title: Utilization and outcome of coronary revascularization and valve procedures in acute heart failure--an evaluation based on the classification from the European Society of Cardiology.
abstract: Early invasive treatments in patients with acute heart failure (AHF) are critical components to improve outcome. We aimed to establish if such treatments were applied according to existing guidelines and also to assess the subsequent mortality in the complete AHF population. All patients with AHF admitted to the intensive care unit/coronary care unit during the years 2003-2004 (n=302) were retrospectively reviewed and classified according to the European Society of Cardiology. Invasive revascularization was applied more frequently in patients with cardiogenic shock following acute coronary syndromes (78%, n=40) than in less severe AHF (58%, n=62, P<0.05). Only 8% (n=4) of eligible patients with acute coronary syndromes and cardiogenic shock were treated non-invasively. Valvular dysfunction was a precipitating factor for AHF in 15% (n=38). Acute mitral regurgitation was treated surgically exclusively in patients with mechanical defects. In-hospital mortality rates for less severe AHF was 12%, cardiogenic shock 46% and postcardiotomy HF 32%. Invasively treated patients had lower in-hospital mortality in both cardiogenic shock (35% vs. 70%, P=0.006) and less severe AHF (6% vs.17%, P=0.042). The study revealed an appropriate use of invasive revascularization. The high mortality in patients with severe AHF indicates that more effective treatment options are needed in eligible patients.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, University Hospital North Norway, 9038 Tromsø, Norway. Stig.Eggen.Hermansen@unn.no
authors.forename: Stig Eggen
authors.initials: SE
authors.lastname: Hermansen
authors.forename: Magna
authors.initials: M
authors.lastname: Hansen
authors.forename: Marius
authors.initials: M
authors.lastname: Roaldsen
authors.forename: Stig
authors.initials: S
authors.lastname: Muller
authors.forename: Ole-Jakob
authors.initials: OJ
authors.lastname: How
authors.forename: Truls
authors.initials: T
authors.lastname: Myrmel
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000401:mortality / Q000628:therapy*; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D005060:Europe; D005260:Female; D019983:Guideline Adherence; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006349:Heart Valve Diseases / Q000150:complications / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012955:Societies, Medical; D013997:Time Factors; D016896:Treatment Outcome