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Circulation Journal
Vol. 69 (2005) No. 2 p. 143-149



Clinical Investigation

Background Myocardial infarction (MI) is one of the major etiologies of chronic heart failure (CHF) in Japan. Methods and Results The prognoses of CHF patients after MI (n=283) were investigated by comparing them with those of CHF patients with nonischemic cardiomyopathy (NICM, n=310) from the CHF registry (CHART; n=1,154). The Kaplan-Meier (KM) analyses revealed that the 3-year all-cause mortality was significantly higher in the MI cohort compared with the NICM cohort (29.0% vs 12.4%, p<0.0005). Age/gender/treatment-adjusted KM analysis revealed significant differences only in the cohorts with preserved left ventricular ejection fraction (LVEF), defined as LVEF >45%, or in less symptomatic patients (New York Heart Association I or II). Multivariate Cox regression analysis showed that β-blocker (BB) was associated with a significant reduction in mortality from cardiac causes, and either angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (ACEI/ARB) was significantly related to the improvement of survival in the MI cohort (adjusted hazard ratio: 0.222 and 0.497, p<0.05), even though these medicines were used significantly less often in the MI cohort. Conclusions Underlying MI has a significant impact on the survival of Japanese CHF patients, especially those with preserved LVEF or with fewer symptoms. The appropriate expansion of ACEI/ARB or BB therapy might be necessary to improve their survival. (Circ J 2005; 69: 143 - 149)


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