Incident heart failure and recurrent coronary events following acute myocardial infarction

Abstract

Background and aims: Recurrent myocardial infarction (MI) and incident heart failure (HF) are major post-MI complications. Herein, contemporary post-MI risks for recurrent MI and HF are described.

Methods: A total of 6804 patients with a primary discharge diagnosis of MI at 28 Baylor Scott & White Health hospitals (January 2015 to December 2021) were studied. Patient characteristics, treatment, and outcomes, including incident HF, recurrent MI, all-cause death, and all-cause and cardiovascular rehospitalizations, were assessed. Landmark approach anchored at 3 months post-discharge was used to assess 1-year outcomes.

Results: Median age was 69 years, 59.7% were male, and 76.7% had non-ST-elevation MI. Comorbidities included hypertension (89%), dyslipidaemia (87%), Type 2 diabetes (48%), and chronic kidney disease (34%); 17% had a history of MI and 23% of HF; 63% underwent percutaneous/surgical revascularization. In landmark-anchored 1-year outcomes (N = 6210), 413 (6.7%) patients died, 1730 (27.9%) had all-cause and 735 (11.8%) cardiovascular hospitalizations, 234 (3.8%) had recurrent MI. Of patients without history of HF, 1160 (23.8%) developed incident HF [42.2%, 26.7%, and 31.1% with ejection fraction (EF) < 40%, 41-49%, and >50%, respectively) within 3 months of discharge. Patients who developed HF had higher risk of death and hospitalizations (all P < .001), irrespective of EF. Of 2179 patients with EF > 50% without prevalent HF or HF during index hospitalization, 257 (11.8%) developed HF and 77 (3.5%) recurrent MI within 1 year.

Conclusions: In a contemporary post-MI cohort, the risk for incident HF was greater than recurrent MI, even among those with normal EF and no HF at discharge.

Keywords: Epidemiology; Heart failure; Mortality; Myocardial infarction; Registry.

Structured Graphical Abstract

Incident heart failure after acute myocardial infarction and its impact on patient outcomes. ACM, all-cause mortality; AMI, acute myocardial infarction; HF, heart failure; HR, hazard ratio; NSTEMI, non-ST-elevation myocardial infarction; STEMI, ST-elevation myocardial infarction.

Figure 1

Consort diagram. Stepwise breakdown of patients with an acute myocardial infarction discharge diagnosis who were included in the study. Landmark date was defined as 3 months following the discharge, and landmark period was defined as the 12-month duration thereafter. AMI, acute myocardial infarction; NSTEMI, non-ST-elevation myocardial infarction; STEMI, ST-elevation myocardial infarction

Figure 2

Outcomes after ST-elevation and non-ST-elevation myocardial infarction. Kaplan–Meier cumulative incidence estimates for (A) all-cause mortality excluding myocardial infarction patients with baseline history of heart failure in patients with ST-elevation myocardial infarction vs. non-ST-elevation myocardial infarction and (B) recurrent myocardial infarction excluding baseline history of heart failure in patients with ST-elevation myocardial infarction vs. non-ST-elevation myocardial infarction. ACM, all-cause mortality; HF, heart failure; HR, hazard ratio; MI, myocardial infarction; NSTEMI, non-ST-elevation myocardial infarction; STEMI, ST-elevation myocardial infarction

Figure 3

Mortality risk in relation to heart failure post-myocardial infarction. Kaplan–Meier cumulative incidence estimates for (A) all-cause mortality (ACM) in patients with and without incident heart failure, and (B) ACM in patients with heart failure and reduced, mildly reduced, and preserved ejection fraction. ACM, all-cause mortality; HF, heart failure; HFrEF, HF with reduced ejection fraction; HFmrEF, HF with mildly reduced with ejection fraction; HFpEF, HF with preserved ejection fraction; HR, hazard ratio; MI, myocardial infarction