Heart failure after myocardial infarction in the era of primary percutaneous coronary intervention: Mechanisms, incidence and identification of patients at risk

Abstract

Myocardial infarction (MI) remains the most common cause of heart failure (HF) worldwide. For almost 50 years HF has been recognised as a determinant of adverse prognosis after MI, but efforts to promote myocardial repair have failed to translate into clinical therapies. Primary percutaneous coronary intervention (PPCI) has driven improved early survival after MI, but its impact on the incidence of downstream HF is debated. The effects of PPCI are confounded by the changing epidemiology of MI and HF, with an ageing patient demographic, an increasing proportion of non-ST-elevation myocardial infarction, and the recognition of HF with preserved ejection fraction. Herein we review the mechanisms of HF after MI and discuss contemporary data on its incidence and outcomes. We review current and emerging strategies for early detection of patients at risk of HF after MI, with a view to identification of patient cohorts for novel therapeutic agents.

Keywords: Angioplasty; Heart failure; Myocardial infarction; Percutaneous coronary intervention; ST-elevation myocardial infarction.

Figure 1

Mechanisms of heart failure after myocardial infarction.

Figure 2

Heart failure after myocardial infarction - strategies for prediction of infarct size and salvage. BNP: B-type natriuretic peptide; CFR: Coronary flow reserve; CK: Creatine kinease; IMR: Index of microcirculatory resistance; LAD: Left anterior descending; MBG: Myocardial blush grade; MVO: Microvascular occlusion; PET: Positron emission tomography; PCI: Percutaneous coronary intervention; TIMI flow: Thrombolysis In Myocardial Infarction flow score; TnI: Troponin I; WMSI: Wall motion score index.