Department of Cardiology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Department of Cardiology, Centro Hospitalar Universitário do Porto, Porto, Portugal.
Am J Cardiol. 2022 Feb 1;164:14-20. doi: 10.1016/j.amjcard.2021.10.035. Epub 2021 Nov 21.
ST-elevation myocardial infarction (STEMI) survivors have a heightened risk of developing heart failure (HF). The magnitude of this risk with the advent of primary percutaneous coronary intervention is less characterized. We aimed to examine the incidence and predictors of incident HF and all-cause mortality in a contemporary STEMI cohort. We performed a retrospective analysis of 700 consecutive patients with STEMI treated with primary percutaneous coronary intervention at a tertiary hospital. The primary outcome was the occurrence of HF during follow-up. HF was defined by HF hospitalization or the presence of congestion that led to de novo prescription or up-titration of diuretics in the outpatient clinic. The secondary outcome was defined by the occurrence of HF or all-cause mortality. During a median follow-up period of 43.6 months, HF events occurred in 110 patients (15.7%), 34 (4.8%) managed as outpatient and 76 (10.9%) requiring hospitalization. Left ventricular ejection fraction (LVEF) <50% was present in 76% of those who developed HF. Age (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.01 to 1.06), diabetes (HR 1.85, 95% CI 1.12 to 3.05), door-to-balloon time (HR 1.002, 95% CI 1.000 to 1.003), Killip-Kimball class ≥II (HR 2.24, 95% CI 1.32 to 3.80) and LVEF <50% (HR 1.71, 95% CI 1.01 to 2.92) were independent predictors. All-cause mortality incidence was 8.7%. HF was independently associated with a threefold increased risk of dying (HR 3.52, 95% CI 1.85 to 6.69, p <0.001). In conclusion, a substantial proportion of contemporary patients with STEMI develop HF, which triplicates the risk of dying. Older age, diabetes and LVEF <50% independently predicted the development of HF and all-cause death.
ST 段抬高型心肌梗死（STEMI）幸存者发生心力衰竭（HF）的风险增加。随着经皮冠状动脉介入治疗的出现，这种风险的程度尚未得到充分描述。我们旨在研究当代 STEMI 患者队列中 HF 发作和全因死亡率的发生率和预测因素。我们对在一家三级医院接受经皮冠状动脉介入治疗的 700 例连续 STEMI 患者进行了回顾性分析。主要结局是随访期间 HF 的发生。HF 通过 HF 住院或门诊就诊时因充血导致利尿剂新处方或剂量调整来定义。次要结局定义为 HF 或全因死亡率的发生。在中位随访期 43.6 个月期间，110 例（15.7%）患者发生 HF，34 例（4.8%）为门诊患者，76 例（10.9%）需要住院治疗。发生 HF 的患者中有 76%存在左心室射血分数（LVEF）<50%。年龄（风险比 [HR] 1.03，95%置信区间 [CI] 1.01 至 1.06）、糖尿病（HR 1.85，95% CI 1.12 至 3.05）、门球时间（HR 1.002，95% CI 1.000 至 1.003）、Killip-Kimball 分级≥Ⅱ级（HR 2.24，95% CI 1.32 至 3.80）和 LVEF<50%（HR 1.71，95% CI 1.01 至 2.92）是独立的预测因素。全因死亡率为 8.7%。HF 与死亡风险增加三倍独立相关（HR 3.52，95% CI 1.85 至 6.69，p<0.001）。总之，当代 STEMI 患者中有相当一部分发生 HF，使死亡风险增加了三倍。年龄较大、糖尿病和 LVEF<50%独立预测 HF 和全因死亡的发生。
