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Acute heart failure in patients with acute myocardial infarction treated with primary percutaneous coronary
Giovanni M Santoro1, Nazario Carrabba, Angela Migliorini
1Division of Cardiology, Careggi Hospital, Florence, Italy.
Insights
Acute heart failure (HF) is common in acute myocardial infarction (AMI) patients undergoing primary percutaneous coronary intervention (PCI). While HF on admission increases mortality risk, primary PCI may reduce HF development during hospitalization, though prognosis remains severe if HF occurs.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Limited data exist on the relationship between acute heart failure (HF) and acute myocardial infarction (AMI).
- Understanding this relationship is crucial for optimizing patient outcomes in acute cardiac events.
Purpose of the Study:
- To evaluate the impact of acute heart failure (HF) on patient outcomes in acute myocardial infarction (AMI) cases treated with primary percutaneous coronary intervention (PCI).
Main Methods:
- Analysis of 2,089 patients with acute myocardial infarction (AMI).
- Assessment of heart failure (HF) incidence on admission and during hospitalization.
- Identification of predictors for HF development.
- Comparison of mortality rates between patients with and without HF.
Main Results:
- 17% of AMI patients presented with HF on admission; 1% developed HF post-hospitalization.
- Predictors of HF included age, diabetes, prior MI, delayed admission, anterior infarct location, and poor initial coronary blood flow.
- Mortality rates were significantly higher for patients with HF on admission (6-month mortality 12%) and those developing HF during hospitalization (6-month mortality 33%) compared to those without HF (6-month mortality 2.2%).
- The hazard ratio for death was 3.47 for patients with HF versus without, 5.19 for HF developing post-admission, and 2.44 for HF on admission.
Conclusions:
- The incidence of acute heart failure (HF) upon hospital admission for acute myocardial infarction (AMI) remains high.
- Primary percutaneous coronary intervention (PCI) may reduce the development of HF during hospitalization.
- Despite advancements, HF in AMI patients is associated with severe prognosis and increased mortality risk.
Background:
Scanty data exist about the relation between acute heart failure (HF) and acute myocardial infarction (AMI).
Aim:
To assess the impact of HF on outcome in AMI patients treated with primary percutaneous coronary intervention (PCI).
Methods And Results:
Out of 2,089 AMI patients, 82% did not present HF, 17% presented HF on admission and 1% developed HF after hospitalisation. Predictors of HF on admission were age, diabetes, prior MI, time delay to admission, anterior location, and TIMI grade 0-1 in the culprit vessel. Predictors of HF during hospitalisation were age and peak creatine kinase. The 1- and 6-month mortalities were 1.1% and 2.2%, 8% and 12%, 26% and 33% in patients without HF, with HF on admission and after hospitalisation, respectively. The risk of death was higher in patients with HF than in patients without HF (HR 3.47), as well as in patients with HF after admission (HR 5.19) than in patients with HF on admission (HR 2.44).
Conclusions:
In a primary PCI setting, the incidence of HF on hospital admission remains high, but mortality is lower when compared with historical patient series. Primary PCI may prevent the development of HF during hospitalisation; however, when HF develops, the prognosis remains severe.
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