Gennaro Giustino1,2, Björn Redfors2, Sorin J Brener2,3, Ajay J Kirtane2,4, Philippe Généreux2,5, Akiko Maehara2,4, Dariusz Dudek6, Thomas Neunteufl7, D Christopher Metzger8, Aaron Crowley2, Roxana Mehran1,2, C Michael Gibson9, Gregg W Stone2,4. 1. 1 Zena and Michael A Wiener Cardiovascular Institute, The Icahn School of Medicine at Mount Sinai, USA. 2. 2 Clinical Trials Center, Cardiovascular Research Foundation, USA. 3. 3 Department of Medicine, New York Methodist Hospital, USA. 4. 4 Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Medical Center, USA. 5. 5 Department of Medicine, Hôpital du Sacré-Coeur de Montréal, Canada. 6. 6 Department of Medicine, Department of Interventional Cardiology, Jagiellonian University Medical College, Poland. 7. 7 Department of Medicine, Universitätsklinikum Krems, Austria. 8. 8 Wellmont CVA Heart Institute, USA. 9. 9 Department of Cardiology, Beth Israel Deaconess Med Center, USA.
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.
RCT Entities:
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.
Entities:
Keywords:
New York Heart Association; ST-segment elevation myocardial infarction; heart failure; infarct size; magnetic resonance imaging