De Filippo Ovidio, D'Ascenzo Fabrizio, Wańha Wojciech, Leonardi Sergio, Raposeiras Roubin Sergio, Fabris Enrico, Truffa Giachet Alessandra, Huczek Zenon, Gaibazzi Nicola, Ielasi Alfonso, Cortese Bernardo, Borin Andrea, Núñez-Gil Iván J, Ugo Fabrizio, Marengo Giorgio, Bianco Matteo, Barbieri Lucia, Marchini Federico, Desperak Piotr, Melendo-Viu María, Montalto Claudio, Bruno Francesco, Mancone Massimo, Ferrandez-Escarabajal Marcos, Morici Nuccia, Scaglione Marco, Tuttolomondo Domenico, Gąsior Mariusz, Mazurek Maciej, Gallone Gugliemo, Campo Gianluca, Wojakowski Wojciech, Abu Assi Emad, Sinagra Gianfranco, de Ferrari Gaetano Maria
Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy.
Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Turin, Italy.
Int J Cardiol. 2023 Jan 1;370:35-42. doi: 10.1016/j.ijcard.2022.10.146. Epub 2022 Oct 25.
Previous studies investigating predictors of Heart Failure (HF) after acute coronary syndrome (ACS) were mostly conducted during fibrinolytic era or restricted to baseline characteristics and diagnoses prior to admission. We assessed the incidence and predictors of HF hospitalizations among patients treated with percutaneous coronary intervention (PCI) for ACS.
CORALYS is a multicenter, retrospective, observational registry including consecutive patients treated with PCI for ACS. Patients with known history of HF or reduced left ventricular ejection fraction (LVEF) were excluded. Incidence of HF hospitalizations was the primary endpoint. The composite of HF hospitalization or cardiovascular death, and cardiovascular and all-cause death were the secondary endpoints. Predictors of HF hospitalizations and the impact of HF hospitalization on cardiovascular and all-cause death were assessed by means of multivariable Cox proportional hazards model.14699 patients were included. After 2.9 ± 1.8 years, the incidence of HF hospitalizations was 12.7%. Multivariable analysis identified age, diabetes, chronic kidney disease, previous myocardial infarction, atrial fibrillation, pulmonary disease, GRACE risk-score ≥ 141, peripheral artery disease, cardiogenic shock at admission and LVEF ≤40% as independently associated with HF hospitalizations. Complete revascularization was associated with a lower risk of HF (HR 0.46,95%CI 0.39-0.55). HF hospitalization was associated with higher risk of CV and all-cause death (HR 1.89,95%CI 1.5-2.39 and HR 1.85,95%CI 1.6-2.14, respectively).
Incidence of HF hospitalizations among patients treated with PCI for ACS is not negligible and is associated with detrimental impact on patients' prognosis. Several variables may help to assess the risk of HF after ACS.
既往关于急性冠状动脉综合征（ACS）后心力衰竭（HF）预测因素的研究大多在溶栓时代进行，或仅限于入院前的基线特征和诊断。我们评估了接受经皮冠状动脉介入治疗（PCI）的ACS患者中HF住院的发生率及预测因素。
CORALYS是一项多中心、回顾性、观察性注册研究，纳入连续接受PCI治疗的ACS患者。排除有HF病史或左心室射血分数（LVEF）降低的患者。HF住院发生率是主要终点。HF住院或心血管死亡的复合终点，以及心血管死亡和全因死亡是次要终点。通过多变量Cox比例风险模型评估HF住院的预测因素以及HF住院对心血管死亡和全因死亡的影响。共纳入14699例患者。在2.9±1.8年的随访后，HF住院发生率为12.7%。多变量分析确定年龄、糖尿病、慢性肾脏病、既往心肌梗死、心房颤动、肺部疾病、GRACE风险评分≥141、外周动脉疾病、入院时心源性休克以及LVEF≤40%与HF住院独立相关。完全血运重建与较低的HF风险相关（风险比[HR]0.46，95%置信区间[CI]0.39 - 0.55）。HF住院与心血管死亡和全因死亡的较高风险相关（分别为HR 1.89，95%CI 1.5 - 2.39和HR 1.85，95%CI 1.6 - 2.14）。
接受PCI治疗的ACS患者中HF住院的发生率不可忽视，且对患者预后有不利影响。几个变量可能有助于评估ACS后HF的风险。
