. Moderate exercise three or more times per week was independently associated with a 30% lower risk of HF.CONCLUSIONS Heart failure post MI occurs in a time-dependent fashion, which is usually not a direct consequence of a detectable interim MI. Patients who experience late-onset HF have a 10-fold increased risk of death compared with other MI survivors. Baseline characteristics can risk stratify patients at high risk of subsequent HF. (C) 2003 by the American College of Cardiology Foundation.