Extent of CAD and development of heart failure after AMI

Heart failure develops very commonly after AMI despite of extensive acute revascularization as well as wide spread use of medicine for secondary prevention.

Whether the extent of coronary artery disease (CAD) is associated with the occurrence of HF after myocardial infarction is not known, nor is it known whether the treatment of non-culprit lesion CAD might reduce the occurrence of HF.

Gerber et al sought to examine the association of angiographic CAD with subsequent HF, looking specifically at the prognostic role of CAD according to HF subtypes: HF with reduced EF (HFrEF) and HF with preserved EF (HFpEF).

In this population-based cohort study, 1,922 individuals (65% men; mean age 64 years) with incident MI diagnosed between January 1990, and December 2010, and no prior HF were followed until March 2013. The extent of angiographic CAD was determined at baseline. Those with more extensive CAD were older and presented with greater comorbidities. They were also more likely to undergo coronary artery bypass grafting and less likely to undergo reperfusion compared with patients with fewer diseased vessels.

During a mean follow-up of 6.7 years, 30.6% of participants developed HF (as ascertained by the Framingham criteria). Half of these patients had HF with HFrEF, 32% had HFpEF, and 18% had no EF assessment available.

The cumulative incidence rates of HF among patients with 0 or 1, 2, and 3 diseased vessels were 10.7%, 14.6%, and 23.0% at 30 days; and 14.7%, 20.6%, and 29.8% at 5 years post-MI, respectively (p<0.001 for trend).

After multivariate adjustment, the hazard ratios for HF were 1.25 for 2 occluded vessels and 1.75 for 3 occluded vessels, versus 0 or 1 occluded vessel (p<0.001 for trend). This increased risk for HF with increased CAD burden was found to be independent of the occurrence of a recurrent MI and was similar for the difference HF subtypes.

The investigators concluded that the study provides evidence that “the number of disease vessels, as defined angiographically at the time of the first-ever MI, is a strong indicator of both HFrEF and HFpEF.” The mechanisms behind this association require further study.

Reference

• 1 Gerber Y, Weston SA, Enriquez-Sarano M, Manemann SM, Chamberlain AM, Jiang R, Roger VL.Atherosclerotic burden and heart failure after myocardial infarction. JAMA Cardiol. 2016; 1: 156-162.