Abstract 10426: Worse Clinical Outcomes in Patients with Acute Coronary Syndrome and Prior or New Onset Heart Failure: Insights from 47,474 Patients in a Pooled Analysis of Randomized Clinical Trials

Abstract

Introduction: Heart failure (HF) frequently complicates acute coronary syndrome (ACS). Despite known associated high rates of mortality, there are only limited data regarding recurrent ischemic events and re-hospitalization for HF (HHF) in those with HF and ACS. Methods: We used a pooled dataset of four randomized clinical ACS trials (Platelet Inhibition and Patient Outcomes [PLATO], Apixaban for Prevention of Acute Ischemic Events 2 [APPRAISE-2], Thrombin Receptor Antagonist for Clinical Event Reduction in Acute Coronary Syndrome [TRA-CER], and Targeted Platelet Inhibition to Clarify the Optimal Strategy to Medically Manage Acute Coronary Syndrome [TRILOGY ACS]). We assessed the association between HF status (history of HF, de novo HF, no HF) at presentation for ACS on death, future ischemic events, and HHF at one year following hospital discharge using Cox proportional hazards analysis and estimated cumulative event rates using cumulative incidence function. Results: Of 47,474 patients presenting with ACS, 11.1% showed evidence of acute HF, 55.0% of whom had no previous history of HF. Patients with prior/chronic HF were more likely to present with acute HF than those with no previous HF (40.3% vs 6.9%). Compared to those without HF, patients with prior and de novo HF were at a significantly increased risk at one year of all-cause mortality (adjusted HR (aHR) 2.10, 95% Confidence Interval [CI] 1.80-2.45, and aHR 1.51, CI 1.18-1.93, respectively), MACE (aHR 1.50, CI 1.34-1.69, and aHR 1.40, CI 1.14-1.72), recurrent MI (aHR 1.58, CI 1.41-1.78, and aHR 1.40, CI 1.15-1.70), stroke (aHR 1.93, CI 1.67-2.32, and aHR 1.38, CI 1.09-1.75), and HHF (aHR 2.38, CI 2.09-2.71, and aHR 1.53, CI 1.24-1.88). Conclusion: Following an ACS event, both prior and de novo HF were found to be major predictors of death, recurrent ischemic events, and HHF by one year. These findings highlight the need for improved strategies to prevent and manage adverse outcomes in this high-risk population.