Incidence, timing, predictors and impact of acute heart failure complicating ST-segment elevation myocardial infarction in patients treated by primary percutaneous coronary intervention.

Abstract

BACKGROUND:

Acute heart failure (AHF) complicating ST-segment elevation myocardial infarction (STEMI) is recognized as an ominous complication. Previous studies mostly reported outcomes of heterogeneous, non-contemporary population. Moreover, few studies assessed the prognosis of AHF according to its timing. This study evaluated incidence, predictors and impact of AHF according to its timing in a homogeneous STEMI patients population treated by primary percutaneous coronary intervention (pPCI).

METHODS:

Data from 6282 patients included in a prospective multicenter registry were analyzed. Patients with AHF (Killip class>I) were compared to patients without AHF and patients with admission AHF were compared to patients who developed in-hospital AHF. In-hospital mortality was the primary endpoint of the study. Propensity-score matching and multivariable regression were used to adjust for confounders.

RESULTS:

A total of 1328 patients (21.1%) presented AHF: 739 on admission and 589 during hospitalization. AHF was associated with a markedly increased in-hospital mortality rate (19.9% vs. 0.8%, p<0.001). There was a gradual excess risk with each Killip class and admission AHF patients displayed the highest crude mortality rate (24.1%). By multivariable analysis, AHF was the strongest independent predictor of in-hospital mortality (HR=3.852 (2.303-6.442), p<0.001) without evidence of any difference according to its timing (HR=0.947 (0.638-1.372), p=0.767). These results were consistent after extensive adjustment on baseline characteristics in the matched cohorts. Among other predictors, pPCI beyond guidelines-recommended delays and stent thrombosis were independently associated with AHF.

CONCLUSION:

AHF regardless of its timing remains a common and dreadful complication of STEMI in the contemporary era.

• Authors: Vincent Auffret, Guillaume Leurent, Martine Gilard, Jean-Philippe Hacot, Emmanuelle Filippi, Régis Delaunay, Antoine Rialan, Gilles Rouault, Philippe Druelles, Philippe Castellant, Isabelle Coudert, Bertrand Boulanger, Josiane Treuil, Emilie Bot, Marc Bedossa, Dominique Boulmier, Marielle Le Guellec, Erwan Donal, Hervé Le Breton
• Journal: International journal of cardiology (Int J Cardiol) Vol. 221 Pg. 433-42 (Oct 15 2016) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 27409570 (Publication Type: Journal Article)
• Copyright: Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Topics

• Acute Disease
• Aged
• Female
• Heart Failure (diagnosis, epidemiology, therapy)
• Humans
• Incidence
• Male
• Middle Aged
• Mortality (trends)
• Percutaneous Coronary Intervention (methods, trends)
• Predictive Value of Tests
• ST Elevation Myocardial Infarction (diagnosis, epidemiology, therapy)
• Time Factors
• Treatment Outcome