Brigham and Women's Hospital, Boston, Massachusetts.
RHJ Department of Veterans Affairs Medical Center and Medical University of South Carolina, Charleston, South Carolina.
JACC Heart Fail. 2020 Aug;8(8):618-626. doi: 10.1016/j.jchf.2020.02.007. Epub 2020 May 6.
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).
目的：作者研究了既往或现患心肌梗死（MI）与射血分数保留的心力衰竭（HFpEF）患者心血管（CV）事件之间的关系。
背景：MI 和 HFpEF 具有一些共同的危险因素。MI 在 HFpEF 患者中的预后意义尚不确定。
方法：作者汇总了 3 项试验-CHARM 保留试验（坎地沙坦酯在心力衰竭评估降低死亡率和发病率）、I-Preserve 试验（伊贝沙坦治疗射血分数保留的心力衰竭）和美国地区 TOPCAT 试验（醛固酮拮抗剂治疗保留心脏功能的心力衰竭）的数据（N=8916），并研究了 MI 是在入组前还是入组后是否独立预测 CV 死亡和心力衰竭（HF）住院。
结果：基线时，2668 例患者（30%）有 MI 病史。既往 MI 与更高的 CV 死亡风险独立相关（4.7 比 3.5 例/100 患者年[py]，校正后的 HR：1.42[95%置信区间（CI）：1.23 至 1.64]；p<0.001）。额外的猝死导致了这种差异（1.9 比 1.2 例/100 py，校正 HR：1.55[95%CI：1.23 至 1.97]；p<0.001）。MI 组和非 MI 组 HF 住院（5.9 比 5.5 例/100 py，校正 HR：1.05，95%CI：0.92 至 1.19）或 HF 死亡率无差异。随访期间，336 例患者（3.8%）发生 MI。首次入组后 30 天内，CV 死亡风险增加 31 倍，MI 后 1 年以上，CV 死亡风险仍增加 58%。MI 后首次或复发 HF 住院的风险增加了 2.4 倍。
结论：HFpEF 患者既往 MI 与更高的 CV 和猝死风险相关，但 HF 结局风险相似。经历 MI 的 HFpEF 患者随后发生 CV 死亡和 HF 住院的风险很高。这些数据强调了在 HFpEF 患者中进行 MI 一级和二级预防的重要性。（坎地沙坦酯在心力衰竭评估降低死亡率和发病率试验[CHARM 保留]；NCT00634712；伊贝沙坦治疗射血分数保留的心力衰竭试验[I-Preserve]；NCT00095238；以及醛固酮拮抗剂治疗保留心脏功能的心力衰竭试验[TOPCAT]；NCT00094302）。
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