Informative value of clinical markers for the risk of cardiovascular death in postinfarction chronic heart failure

Symptomatic chronic heart failure (CHF) in patients with previous myocardial infarction results in a high risk of death. The aim of the study was to determine the informative value of different clinical markers and their combinations for cardiovascular death risk evaluation in case of CHF after Q-wave myocardial infarction (MI). Methods-Two hundred and twenty-four patients with congestive heart failure NYHA class II-IV after Q-wave MI were followed-up for five years (median 2.6 +/- 2.0 years). The probability of cardiovascular death was evaluated using Kaplan-Meier curves, the impact of clinical variables on the risk of death, and adjusted risk of death were evaluated using Cox proportional regression method, and the total risk score of death was determined using the multivariate regression method. Results - The probability of cardiovascular death within the first year was 21%, within two years 40%, within three years 55%, within four years 61%, and within five years 65%. According to the risk of death, the independent predictors were allotted a risk score which was determined for all patients and had shown a strong association with 5-year cardiovascular mortality. Patients with a risk score of 9, versus those with a score of 0, were found to have a 15-fold increase in cardiovascular mortality rate. Conclusion-The probability of cumulative cardiovascular mortality within five years in case of a symptomatic CHF after Q-wave MI was 65%. In the presence of risk factor combinations, the probability of death within three years reached 98%.