Following STEMI in the contemporary era of early reperfusion, the incidence of de-novo heart failure was 10.9% over a median 3.7 years, with distinct predictors for HFrEF and HFpEF.
Cohort (n=1,172)
What is the incidence and what are the predictors of de-novo heart failure (HFrEF, HFmrEF, HFpEF) after STEMI in the contemporary era of early percutaneous coronary intervention?
In the contemporary era of early STEMI reperfusion, approximately 10.9% of patients develop heart failure, with distinct clinical predictors for HFrEF versus HFpEF.
Abstract Aims The development and incidence of de-novo heart failure after ST-elevation myocardial infarction (STEMI) in the contemporary era of rapid reperfusion are largely unknown. We aimed to establish the incidence of post-STEMI heart failure, stratified by left ventricular ejection fraction (LVEF) and to find predictors for its occurrence. Furthermore, we investigated the course of left ventricular systolic and diastolic function after STEMI. Methods and results A total of 1172 all-comer STEMI patients from the CardioLines Biobank were included. Patients were predominantly male (74.5%) and 64 ± 12 years of age. During a median follow-up of 3.7 years (2.0, 5.5) we found a total incidence of post-STEMI heart failure of 10.9%, of which 52.1% heart failure with reduced ejection fraction (HFrEF), 29.4% heart failure with mildly reduced ejection fraction and 18.5% heart failure with preserved ejection fraction (HFpEF). Independent predictors for the development of HFrEF were male sex (β = 0.97, p = 0.009), lung crepitations (β = 1.09, p = 0.001), potassium level (mmol/L, β = 0.43, p = 0.012), neutrophil count (109/L, β = 0.09, p = 0.001) and a reduced LVEF (β = 1.91, p 0.001) at baseline. Independent predictors for the development of HFpEF were female sex (β = 0.99, p = 0.029), pre-existing kidney failure (β = 1.95, p = 0.003) and greater left atrial volume index (β = 0.04, p = 0.033) at baseline. Follow-up echocardiography (median follow-up 20 months) showed an improvement in LVEF (p 0.001), whereas changes in diastolic function parameters showed both improvement and deterioration. Conclusion In the current era of early STEMI reperfusion, still one in 10 patients develops heart failure, with approximately half of the patients with a reduced and half with a mildly reduced or normal LVEF. Predictors for the development of HFrEF were different from HFpEF.
Lenselink et al. (Thu,) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=1,172). Following STEMI in the contemporary era of early reperfusion, the incidence of de-novo heart failure was 10.9% over a median 3.7 years, with distinct predictors for HFrEF and HFpEF.