title: Effect of acute heart failure following discharge in patients with non-ST-elevation acute coronary syndrome on the subsequent risk of death or acute myocardial infarction.
abstract: OBJECTIVE
  Little is known about how prognosis is influenced by readmission for acute heart failure (AHF) following non-ST-segment elevation acute coronary syndrome (NSTEACS). The aim of this study was to determine the prognostic effect of a first admission for AHF on the risk of acute myocardial infarction (AMI) or death in patients who survived an episode of high-risk NSTEACS.
  
  
  METHODS
  The study involved 972 consecutive patients with high-risk NSTEACS who survived after hospital admission. Readmission for AHF was selected as the main exposure variable, and its association with subsequent AMI or all-cause death was assessed using Cox proportional hazards models for time-dependent covariates that also included adjustment for competing risks.
  
  
  RESULTS
  After a median follow-up period of 30 [interquartile range, 12-48] months, 82 patients (8.4%) were admitted for AHF, 146 (15%) had an AMI, and 202 (20.8%) died. The median time to readmission for AHF was 203 [56-336] days after NSTEACS. Patients readmitted for AHF had an increased risk of subsequent death (hazard ratio [HR]=1.67; 95% confidence interval [CI], 1.13-2.45; P=.009) or AMI (HR=2.15; 95% CI, 1.41-3.27; P< .001), which was independent of baseline prognostic and time-dependent variables.
  
  
  CONCLUSIONS
  Readmission for AHF after high-risk NSTEACS was associated with an increased risk of subsequent death or AMI.
authors.affiliation: Servicio de Cardiología, Hospital Clínico Universitario, Universidad de Valencia, Valencia, España. yulnunez@gmail.com
authors.forename: Julio
authors.initials: J
authors.lastname: Núñez
authors.forename: Juan
authors.initials: J
authors.lastname: Sanchis
authors.forename: Eduardo
authors.initials: E
authors.lastname: Núñez
authors.forename: Vicent
authors.initials: V
authors.lastname: Bodí
authors.forename: Luis
authors.initials: L
authors.lastname: Mainar
authors.forename: Gema
authors.initials: G
authors.lastname: Miñana
authors.forename: Pilar
authors.initials: P
authors.lastname: Merlos
authors.forename: Patricia
authors.initials: P
authors.lastname: Palau
authors.forename: Oliver
authors.initials: O
authors.lastname: Husser
authors.forename: Eva
authors.initials: E
authors.lastname: Rumiz
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Chorro
authors.forename: Angel
authors.initials: A
authors.lastname: Llàcer
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000503:physiopathology; D000208:Acute Disease; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000150:complications*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality*; D010351:Patient Discharge; D010359:Patient Readmission; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors