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The Pharmaceutical Journal
Vol 270 No 7243 p468
5 April 2003

Related websites
American College of Cardiology congress (more)
Journal of the American College of Cardiology (www.cardiosource.com)

Heart failure after myocardial infarction gives poor prognosis

Many patients develop heart failure (HF) or left ventricular systolic dysfunction (LVSD), or both, during their stay in hospital after a heart attack. They are four times more likely to die in hospital than patients who do not develop these complications, according to results presented at the American College of Cardiology congress in Chicago this week.

The results come from a registry of patients set up alongside a trial of valsartan (Diovan), an angiotensin-II receptor antagonist, in myocardial infarction. The trial, which uses the acronym VALIANT, involves over 14,800 patients. Of these, 5,592 were enrolled in the registry so that their clinical outcomes could be studied.

Professor Eric Velazquez, Duke University, Durham, North Carolina, presented data showing that 42 per cent of patients in the registry developed HF or LVSD, or both. Adjusting for baseline risk, this was associated with a hazard ratio for dying in hospital of 4.39 (95 per cent confidence interval 3.33–5.84) with 12.9 per cent of this group dying.

Professor Velazquez and his colleagues say that identifying this group of high-risk patients during their stay in hospital could lead to them being given more intensive treatment, including surgical revascularisation, than was the case with the patients in the registry (Journal of the American College of Cardiology 2003;41[Suppl A]:148A).

Diabetes risk The adverse cardiovascular risk of diabetes has been confirmed in an analysis of the 14,808 in the full VALIANT trial. Of these, 3,421 were known to have diabetes at the time of enrolment to the study. These patients had an adjusted hazard ratio of 1.22 (CI 1.01–1.47) for 30-day mortality. In addition, diabetes was newly diagnosed in 585 trial patients after admission to hospital following a myocardial infarction. These patients were generally younger and had fewer cardiovascular risk factors than the patients with known diabetes, yet their 30-day mortality risk was similar 1.24 (CI 0.85–1.80) (ibid, p345A).

Full results from the VALIANT trial are expected later this year.

The Pharmaceutical Journal attended the American College of Cardiology congress courtesy of Merck/Schering-Plough Pharmaceuticals