Key result
Elevated estimated plasma volume status (adjusted HR 1.294) and neutrophil-to-lymphocyte ratio (adjusted HR 1.029) were independently associated with increased long-term cardiovascular mortality in patients with acute myocardial infarction complicated by heart failure.
Why the study?
Residual risk of heart failure persists in many individuals after acute myocardial infarction despite revascularisation and standard medical therapies.
Do estimated plasma volume status (ePVS) and neutrophil-to-lymphocyte ratio (NLR) independently predict long-term cardiovascular mortality in patients with acute myocardial infarction complicated by heart failure?
Cohort (n=2,046)
No
Do estimated plasma volume status (ePVS) and neutrophil-to-lymphocyte ratio (NLR) independently predict long-term cardiovascular mortality in patients with acute myocardial infarction complicated by heart failure?
Hazard Ratio: 1.294 (95% CI 1.194–1.403)
p-value: p=<0.001
The combined assessment of volume overload (via ePVS) and systemic inflammation (via NLR) significantly enhances the prognostic accuracy for long-term cardiovascular mortality in patients with heart failure complicating acute myocardial infarction.
This Series paper highlights the substantial progress made in understanding and preventing heart failure after acute myocardial infarction. Improving global standards of care for management of acute myocardial infarction with timelier reperfusion has led to stepwise reductions in risk of incident heart failure. Landmark clinical trials have established the role of renin-angiotensin-aldosterone system inhibitors, β blockers, and mineralocorticoid receptor antagonists to specifically reduce the risk of incident heart failure after acute myocardial infarction. However, residual risk of heart failure persists in many individuals, even after revascularisation and standard medical therapies. We review recent epidemiological trends from the past four decades, evolving understanding of the pathological mechanisms underlying incident heart failure, and modern risk stratification tools. We then propose a treatment pathway tailored to individual patient risk and discuss potential future strategies to incrementally improve the risk of development of heart failure after acute myocardial infarction.
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Udell et al. (2025) conducted a cohort in Acute myocardial infarction complicated by heart failure (n=2,046). Elevated estimated plasma volume status (ePVS) vs. Lower estimated plasma volume status (ePVS) was evaluated on Cardiovascular mortality (HR 1.294, 95% CI 1.194-1.403, p=<0.001). Elevated estimated plasma volume status (adjusted HR 1.294) and neutrophil-to-lymphocyte ratio (adjusted HR 1.029) were independently associated with increased long-term cardiovascular mortality in patients with acute myocardial infarction complicated by heart failure.
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