In AMI patients, in-hospital HF treated with inotropes had 34.9% mortality vs 5.9% with diuretics only and 2.2% with no HF; post-discharge outcomes were similar for HF groups.
Does the pattern of in-hospital heart failure treatment (intravenous diuretics vs inotropes/vasopressors) impact in-hospital mortality and long-term clinical outcomes in patients with acute myocardial infarction undergoing PCI?
In patients with AMI undergoing PCI, developing in-hospital HF requiring inotropes is associated with high in-hospital mortality, but long-term outcomes among survivors are similarly poor regardless of whether HF was treated with diuretics alone or inotropes.
Abstract Background Acute heart failure (HF) is a common complication after acute myocardial infarction (AMI) during hospitalization. Although in-hospital HF is associated with poor outcomes, the prognostic impact of patterns of HF management remains unclear. Purpose We aimed to evaluate the relationship of the patterns of in-hospital HF treatments with intravenous diuretics and inotropes/vasopressors to clinical outcomes after AMI. Methods This retrospective multicenter study included 2426 patients with AMI undergoing percutaneous coronary intervention. In-hospital HF was defined as the administration of intravenous diuretics and/or inotropes and vasopressors during hospitalization for AMI. Patients were categorized into three groups: no HF (patients received neither intravenous diuretics nor inotropes/vasopressors), diuretics only (diuretics without inotropes/vasopressors), and inotropes (inotropes/vasopressors with and without diuretics) groups. The primary endpoints included all-cause death during hospitalization and a composite of all-cause death and HF rehospitalization after discharge (Figure 1). Results Of the 2426 patients with AMI who underwent percutaneous coronary intervention, 646 (26.6%) experienced in-hospital HF. Among them, 185 (7.6%) were categorized into the diuretics only group, and 461 (19.0%) into the inotropes group, while the remaining 1780 (73.4%) patients were categorized as the no HF group (Figure 1). During the hospitalization for the current AMI, 212 (8.7%) patients died. The in-hospital mortality rate was significantly higher in the inotropes group (34.9%), followed by the diuretics only group (5.9%) and the no HF group (2.2%) (P0.001). A follow-up outcome assessment was done in 2018 patients who survived to discharge. During a median follow-up of 535 349-1308 days, the primary endpoint occurred in 196 (9.7%) patients after discharge. A composite of all-cause death and HF rehospitalization occurred in 105 (6.5%) patients in the no HF group, while those in the diuretics (21.2%) and inotropes (24.3%) groups had a similar risk of the primary endpoint after discharge (Figure 2). Conclusions In patients with AMI, the development of HF during hospitalization was associated with increased in-hospital mortality, particularly in those treated with inotropes and vasopressors. Although patients with in-hospital HF had a higher risk of death and HF rehospitalization after discharge as compared to those with no HF, long-term clinical outcomes did not differ significantly between the diuretics only and inotropes groups.Figure 1 Figure 2
Okita et al. (2025) studied this question. In AMI patients, in-hospital HF treated with inotropes had 34.9% mortality vs 5.9% with diuretics only and 2.2% with no HF; post-discharge outcomes were similar for HF groups.
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