Ten-year prognostic impact of acute heart failure in STEMI patients: a prospective cohort study

Background Cardio-vascular death (CVD) in patients with acute myocardial infarction (AMI) significantly decreased due to reperfusion and advances in pharmacotherapy. Acute heart failure (AHF) remains a common and unfavorable AMI-related complication. Aim To determine the incidence and prognostic value of Killip Class II–IV of AHF in long term follow-up of patients with ST-elevation myocardial infarction (STEMI). Methods All patients with STEMI were admitted to our emergency cardiology department during 1995–2011. CVD up to ten years after STEMI was the main outcome endpoint. We compared CVD in patients with and without AHF, and revascularization. Survival curve was generated by the Kaplan-Meier method. Predictors of mortality after STEMI were determined by multivariable Cox regression. Results Prospective cohort study includes 1625 STEMI patients; the mean age of the patients was 54.4±0.3 years, time from symptom onset was 5.0±0.2 hour, 1497 were men (92.1%), and 899 patients (55.5%) were revascularized (TLT – 632 (38.9%), PCI – 267 (16.4%), including 159 patients with stent implantation (9.8%). 412 patients had AHF - Killip Class II–IV (25.4%) during first 24 hours. Ten-year survival after STEMI was 85%; survival exceeded 88% in patients without AHF, but was 75% for those with AHF. Among patients who underwent revascularisation ten-year survival was 82.9% for patients in group with AHF, and was 87.1% for those without AHF. In multivariable Cox regression, age ≥65 years, female gender and HF were the predictive factors for CVD. Kaplan-Meier survival curves demonstrated higher incidence of CVD in AHF patients in compare with those without AHF in long-term follow-up (Figure 1). Conclusion According to the study AMI care is associated with high rates of long term survival, ten-year rates exceed 85%. AHF during first 24 hour in patients with STEMI worsens the prognosis, but reperfusion therapy increases survival. Further efforts to improve survival should be directed to patients with AHF and low revascularization rate that are associated with poor survival after AMI. Funding Acknowledgement Type of funding sources: None.