Frequency, patient characteristics, and outcomes of mild-to-moderate heart failure complicating ST-segment elevation acute myocardial infarction: lessons from 4 international fibrinolytic therapy trials.
BACKGROUND
There is a paucity of data on the incidence of mild-to-moderate heart failure (HF) complicating ST-segment elevation acute myocardial infarction (MI) and its impact on short-term outcomes. Our objective was to determine the incidence, timing, and consequences of mild-to-moderate HF complicating acute MI.


METHODS
We examined the occurrence of death or death/recurrent MI (re-MI) in patients enrolled in the Global Utilization of Streptokinase and Tissue-Plasminogen Activator for Occluded Coronary Arteries (GUSTO-I), the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO IIb), the Global Use of Strategies to Open Occluded Coronary Arteries (GUSTO-III), and Assessment of the Safety and Efficacy of a New Thrombolytic (ASSENT-II) trials, which examined different fibrinolytic therapies for MI. We excluded patients who had cardiogenic shock (n = 2994) or unknown HF status at all time points (n = 13,716). Of the remaining 61,041 patients, 17,949 patients (29.4%) had HF, 1566 (8.7%) only at baseline, 10,339 (57.6%) only after admission, and 6044 (33.7%) at baseline and after.


RESULTS
The incidence of HF was 32.5% in the United States and 26.9% elsewhere. At 30 days, death and death/re-MI occurred in 2% and 4% of patients without HF and 8% and 12% of patients with HF, respectively (2% and 4% of patients with HF only at baseline, 7% and 13% of patients with HF only after baseline, and 10% and 13% of patients with HF at baseline and later). By use of multivariable analyses, the presence of HF was associated with 1.55 times greater risk of dying at 30 days (95% CI 1.38-1.74) and 2.15 times greater risk of death/re-MI (95% CI 1.96-2.36).


CONCLUSIONS
Mild-to-moderate HF is a frequent and ominous complication of MI, especially when it does not resolve or develops after admission.
Hasdai
David
D
Rabin Medical Center, Petah Tikva, Israel.
Topol
Eric J
EJ
Kilaru
Rakhi
R
Battler
Alexander
A
Harrington
Robert A
RA
Vahanian
Alec
A
Ohman
E Magnus
EM
Granger
Christopher B
CB
Van de Werf
Frans
F
Simoons
Maarten L
ML
O'connor
Christopher M
CM
Holmes
David R
DR
D002986:Clinical Trials as Topic; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000453:epidemiology* / Q000503:physiopathology / Q000628:therapy; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D015994:Incidence; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000628:therapy; D016016:Proportional Hazards Models; D017678:Sex Distribution; D013300:Streptokinase / Q000627:therapeutic use; D013318:Stroke Volume; D015996:Survival Rate; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D005343:Fibrinolytic Agents; D013300:Streptokinase; D010959:Tissue Plasminogen Activator