Clinical predictors and prognostic implications of HFpEF following STEMI based on HFA-PEFF score: a multicenter...

ST-segment elevation myocardial infarction (STEMI) is usually associated with impaired systolic function, but heart failure with preserved ejection fraction (HFpEF) may also occur and remains under-recognized in this setting. We aimed to investigate the prevalence, clinical predictors, and outcomes of HFpEF in STEMI patients with preserved left ventricular ejection fraction (LVEF).

We retrospectively analyzed 421 STEMI patients who underwent successful percutaneous coronary intervention (PCI). Among them, 280 patients with LVEF ≥50% on 1-month follow-up echocardiography were included. Patients were classified as HFpEF or non-HFpEF according to the Heart Failure Association Pre-test assessment, Echocardiography and natriuretic peptide, Functional testing, Final etiology (HFA-PEFF) score, with scores ≥5 defining HFpEF. The primary endpoint was a composite of cardiovascular (CV) death or hospitalization for heart failure (HF).

Eighty-eight patients (31.4%) were classified as HFpEF. Compared with the non-HFpEF group, these patients were older (mean age 70 years), more frequently female (46.6% vs. 16.1%), and less likely to be current smokers (31.8% vs. 51.0%). During a median follow-up of 3 years, 2 patients (0.7%) died from CV causes and 29 (10.4%) were hospitalized for HF. The incidence of HF hospitalization was significantly higher in the HFpEF group (17.0% vs. 7.3%). In multivariable Cox regression, HFpEF was independently associated with the composite outcome [hazard ratio (HR) 2.45; 95% confidence interval (CI): 1.10-5.44].

In STEMI patients with preserved LVEF, a substantial proportion developed HFpEF, which was associated with increased risks of HF hospitalization and mortality. The HFA-PEFF score provides incremental prognostic value in this population and may help identify high-risk patients for closer monitoring and tailored management.