Key result
IV inotropes for post-AMI HF linked to ~35% in-hospital mortality versus diuretics or no treatment.
Why the study?
Heart failure is a common complication following acute myocardial infarction, but the prognostic impact of in-hospital heart failure management patterns remains unclear.
Does the pattern of in-hospital heart failure treatment (diuretics vs inotropes) impact in-hospital mortality and long-term composite of death or heart failure rehospitalization in patients with AMI undergoing PCI?
Cohort (n=2,426)
Yes
Does the pattern of in-hospital heart failure treatment (diuretics vs inotropes) impact in-hospital mortality and long-term composite of death or heart failure rehospitalization in patients with AMI undergoing PCI?
In patients with AMI undergoing PCI, the need for in-hospital IV heart failure therapies, particularly inotropes, is associated with significantly higher in-hospital mortality, though long-term outcomes among survivors are similar regardless of the specific IV therapy used.
Inotrope use in post-MI in-hospital HF marks high-risk patients; leaves open causality versus indication bias and need for randomized evidence.[[1]](https://pubmed.ncbi.nlm.nih.gov/42057738/)[[2]](https://journals.lww.com/coronary-artery/fulltext/9900/prognostic_impact_of_treatment_patterns_of.482.
BACKGROUND: Heart failure is a common complication after acute myocardial infarction (AMI). However, the prognostic impact of patterns of heart failure management during hospitalization remains unclear. METHODS: This multicenter, retrospective study included 2426 patients with AMI undergoing percutaneous coronary intervention. Patients were categorized into three groups: no intravenous (i.v.) heart failure treatment (patients received neither i.v. diuretics nor inotropes/vasopressors), diuretics only (diuretics without inotropes/vasopressors), and inotropes (inotropes/vasopressors with or without diuretics) groups. The primary endpoints included all-cause death during hospitalization and a composite of all-cause death and heart failure rehospitalization after discharge. RESULTS: Overall, 646 patients (26.6%) developed in-hospital heart failure. During hospitalization, the mortality rate was higher in the inotropes group (34.9%), followed by the diuretics only group (5.9%) and the no i.v. heart failure treatment group (2.2%) (P < 0.001). During a median follow-up of 535 days, 196 (9.7%) patients developed the primary endpoint after discharge. A composite of all-cause death and heart failure rehospitalization occurred in 6.5% of the no i.v. heart failure treatment group, while those in the diuretics group (21.2%) and inotropes group (24.3%) had a similar risk of the primary endpoint. CONCLUSION: Heart failure events requiring i.v. treatments during hospitalization were associated with an increased in-hospital mortality, particularly in those treated with inotropes in patients with AMI. Among patients who were discharged alive, however, long-term outcomes did not differ significantly between patients treated with diuretics only and inotropes.
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Okita et al. (2026) conducted a cohort in Acute myocardial infarction (n=2,426). Intravenous heart failure treatment (inotropes or diuretics) vs. No intravenous heart failure treatment was evaluated on All-cause death during hospitalization and a composite of all-cause death and heart failure rehospitalization after discharge (p=<0.001). Intravenous inotropes for in-hospital heart failure after AMI were associated with higher in-hospital mortality (34.9%) compared to diuretics only (5.9%) or no intravenous treatment (2.2%, P<0.001).
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