Correlates and prognostic impact of new-onset heart failure after ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: insights from the INFUSE-AMI trial. Issue 4 (1st June 2018)

• Record Type: Journal Article
• Authors: Giustino, Gennaro; Redfors, Björn; Brener, Sorin J; Kirtane, Ajay J; Généreux, Philippe; Maehara, Akiko; Dudek, Dariusz; Neunteufl, Thomas; Metzger, D Christopher; Crowley, Aaron; Mehran, Roxana; Gibson, C Michael; Stone, Gregg W
• Is Part Of: European heart journal. Volume 7:Issue 4(2018)
• Page Start: 339
• Page End: 347
• Publication Date: 2018-06-01
• Subjects: ST-segment elevation myocardial infarction -- New York Heart Association -- heart failure -- infarct size -- magnetic resonance imaging; 616.1205
• DOI: 10.1177/2048872617719649
• Languages: English
• ISSNs: 2048-8726

Abstract

Abstract: Background: The determinants and significance of early (30-day) heart failure symptoms after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) remain unclear. We investigated the clinical and imaging correlates of early post-discharge heart failure in patients with STEMI, and evaluated its impact on clinical outcomes. Methods: Patients from the INFUSE-AMI trial were categorized according to New York Heart Association (NYHA) functional classification at their 30-day visit (NYHA class ≥2 versus 1). Independent correlates of NYHA class ≥2 were determined by multivariable logistic regression. A landmark analysis beyond 30 days was performed to assess the impact of 30-day NYHA class ≥2 on 1-year risk of death or hospitalization for heart failure. Results: Among 402 patients enrolled in the INFUSE-AMI trial with data on NYHA class at 30 days, 76 (18.9%) had NYHA class ≥2. Independent correlates of 30-day NYHA class ≥2 were age, Killip class ≥2 at presentation, heart rate at presentation, intraprocedural no-reflow, and 30-day infarct size (% total ventricular mass). After adjustment for infarct size, patients with NYHA class ≥2 remained at higher risk of death or hospitalization for heart failure at 1-year follow-up compared to those in NYHA class 1 (11.8% vs. 2.8%, adjusted hazard ratio 3.78, 95% confidence interval 1.16–12.22, P =0.03). Conclusions: Clinical, procedural, and imaging variables predict the development of clinical heart failure after primary percutaneous coronary intervention in patients with STEMI. Early post-discharge heart failure symptoms identify a high-risk patient cohort for subsequent heart failure hospitalization and death, independent of infarct size. Trial Registration: ClinicalTrials.gov ; NCT00976521