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[Clinical characteristics and long-term outcome in patients with heart failure complicating acute myocardial
Stella Maris Macín1, Eduardo Roque Perna, Natalia Augier
1Unidad de Cuidados Intensivos Coronarios, Instituto de Cardiología Juana F. Cabral, Corrientes, Argentina. macinucic@hotmail.com
Insights
Heart failure (HF) frequently complicates acute myocardial infarction (AMI), significantly increasing short- and long-term mortality. Independent predictors of mortality include HF, age, hyperglycemia, and leukocytosis upon admission.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Acute myocardial infarction (AMI) remains a leading cause of cardiovascular morbidity and mortality.
- The development of heart failure (HF) post-AMI is a significant complication impacting patient outcomes.
- Understanding the clinical characteristics and prognostic implications of HF following AMI is crucial for improving patient management.
Purpose of the Study:
- To investigate the clinical features and prognosis of patients who develop heart failure (HF) after hospitalization for acute myocardial infarction (AMI).
- To identify factors associated with the development and outcomes of HF in the context of AMI.
Main Methods:
- A cohort of 836 patients admitted for AMI within 24 hours of symptom onset was studied between May 1990 and March 2000.
- Heart failure (HF) was diagnosed based on clinical signs (rales, third heart sound) and chest X-ray evidence of pulmonary congestion.
- Prognostic factors for mortality, including clinical characteristics and laboratory values, were analyzed.
Main Results:
- Heart failure (HF) was diagnosed in 31.5% of AMI patients, who were older and had higher rates of diabetes and prior HF.
- Patients with HF experienced increased rates of recurrent angina, pericarditis, and atrial fibrillation.
- In-hospital mortality was significantly higher in the HF group (15.6% vs 2.3%), as was 10-year mortality (90% vs 70%).
Conclusions:
- Acute myocardial infarction (AMI) is frequently complicated by heart failure (HF), leading to increased short- and long-term morbidity and mortality.
- Heart failure (HF), advanced age, hyperglycemia, and leukocytosis at admission are independent predictors of mortality following AMI.
- Early identification and management of these risk factors are essential for improving outcomes in AMI patients.
Introduction And Objectives:
To evaluate the clinical characteristics and prognosis of heart failure (HF) development in patients hospitalized for acute myocardial infarction (AMI).
Patients And Method:
Between May 1990 and March 2000, 836 consecutive patients were admitted with a diagnosis of AMI within 24 h of symptom onset. HF was defined as the presence of rales and a third heart sound with gallop, and evidence of pulmonary congestion on chest x-ray. It was diagnosed in 263 subjects (31.5%).
Results:
The mean age of patients with HF (group 1) was 63.4 (11.4) years compared with 59.9 (11.6) years in those without HF (group 2) (P<.01). There were differences between groups 1 and 2 in history of diabetes (36% vs 20%; P<.001) or previous HF (9.2% vs 1.1%; P<.001). The reperfusion strategy used in patients with Q-wave infarction, with or without HF, was primary angioplasty in 15% and 14%, respectively (P=.81), and thrombolytic agents in 28% and 37%, respectively (P=.013). Patients with HF were more likely to develop recurrent angina (26.8% vs 19.6%; P=.02), pericarditis (17.5% vs 6.3%; P<.001), and atrial fibrillation (12.3% vs 5.1%; P<.01). In-hospital mortality in groups 1 and 2 was 15.6% and 2.3% (P<.001), respectively, and 10-year survival was 10% and 30%, respectively (P<.001). The variables associated with mortality were: age (HR=1.022; P<.001), hyperglycemia (HR=1.748 per 1.0-g/L increase; P<.001), leukocytosis (HR=1.035 per 1000-cell/.L increase; P<.001), and HF (HR=1.308; P=.028).
Conclusions:
AMI is still frequently complicated by HF, which increases short- and long-term morbidity and mortality. Heart failure, age, hyperglycemia, and leukocytosis at admission were independent predictors of mortality during follow-up.
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