Tuukka Tarvasmäki1, Veli-Pekka Harjola2, Markku S Nieminen3, Krista Siirilä-Waris3, Jukka Tolonen4, Heli Tolppanen3, Johan Lassus3. 1. Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. Electronic address: tuukka.tarvasmaki@fimnet.fi. 2. Division of Emergency Care, Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland. 3. Heart and Lung Center, Helsinki University Central Hospital, Helsinki, Finland. 4. Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland.
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. METHODS AND 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.
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. METHODS AND 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: Wolf-Dieter Zech; Christian Jackowski; Nicole Schwendener; Eva Brencicova; Frederick Schuster; Paolo Lombardo Journal: Int J Legal Med Date: 2015-09-23 Impact factor: 2.686
Authors: A Mebazaa; H Tolppanen; C Mueller; J Lassus; S DiSomma; G Baksyte; M Cecconi; D J Choi; A Cohen Solal; M Christ; J Masip; M Arrigo; S Nouira; D Ojji; F Peacock; M Richards; N Sato; K Sliwa; J Spinar; H Thiele; M B Yilmaz; J Januzzi Journal: Intensive Care Med Date: 2015-09-14 Impact factor: 17.440
Authors: Raban V Jeger; Otmar Pfister; Dragana Radovanovic; Franz R Eberli; Hans Rickli; Philip Urban; Giovanni Pedrazzini; Jean-Christophe Stauffer; Jörg Nossen; Paul Erne Journal: Clin Cardiol Date: 2017-06-09 Impact factor: 2.882
Authors: Piergiuseppe Agostoni; Dimitrios T Farmakis; Jose M García-Pinilla; Veli-Pekka Harjola; Kristjan Karason; Dirk von Lewinski; John Parissis; Piero Pollesello; Gerhard Pölzl; Alejandro Recio-Mayoral; Alexander Reinecke; Patrik Yerly; Endre Zima Journal: Card Fail Rev Date: 2019-11-04
Authors: Hussam AlFaleh; Abdelfatah A Elasfar; Anhar Ullah; Khalid F AlHabib; Ahmad Hersi; Layth Mimish; Ali Almasood; Saleh Al Ghamdi; Abdullah Ghabashi; Asif Malik; Gamal A Hussein; Mushabab Al-Murayeh; Ahmed Abuosa; Waleed Al Habeeb; Tarek S Kashour Journal: BMC Cardiovasc Disord Date: 2016-05-20 Impact factor: 2.298