Heart Institute, Hospital Universitari Germans Trias i Pujol, Badalona, Spain.
Department de Medicina, Universitat Autònoma de Medicina, Barcelona, Spain.
ESC Heart Fail. 2018 Feb;5(1):101-105. doi: 10.1002/ehf2.12245. Epub 2017 Dec 29.
Multidisciplinary heart failure (HF) clinics are a cornerstone of contemporary HF management. The stent-for-life (SFL) initiative improves mortality after ST elevation myocardial infarction (STEMI), but its impact in post-STEMI HF is not well characterized. Here we assessed the impact of SFL among patients referred to a multidisciplinary HF clinic over a 15 year time period.
Between 2001 and 2015, 1921 patients were admitted to our HF clinic. In 2009, Catalonia established the Codi IAM network, a regional STEMI network that prioritizes primary percutaneous coronary intervention in STEMI. Patients admitted during the study period were divided into two groups based on admission date: pre-SFL (2001-June 2009; n = 1031) and post-SFL (July 2009-2015; n = 890). Compared with those in the pre-SFL group, patients admitted in the post-SFL period had better New York Heart Association (NYHA) functional class (22.1 vs. 38.7 NYHA classes III-IV; P < 0.001) and higher left ventricular ejection fraction (LVEF) (36.1 ± 19.6 vs. 32.6 ± 13.4; P < 0.001). Among STEMI survivors, 101 (6.7%) pre-SFL patients and 40 (2%) post-SFL patients (P < 0.001) fulfilled the criteria for HF clinic referral (Killip-Kimball class ≥ 2 during index admission and/or LVEF of <40%). Furthermore, among patients admitted to the HF clinic, post-STEMI HF with reduced ejection fraction patients comprised 8.9% of the pre-SFL group and only 4.2% of the post-SFL group (P < 0.001).
Among patients treated at our multidisciplinary HF clinic, the adoption of an SFL network has decreased the prevalence of post-STEMI HF with reduced ejection fraction.
多学科心力衰竭（HF）诊所是当代 HF 管理的基石。支架终身（SFL）计划改善了 ST 段抬高型心肌梗死（STEMI）后的死亡率，但它在 STEMI 后 HF 中的影响尚未得到很好的描述。在这里，我们评估了在 15 年的时间内，将 SFL 应用于多学科 HF 诊所患者的影响。
在 2001 年至 2015 年间，有 1921 名患者被收入我们的 HF 诊所。2009 年，加泰罗尼亚建立了 Codi IAM 网络，这是一个区域 STEMI 网络，优先考虑 STEMI 的经皮冠状动脉介入治疗。根据入院日期，将研究期间入院的患者分为两组：SFL 前（2001 年 6 月至 2009 年；n=1031）和 SFL 后（2009 年 7 月至 2015 年；n=890）。与 SFL 前组相比，SFL 后组患者的纽约心脏协会（NYHA）功能分级更好（22.1 级 vs. 38.7 级 NYHA Ⅲ~Ⅳ级；P<0.001），左心室射血分数（LVEF）更高（36.1±19.6 vs. 32.6±13.4；P<0.001）。在 STEMI 幸存者中，SFL 前组有 101 名（6.7%）和 SFL 后组有 40 名（2%）患者（P<0.001）符合 HF 诊所转诊标准（指数入院时 Killip-Kimball 分级≥2 级和/或 LVEF<40%）。此外，在收入 HF 诊所的患者中，SFL 前组的射血分数降低型 post-STEMI HF 患者占 8.9%，而 SFL 后组仅占 4.2%（P<0.001）。
在我们的多学科 HF 诊所接受治疗的患者中，采用 SFL 网络降低了射血分数降低型 post-STEMI HF 的患病率。
