TY - JOUR
T1 - Correlates and prognostic impact of new-onset heart failure after ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention
T2 - insights from the INFUSE-AMI trial
AU - Giustino, Gennaro
AU - Redfors, Björn
AU - Brener, Sorin J
AU - Kirtane, Ajay J
AU - Généreux, Philippe
AU - Maehara, Akiko
AU - Dudek, Dariusz
AU - Neunteufl, Thomas
AU - Metzger, D Christopher
AU - Crowley, Aaron
AU - Mehran, Roxana
AU - Gibson, C Michael
AU - Stone, Gregg W
PY - 2018/6/1
Y1 - 2018/6/1
N2 - BACKGROUND: The determinants and significance of early (30-day) heart failure symptoms after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) remain unclear. We investigated the clinical and imaging correlates of early post-discharge heart failure in patients with STEMI, and evaluated its impact on clinical outcomes.METHODS: Patients from the INFUSE-AMI trial were categorized according to New York Heart Association (NYHA) functional classification at their 30-day visit (NYHA class ≥2 versus 1). Independent correlates of NYHA class ≥2 were determined by multivariable logistic regression. A landmark analysis beyond 30 days was performed to assess the impact of 30-day NYHA class ≥2 on 1-year risk of death or hospitalization for heart failure.RESULTS: Among 402 patients enrolled in the INFUSE-AMI trial with data on NYHA class at 30 days, 76 (18.9%) had NYHA class ≥2. Independent correlates of 30-day NYHA class ≥2 were age, Killip class ≥2 at presentation, heart rate at presentation, intraprocedural no-reflow, and 30-day infarct size (% total ventricular mass). After adjustment for infarct size, patients with NYHA class ≥2 remained at higher risk of death or hospitalization for heart failure at 1-year follow-up compared to those in NYHA class 1 (11.8% vs. 2.8%, adjusted hazard ratio 3.78, 95% confidence interval 1.16-12.22, P=0.03).CONCLUSIONS: Clinical, procedural, and imaging variables predict the development of clinical heart failure after primary percutaneous coronary intervention in patients with STEMI. Early post-discharge heart failure symptoms identify a high-risk patient cohort for subsequent heart failure hospitalization and death, independent of infarct size.TRIAL REGISTRATION: ClinicalTrials.gov ; NCT00976521.
AB - BACKGROUND: The determinants and significance of early (30-day) heart failure symptoms after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) remain unclear. We investigated the clinical and imaging correlates of early post-discharge heart failure in patients with STEMI, and evaluated its impact on clinical outcomes.METHODS: Patients from the INFUSE-AMI trial were categorized according to New York Heart Association (NYHA) functional classification at their 30-day visit (NYHA class ≥2 versus 1). Independent correlates of NYHA class ≥2 were determined by multivariable logistic regression. A landmark analysis beyond 30 days was performed to assess the impact of 30-day NYHA class ≥2 on 1-year risk of death or hospitalization for heart failure.RESULTS: Among 402 patients enrolled in the INFUSE-AMI trial with data on NYHA class at 30 days, 76 (18.9%) had NYHA class ≥2. Independent correlates of 30-day NYHA class ≥2 were age, Killip class ≥2 at presentation, heart rate at presentation, intraprocedural no-reflow, and 30-day infarct size (% total ventricular mass). After adjustment for infarct size, patients with NYHA class ≥2 remained at higher risk of death or hospitalization for heart failure at 1-year follow-up compared to those in NYHA class 1 (11.8% vs. 2.8%, adjusted hazard ratio 3.78, 95% confidence interval 1.16-12.22, P=0.03).CONCLUSIONS: Clinical, procedural, and imaging variables predict the development of clinical heart failure after primary percutaneous coronary intervention in patients with STEMI. Early post-discharge heart failure symptoms identify a high-risk patient cohort for subsequent heart failure hospitalization and death, independent of infarct size.TRIAL REGISTRATION: ClinicalTrials.gov ; NCT00976521.
KW - Aged
KW - Austria/epidemiology
KW - Cause of Death/trends
KW - Coronary Angiography
KW - Electrocardiography
KW - Female
KW - Follow-Up Studies
KW - Heart Failure/diagnosis
KW - Humans
KW - Incidence
KW - Magnetic Resonance Imaging, Cine
KW - Male
KW - Middle Aged
KW - Percutaneous Coronary Intervention/adverse effects
KW - Poland/epidemiology
KW - Prognosis
KW - Prospective Studies
KW - Quebec/epidemiology
KW - Risk Assessment
KW - ST Elevation Myocardial Infarction/diagnosis
KW - Single-Blind Method
KW - Survival Rate/trends
KW - Time Factors
KW - United States/epidemiology
UR - http://www.scopus.com/inward/record.url?scp=85052839656&partnerID=8YFLogxK
U2 - 10.1177/2048872617719649
DO - 10.1177/2048872617719649
M3 - Journal article
C2 - 28828881
SN - 2048-8726
VL - 7
SP - 339
EP - 347
JO - European Heart Journal: Acute Cardiovascular Care
JF - European Heart Journal: Acute Cardiovascular Care
IS - 4
ER -