Epidemiology of myocardial infarction in France: Therapeutic and prognostic implications of heart failure during the acute phase
Identifieur interne : 001B01 ( Main/Exploration ); précédent : 001B00; suivant : 001B02Epidemiology of myocardial infarction in France: Therapeutic and prognostic implications of heart failure during the acute phase
Auteurs : Laurent Vaur [France] ; Nicolas Danchin [France] ; Nathalie Genès [France] ; Isabelle Dubroca [France] ; Sylvie Etienne [France] ; Jean Ferrières [France] ; Jean-Pierre Cambou [France]Source :
- American Heart Journal [ 0002-8703 ] ; 1999.
Abstract
Background The aim of this study was to assess the 1-year outcome of acute myocardial infarction, in current practice, according to the presence or absence of heart failure. This was an epidemiologic, prospective survey involving 2152 patients recruited in November 1995 from 312 French coronary care units. Methods and Results All consecutive patients admitted within 48 hours for confirmed acute myocardial infarction to the participating centers in November 1995 were included. For each patient, baseline parameters, as well as clinical course and therapeutic treatment during the first 5 days, were collected. For the purpose of this study, the diagnosis of heart failure required a left ventricular ejection fraction ≤35% and/or a Killip class >1. During the 1-year follow-up, date and cause of death were recorded. Kaplan-Meier survival curves were analyzed with the log rank test. Cox multivariate analyses were used to assess the independent prognostic factors among 5-day survivors. Eight hundred twenty-one (38%) patients exhibited heart failure during the first 5 days after myocardial infarction. Patients with heart failure were 10 years older and were more likely to be hypertensive or diabetic; use of primary revascularization (33% vs 47%, P < .001) and β-blockers (40% vs 79%, P < .001) was less frequent, whereas prescription of angiotensin-converting enzyme (ACE) inhibitors was enhanced (56% vs 41%, P < .001). Mortality rate was strongly related to both left ventricular ejection fraction (P < .001) and Killip class (P < .001). One-year mortality rate was 39.7% in patients with heart failure compared with 7.1% in patients without heart failure (P < .001). A significant reduction in mortality rates was observed with β-blockers (risk ratio 0.63 [0.45 to 0.89], P = .01) and ACE inhibitors (risk ratio 0.73 [0.54 to 0.99], P = .04). It was more pronounced in patients with heart failure. Conclusions Results of this French observational survey are in line with previous epidemiologic studies and with major therapeutic trials. Patients with heart failure after acute myocardial infarction constitute a high-risk group. They appear to derive a greater benefit from treatment with both β-blockers and ACE inhibitors than from each class on its own. (Am Heart J 1999;137:49-58.)
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DOI: 10.1016/S0002-8703(99)70459-X
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Service de Cardiologie, CHRU Nancy, Vandoeuvre-les-Nancy; Service de Cardiologie, CHU Purpan, Toulouse ; and Départment d’Epidemiologie, CJF INSERM 9406</wicri:orgArea></affiliation></author><author><name sortKey="Dubroca, Isabelle" sort="Dubroca, Isabelle" uniqKey="Dubroca I" first="Isabelle" last="Dubroca">Isabelle Dubroca</name><affiliation wicri:level="3"><country>France</country><placeName><settlement type="city">Toulouse</settlement><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Midi-Pyrénées</region></placeName><wicri:orgArea>Paris, Nancy, and Toulouse, FranceFrom the Medical Department, Laboratoires Roussel Diamant, Paris La Défense; Service de Cardiologie, CHRU Nancy, Vandoeuvre-les-Nancy; Service de Cardiologie, CHU Purpan, Toulouse ; and Départment d’Epidemiologie, CJF INSERM 9406</wicri:orgArea></affiliation></author><author><name sortKey="Etienne, Sylvie" sort="Etienne, Sylvie" uniqKey="Etienne S" first="Sylvie" last="Etienne">Sylvie Etienne</name><affiliation wicri:level="3"><country>France</country><placeName><settlement type="city">Toulouse</settlement><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Midi-Pyrénées</region></placeName><wicri:orgArea>Paris, Nancy, and Toulouse, FranceFrom the Medical Department, Laboratoires Roussel Diamant, Paris La Défense; Service de Cardiologie, CHRU Nancy, Vandoeuvre-les-Nancy; Service de Cardiologie, CHU Purpan, Toulouse ; and Départment d’Epidemiologie, CJF INSERM 9406</wicri:orgArea></affiliation></author><author><name sortKey="Ferrieres, Jean" sort="Ferrieres, Jean" uniqKey="Ferrieres J" first="Jean" last="Ferrières">Jean Ferrières</name><affiliation wicri:level="3"><country>France</country><placeName><settlement type="city">Toulouse</settlement><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Midi-Pyrénées</region></placeName><wicri:orgArea>Paris, Nancy, and Toulouse, FranceFrom the Medical Department, Laboratoires Roussel Diamant, Paris La Défense; Service de Cardiologie, CHRU Nancy, Vandoeuvre-les-Nancy; Service de Cardiologie, CHU Purpan, Toulouse ; and Départment d’Epidemiologie, CJF INSERM 