Journal Article

Incidence and predictors of heart failure following percutaneous coronary intervention in ST-segment elevation myocardial infarction: The HORIZONS-AMI trial

Guagliumi, Giulio, Dangas, George, Stone, Gregg W., Witzenbichler, Bernhard, Fahy, Martin, Kelly, Damian J., Gershlick, Tony, Mehran, Roxana

2011

Overview

Congestive heart failure (CHF) is a major source of morbidity, mortality, and health-care resource consumption. However, the incidence of symptomatic CHF after primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) has rarely been fully reported. We therefore examined the early and late incidence, predictors, and implications of CHF in the large-scale, prospective, randomized HORIZONS-AMI trial. New York Heart Association (NYHA) functional classification was prospectively collected from patient-level data at baseline, 30 days, 6 months, and at 1 and 2 years from 3,343 patients with STEMI undergoing PCI at 123 centers in 11 countries. The baseline incidence of CHF (before the index STEMI) was 2.6%, increasing to 4.6% 1 month after primary PCI ( P < .0001), 4.7% at 1 year, and 5.1% at 2 years. The incidence of NYHA class III/IV symptoms was 0.4% at baseline and 0.8% at 2 years ( P = .03). CHF at 1 year was associated with diabetes ( P < .0001), dyslipidemia ( P = .009), previous MI ( P < .0001), previous revascularization ( P = .01), anterior STEMI ( P = .02), and baseline TIMI grade 0 flow ( P = .01) but not procedural anticoagulation with bivalirudin versus heparin + GPIIb/IIIa inhibitors ( P = .93) or use of drug-eluting versus bare metal stents ( P = .66). Among patients in whom CHF was not present at baseline but developed after PCI, the rate of all-cause mortality was significantly higher during 2-year follow-up (7.3% vs 2.0%, P < .0001), as was cardiac mortality (2.4% vs 0.8%, P = .004), reinfarction (9.4% vs 5.2%, P = .0009), stent thrombosis (7.0% vs 3.8%, P = .007), and ischemic target vessel revascularization (19.4% vs 11.8%, P < .0001). In the HORIZONS-AMI trial, the development of new-onset CHF within 2 years after contemporary PCI, although infrequent, was associated with significantly increased rates of mortality and major adverse ischemic events.

• Publisher: Mosby, Inc,Mosby,Elsevier Limited
• Subject: Aged / Angioplasty, Balloon, Coronary / Biological and medical sciences / Cardiology. Vascular system / Cardiovascular / Clinical outcomes / Coronary heart disease / Diseases of the cardiovascular system / Drug therapy / Female / Heart / Heart attacks / Heart Failure - epidemiology / Heart Failure - etiology / Heart failure, cardiogenic pulmonary edema, cardiac enlargement / Humans / Incidence / Male / Medical sciences / Middle Aged / Mortality / Myocardial Infarction - complications / Myocardial Infarction - physiopathology / Myocardial Infarction - surgery / Myocarditis. Cardiomyopathies / Patients / Prospective Studies / Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)