Heart failure admissions following ST segment elevation myocardial infarction

Abstract

The incidence of acute myocardial infarction (AMI) has fallen by 23% over the past 20 years in the Hunter New England Local Health district (HNELHD), 1 which covers an area of over 130 000 km 2 and has a single 24-hour primary percutaneous intervention (PCI) centre serving a population of over 900 000. This geographical area is comparable to England in size, which has 69 primary PCI centres. Travel time to our PCI centre can be up to five hours. Therefore, in patients whom the estimated time to PCI centre is greater than 60 min, thrombolysis is preferred. The falling incidence of AMI in Australia seems to be primarily driven by a 30% decline in ST-elevation myocardial infarction (STEMI). 2 During a similar time period, mortality following AMI has also decreased across Australia. 3 Despite the falling incidence and reduced mortality following AMI, we have shown an increase in total heart failure (HF) hospitalisations in the HNELHD. 4 While population growth and ageing partly explain these findings, controversy exists as to whether the improved survival postAMI is contributing to the HF epidemic.In the context of these temporal trends of AMI and HF, the rate of HF admission in patients who have suffered STEMI has not been well defined in a contemporary population. We sought to evaluate this relationship and define characteristics that might predict patients at high risk of being readmitted with HF following STEMI.

Natural history and prognostic implications of left ventricular end-diastolic pressure in reperfused ST-segment elevation myocardial infarction: an analysis of the thrombolysis in myocardial infarction (TIMI) II randomized controlled trial

“…Despite having adequate evidence-based anti-heart failure medications, post-myocardial infarction heart failure is still a clinical concern even when achieving the guideline-recommended door to balloon times in the contemporary management of STEMI in the developed world [ 20 , 21 ]. This is related to ischemia and left ventricular loading resulting in adverse remodelling.…”

Natural History and Prognostic Implications of Left Ventricular End-Diastolic Pressure in Reperfused ST-Segment Elevation Myocardial Infarction – An Analysis of the Thrombolysis in Myocardial Infarction (TIMI) II Randomized Controlled Trial.

“…Despite having adequate evidence-based anti-heart failure medications, post-myocardial infarction heart failure is still a clinical concern even when achieving the guideline-recommended door to balloon times in the contemporary management of STEMI in the developed world. (20,21) This is related to ischemia and left ventricular loading resulting in adverse remodelling. Recently, there has been renewed interest in the early unloading of the left ventricle in the STEMI patients.…”

Calcium/Calmodulin-Dependent Protein Kinase II Delta Inhibition and Ventricular Remodeling After Myocardial Infarction

“…However, morbidity due to post-MI heart failure (HF) remains significant and may even be increasing in some groups . Furthermore, those patients who are admitted to the hospital with HF after STEMI have a markedly increased mortality, and this also appears to be rising …”

“…3,4 Furthermore, those patients who are admitted to the hospital with HF after STEMI have a markedly increased mortality, and this also appears to be rising. 5 Progressive adverse left ventricular (LV) remodeling may follow STEMI when a significant percentage of the left ventricle is damaged and may result in subsequent HF. Cardiovascular magnetic resonance (CMR) imaging allows noninvasive serial assessment of myocardial function and viability with high spatial resolution.…”