title: Determinants and prognostic impact of heart failure complicating acute coronary syndromes: observations from the Global Registry of Acute Coronary Events (GRACE).
abstract: BACKGROUND
  Few data are available on the impact of heart failure (HF) across all types of acute coronary syndromes (ACS).
  
  
  RESULTS
  The Global Registry of Acute Coronary Events (GRACE) is a prospective study of patients hospitalized with ACS. Data from 16 166 patients were analyzed: 13 707 patients without prior HF or cardiogenic shock at presentation were identified. Of these, 1778 (13%) had an admission diagnosis of HF (Killip class II or III). HF on admission was associated with a marked increase in mortality rates during hospitalization (12.0% versus 2.9% [with versus without HF], P<0.0001) and at 6 months after discharge (8.5% versus 2.8%, P<0.0001). Of note, HF increased mortality rates in patients with unstable angina (defined as ACS with normal biochemical markers of necrosis; mortality rates: 6.7% with versus 1.6% without HF at admission, P<0.0001). By logistic regression analysis, admission HF was an independent predictor of hospital death (odds ratio, 2.2; P<0.0001). Admission HF was associated with longer hospital stay and higher readmission rates. Patients with HF had lower rates of catheterization and percutaneous cardiac intervention, and fewer received beta-blockers and statins. Hospital development of HF (versus HF on presentation) was associated with an even higher in-hospital mortality rate (17.8% versus 12.0%, P<0.0001). In patients with HF, in-hospital revascularization was associated with lower 6-month death rates (14.0% versus 23.7%, P<0.0001; adjusted hazard ratio, 0.5; 95% CI, 0.37 to 0.68, P<0.0001).
  
  
  CONCLUSIONS
  In this observational registry, heart failure was associated with reduced hospital and 6-month survival across all ACS subsets, including patients with normal markers of necrosis. More aggressive treatment of these patients may be warranted to improve prognosis.
authors.affiliation: Centre Hospitalier Universitaire Bichat-Beaujon, Assistance Publique-Hôpitaux de Paris, France. gabriel.steg@bch.ap-hop-paris.fr
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Omar H
authors.initials: OH
authors.lastname: Dabbous
authors.forename: Laurent J
authors.initials: LJ
authors.lastname: Feldman
authors.forename: Alain
authors.initials: A
authors.lastname: Cohen-Solal
authors.forename: Marie-Claude
authors.initials: MC
authors.lastname: Aumont
authors.forename: José
authors.initials: J
authors.lastname: López-Sendón
authors.forename: Andrzej
authors.initials: A
authors.lastname: Budaj
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.forename: Werner
authors.initials: W
authors.lastname: Klein
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Anderson
mesh_terms: D000208:Acute Disease; D000368:Aged; D000789:Angina, Unstable / Q000150:complications* / Q000175:diagnosis; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D013577:Syndrome; D013997:Time Factors