title: Incidence, timing, predictors and impact of acute heart failure complicating ST-segment elevation myocardial infarction in patients treated by primary percutaneous coronary intervention.
abstract: BACKGROUND
  Acute heart failure (AHF) complicating ST-segment elevation myocardial infarction (STEMI) is recognized as an ominous complication. Previous studies mostly reported outcomes of heterogeneous, non-contemporary population. Moreover, few studies assessed the prognosis of AHF according to its timing. This study evaluated incidence, predictors and impact of AHF according to its timing in a homogeneous STEMI patients population treated by primary percutaneous coronary intervention (pPCI).
  
  
  METHODS
  Data from 6282 patients included in a prospective multicenter registry were analyzed. Patients with AHF (Killip class>I) were compared to patients without AHF and patients with admission AHF were compared to patients who developed in-hospital AHF. In-hospital mortality was the primary endpoint of the study. Propensity-score matching and multivariable regression were used to adjust for confounders.
  
  
  RESULTS
  A total of 1328 patients (21.1%) presented AHF: 739 on admission and 589 during hospitalization. AHF was associated with a markedly increased in-hospital mortality rate (19.9% vs. 0.8%, p<0.001). There was a gradual excess risk with each Killip class and admission AHF patients displayed the highest crude mortality rate (24.1%). By multivariable analysis, AHF was the strongest independent predictor of in-hospital mortality (HR=3.852 (2.303-6.442), p<0.001) without evidence of any difference according to its timing (HR=0.947 (0.638-1.372), p=0.767). These results were consistent after extensive adjustment on baseline characteristics in the matched cohorts. Among other predictors, pPCI beyond guidelines-recommended delays and stent thrombosis were independently associated with AHF.
  
  
  CONCLUSIONS
  AHF regardless of its timing remains a common and dreadful complication of STEMI in the contemporary era.
authors.affiliation: CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France; INSERM 1414, Clinical Investigation Center, Innovative Technology, Rennes F-35000, France. Electronic address: vincent.auffret@chu-rennes.fr.
authors.forename: Vincent
authors.initials: V
authors.lastname: Auffret
authors.affiliation: CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France; INSERM 1414, Clinical Investigation Center, Innovative Technology, Rennes F-35000, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Leurent
authors.affiliation: CHU de Brest, Département de Cardiologie, Brest F-29200, France; EA4324, Optimisation des Régulations Physiologiques (ORPhy), UFR Sciences et Techniques, Brest F-29200, France.
authors.forename: Martine
authors.initials: M
authors.lastname: Gilard
authors.affiliation: CH de Lorient, Service de Cardiologie, Lorient, F-56100, Lorient, France.
authors.forename: Jean-Philippe
authors.initials: JP
authors.lastname: Hacot
authors.affiliation: CH de Vannes, Service de Cardiologie, Vannes F-56000, France.
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Filippi
authors.affiliation: CH de Saint Brieuc, Service de Cardiologie, Saint Brieuc, F-22000, France.
authors.forename: Régis
authors.initials: R
authors.lastname: Delaunay
authors.affiliation: CH de Saint Malo, Service de Cardiologie, Saint Malo F-35400, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Rialan
authors.affiliation: CH de Quimper, Service de Cardiologie, Quimper F-29000, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Rouault
authors.affiliation: Clinique Saint Laurent, Service de Cardiologie, Rennes F-35000, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Druelles
authors.affiliation: CHU de Brest, Département de Cardiologie, Brest F-29200, France; EA4324, Optimisation des Régulations Physiologiques (ORPhy), UFR Sciences et Techniques, Brest F-29200, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Castellant
authors.affiliation: CH de Saint-Brieuc, SAMU, Saint Brieuc F-22000, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Coudert
authors.affiliation: CH de Vannes, SAMU, Vannes F-56000, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Boulanger
authors.affiliation: CHU de Brest, SAMU, Brest F-29200, France.
authors.forename: Josiane
authors.initials: J
authors.lastname: Treuil
authors.affiliation: CHU de Rennes, SAMU, Rennes F-35000, France.
authors.forename: Emilie
authors.initials: E
authors.lastname: Bot
authors.affiliation: CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France; INSERM 1414, Clinical Investigation Center, Innovative Technology, Rennes F-35000, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Bedossa
authors.affiliation: CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France; INSERM 1414, Clinical Investigation Center, Innovative Technology, Rennes F-35000, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Boulmier
authors.affiliation: CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes F-35000, France; INSERM 1414, Clinical Investigation Center, Innovative Technology, Rennes F-35000, France.
authors.forename: Marielle
authors.initials: M
authors.lastname: Le Guellec
authors.affiliation: CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France; INSERM 1414, Clinical Investigation Center, Innovative Technology, Rennes F-35000, France.
authors.forename: Erwan
authors.initials: E
authors.lastname: Donal
authors.affiliation: CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes F-35000, France; Université de Rennes 1, LTSI, Rennes, F-35000, France; INSERM 1414, Clinical Investigation Center, Innovative Technology, Rennes F-35000, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Le Breton
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000639:trends; D011237:Predictive Value of Tests; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy*; D013997:Time Factors; D016896:Treatment Outcome
keywords: Complications; Heart failure; Mortality; ST-elevation myocardial infarction