History of MI May Be Associated With Greater Risk for Sudden Death in HFpEF – The Cardiology Advisor

A history of myocardial infarction (MI) was found to be associated with enhanced risk for cardiovascular (CV) death, particularly sudden death, according to study results published in JACC: Heart Failure.

This was a pooled analysis of individual patient-level data from 3 multicenter, randomized, double-blind, placebo-controlled trials in which pharmacotherapy for HFpEF was examined: Candesartan Cilexetil in Heart Failure Assessment of Reduction in Mortality and Morbidity (ClinicalTrials.gov identifierNCT00634712; n=3023), Irbesartan in Heart Failure With Preserved Systolic Function (ClinicalTrials.gov identifier: NCT00095238; n=4128) and Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (ClinicalTrials.gov identifier: NCT00094302; n=1765)in a total of 8916 patients with symptomatic HFpEF. Participants in the trials were assigned placebo or candesartan 32 mg, irbesartan 300 mg, or spironolactone 15 to 45 mg, respectively (once daily for all).

The primary study outcome was CV mortality; secondary outcomes included MI, HF hospitalization, and all-cause mortality.

At baseline, there were 2668 patients (29.9%; mean age, 69.09.4 years; 65.0% men) with a history of MI prior to enrollment, and 6248 participants (70.1%; mean age, 70.39.4 years; 41.5% men) without a history of previous MI. The groups differed significantly in terms of age and sex (P<.001 for both).

A history vs no history of MI was found to be associated with a higher risk for CV death(4.7 vs 3.5 events/100 patient-years, respectively; adjusted hazard ratio [HR], 1.42; 95% CI, 1.23-1.64; P<.001). The main driver of this between-group difference was the excess sudden death (1.9 vs 1.2 events/100 patient-years, respectively; adjusted HR, 1.55; 95% CI, 1.23-1.97; P<.001).

A history vs no history of MI had no impact on HF hospitalizations (5.9 vs 5.5 events/100 patient-years, respectively; adjusted HR, 1.05; 95% CI, 0.92-1.19; P =.49) or HF deaths (1.0 vs 0.9 events/100 patient-years, respectively; adjusted HR, 1.05; 95% CI, 0.78-1.42; P =.73).

There were 336 patients (3.8%) who had a MI during follow-up, 51% of whom had a history of previous MI. Patients with vs without post-enrollment MI had a 31-fold higher risk for 30-day CV death post-MI (adjusted HR, 31; 95% CI, 22-44; P<.001), a 2.4-fold greater risk for HF hospitalization (adjusted HR, 2.4; 95% CI, 1.8-3.2; P<.001), and a 58% greater risk for CV death 1yearafter MI.

Study limitations include a diversity in inclusion criteria and trial durations across the 3 studies analyzed, the exclusion of patients who had a recent MI, and the inability to determine the actual cause of sudden death.

These data highlight the importance of primary and secondary prevention of MI in patients with HFpEF, noted the authors.

Reference

Cunningham JW, Vaduganathan M, Claggett BL, et al. Myocardial Infarction in HeartFailure With Preserved Ejection Fraction. JACC: Heart Failure. May 2020. doi:10.1016/j.jchf.2020.02.007

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History of MI May Be Associated With Greater Risk for Sudden Death in HFpEF - The Cardiology Advisor