Correlates and prognostic impact of new-onset heart failure after ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

insights from the INFUSE-AMI trial

Gennaro Giustino, Björn Redfors, Sorin J. Brener, Ajay J. Kirtane, Philippe Genereux, Akiko Maehara, Dariusz Dudek, Thomas Neunteufl, D. Christopher Metzger, Aaron Crowley, Roxana Mehran, C. Michael Gibson, Gregg W. Stone

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)339-347
Number of pages9
JournalEuropean heart journal. Acute cardiovascular care
Volume7
Issue number4
DOIs
StatePublished - Jun 1 2018
Externally publishedYes

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Percutaneous Coronary Intervention
Heart Failure
Hospitalization
Myocardial Infarction
ST Elevation Myocardial Infarction
Heart Rate
Logistic Models
Confidence Intervals

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Giustino, Gennaro ; Redfors, Björn ; Brener, Sorin J. ; Kirtane, Ajay J. ; Genereux, Philippe ; Maehara, Akiko ; Dudek, Dariusz ; Neunteufl, Thomas ; Metzger, D. Christopher ; Crowley, Aaron ; Mehran, Roxana ; Gibson, C. Michael ; Stone, Gregg W. / Correlates and prognostic impact of new-onset heart failure after ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention : insights from the INFUSE-AMI trial. In: European heart journal. Acute cardiovascular care. 2018 ; Vol. 7, No. 4. pp. 339-347.
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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.",
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Correlates and prognostic impact of new-onset heart failure after ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention : insights from the INFUSE-AMI trial. / Giustino, Gennaro; Redfors, Björn; Brener, Sorin J.; Kirtane, Ajay J.; Genereux, Philippe; Maehara, Akiko; Dudek, Dariusz; Neunteufl, Thomas; Metzger, D. Christopher; Crowley, Aaron; Mehran, Roxana; Gibson, C. Michael; Stone, Gregg W.

In: European heart journal. Acute cardiovascular care, Vol. 7, No. 4, 01.06.2018, p. 339-347.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Correlates and prognostic impact of new-onset heart failure after ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

T2 - insights from the INFUSE-AMI trial

AU - Giustino, Gennaro

AU - Redfors, Björn

AU - Brener, Sorin J.

AU - Kirtane, Ajay J.

AU - Genereux, Philippe

AU - Maehara, Akiko

AU - Dudek, Dariusz

AU - Neunteufl, Thomas

AU - Metzger, D. Christopher

AU - Crowley, Aaron

AU - Mehran, Roxana

AU - Gibson, C. Michael

AU - Stone, Gregg W.

PY - 2018/6/1

Y1 - 2018/6/1

N2 - 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.

AB - 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.

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