title: Acute heart failure with and without concomitant acute coronary syndromes: patient characteristics, management, and survival.
abstract: BACKGROUND
  Acute coronary syndromes (ACS) may precipitate up to a third of acute heart failure (AHF) cases. We assessed the characteristics, initial management, and survival of AHF patients with (ACS-AHF) and without (nACS-AHF) concomitant ACS.
  
  
  RESULTS
  Data from 620 AHF patients were analyzed in a prospective multicenter study. The ACS-AHF patients (32%) more often presented with de novo AHF (61% vs. 43%; P < .001). Although no differences existed between the 2 groups in mean blood pressure, heart rate, or routine biochemistry on admission, cardiogenic shock and pulmonary edema were more common manifestations in ACS-AHF (P < .01 for both). Use of intravenous nitrates, furosemide, opioids, inotropes, and vasopressors, as well as noninvasive ventilation and invasive coronary procedures (angiography, percutaneous coronary intervention, coronary artery bypass graft surgery), were more frequent in ACS-AHF (P < .001 for all). Although 30-day mortality was significantly higher for ACS-AHF (13% vs. 8%; P = .03), survival in the 2 groups at 5 years was similar. Overall, ACS was an independent predictor of 30-day mortality (adjusted odds ratio 2.0, 95% confidence interval 1.07-3.79; P = .03).
  
  
  CONCLUSIONS
  Whereas medical history and the manifestation and initial treatment of AHF between ACS-AHF and nACS-AHF patients differ, long-term survival is similar. ACS is, however, independently associated with increased short-term mortality.
authors: Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: tuukka.tarvasmaki@fimnet.fi.
authors: Tuukka
authors: T
authors: Tarvasmäki
authors: Division of Emergency Care, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
authors: Veli-Pekka
authors: VP
authors: Harjola
authors: Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
authors: Markku S
authors: MS
authors: Nieminen
authors: Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
authors: Krista
authors: K
authors: Siirilä-Waris
authors: Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
authors: Jukka
authors: J
authors: Tolonen
authors: Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
authors: Heli
authors: H
authors: Tolppanen
authors: Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland.
authors: Johan
authors: J
authors: Lassus
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D000208:Acute Disease; D000368:Aged; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D019468:Disease Management; D005260:Female; D005387:Finland / Q000453:epidemiology; D006333:Heart Failure / Q000150:complications / Q000401:mortality / Q000503:physiopathology; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization / Q000379:methods / Q000706:statistics & numerical data; D011446:Prospective Studies; D011654:Pulmonary Edema / Q000209:etiology; D012770:Shock, Cardiogenic / Q000209:etiology; D016019:Survival Analysis
chemical_list: D002317:Cardiovascular Agents
keywords: Acute heart failure; acute coronary syndromes; management; survival