Fiusa Vinícius C, Stephanus Andrea D, Couto Victor F, Alexim Gustavo A, Severino Thaiene M M, Nogueira Ana Claudia C, Guimarães Adriana J B A, Soares Alexandre Anderson S M, Bilevicius Elizabeth, Batista Vivian, Staffico Alessandra, Sposito Andrei C, Carvalho Luiz Sérgio F de
Universidade Católica de Brasília, Brasília, DF - Brasil.
Escola Superior de Ciências da Saúde, Brasília, DF - Brasil.
Arq Bras Cardiol. 2025 Mar;122(3):e20240447. doi: 10.36660/abc.20240447.
Heart failure (HF) is a common complication of ST-elevation myocardial infarction (STEMI) in low- and middle-income countries (LMICs), where cardiovascular mortality is disproportionately high. Primary percutaneous coronary intervention (PCI) has reduced post-STEMI HF incidence in high-income countries. However, access to this standard of care is poor in LMICs, and data in these settings remain scarce.
To identify predictors of HF following STEMI in a LMIC with limited access to PCI, aiming at better management and outcomes.
This retrospective cohort study analyzed 2,467 STEMI patients admitted to two Brazilian public hospitals between January/2015 and February/2020. All participants received pharmacological thrombolysis and underwent coronarography within 48h post-admission. The primary outcome was symptomatic HF, defined as dyspnea with chest X-ray evidence of congestion, from 48h post-admission until discharge. Stepwise binary logistic regression was used to identify HF predictors. Significance was defined as p-values<0.05.
The population was 61.9% male, mean age was 58.3±12.6 years, and 39.9% developed post-STEMI HF. HF was more common among older men with cardiovascular-kidney-metabolic (CKM) disease, larger infarcts, and left anterior descending artery involvement. Medications were often underprescribed at discharge, especially aldosterone antagonists (11.0%). HF was notably more frequent among individuals with failed thrombolysis (47.0%).
This regionally representative cohort from a LMIC with limited access to PCI showed that older men with CKM disease are particularly vulnerable to post-STEMI HF, and that HF pharmacotherapy at discharge needs optimization. The high HF incidence among patients with failed thrombolysis highlights the need to expand PCI availability.
在心血管死亡率极高的低收入和中等收入国家（LMICs），心力衰竭（HF）是ST段抬高型心肌梗死（STEMI）的常见并发症。在高收入国家，直接经皮冠状动脉介入治疗（PCI）降低了STEMI后HF的发病率。然而，在LMICs中，这种标准治疗的可及性较差，且这些地区的数据仍然匮乏。
在PCI可及性有限的LMIC中，确定STEMI后HF的预测因素，以实现更好的管理并改善预后。
这项回顾性队列研究分析了2015年1月至2020年2月期间入住巴西两家公立医院的2467例STEMI患者。所有参与者均接受了药物溶栓治疗，并在入院后48小时内接受了冠状动脉造影。主要结局是有症状的HF，定义为入院后48小时至出院期间出现呼吸困难且胸部X线有充血证据。采用逐步二元逻辑回归来确定HF的预测因素。显著性定义为p值<0.05。
研究人群中男性占61.9%，平均年龄为58.3±12.6岁，39.9%的患者发生了STEMI后HF。HF在患有心血管-肾脏-代谢（CKM）疾病、梗死面积较大且累及左前降支动脉的老年男性中更为常见。出院时药物治疗往往处方不足，尤其是醛固酮拮抗剂（11.0%）。溶栓失败的患者中HF的发生率明显更高（47.0%）。
这个来自PCI可及性有限的LMIC的具有区域代表性的队列研究表明，患有CKM疾病的老年男性尤其容易发生STEMI后HF，且出院时的HF药物治疗需要优化。溶栓失败患者中HF的高发生率凸显了扩大PCI可及性的必要性。
