Correlates and prognostic impact of new-onset heart failure after ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: insights from the INFUSE-AMI trial

Gennaro Giustino, Björn Redfors, Sorin J Brener, Ajay J Kirtane, Philippe Généreux, Akiko Maehara, Dariusz Dudek, Thomas Neunteufl, D Christopher Metzger, Aaron Crowley, Roxana Mehran, C Michael Gibson, Gregg W Stone

Research output: Journal article (peer-reviewed)Journal article

17 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)339-347
Number of pages9
JournalEuropean Heart Journal: Acute Cardiovascular Care
Volume7
Issue number4
DOIs
Publication statusPublished - 01 Jun 2018

Keywords

  • Aged
  • Austria/epidemiology
  • Cause of Death/trends
  • Coronary Angiography
  • Electrocardiography
  • Female
  • Follow-Up Studies
  • Heart Failure/diagnosis
  • Humans
  • Incidence
  • Magnetic Resonance Imaging, Cine
  • Male
  • Middle Aged
  • Percutaneous Coronary Intervention/adverse effects
  • Poland/epidemiology
  • Prognosis
  • Prospective Studies
  • Quebec/epidemiology
  • Risk Assessment
  • ST Elevation Myocardial Infarction/diagnosis
  • Single-Blind Method
  • Survival Rate/trends
  • Time Factors
  • United States/epidemiology

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