Clinical characteristics and long-term outcome of patients in whom congestive heart failure develops after thrombolytic therapy for acute myocardial infarction: Development of a predictive model☆,☆☆,★
Section snippets
Patients
The population for this study were the 1619 consecutive patients prospectively enrolled at seven regional cardiac centers and 29 community hospitals during the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) trials between December 1985 and June 1990. Patients were included in the study cohort if they were seen within 6 hours of the onset of symptoms compatible with acute myocardial infarction with >1 mm (0.1 mV) of ST-segment elevation in two or more leads on the
Baseline clinical characteristics and demographics
Among the 1619 patients enrolled in the six TAMI trials included in this study, 98 (6%) patients were admitted to the hospital with CHF and are excluded from further analysis in this article because of the primary objective of developing a model to predict new CHF. The incidence of CHF ranged from a low of 14% in the TAMI 5 study to a high of 28% in the TAMI 7 study. Patients in whom CHF developed after admission were older and more often female; they were more likely to be nonsmokers, with a
DISCUSSION
This study demonstrates that the prevalence of heart failure after myocardial infarction remains high despite the routine use of thrombolytic therapy, cardiac catheterization, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting, and aggressive medical therapy. Once developed, CHF is associated with a high rate of short-term and long-term morbidity and mortality. Simple baseline and angiographic characteristics were used in our patient population to develop a simple
Acknowledgements
We thank all the members of the TAMI study group for their contributions over the past decade. We also thank Penny Hodgson for her editorial support. In addition, we thank Laverne Alston and Renee Story and Wendy Gattis for manuscript preparation.
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Supported by research grants HS-05635 and HS-06503 from the Agency for Health Care Policy and Research, Rockville, Md., and grants from the Robert Wood Johnson Foundation, Princeton, N.J., and the DUCCS Research Foundation, Durham, N.C.
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Reprint requests: Christopher M. O'Connor, MD, Box 3356, Duke University Medical Center, Durham, NC 27710.
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