Correlates and prognostic impact of new-onset heart failure after ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: insights from the INFUSE-AMI trial
Correlates and prognostic impact of new-onset heart failure after ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention: insights from the INFUSE-AMI trial
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DOI：
10.1177/2048872617719649
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发表时间：
2018-06-01
影响因子：
4.1
通讯作者：
Stone, Gregg W.
中科院分区：
文献类型：
--
作者：
Giustino, Gennaro;Redfors, Bjorn;Stone, Gregg W.
背景：st段抬高型心肌梗死（STEMI）原发性经皮冠状动脉介入治疗后早期（30天）心衰症状的决定因素和意义尚不清楚。我们研究了STEMI患者出院后早期心力衰竭的临床和影像学相关因素，并评估了其对临床结果的影响。方法：INFUSE-AMI试验的患者在30天的随访中根据纽约心脏协会（NYHA）的功能分类（NYHA 2级对1级）进行分类。通过多变量logistic回归确定NYHA 2类的独立相关因素。对30天以上的患者进行里程碑式分析，以评估30天NYHA 2级治疗对1年死亡或心力衰竭住院风险的影响。结果：在402例纳入INFUSE-AMI试验的患者中，有30天NYHA分级数据，76例（18.9%）为NYHA 2级。30天NYHA 2级的独立相关因素有：年龄、发病时Killip 2级、发病时心率、术中无再流和30天梗死面积（心室总质量的%）。在调整梗死面积后，与NYHA 1级患者相比，NYHA 2级患者在1年随访时仍有较高的死亡或心力衰竭住院风险（11.8% vs. 2.8%，调整风险比3.78,95%置信区间1.16-12.22，P=0.03）。结论：临床、程序和影像学变量预测STEMI患者经皮冠状动脉介入治疗后临床心力衰竭的发展。出院后早期心衰症状确定随后心衰住院和死亡的高危患者队列，与梗死面积无关。试验注册：ClinicalTrials.gov；NCT00976521
Background: The determinants and significance of early (30-day) heart failure symptoms after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction (STEMI) remain unclear. We investigated the clinical and imaging correlates of early post-discharge heart failure in patients with STEMI, and evaluated its impact on clinical outcomes.Methods: Patients from the INFUSE-AMI trial were categorized according to New York Heart Association (NYHA) functional classification at their 30-day visit (NYHA class 2 versus 1). Independent correlates of NYHA class 2 were determined by multivariable logistic regression. A landmark analysis beyond 30 days was performed to assess the impact of 30-day NYHA class 2 on 1-year risk of death or hospitalization for heart failure.Results: Among 402 patients enrolled in the INFUSE-AMI trial with data on NYHA class at 30 days, 76 (18.9%) had NYHA class 2. Independent correlates of 30-day NYHA class 2 were age, Killip class 2 at presentation, heart rate at presentation, intraprocedural no-reflow, and 30-day infarct size (% total ventricular mass). After adjustment for infarct size, patients with NYHA class 2 remained at higher risk of death or hospitalization for heart failure at 1-year follow-up compared to those in NYHA class 1 (11.8% vs. 2.8%, adjusted hazard ratio 3.78, 95% confidence interval 1.16-12.22, P=0.03).Conclusions: Clinical, procedural, and imaging variables predict the development of clinical heart failure after primary percutaneous coronary intervention in patients with STEMI. Early post-discharge heart failure symptoms identify a high-risk patient cohort for subsequent heart failure hospitalization and death, independent of infarct size.Trial Registration: ClinicalTrials.gov; NCT00976521