Impact of Prior Heart Failure Hospitalization on Long-Term Cardiac Mortality in ST-Elevated Myocardial Infarction...

Heart failure is associated with poor outcomes in ST-elevation myocardial infarction (STEMI). While heart failure following STEMI has been extensively studied, the role of a prior history of heart failure hospitalization (HFH) as a specific risk factor for long-term outcomes in patients with STEMI who underwent primary percutaneous coronary intervention (PCI) has not been fully explored.Consecutive 1,544 patients (median age, 69 [60-78] years; male, 75.1%) who presented to the hospital within 24-hours after symptom onset and underwent primary PCI were evaluated. The predictive risk factors for long-term cardiac mortality were analyzed using the random survival forest method. In addition, a Cox proportional hazards regression analysis was performed to assess the independent impact of HFH on cardiac mortality.Among the cohort, 26 patients (1.7%) had a HFH. During a median follow-up of 5.6-years, 173 (11.2%) patients died due to cardiac disease. In the Kaplan-Meyer analysis, patients with HFH showed a significantly higher cardiac mortality than those without HFH (log-rank, P < 0.001). In order of importance, estimated glomerular filtration rate, the necessity of intubation, age, Killip class, left ventricular ejection fraction, HFH, serum albumin, and serum brain natriuretic peptide were identified as predictive risk factors of cardiac mortality. The multivariate Cox regression model revealed that HFH was a significant independent risk predictor of cardiac mortality (hazard ratio: 3.587; 95% confidence interval: 1.687-7.624; P < 0.001).HFH may independently increase the long-term risk of cardiac mortality by 4-fold in patients with STEMI undergoing primary PCI.