Acute heart failure and acute coronary syndrome: not uncommon duo and dangerous

Abstract

Abstract Funding Acknowledgements None. Introduction Acute Heart Failure (AHF) is a common cause of hospitalisation. Its ethology and triggering factors influence the prognosis and evolution. Methods and purpose Retrospective analysis of 6330 patients admitted to our hospital's Coronary Care Unit (CCU) between 2012 and 2022. The main objective was to analyse the characteristics during hospital progress and follow-up of patients with AHF after an Acute Coronary Syndrome (ACS) in class Killip III or IV, comparing it with those admitted for AHF not secondary to ACS. Results 698 patients with AHF after ACS and 384 with AHF not secondary to ACS were included. 68.8% of patients presented Acute Coronary Syndrome with ST elevation (STEMI), with a higher prevalence in the anterior location (34,3%). Angioplasty was performed in 53.4% of patiens with STEMI and in 40.3% of patients with NSTEMI. The Cardiovascular risk factors (Figure 1) were similar in both groups, while patients with AHF not secondary to ACS had a history of Coronary Heart Disease (CHD) and atrial fibrilación (AF) more frequently. Patients with AHF after ACS more frequently required treatment with dobutamine and norepinephrine (63.6% and 57.6%, respectively) as well as orotracheal intubation. At the same time, levosimendan was administered more frequently to patients with AHF not secondary to ACS, with non-invasive mechanical ventilation being more frequent in this group. Both groups similarly received neurohormonal treatment, with beta-blockers being used the most. Events during follow-up (Figure 2) were higher in patients with AHF after ACS, except HF events. Cardiovascular mortality was 21.9% in patients with AHF after ACS. Conclusions Patients admitted for ACS complicated with AHF Killip III-IV represented 11.02%. The majority presented previously STEMI. During their admission, compared to patients admitted for AHF not secondary to ACS, they more frequently required vasoactive drugs and orotracheal intubation. Cardiovascular complications and mortality during follow-up were higher in patients with AHF after ACS. Therefore, early identification of patients with ACS at risk of developing AHF and establishing a specific and optimal treatment is crucial in the evolution of these patients.