JACC: Heart Failure ( IF 10.3 ) Pub Date : 2020-05-06 , DOI: 10.1016/j.jchf.2020.02.007 Jonathan W Cunningham 1 , Muthiah Vaduganathan 1 , Brian L Claggett 1 , Jenine E John 1 , Akshay S Desai 1 , Eldrin F Lewis 1 , Michael R Zile 2 , Peter Carson 3 , Pardeep S Jhund 4 , Lars Kober 5 , Bertram Pitt 6 , Sanjiv J Shah 7 , Karl Swedberg 8 , Inder S Anand 9 , Salim Yusuf 10 , John J V McMurray 4 , Marc A Pfeffer 1 , Scott D Solomon 1
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Objectives
The authors investigated the relationship between past or incident myocardial infarction (MI) and cardiovascular (CV) events in heart failure with preserved ejection fraction (HFpEF).
Background
MI and HFpEF share some common risk factors. The prognostic significance of MI in patients with HFpEF is uncertain.
Methods
The authors pooled data from 3 trials—CHARM Preserved (Candesartan Cilexietil in Heart Failure Assessment of Reduction in Mortality and Morbidity), I-Preserve (Irbesartan in Heart Failure With Preserved Systolic Function), and the Americas region of TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist) (N = 8,916)—and examined whether MI before or following enrollment independently predicted CV death and heart failure (HF) hospitalization.
Results
At baseline, 2,668 patients (30%) had history of MI. Prior MI was independently associated with greater risk of CV death (4.7 vs. 3.5 events/100 patient-years [py], adjusted hazard ratio [HR]: 1.42 [95% confidence interval (CI): 1.23 to 1.64]; p < 0.001). Excess sudden death drove this difference (1.9 vs. 1.2 events/100 py, adjusted HR: 1.55 [95% CI: 1.23 to 1.97]; p < 0.001). There was no difference in HF hospitalization (5.9 vs. 5.5 events/100 py, adjusted HR: 1.05, 95% CI: 0.92 to 1.19) or HF death by prior MI. During follow-up, MI occurred in 336 patients (3.8%). Risk of CV death increased 31-fold in the first 30 days after first post-enrollment MI, and remained 58% higher beyond 1 year after MI. Risk of first or recurrent HF hospitalization increased 2.4-fold after MI.
Conclusions
Prior MI in HFpEF is associated with greater CV and sudden death but similar risk of HF outcomes. Patients with HFpEF who experience MI are at high risk of subsequent CV death and HF hospitalization. These data highlight the importance of primary and secondary prevention of MI in patients with HFpEF. (Candesartan Cilexietil in Heart Failure Assessment of Reduction in Mortality and Morbidity [CHARM Preserved]; NCT00634712; Irbesartan in Heart Failure With Preserved Systolic Function [I-Preserve]; NCT00095238; and Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist [TOPCAT]; NCT00094302)
中文翻译：
射血分数保留的心力衰竭中的心肌梗死：3 项临床试验的汇总分析。
目标
作者研究了射血分数保留的心力衰竭 (HFpEF) 中过去或发生的心肌梗死 (MI) 与心血管 (CV) 事件之间的关系。
背景
MI 和 HFpEF 有一些共同的危险因素。 MI 对 HFpEF 患者的预后意义尚不确定。
方法
作者汇集了 3 项试验的数据：CHARM Preserved（坎地沙坦 Cilexietil 在心力衰竭中评估死亡率和发病率降低情况）、I-Preserve（厄贝沙坦在保留收缩功能的心力衰竭中的应用）和 TOPCAT（保留心脏的治疗）的美洲地区使用醛固酮拮抗剂治疗心力衰竭 (N = 8,916)，并检查入组之前或之后的 MI 是否独立预测心血管死亡和心力衰竭 (HF) 住院。
结果
基线时，2,668 名患者 (30%) 有 MI 病史。既往 MI 与较高的 CV 死亡风险独立相关（4.7 比 3.5 事件/100 患者年 [py]，调整后风险比 [HR]：1.42 [95% 置信区间 (CI)：1.23 至 1.64]；p < 0.001）。猝死过多导致了这种差异（1.9 vs. 1.2 事件/100 py，调整后 HR：1.55 [95% CI：1.23 至 1.97]；p < 0.001）。心力衰竭住院（5.9 例与 5.5 例事件/100 py，调整后 HR：1.05，95% CI：0.92 至 1.19）或既往心梗导致的心力衰竭死亡没有差异。随访期间，336 名患者（3.8%）发生心肌梗死。首次入组后 MI 后的前 30 天内，心血管死亡风险增加了 31 倍，并且在 MI 后 1 年后仍高出 58%。 MI 后首次或复发 HF 住院的风险增加 2.4 倍。
结论
HFpEF 中的既往 MI 与较高的 CV 和猝死相关，但 HF 结果的风险相似。患有心梗的 HFpEF 患者随后发生心血管死亡和心衰住院的风险很高。这些数据强调了 HFpEF 患者心肌梗死一级和二级预防的重要性。 （坎地沙坦西乐昔提在心力衰竭中降低死亡率和发病率的评估[CHARM Preserved]；NCT00634712；厄贝沙坦治疗保留收缩功能的心力衰竭[I-Preserve]；NCT00095238；以及用醛固酮拮抗剂治疗保留心脏功能的心力衰竭[TOPCAT] ]；NCT00094302）
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