9406</wicri:orgArea></affiliation></author><author><name sortKey="Cambou, Jean Pierre" sort="Cambou, Jean Pierre" uniqKey="Cambou J" first="Jean-Pierre" last="Cambou">Jean-Pierre Cambou</name><affiliation wicri:level="3"><country>France</country><placeName><settlement type="city">Toulouse</settlement><region type="region" nuts="2">Occitanie (région administrative)</region><region type="old region" nuts="2">Midi-Pyrénées</region></placeName><wicri:orgArea>Paris, Nancy, and Toulouse, FranceFrom the Medical Department, Laboratoires Roussel Diamant, Paris La Défense; Service de Cardiologie, CHRU Nancy, Vandoeuvre-les-Nancy; Service de Cardiologie, CHU Purpan, Toulouse ; and Départment d’Epidemiologie, CJF INSERM 9406</wicri:orgArea></affiliation></author></analytic><monogr></monogr><series><title level="j">American Heart Journal</title><title level="j" type="abbrev">YMHJ</title><idno type="ISSN">0002-8703</idno><imprint><publisher>ELSEVIER</publisher><date type="published" when="1999">1999</date><biblScope unit="volume">137</biblScope><biblScope unit="issue">1</biblScope><biblScope unit="page" from="49">49</biblScope><biblScope unit="page" to="58">58</biblScope></imprint><idno type="ISSN">0002-8703</idno></series><idno type="istex">731162E4DD1AABF080FC51D91D9A9398FB1A1A6A</idno><idno type="DOI">10.1016/S0002-8703(99)70459-X</idno><idno type="PII">S0002-8703(99)70459-X</idno><idno type="ArticleID">91402</idno></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0002-8703</idno></seriesStmt></fileDesc><profileDesc><textClass></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background The aim of this study was to assess the 1-year outcome of acute myocardial infarction, in current practice, according to the presence or absence of heart failure. This was an epidemiologic, prospective survey involving 2152 patients recruited in November 1995 from 312 French coronary care units. Methods and Results All consecutive patients admitted within 48 hours for confirmed acute myocardial infarction to the participating centers in November 1995 were included. For each patient, baseline parameters, as well as clinical course and therapeutic treatment during the first 5 days, were collected. For the purpose of this study, the diagnosis of heart failure required a left ventricular ejection fraction ≤35% and/or a Killip class >1. During the 1-year follow-up, date and cause of death were recorded. Kaplan-Meier survival curves were analyzed with the log rank test. Cox multivariate analyses were used to assess the independent prognostic factors among 5-day survivors. Eight hundred twenty-one (38%) patients exhibited heart failure during the first 5 days after myocardial infarction. Patients with heart failure were 10 years older and were more likely to be hypertensive or diabetic; use of primary revascularization (33% vs 47%, P < .001) and β-blockers (40% vs 79%, P < .001) was less frequent, whereas prescription of angiotensin-converting enzyme (ACE) inhibitors was enhanced (56% vs 41%, P < .001). Mortality rate was strongly related to both left ventricular ejection fraction (P < .001) and Killip class (P < .001). One-year mortality rate was 39.7% in patients with heart failure compared with 7.1% in patients without heart failure (P < .001). A significant reduction in mortality rates was observed with β-blockers (risk ratio 0.63 [0.45 to 0.89], P = .01) and ACE inhibitors (risk ratio 0.73 [0.54 to 0.99], P = .04). It was more pronounced in patients with heart failure. Conclusions Results of this French observational survey are in line with previous epidemiologic studies and with major therapeutic trials. Patients with heart failure after acute myocardial infarction constitute a high-risk group. They appear to derive a greater benefit from treatment with both β-blockers and ACE inhibitors than from each class on its own. (Am Heart J 1999;137:49-58.)</div></front></TEI><affiliations><list><country><li>France</li></country><region><li>Midi-Pyrénées</li><li>Occitanie (région administrative)</li></region><settlement><li>Toulouse</li></settlement></list><tree><country name="France"><region name="Occitanie (région administrative)"><name sortKey="Vaur, Laurent" sort="Vaur, Laurent" uniqKey="Vaur L" first="Laurent" last="Vaur">Laurent Vaur</name></region><name sortKey="Cambou, Jean Pierre" sort="Cambou, Jean Pierre" uniqKey="Cambou J" first="Jean-Pierre" last="Cambou">Jean-Pierre Cambou</name><name sortKey="Danchin, Nicolas" sort="Danchin, Nicolas" uniqKey="Danchin N" first="Nicolas" last="Danchin">Nicolas Danchin</name><name sortKey="Dubroca, Isabelle" sort="Dubroca, Isabelle" uniqKey="Dubroca I" first="Isabelle" last="Dubroca">Isabelle Dubroca</name><name sortKey="Etienne, Sylvie" sort="Etienne, Sylvie" uniqKey="Etienne S" first="Sylvie" last="Etienne">Sylvie Etienne</name><name sortKey="Ferrieres, Jean" sort="Ferrieres, Jean" uniqKey="Ferrieres J" first="Jean" last="Ferrières">Jean Ferrières</name><name sortKey="Genes, Nathalie" sort="Genes, Nathalie" uniqKey="Genes N" first="Nathalie" last="Genès">Nathalie Genès</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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