History of heart failure in patients with acute coronary syndrome: population characterization and impact on prognosis

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients with Heart Failure (HF) usually have multiple co-morbidities, so their approach in the context of Acute Coronary Syndrome (ACS) could be an important challenge. Purpose To characterize patients with ACS and previous HF and evaluate its impact on the therapeutic approach, complications and in-hospital mortality. Methods We studied 745 patients admitted to a Cardiac Intensive Care Unit with a diagnosis of ACS. We considered 2 groups: patients with previous HF and patients without a previous history of HF. Age, gender, personal history, clinical and electrocardiographic presentation of the ACS, treatment at admission, left ventricular ejection fraction (EFj), coronary angiography and angioplasty were recorded. The following in-hospital complications were defined: heart failure, cardiogenic shock, need for invasive mechanical ventilation (IMV), re-infarction, mechanical complications, sudden aborted death, stroke and major hemorrhage. In-hospital mortality was compared between both groups. Results Patients with previous HF constituted 7.1% (53 patients) of the population studied. These were older (77.3 ± 8.9 vs 66.6 ± 13.6, p<0.001), a higher prevalence of arterial hypertension (88.7% vs 76.2%; p=0.03), of myocardial infarction (50.9% vs 24.3%, p<0.001), coronary artery bypass graft surgery (18.9% vs 5.2%, p<0.001), valvular disease 22.6% vs 1, 4%, p<0.001), peripheral arterial disease 22.6% vs 5.1%, p<0.001), chronic renal failure (41.5% vs 10.1%, p<0.001), chronic lung disease 22.6% vs 4.2%, p<0.001 and hemorrhage (9.6% vs 1.8%, p<0.001). Patients with HF presented more frequently with AMI without ST elevation (62.3% vs 45.7%; p<0.001) and infarction of undetermined location (26.4% vs 4.6%, p=0 .02) and Killip-Kimbal class ≥ 2 (64.2% vs 16.8%, p<0.001) and less with ST-elevation AMI (5.7% vs 42.5%, p<0.001) and pain (58.5% vs 87.7%, p<0.001). On admission, patients with previous HF underwent fewer coronary angiograms (56.6% vs 86.7%, p<0.001) and via the radial approach (53.6% vs 79.0%, p=0.001)5.7%, p<0.001), and less angioplasties (32.1% vs 68.7%, p<0.001). The presence of HF was associated with lower EFj (40.9 ± 10.4% vs 48.2 ± 9.9%, p=0.004), with greater development of HF during hospitalization (47.2% vs 12, 4%, p<0.001), greater need for non-invasive ventilation (17.0% vs 2.2%, p<0.001) and higher in-hospital mortality (13.7% vs 4.8%, p=0.008). Conclusion The previous presence of HF seems to condition the clinical and electrocardiographic presentation of the ACS and is associated with greater development of HF and in-hospital mortality.