Heart failure following STEMI: a contemporary cohort study of incidence and prognostic factors

Abstract

ObjectiveThe aim of the current study was to determine the contemporary incidence, risk factors and prognosis of heart failure (HF) after ST-elevation myocardial infarction (STEMI).MethodsWe used the Arrhythmia Genetics in the Netherlands observational cohort study to identify patients with a first STEMI from 2001 onwards (n=1459). HF during follow-up was defined as hospitalisation for HF or an outpatient clinic visit for HF. Cox regression was performed to estimate the relationship between baseline covariates and the onset of HF.ResultsFollow-up was completed for 1360 (93.2%) patients with an overall median follow-up time of 6.7 years, 1232 (90.6%) of these patients had undergone primary percutaneous coronary intervention (PCI). A total of 85 patients (6.3%) developed HF during follow-up. HF cases were significantly older at their index MI (59.9 vs 57.2 years, P<0.001) and more commonly had a history of atrial fibrillation (6.1% vs 1.4%, P=0.001) than controls without HF. The crude incidence rate of HF after STEMI was 9.7 (95% CI 7.7 to 11.8) per 1000 person-years. In multivariable analysis, peak creatine kinase MB (CK-MB) levels (HR 1.11 per 100 U/L (95% CI 1.11 to 1.22)) and a left anterior descending artery (LAD) culprit lesion (HR 2.88 (95% CI 1.53 to 5.40)) were risk factors associated with HF.ConclusionsWe found a relatively low long-term contemporary incidence of HF after a first STEMI in the current PCI era in comparison with other reports. Higher CK-MB levels and a LAD culprit lesion at index STEMI were important risk factors for the development of HF after STEMI.Trial registration numberNCT03007199; Results.

Heart failure after myocardial infarction: incidence and predictors

“…Female sex was found to be independently associated with increased HF risk after MI in some studies, but not in others. 18,19,[21][22][23] In the studies that reported higher risk associated with female sex, the excess HF risk ranged from 15% to 34%. 6,20,24 Several reasons may explain higher HF risk in women.…”

“…62 Several studies have shown the association of troponin or CK-MB level with MACE, including HF. 19,63,64 Yet the association of peak troponin or CK-MB with HF has not been seen in all investigations. 65,66…”

Trimethylamine N-Oxide Was Not Associated With 30-Day Left Ventricular Systolic Dysfunction in Patients With a First Anterior ST-Segment Elevation Myocardial Infarction After Primary Revascularization: A Sub-analysis From an Optical Coherence Tomography Registry

“…Left ventricular systolic dysfunction (LVSD) and heart failure are frequently observed after ST-segment elevation myocardial infarction (STEMI) (1)(2)(3) and patients with left anterior descending artery as the culprit vessel face even higher risks (4). Thus, it's important to optimize risk stratification after STEMI and find out novel treatment targets for preventing heart failure.…”

<p>Predictive value of high sensitivity C-reactive protein on progression to heart failure occurring after the first myocardial infarction</p>

“…The development of heart failure after acute coronary syndromes (ACS) is the most common complication associated with a high mortality rate 1,2. Circulating levels of C-reactive protein (CRP) have been shown to be linked to poor prognosis in patients with atherothrombotic problems, heart failure, arrhythmias, and myocarditis.3 Fourteen predictors of heart failure were studied by Ho et al4,5 Important predictors identified were older age, diabetes mellitus, valvular disease, hypertension, higher heart rate, left ventricular hypertrophy, left bundle branch block, cardiovascular disease, body mass index, smoking, gender, and dyslipidemia 4,5.…”