Abstract 14185: Heart Failure Occurring at any Time During Hospitalization is Associated with Higher Mortality in Non-ST Elevation-Acute Coronary Syndromes
Background: Heart failure (HF) is a frequent complication of ACS and is associated with poor prognosis. However, most studies only included patients with ST elevation myocardial Infarction (STEMI). Thus, we aim to describe the occurrence and timing of HF complicating non-ST elevation acute coronary syndrome (NSTE-ACS), identify predictors of admission and in-hospital new onset HF, and assess the association of HF with post-discharge mortality at 30 day.
Methods: We examined combined patient-level data from 46,519 NSTE-ACS patients enrolled in 7 clinical trials: GUSTO IIb, PURSUIT, PARAGON A, PARAGON B, ESSENCE, SYNERGY and EARLY-ACS. Patients with cardiogenic shock or Killip class IV were excluded. Admission HF was defined as Killip Class II or III and patients with in-hospital HF had no admission HF and had a complication of HF or pulmonary edema prior discharge. Logistic regression models were performed to assess predictors of HF and the association of 30-day mortality after hospital discharge with HF, adjusting for baseline variables.
Results: From the NSTE-ACS patients, 4,910 (10.5%) had HF on admission, 1,194 (2.6%) developed HF during hospitalization, and 40,415 (86.9%) had no HF at any time. Patients presenting with HF or developing HF during hospitalization tended to be older and more likely female compared with those with no heart failure. Increased age, female sex, current smoker, higher HR, DM, lower SBP, hypertension, prior MI, and ST changes were strongly associated with HF. Patients with HF on admission and during hospitalization had higher risk of post-discharge death at 30 days when compared with patients without heart failure (Table).
Conclusion: In this large patient population of NSTE-ACS, occurrence of heart failure at any time was associated with increased risk of death within 30 days of hospital discharge. Research targeting new strategies to prevent and to manage HF after NSTE-ACS is needed. Table. Post-discharge 30-day mortality
- © 2011 by American Heart Association, Inc.