Prognostic impact of patterns of in-hospital heart failure on clinical outcomes after myocardial infarction

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%) (P<0.001). 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.