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Published on: April 17, 2021
Timing of heart failure development and clinical outcomes in patients with acute myocardial infarction
Hyung Yoon Kim1, Kye Hun Kim1, Nuri Lee1
1Department of Cardiology, Chonnam National University Medical School/Hospital, Gwangju, Republic of Korea.
Insights
Heart failure (HF) developing after acute myocardial infarction (AMI) is common and linked to worse outcomes. Early HF detection post-AMI is crucial for improving patient prognosis and guiding treatment.
Area of Science:
- Cardiology
- Clinical Medicine
- Outcomes Research
Background:
- Acute myocardial infarction (AMI) is a leading cause of cardiovascular morbidity.
- Heart failure (HF) is a frequent complication following AMI, significantly impacting long-term prognosis.
- The timing of HF development relative to AMI is a critical factor in patient outcomes.
Purpose of the Study:
- To investigate the clinical relevance of the timing of heart failure (HF) development on long-term outcomes in patients with acute myocardial infarction (AMI).
- To assess the association between the onset of HF and major adverse cardiac events (MACE) after AMI.
Main Methods:
- A cohort of 1,925 AMI patients was analyzed.
- Patients were categorized into four groups based on HF development: at admission, during hospitalization, after discharge, or no HF.
- Major adverse cardiac events (MACE), including death, re-hospitalization, recurrent MI, or revascularization, were evaluated.
Main Results:
- HF developed in 46.1% of AMI patients.
- MACE rates were highest in patients with HF at admission (43.9%) and lowest in those without HF (22.6%).
- Three-year MACE-free survival rates were significantly lower for patients who developed HF earlier after AMI (56% for HF at admission vs. 77% for no HF).
Conclusions:
- Heart failure is a common complication after AMI and is associated with poor long-term prognosis.
- The earlier HF develops post-AMI, the worse the clinical outcome.
- Close monitoring for HF development, even after discharge, is essential for timely intervention and optimal medical therapy.
Background And Objectives:
To investigate the clinical relevance of the timing of heart failure (HF) development on long-term outcome in patients with acute myocardial infarction (AMI).
Materials And Methods:
A total of 1,925 consecutive AMI patients were divided into 4 groups according to the timing of HF development; HF at admission (group I, n = 627), de novo HF during hospitalization (group II, n = 162), de novo HF after discharge (group III, n = 98), no HF (group IV, n = 1,038). Major adverse cardiac events (MACE) defined as the development of death, re-hospitalization, recurrent MI or revascularization were evaluated.
Results:
HF was developed in 887 patients (46.1%) after an index AMI. HF was most common at the time of admission for AMI, but the development of de novo HF during hospitalization or after discharge was not uncommon. MACE was developed in 619 out of 1,925 AMI patients (31.7%). MACE was highest in group I, lowest in group IV, and significantly different among groups; 275 out of 627 patients (43.9%) in group I, 64 out of 192 patients (39.5%) in group II, 36 out of 98 patients (36.7%) in group III, and 235 out of 1,038 patients (22.6%) in group IV (P < 0.001). MACE free survival rates at 3 years were 56% in group I, 62% in group II, 64% in group III, and 77% in group IV (P < 0.001).
Conclusions:
HF was not uncommon and can develop at any time after an index AMI, and the development of HF was associated with poor prognosis. The earlier the HF has occurred after AMI, the poorer the clinical outcome was. To initiate the guideline directed optimal medical therapy, therefore, the development of HF should be carefully monitored even after the discharge from an index AMI.
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