Myocardial Infarction in Heart Failure With Preserved Ejection Fraction
Open accessAbstract
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).
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Patients with heart failure are at high risk for atherosclerotic cardiovascular disease, as designated by professional society guidelines.
“Patients with heart failure (HF) are at high risk for atherosclerotic cardiovascular disease (ASCVD), 1 , 2 as designated by professional society guidelines. 3”
From Impact of Icosapent Ethyl on Cardiovascular Risk Reduction in Patients With Heart Failure in REDUCE‐IT (2022) · cites this paper as [1]
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- Authors
- Cunningham, J. W., Vaduganathan, M., Claggett, B. L., John, J. E., Desai, A. S., Lewis, E. F., Zile, M. R., Carson, P., Jhund, P. S., Kober, L., Pitt, B., Shah, S. J., Swedberg, K., Anand, I. S., Yusuf, S., McMurray, J. J. V., Pfeffer, M. A., & Solomon, S. D.
- Affiliations
- Brigham and Women's Hospital (US)
- Medical University of South Carolina (US)
- Veterans Health Administration (US)
- University of Glasgow (GB)
- University of Michigan (US)
- Northwestern University (US)
- University of Gothenburg (SE)
- University of Minnesota (US)
- Hamilton Health Sciences (CA)
- Corresponding author
- Solomon, Scott D.
- ORCID
- Venue
- JACC: Heart Failure
- Publisher
- Elsevier BV
- Published
- 2020-08
- Volume
- 8
- Issue
- 8
- Pages
- 618-626
- ISSN
- 2213-1779 (ISSN-L)
- OpenAlex
- W3022528964
- Cited by
- 33
- References
- 31
- Citations by year
- 2026: 4 · 2025: 7 · 2024: 5 · 2023: 5 · 2022: 10 · 2021: 2
- FWCI
- 2.63
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- JACC Heart Failure (publishedVersion)
- PubMed (publishedVersion)
- Research at the University of Copenhagen (University of Copenhagen) (publishedVersion, other-oa)
- Funders
- Abbott Laboratories
- Harvard Catalyst
- Novartis
- Forest Laboratories
- Daiichi-Sankyo
- Bayer Fund
- Baxter Healthcare Corporation
- National Heart, Lung, and Blood Institute (T32HL094301, HHSN268200425207C)
- National Institutes of Health
- Takeda Pharmaceuticals U.S.A.
- Boston Scientific Corporation
- Cytokinetics
- AbbVie
- Amgen
- Sanofi Pasteur
- Merck
- National Center for Advancing Translational Sciences
- Servier
- Kidney Research UK
- Pfizer
- AstraZeneca
- MyoKardia
- Medtronic
- Boehringer Ingelheim
- Gilead Sciences
- GlaxoSmithKline
- Bristol-Myers Squibb
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Failure Treatment and Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Function and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Keywords
- heart failure with preserved ejection fraction, myocardial infarction, cardiovascular mortality, sudden death, heart failure hospitalization, prognosis, TOPCAT, mineralocorticoid receptor antagonists, secondary prevention, risk stratification, heart failure with reduced ejection fraction
- MeSH terms
- Irbesartan, Aged, Benzimidazoles, Biphenyl Compounds, Diuretics, Double-Blind Method, Female, Heart Failure, Humans, Male, Morbidity, Myocardial Infarction, Risk Factors, Spironolactone, Stroke Volume, Systole, Tetrazoles, Angiotensin II Type 1 Receptor Blockers
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