Departamento de Cardiología, Hospital Universitario de San Juan, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain; Departamento de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, A Coruña, Spain.
Rev Esp Cardiol (Engl Ed). 2021 Jun;74(6):494-501. doi: 10.1016/j.rec.2020.03.011. Epub 2020 May 21.
Coronary heart disease is the leading cause of heart failure (HF). The aim of this study was to assess the risk of readmission for HF in patients with acute coronary syndrome without previous HF or left ventricular dysfunction.
Prospective study of consecutive patients admitted for acute coronary syndrome in 2 institutions. Risk factors for HF were analyzed by competing risk regression, taking all-cause mortality as a competing event.
We included 5962 patients and 567 (9.5%) experienced at least 1 hospital readmission for acute HF. Median follow-up was 63 months and median time to HF readmission was 27.1 months. The cumulative incidence of HF was higher than mortality in the first 7 years after hospital discharge. A higher risk of HF readmission was associated with age, diabetes, previous coronary heart disease, GRACE score> 140, peripheral arterial disease, renal dysfunction, hypertension and atrial fibrillation; a lower risk was associated with optimal medical treatment. The incidence of HF in the first year of follow-up was 2.73% and no protective variables were found. A simple HF risk score predicted HF readmissions risk.
One out of 10 patients discharged after an acute coronary syndrome without previous HF or left ventricular dysfunction had new-onset HF and the risk was higher than the risk of mortality. A simple clinical score can estimate individual risk of HF readmission even in patients without previous HF or left ventricular dysfunction.
冠心病是心力衰竭（HF）的主要病因。本研究旨在评估无既往 HF 或左心室功能障碍的急性冠状动脉综合征患者因 HF 再入院的风险。
对 2 家机构连续收治的急性冠状动脉综合征患者进行前瞻性研究。采用竞争风险回归分析 HF 的危险因素，以全因死亡率为竞争事件。
我们纳入了 5962 例患者，其中 567 例（9.5%）至少因急性 HF 经历了 1 次住院再入院。中位随访时间为 63 个月，HF 再入院的中位时间为 27.1 个月。HF 的累积发生率在出院后 7 年内高于死亡率。HF 再入院的风险与年龄、糖尿病、既往冠心病、GRACE 评分>140、外周动脉疾病、肾功能不全、高血压和心房颤动相关；与最佳药物治疗相关的风险较低。随访第 1 年 HF 的发生率为 2.73%，未发现保护性变量。一个简单的 HF 风险评分可预测 HF 再入院的风险。
在无既往 HF 或左心室功能障碍的急性冠状动脉综合征患者中，每 10 例出院患者中就有 1 例出现新发 HF，且风险高于死亡率。即使在无既往 HF 或左心室功能障碍的患者中，简单的临床评分也可以估计 HF 再入院的个体风险。
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