Atherosclerotic Burden and Heart Failure after Myocardial Infarction

Background: The association between coronary artery disease (CAD) and heart failure (HF) risk after myocardial infarction (MI) is not completely quantified, and whether it differs by HF type according to preserved or reduced ejection fraction (EF) has yet to be determined.

Methods and Results: Olmsted County, Minnesota residents (n=1,922; mean age, 64 years) with incident MI diagnosed between 1990-2010 and no prior HF were followed through 2013. The extent of angiographic CAD was defined at baseline according to the number of major epicardial coronary arteries with ≥50% lumen diameter obstruction. Framingham criteria were used to define HF, which was further classified according to EF (applying a 50% cutoff). Survival models were used to assess the association of CAD with HF, applying different adjustment approaches. During a mean (SD) follow-up of 6.7 (5.9) years, 588 patients developed HF. With death and recurrent MI modeled as competing risks, the cumulative incidence rates of post-MI HF among patients with 0-1, 2, and 3 diseased vessels were 10.6%, 15.1% and 21.5% at 30 days; and 14.6%, 20.6% and 28.8% at 5 years, respectively (p for trend<.001). Adjusted for propensity score of CAD via inverse probability weighting, the hazard ratios (95% confidence intervals) for HF were 1.43 (1.15-1.80) and 1.67 (1.35-2.06) in patients with 2 and 3 vs 0-1 occluded vessels, respectively (p for trend<.001). The increased risk with greater number of occluded vessels was independent of the occurrence of recurrent MI and did not differ appreciably by HF type.

Conclusions: The extent of angiographic CAD is predictive of post-MI HF, regardless of HF type and independently of recurrent MI. These data underscore the need to further investigate the processes taking place in the transition from myocardial injury to HF.