Prior and Incident Myocardial Infarction in HFpEF: A Pooled, Patient-Level Analysis of 3 Contemporary Clinical Trials with 8,916 Patients

BackgroundMyocardial infarction (MI) and heart failure with preserved ejection fraction (HFpEF) share common risk factors. Little is known about the prognostic significance of remote or recent MI in patients with HFpEF.MethodsWe pooled data from 3 trials: CHARM-Preserved, I-Preserve, and Americas region of TOPCAT (n=8,916), and examined whether prior (before randomization) and post randomization MI predicted cardiovascular (CV) death using multivariable Cox proportional hazards models accounting for 31 clinically relevant covariates.ResultsAt baseline, 2,668 patients (30%) had a history of MI. Prior MI was independently associated with a greater risk of CV death (adj. HR 1.42, 95% CI 1.23-1.64) (Panel A). During follow-up, MI occurred in 338 patients (3.8%), 2 of whom died the same day. In the first 30 days after first post-randomization MI, risk of CV death increased 34-fold, and remained 58% higher 1 year after MI (Panel B).ConclusionIn patients with HFpEF who experience MI, risk of CV death is very high in the early period and remains elevated at 1 year. Prevention of MI in HFpEF may represent an under-recognized therapeutic goal. Myocardial infarction (MI) and heart failure with preserved ejection fraction (HFpEF) share common risk factors. Little is known about the prognostic significance of remote or recent MI in patients with HFpEF. We pooled data from 3 trials: CHARM-Preserved, I-Preserve, and Americas region of TOPCAT (n=8,916), and examined whether prior (before randomization) and post randomization MI predicted cardiovascular (CV) death using multivariable Cox proportional hazards models accounting for 31 clinically relevant covariates. At baseline, 2,668 patients (30%) had a history of MI. Prior MI was independently associated with a greater risk of CV death (adj. HR 1.42, 95% CI 1.23-1.64) (Panel A). During follow-up, MI occurred in 338 patients (3.8%), 2 of whom died the same day. In the first 30 days after first post-randomization MI, risk of CV death increased 34-fold, and remained 58% higher 1 year after MI (Panel B). In patients with HFpEF who experience MI, risk of CV death is very high in the early period and remains elevated at 1 year. Prevention of MI in HFpEF may represent an under-recognized therapeutic goal.