Rashid Muhammad, Abramov Dmitry, Naseer Muhammad Usman, Van Spall Harriette G C, Ahmed Fozia Z, Lawson Claire, Dafaalla Mohamed, Kontopantelis Evangelos, Mohamed Mohamed O, Petrie Mark C, Mamas Mamas A
Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health Research Leicester Biomedical Research Centre, Glenfield Hospital, LE1 7RH Leicester, UK.
Department of Cardiology, Glenfield Hospital, University Hospitals of Leicester, LE3 9QP Leicester, UK.
Eur Heart J Open. 2025 Feb 19;5(2):oeaf013. doi: 10.1093/ehjopen/oeaf013. eCollection 2025 Mar.
Heart failure (HF) following acute myocardial infarction (AMI) is a global health concern, but data on risk factors associated with HF hospitalization post-AMI are limited.
We analysed data from the Myocardial Ischaemia National Audit Project, including patients admitted with AMI from 1 January 2006 to 31 March 2019. Data linkage with Hospital Episode Statistics Admitted Patient Care and the Office for National Statistics facilitated a longitudinal analysis. High-risk patients were identified using dapagliflozin in patients without diabetes mellitus with acute myocardial infarction (DAPA-MI) and EMPAgliflozin on Hospitalization for Heart Failure and Mortality in Patients With aCuTe Myocardial Infarction (EMPACT-MI) criteria. We assessed clinical outcomes, adherence to European Society of Cardiology quality indicators, and predictors of HF-related hospitalizations. Out of 1 046 480 AMI patients, 9.1% overall, 17.2% in the DAPA-MI cohort, and 16.6% in the EMPACT-MI cohort experienced HF hospitalization within a year post-AMI. High-risk patients, defined by the presence of five risk factors, had nearly one in four hospitalizations with HF at 1-year follow-up. The predicted adjusted incidence rate for heart failure within 1 year almost doubled from 64.5 cases per 1000 person-years [95% confidence interval (CI): 51.1 to 78.0] in 2005, to 118.2 cases per 1000 person-years in 2019 (95% CI: 115.0 to 121.5). Heart failure hospitalization was associated with a three-fold increase in 1-year mortality (hazard ratio 3.01, 95% CI 2.95-3.13).
One in 10 AMI patients experienced HF hospitalization within the first-year post-AMI, with rising trends in high-risk subgroups. These findings highlight the need for targeted post-AMI care strategies to improve outcomes and address the increasing burden of HF in the modern percutaneous coronary intervention era.
急性心肌梗死（AMI）后发生的心衰（HF）是一个全球性的健康问题，但关于AMI后与HF住院相关的危险因素的数据有限。
我们分析了来自心肌缺血国家审计项目的数据，包括2006年1月1日至2019年3月31日收治的AMI患者。与医院事件统计住院患者护理数据以及国家统计局的数据关联有助于进行纵向分析。使用达格列净在无糖尿病的急性心肌梗死患者中确定高危患者（DAPA-MI），并根据急性心肌梗死患者心力衰竭住院和死亡率的恩格列净（EMPAgliflozin）标准（EMPACT-MI）。我们评估了临床结局、对欧洲心脏病学会质量指标的依从性以及HF相关住院的预测因素。在1046480例AMI患者中，总体上9.1%、DAPA-MI队列中17.2%以及EMPACT-MI队列中16.6%在AMI后一年内发生了HF住院。由五个危险因素定义的高危患者在1年随访中有近四分之一的住院是因HF。2005年，1年内心力衰竭的预测调整发病率从每1000人年64.5例[95%置信区间（CI）：51.1至78.0]几乎翻倍，到2019年为每1000人年118.2例（95%CI：115.0至121.5）。HF住院与1年死亡率增加三倍相关（风险比3.01，95%CI 2.95 - 3.13）。
每10例AMI患者中有1例在AMI后第一年内发生HF住院，高危亚组呈上升趋势。这些发现凸显了在现代经皮冠状动脉介入治疗时代，需要有针对性的AMI后护理策略来改善结局并应对HF日益增加的负担。
