Impact of nonfatal myocardial infarction on outcomes in patients with advanced heart failure and the effect of bucindolol therapy

Christopher M. O'Connor, Steven Gottlieb, Jamieson M. Bourque, Heidi Krause-Steinrauf, Inder Anand, Jeffrey L. Anderson, Jonathan F. Plehn, Marc A. Silver, Michel White, Peter Carson

Research output: Contribution to journalArticlepeer-review

18 Scopus citations


We sought to identify the clinical characteristics and outcomes of patients who had advanced heart failure and nonfatal myocardial infarction (MI) in the β-Blocker Evaluation of Survival Trial (BEST) and to investigate whether bucindolol alters the risk of developing nonfatal MI. Of the 2,708 patients enrolled in the study, 142 had suspected MI and 69 had confirmed MI; there were 860 deaths overall. The rate of nonfatal MI in the BEST was low over the 4.1 years of follow-up (4.8% had suspected events and 2.4% had adjudicated events) and was similar to that in high-risk populations. Cox's proportional hazard model with 23 prespecified candidate variables associated advanced age, heart failure symptoms, male gender, ischemic etiology, diabetes, and hypertension with nonfatal MI or cardiovascular death. The 2-year mortality rate was 56% for the cohort that had suspected nonfatal MI versus 30% for the cohort that did not (p = 0.01). Likewise, the risk of hospitalization for congestive heart failure was twofold greater. Beta-blocker therapy with bucindolol resulted in a 52% decrease in suspected nonfatal MI (2.9% vs 5.5%, p = 0.001). In conclusion, nonfatal MI occurs at low rates but increases the risks for mortality and hospitalization in patients who have advanced heart failure. Beta-blocker therapy with bucindolol appears to attenuate the risk of nonfatal MI in this population.

Original languageEnglish (US)
Pages (from-to)558-564
Number of pages7
JournalAmerican Journal of Cardiology
Issue number5
StatePublished - Mar 1 2005

Bibliographical note

Funding Information:
The β-Blocker Evaluation of Survival Trial was sponsored by the Division of Epidemiology and Clinical Applications of the National Heart, Lung and Blood Institute, Bethesda, Maryland and the Department of Veterans Affairs Cooperative Studies Program, Washington, DC, through an interagency agreement. Additional support was provided by Incara Pharmaceuticals Corporation, Durham, North Carolina, which also supplied bucindolol and placebo.

Copyright 2017 Elsevier B.V., All rights reserved.

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