What is the clinical evidence from this study?

Study design: Cohort. Population: Chronic Heart Failure (n=593). Intervention: Underlying myocardial infarction vs. Nonischemic cardiomyopathy. Primary outcome: 3-year all-cause mortality (p=<0.0005).

January 1, 2005Open Access

Poor Prognosis of Japanese Patients With Chronic Heart Failure Following Myocardial Infarction-Comparison With Nonischemic Cardiomyopathy-

Q: What are the key findings of this study?

Underlying myocardial infarction was associated with a significantly higher 3-year all-cause mortality compared to nonischemic cardiomyopathy in Japanese patients with chronic heart failure (29.0% vs 12.4%).

Key Result

Underlying myocardial infarction was associated with a significantly higher 3-year all-cause mortality compared to nonischemic cardiomyopathy in Japanese patients with chronic heart failure (29.0% vs 12.4%).

Study Design

Type

Cohort (n=593)

Multicenter

Yes

PICO

Population

593 Japanese patients with chronic heart failure, including 283 with underlying myocardial infarction and 310 with nonischemic cardiomyopathy, followed for a mean of 1.9 years.

Exposure / Comparator

Underlying myocardial infarction vs Nonischemic cardiomyopathy

Primary Outcome

3-year all-cause mortality, p=<0.0005

Main Result

Absolute Event Rate: 29% vs 12.4%

p-value: p=<0.0005

Limitations

Hospital-based registry may not reflect the general CHF population in Japan.
Inclusion of asymptomatic Stage B heart failure patients limits comparability with traditional CHF cohorts.
Lack of data on reperfusion therapies or revascularization interventions.
True etiology of CHF may be uncertain due to diagnosis by multiple cardiologists in real-world clinical settings.

Abstract

BACKGROUND: Myocardial infarction (MI) is one of the major etiologies of chronic heart failure (CHF) in Japan. METHODS AND RESULTS: The prognoses of CHF patients after MI (n=283) were investigated by comparing them with those of CHF patients with nonischemic cardiomyopathy (NICM, n=310) from the CHF registry (CHART; n=1,154). The Kaplan-Meier (KM) analyses revealed that the 3-year all-cause mortality was significantly higher in the MI cohort compared with the NICM cohort (29.0% vs 12.4%, p45%, or in less symptomatic patients (New York Heart Association I or II). Multivariate Cox regression analysis showed that beta-blocker (BB) was associated with a significant reduction in mortality from cardiac causes, and either angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB) was significantly related to the improvement of survival in the MI cohort (adjusted hazard ratio: 0.222 and 0.497, p<0.05), even though these medicines were used significantly less often in the MI cohort. CONCLUSIONS: Underlying MI has a significant impact on the survival of Japanese CHF patients, especially those with preserved LVEF or with fewer symptoms. The appropriate expansion of ACEI/ARB or BB therapy might be necessary to improve their survival.

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