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Determinants and Prognostic Impact of Heart Failure and Left Ventricular Ejection Fraction in Acute Coronary Syndrome

Rosa Agra Bermejo1, Alberto Cordero2, José M García-Acuña1

  • 1Servicio de Cardiología y Unidad Coronaria, Complejo Hospitalario Universitario de Santiago de Compostela, CIBERCV, Santiago de Compostela, A Coruña, Spain.

Revista Espanola De Cardiologia (English Ed.)
|December 19, 2017
PubMed

Insights

Heart failure (HF) significantly worsens long-term prognosis after acute coronary syndrome (ACS), regardless of left ventricular ejection fraction (LVEF). LVEF is a key predictor of outcomes only in ACS patients without HF.

Area of Science:

  • Cardiology
  • Clinical Research
  • Heart Failure Management

Background:

  • Limited contemporary data exists on heart failure (HF) incidence and prognosis in acute coronary syndrome (ACS) patients.
  • The prognostic impact of left ventricular ejection fraction (LVEF) in ACS, particularly concerning HF development, requires further investigation.

Purpose of the Study:

  • To investigate the relationship between LVEF and HF development in ACS patients.
  • To examine the influence of LVEF on long-term prognosis, including mortality and HF rehospitalization, in a large ACS cohort.

Main Methods:

  • Retrospective observational study including 6208 patients admitted for ACS across two Spanish hospitals.
  • Analysis of baseline characteristics and long-term follow-up for mortality and HF rehospitalization as primary endpoints.
  • Stratification of patients based on LVEF (<40%, 40%-49%, ≥50%) and presence of acute HF.

Main Results:

  • Of 6208 ACS patients, 1144 developed acute HF. Among those without HF, LVEF ≥ 50% was an independent prognostic factor.
  • Mortality and HF readmissions differed significantly by LVEF in patients without acute HF, but not in those with HF.
  • Patients developing HF during ACS hospitalization had a considerably worse long-term prognosis irrespective of their LVEF.

Conclusions:

  • Developing heart failure during acute coronary syndrome hospitalization portends a worse long-term prognosis, independent of left ventricular ejection fraction.
  • Left ventricular ejection fraction serves as a significant independent prognostic predictor solely in acute coronary syndrome patients who do not develop heart failure.
Abstract

Keywords:
Acute coronary syndromeFracción de eyección del ventrículo izquierdoHeart failureInsuficiencia cardiacaLeft ventricular ejection fractionPrognosisPronósticoSíndrome coronario agudo

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