MYOCARDIAL INFARCTION;

Abstract

Objectives: To determine the frequency of new onset heart failure after acutemyocardial infarction and factors contributing it. Methods: A total of 228 patients were studiedfor occurrence of new onset clinical heart failure within24 hours after admission with anacute Myocardial Infarction. Clinical parameters were used to diagnose heart failure. Variousrisk factors were analyzed which contributed to occurrence of heart failure after MI. Patientsundergoing primary angioplasty were not included into this study as medical thrombolysis wasthe most common mode of therapy (in >90% of patients). Results: Among the 228 patientsstudied 77.2 %( 176) were males and 22.8 %(52) were females. Mean age of the populationwas 56.3(±12.1) years. Women were relatively older on presentation as compared to men(mean age 58.9±10.9yr vs 55.5±12.3yr). Similarly mean age for NSTEMI was higher ascompared to STEMI (58.59±11.1 vs 54.2±12.6yr.). A total of36.8 %( 84) patients exhibitedclinical signs of heart failure within24 hours of their admission. These patients tend to be olderthan patients without HF (mean age 60±11years vs 54±12 years). Females after MI showed agreater frequency for going into HF as compared to males (42.3% vs 35.2% respectively). Nowregarding the association of HF with various factors it was seen that, having a previous historyof MI was found to be the strongest factor associated with occurrence of HF, with HF beingnearly three times more common in these patients (i.e. 73% vs 26.1%, p value < 0.05). Thecurrent type of MI on presentation also showed a direct relationship with HF, being highest inpatients with NSTEMI (i.e. up to 50 %) followed by AWMI (35.5%) and lowest in inferior wall MI (pvalue < 0.05). Diabetes, hypertension and smoking also showed a higher but statistically nonsignificantrelationship with HF development (41.2% vs 34.3%, 41% vs 32.2% and 44% vs 32%respectively p value > 0.05). The blood pressure on presentation however was significantlyassociated with HF in these patients. Patients having high BP (> 140/80) on presentationdepicted an overall higher incidence of HF as compared to patients having BP equal to or lessthan 140/80 (45.2% vs 31.3% p value < 0.05). Conclusion: Heart failure is a fairly commonentity after acute MI, being the commonest in patients suffering an NSTEMI. Previous history ofan MI showed to be the strongest coexisting factor associated with HF.