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A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
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13. Acute Coronary Syndromes
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15. Valvular Heart Disease
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
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Prognostic impact of acute heart failure in acute coronary syndrome
Session:
Painel 2 -Insuficiencia cardiaca 2
Speaker:
Diana De Campos
Congress:
CPC 2020
Topic:
D. Heart Failure
Theme:
11. Acute Heart Failure
Subtheme:
11.2 Acute Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Diana Decampos; Carolina Saleiro; Rogerio Teixeira; Ana Rita M. Gomes; Joana M. Ribeiro; João Lopes; Luís Puga; José Pedro Sousa; Ana Botelho; Lino Gonçalves
Abstract
<p>Background: Contemporary data on the incidence and prognosis of acute heart failure (AHF) and the influence of left ventricular ejection fraction (LVEF) in the setting of acute coronary syndrome (ACS) are scarce. The aim of this study was to compare the prognostic significance of AHF according to LVEF.</p> <p>Methods: This is a retrospective observational study of patients consecutively admitted for ACS between 2009 and 2016 in a single coronary intensive unit. Patients were divided into 2 groups depending on the development of AHF (Killip-Kimbal=I or Killip-Kimbal≥ II) and in each of theses groups, they were further classified according to LVEF (normal≥50%, mid-range 40% to 49% and reduced<40%). All-cause death was the primary endpoint. Survival analyses using Kaplan-Meier curves was performed. All-cause mortality predictors were assessed by Cox regression models. </p> <p>Results: A total of 1395 patients (70.1% male, 67.4±12.2 years, median follow-up of 47 months) were enrolled. Only 15% of the patients had previous history of heart failure. A total of 993 patients had an ACS without AHF and LVEF was normal in 71.3%, mid-range in 21% and reduced in 7.7% of the patients. The remaining 402 patients developed AHF: 36.6% with normal, 34.6% with mid-range, and 28.9% with reduced LVEF. The incidence of HF was increasingly higher with decreasing LVEF. Patients with AHF were older. ST-elevation myocardial infarction was more frequent in AHF patients but previous history of coronary artery disease was not different. Chronic kidney disease was more common among AHF patients. All-cause mortality was 27.7% and was much higher in patients with AHF (50% vs 18.7%, <em>P</em>=0.000). Adjusted multivariate analysis of all-cause mortality showed that AHF was independently associated with the end-point and it was the most powerful predictor of the model (Hazard Ratio (HR) 1.89, 95% CI 1.49-2.36, <em>P</em>=0.000).</p> <p>Conclusions: Clinical diagnosis of AHF is a long-term prognostic risk after ACS. LVEF in AHF subgroup was not related to long-term prognosis. This study suggests that these patients should be managed as very high risk, regardless of LVEF. </p>
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