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Acute heart failure following ST-elevation myocardial infarction: patient profiling
Session:
SESSÃO DE POSTERS 32 - DOENÇAS CARDIOVASCULARES - EAM COM SUPRADESNIVELAMENTO DO SEGMENTO ST
Speaker:
Miguel Caramelo Abrantes de Figueiredo
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Cartazes
FP Number:
---
Authors:
Miguel Abrantes De Figueiredo; Ana Rita Teixeira; André Ferreira; Inês Rodrigues; João Ferreira Reis; António Fiarresga; Ana Teresa Timóteo; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="background-color:white"><span style="color:black">Background:</span></span></strong><span style="background-color:white"><span style="color:black"> Acute heart failure (AHF) is a major complication following ST segment elevation myocardial infarction (STEMI), significantly impacting patient outcomes.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="background-color:white"><span style="color:black">Purpose:</span></span></strong><span style="background-color:white"><span style="color:black"> To clarify the disparities between patients who develop AHF following STEMI and those without AHF, potentially identifying risk factors and clinical markers.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Methods:</strong> <span style="background-color:white"><span style="color:black">A retrospective analysis of patients admitted with STEMI between 2015 and 2021 in one high-volume center in Portugal was conducted. Patients were categorized in two groups based on the presence or absence of AHF (Killip class greater than 1) during the post-infarction period. Demographic, clinical, and laboratory data were collected and compared between the two groups. Logistic regression was performed to assess predictors of new-onset AHF.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Results:</strong> Of the 1050 STEMI patients included, 16.2% had AHF either on admission or during hospitalization. These patients were more likely to be older (p<0.001) and female (32.9% vs 21.9%, p=0.002). Cardiovascular risk factors, including diabetes (30.6% vs 18.9%, p<0.001), arterial hypertension (47.6% vs 57.6%, p=0.017), dyslipidemia (39.4% vs 25.9%, p<0.001) and chronic kidney disease (7.6% vs 3.1%, p=0.004) were more prevalent among the AHF group, while smoking (28.8% vs 46.5% vs p<0.001) and family history (3.5% vs 8.8%, p=0.021) were less prevalent. AHF rate was higher with a positive history of previous coronary artery bypass grafting (p=0.001). Anterior STEMI was more prevalent in the AHF group (53.5% vs 44.8%, p=0.036) as well as involvement of the right ventricle (2.9% vs 0.2%, p<0.001). Patients with AHF had a higher concentration of leucocytes (p<0.001), cardiac troponins (p<0.001) and natriuretic peptides (p<0.001), with a lower hemoglobin (p=0.047) concentration. Patients with AHF were more likely to have multivessel disease (p=0.022), more likely not to receive complete revascularization (p=0.020) and had higher in-hospital mortality (p<0.001) through multivariate analysis. Independent predictors of AHF in patients with STEMI included old age, higher troponin and natriuretic peptides at presentation and right ventricle infarction (p<0.001, all).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong><span style="color:black">Conclusion:</span></strong><span style="color:black"> Elevated levels of troponin and natriuretic peptides at presentation along with right ventricle infarction were predictors of new onset AHF in hospitalization for STEMI. The association of AHF with higher in-hospitality mortality underscores its clinical relevance, suggesting the need to closely monitor these high-risk patients.</span></span></span></p>
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