Abstract 15514: Twelve-Year Predictive Value of Acute Heart Failure Among 15,151 Patients With Acute Myocardial Infarction
Introduction: Acute heart failure occurring during hospitalization for acute myocardial infarction (AMI) is a strong predictor of short-term mortality. However, the long-term prognostic implications in patients receiving contemporary treatment are unknown.
Hypothesis: Acute heart failure occurring during initial hospitalization for AMI independently predicts late mortality.
Methods: We determined the presence and severity of acute heart failure according to the Killip classification among 15,151 consecutive patients hospitalized for AMI in Singapore from 2000-2005. Death status for each patient until 1st March 2012 was ascertained through linkage with national death records. The 12-year mortality hazard ratio with each increase in Killip class was compared with Killip class I as the reference group, with and without adjustment for age, sex, co-morbidities and treatment differences.
Results: Among patients in Kilip class I (n=10,123), II (n=2913), III (n=1217) and IV (n=898), use of ACE-inhibitors/ARBs was 61.9%, 70.1%, 64.2% and 38.0%, beta blockers 79.4%, 65.0%, 47.3% and 37.0%, intraoartic balloon pump 1.7%, 3.9%, 8.0% and 22.1%, and coronary revascularization/reperfusion 68.4%, 49.3%, 29.2% and 35.7%, respectively, all P<0.001. Compared with Killip I, a stepwise increase in the 12-year mortality hazard ratio was observed with each increase in Killip class (see figure) as follows: Killip II 1.95 (95% confidence interval 1.84-2.08), Killip III 3.80 (3.53-4.09) and Killip IV 8.05 (7.43- 8.72) on univariate analysis and Killip II 1.13 (1.06-1.21), Killip III 1.49 (1.37-1.62) and Killip IV 2.80 (2.53- 3.10) on multivariate analysis.
Conclusions: In this contemporary AMI cohort, acute heart failure occurring during the initial hospitalization was a potent independent predictor of late mortality, suggesting the need to continuously monitor and manage its associated late residual risk long after the index MI event.
- © 2013 by American Heart Association, Inc.