Revascularization in AMI reduces mortality without increased HF trade-off

27 June 2008

Medwire News: Invasive coronary revascularization in patients hospitalized with acute myocardial infarction (AMI) reduces mortality without increasing the risk for subsequent heart failure (HF) in the short-to-intermediate term, say researchers.

David Johnson (University of Alberta, Edmonton, Canada) and colleagues show in a population-based study that AMI patients undergoing revascularization during their index hospitalization had a decreased incidence of both HF and mortality over the subsequent 3 years.

"Thus, we found no evidence that invasive coronary revascularization resulted in a trade-off in outcomes (ie, preventing short-term mortality but at the expense of increasing HF in the short-to-intermediate term)," the researchers write in the American Journal of Cardiology.

There has been debate in the published literature as to whether improvements in short-term AMI mortality will result in an increase in cases of HF in the future, they explain.

The team studied 13,472 patients hospitalized with AMI, with no history of HF or previous AMI in the preceding 2 years. A total of 4502 (33%) patients underwent cardiac catheterization and 3287 (24%) underwent invasive coronary revascularization - 2757 having percutaneous coronary intervention and 521 coronary artery bypass graft surgery.

Patients who underwent revascularization were less likely to die over the mean 32-month follow-up than those who did not (5% vs 17%, p<0.0001).

Revascularized patients were also less likely than those not revascularized to develop HF, either during hospitalization (17% vs 24%, p<0.0001) or after discharge (4% vs 7%, p<0.0001).

Cox-proportional hazards modeling showed that these associations persisted after adjusting for covariates. Revascularization was associated with a 32% lower relative risk for HF, and a 40% lower risk for death or HF.

Invasive coronary revascularization remained associated with a 30% lower risk for HF even after excluding patients who died or developed HF during their index hospitalizations, Johnson et al note.

The authors stress that the results do not prove that revascularization prevents HF.

"However, our data do provide a counterpoint against arguments that AMI therapies that reduce mortality will automatically result in increases in the HF epidemic."

Am J Cardiol 2008; 102: 1-5