Influence of heart failure on the prognosis of patients with acute myocardial infarction in southwestern China

Abstract

The impact of heart failure (HF) on acute myocardial infarction (AMI) in patients from southwestern China remains unclear. The present study aimed to compare in-hospital cardiovascular events, mortality and clinical therapies in AMI patients with or without HF in southwestern China. In total, 591 patients with AMI hospitalized between February 2009 and December 2012 were examined; those with a history of HF were excluded. The patients were divided into four groups according to AMI type (ST-elevated or non-ST-elevated AMI) and the presence of HF during hospitalization. Clinical characteristics, in-hospital cardiovascular events, mortality, coronary angiography and treatment were compared. Clinical therapies, specifically evidence-based drug use were analyzed in patients with HF during hospitalization, including angiotensin converting enzyme inhibitors (ACEIs) and β-blockers (BBs). AMI patients with HF had a higher frequency of co-morbidities, lower left ventricular ejection fraction, longer length of hospital stay and a greater risk of in-hospital mortality compared with AMI patients without HF. AMI patients with HF were less likely to be examined by cardiac angiography or treated with reperfusion therapy or recommended medications. AMI patients with HF co-treated with ACEIs and BBs had a significantly higher survival rate (94.4 vs. 67.5%; P<0.001) compared with untreated patients or patients treated with either ACEIs or BBs alone. Logistic regression analysis revealed that HF and cardiogenic shock in patients with AMI were the strongest predictors of in-hospital mortality. AMI patients with HF were at a higher risk of adverse outcomes. Cardiac angiography and timely standard recommended medications were associated with improved clinical outcomes.

Keywords: acute myocardial infarction; heart failure; in-hospital cardiovascular events; in-hospital mortality.

Figure 1.

Comparison of unadjusted in-hospital survival rates among the study groups. Unadjusted in-hospital survival rates among patients without HF (n=369), patients with HF treated with both BBs and ACEIs (n=142), patients with HF treated with either drug class (n=50), and patients with HF receiving no treatment (n=30) during their hospital stay. HF, heart failure; BBs, β-blockers; ACEIs, angiotensin-converting enzyme inhibitors.

Figure 2.

In-hospital survival rates of patients with or without HF during their hospital stay (P<0.001). Patients with heart failure, 222 individuals; patients without heart failure, 369 individuals. HF, heart failure.

Figure 3.

In-hospital survival rates of non-HF patients, HF patients with MACEs, and those without MACEs (P<0.001). Patients without HF, 369 individuals; HF patients with MACEs, 103 individuals; HF patients without MACEs, 119 individuals. MACEs included atrial fibrillation, ventricular arrhythmia, major bleeding, cardiogenic shock, recurrent ischemia, and recurrent myocardial infarction. HF, heart failure; MACEs, major cardiovascular events.

Figure 4.

In-hospital mortality rates among HF patients with various Killip classes (P<0.001). Killip class I–IV, patients with post-acute myocardial infarction HF. HF, heart failure.