Construction of prognostically relevant endpoints for clinical trials in hypertension has increasingly included coronary revascularization with myocardial infarction (MI) as manifestations of coronary artery disease. However, whether coronary revascularization and MI predict other cardiovascular events similarly is unknown.
We examined risks of cardiovascular death, all-cause death, and stroke following MI or coronary revascularization in hypertensive patients with left ventricular hypertrophy (LVH) enrolled in the Losartan Intervention For Endpoint reduction in hypertension study (LIFE). We studied 9113 patients after excluding those who died within 7 days after MI or underwent coronary revascularization within 24 h after MI.
In multivariate Cox regression adjusting for participating countries, time-varying systolic blood pressure, and Framingham risk score, hazard ratios for cardiovascular death, all-cause death, and stroke were, respectively, 4.5 (P < 0.0001), 2.9 (P < 0.0001), and 1.9 (P = 0.003) in 321 patients with MI as first event. In similar models, coronary revascularization as first event (n = 202) was not associated with increased risks of cardiovascular death, all-cause death, and stroke (P = 0.06–0.86).
During follow-up of hypertensive patients with LVH, occurrence of MI but not coronary revascularization as first cardiovascular event significantly increased risk of subsequent cardiovascular death, all-cause death, and stroke. In view of differences in prognostic implications, when the goal is to have a prognostically relevant composite endpoint for trials in hypertensive patients, caution should be used in combining coronary revascularization with MI.
aDivision of Cardiology, Weill Cornell Medical College, New York, New York, USA
bDepartment of Clinical and Experimental Medicine, Federico II University of Naples, Naples, Italy
cInstitute of Medicine, University of Bergen and Haukeland University Hospital, Bergen, Norway
dDepartment of Medicine, Sahlgrenska University Hospital/Östra, University of Göteborg, Gothenburg, Sweden
eDepartment of Public Health and Clinical Medicine, Umeå University, Umea, Sweden
fUllevål University Hospital, Oslo, Norway
Received 12 June, 2009
Revised 26 November, 2009
Accepted 18 January, 2010
Correspondence to Dr Richard B. Devereux, MD, Greenberg Division of Cardiology, The New York Presbyterian Hospital–Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021, USA Tel: +1 212 746 4655; fax: +1 212 746 8561; e-mail: firstname.lastname@example.org