Vincent Auffret1, Guillaume Leurent2, Martine Gilard3, Jean-Philippe Hacot4, Emmanuelle Filippi5, Régis Delaunay6, Antoine Rialan7, Gilles Rouault8, Philippe Druelles9, Philippe Castellant3, Isabelle Coudert10, Bertrand Boulanger11, Josiane Treuil12, Emilie Bot13, Marc Bedossa2, Dominique Boulmier2, Marielle Le Guellec14, Erwan Donal2, Hervé Le Breton2. 1. 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. 2. 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. 3. CHU de Brest, Département de Cardiologie, Brest F-29200, France; EA4324, Optimisation des Régulations Physiologiques (ORPhy), UFR Sciences et Techniques, Brest F-29200, France. 4. CH de Lorient, Service de Cardiologie, Lorient, F-56100, Lorient, France. 5. CH de Vannes, Service de Cardiologie, Vannes F-56000, France. 6. CH de Saint Brieuc, Service de Cardiologie, Saint Brieuc, F-22000, France. 7. CH de Saint Malo, Service de Cardiologie, Saint Malo F-35400, France. 8. CH de Quimper, Service de Cardiologie, Quimper F-29000, France. 9. Clinique Saint Laurent, Service de Cardiologie, Rennes F-35000, France. 10. CH de Saint-Brieuc, SAMU, Saint Brieuc F-22000, France. 11. CH de Vannes, SAMU, Vannes F-56000, France. 12. CHU de Brest, SAMU, Brest F-29200, France. 13. CHU de Rennes, SAMU, Rennes F-35000, France. 14. CHU Rennes, Service de Cardiologie et Maladies Vasculaires, Rennes F-35000, France; INSERM 1414, Clinical Investigation Center, Innovative Technology, Rennes F-35000, France.
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. CONCLUSION: AHF regardless of its timing remains a common and dreadful complication of STEMI in the contemporary era.
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. CONCLUSION: AHF regardless of its timing remains a common and dreadful complication of STEMI in the contemporary era.
Authors: Mayra Tisminetzky; Jerry H Gurwitz; Ruben Miozzo; Joel M Gore; Darleen Lessard; Jorge Yarzebski; Robert J Goldberg Journal: Am J Cardiol Date: 2019-08-08 Impact factor: 2.778
Authors: Nso Nso; Mahmoud Nassar; Milana Zirkiyeva; Yolanda Mbome; Anthony Lyonga Ngonge; Solomon O Badejoko; Shahzad Akbar; Atika Azhar; Sofia Lakhdar; Laura M Guzman Perez; Yousef Abdalazeem; Vincent Rizzo; Most Munira Journal: Cureus Date: 2022-04-09
Authors: Anne Cornelissen; Roberta Florescu; Kinan Kneizeh; Christian Cornelissen; Elisa Liehn; Vincent Brandenburg; Alexander Schuh Journal: J Clin Med Date: 2022-01-25 Impact factor: 4.241