Author + information
- Gennaro Giustino1,
- Bjorn Redfors2,
- Sorin Brener3,
- Ajay Kirtane4,
- Philippe Généreux5,
- Akiko Maehara6,
- Dariusz Dudek7,
- Thomas Neunteufl8,
- D. Christopher Metzger9,
- Roxana Mehran10,
- C. Michael Gibson11 and
- Gregg Stone12
- 1Icahn School of Medicine at Mount Sinai, New York, New York, United States
- 2CRF, New York, New York, United States
- 3New York Methodist Hospital, Brooklyn, New York, United States
- 4NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States
- 5Columbia University Medical Center/Hôpital du Sacré-Coeur de Montréal, New York, New York, United States
- 6Cardiovascular Research Foundation, New York, New York, United States
- 72nd Department of Cardiology and Cardiovascular Interventions, Jagiellonian University, Medical College, University Hospital, Krakow, Poland
- 8Medizinische UniversitÃ¤t Wien, Wien, Austria
- 9Wellmont CVA Heart Institute, Kingsport, Tennessee, United States
- 10Cardiovascular Research Foundation, Zena and Michael A. Weiner Cardiovascular Institute at Mount Sinai School of Medicine, New York, New York, United States
- 11Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States
- 12Cardiovascular Research Foundation, Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
The determinants and significance of early (30 day) heart failure (HF) symptoms after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) remain unclear. We investigated the clinical and imaging correlates of early post-discharge HF in patients with STEMI, and evaluated its impact on clinical outcomes.
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 HF.
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 HF 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).
Clinical, procedural, and imaging variables predict development of clinical HF after primary PCI in patients with STEMI. Early post-discharge HF symptoms identifies a high-risk patient cohort for subsequent HF hospitalization and death, independent of infarct size.
CORONARY: Acute Myocardial Infarction