Department of Internal Medicine, University of Nevada Reno School of Medicine, 1155 Mill St W11, Reno, NV, 89502, USA.
Department of Cardiology, North Shore University Hospital, Northwell Health, Manhasset, NY, USA.
Ir J Med Sci. 2019 Aug;188(3):791-799. doi: 10.1007/s11845-018-1910-2. Epub 2018 Oct 16.
Studies comparing characteristics and in-hospital outcomes for heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF) for hospitalisations undergoing percutaneous coronary intervention (PCI) for ST-segment elevated myocardial infarction (STEMI) remain limited.
This sought to investigate characteristics and in-hospital outcomes for HFpEF and HFpEF hospitalisations undergoing STEMI-PCI.
The National inpatient sample database from years 2012 to 2014 was queried and appropriate International Classification of Disease, Ninth Revision, Clinical Modification codes were utilised to identify study cohorts. A total of 400,590 hospitalisations underwent STEMI-PCI, of which, 31,180 presented with acute heart failure (89.3% with acute HFrEF and 10.7% with acute HFpEF). The HFpEF cohort was older (65.6 vs. 69.9 years), consisted of more females (35% vs. 48.7%), and presented with significantly higher comorbidities as demonstrated by higher Charlson's Comorbidity Index ≥ 3 (59.6 vs. 68%) (P < 0.001 for all). However, lower in-hospital mortality (9.2% vs. 8.0%, P = 0.04) was observed with HFpEF hospitalisations, which accompanied by lower mechanical circulatory support (MCS) device (20.3 vs. 12.3%, P < 0.001) use after propensity score matching. These translated to lower median hospitalisation cost ($28,116 vs. $27,823, P < 0.001) with HFpEF without significant change in median length of hospitalisation stay (6 vs. 6 days, P = 0.08).
This study highlights the distinct risk profile for hospitalisations with HFpEF undergoing STEMI-PCI. HFpEF hospitalisations are associated with the lesser need for MCS, lower in-hospital mortality, and ultimately lower hospitalisation cost compared to HFrEF.
比较射血分数降低的心力衰竭（HFrEF）和射血分数保留的心力衰竭（HFpEF）患者因 ST 段抬高型心肌梗死（STEMI）而行经皮冠状动脉介入治疗（PCI）的住院特征和院内结局的研究仍然有限。
本研究旨在探讨 HFpEF 和 HFpEF 患者因 STEMI-PCI 住院的特征和院内结局。
检索了 2012 年至 2014 年全国住院患者数据库，并使用适当的国际疾病分类，第九修订版，临床修正码来确定研究队列。共有 400590 例患者因 STEMI-PCI 住院，其中 31180 例患者出现急性心力衰竭（89.3%为急性 HFrEF，10.7%为急性 HFpEF）。HFpEF 组年龄更大（65.6 岁 vs. 69.9 岁），女性比例更高（35% vs. 48.7%），Charlson 合并症指数≥3 的患者比例显著更高（59.6% vs. 68%）（所有 P 值均<0.001）。然而，HFpEF 住院患者的院内死亡率较低（9.2% vs. 8.0%，P=0.04），在倾向性评分匹配后，机械循环支持（MCS）装置的使用也较低（20.3% vs. 12.3%，P<0.001）。这导致 HFpEF 的中位住院费用（$28116 与 $27823，P<0.001）更低，而中位住院时间无明显变化（6 天与 6 天，P=0.08）。
本研究强调了 HFpEF 患者因 STEMI-PCI 住院的独特风险特征。与 HFrEF 相比，HFpEF 住院患者的 MCS 需求较少，院内死亡率较低，最终住院费用较低。
