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Review
. 2025 Apr 15;17(4):2352-2375.
doi: 10.62347/FPXH3010. eCollection 2025.

Factors influencing the development of heart failure after PCI in patients with acute coronary syndrome: a meta-analysis

Qian-Zhu Jiang  1   2 , Qian Xu  1   3 , Dong-Mei Wan  1   3 , Ying Kong  1   4
Affiliations
Review

Factors influencing the development of heart failure after PCI in patients with acute coronary syndrome: a meta-analysis

Qian-Zhu Jiang et al. Am J Transl Res. .

Abstract

Objective: To systematically analyze the factors associated with heart failure (HF) development after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome (ACS).

Methods: Relevant literature on risk factors for HF following PCI in ACS patients were retrieved from PubMed, Embase, The Cochrane Library, Web of Science, and Medline buildup to September 2024. Two independent investigators conducted literature screening, quality assessment, and data extraction based on inclusion and exclusion criteria. Meta-analysis was performed using Stata 12.0 software.

Results: A total of 20 papers were included, comprising 45,578 patients of whom 4,345 ACS patients developed HF after PCI. Meta-analysis identified several predictors of post-PCI HF in ACS patients, including advanced age [odds ratio (OR) =1.04, 95% confidence intervals (CI): 1.03-1.06], female gender (OR=1.43, 95% CI: 1.18-1.72), history of hypertension (OR=1.54, 95% CI: 1.31-1.80), history of diabetes mellitus (OR=1.55, 95% CI: 1.39-1.72), previous myocardial infarction (OR=1.58, 95% CI: 1.11-2.23), anterior wall myocardial infarction (OR=2.22, 95% CI: 1.89-2.61), reduced left ventricular ejection fraction (LVEF) (OR=1.40, 95% CI: 1.21-1.62), elevated white blood cell count (OR=1.14, 95% CI: 1.07-1.22), atrial fibrillation [hazard ratio (HR) =2.14, 95% CI: 1.11-4.12], increased heart rate (OR=1.03, 95% CI: 1.02-1.04), elevated Pentraxin-3 (PTX3) levels (OR=2.67, 95% CI: 1.45-4.93), and decreased myocardial contractility (HR=1.18, 95% CI: 1.10-1.26). Notably, complete revascularization (HR=0.29, 95% CI: 0.10-0.86) was identified as a protective factor. Sensitivity analysis confirmed the robustness of these findings.

Conclusions: Advanced age, female gender, history of hypertension and diabetes, previous myocardial infarction, anterior wall myocardial infarction, decreased LVEF at admission, increased white blood cell count, atrial fibrillation at admission, increased heart rate, elevated PTX3 levels, and impaired myocardial contractility were risk factors for HF development after PCI in ACS patients. Conversely, complete revascularization was associated with a lower risk of post-PCI HF.

Keywords: Acute coronary syndrome; PCI; heart failure; influencing factors; meta-analysis.

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Conflict of interest statement

None.

Figures

Figure 1
Figure 1
Literature screening process.
Figure 2
Figure 2
Meta-analysis of the effect of age on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 3
Figure 3
Sensitivity analysis of the effect of age on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 4
Figure 4
Meta-analysis of the effect of gender on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 5
Figure 5
Sensitivity analysis of the effect of gender on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 6
Figure 6
Meta-analysis of the effect of diabetes mellitus on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 7
Figure 7
Sensitivity analysis of the effect of diabetes mellitus on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 8
Figure 8
Meta-analysis of the effect of hypertension on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 9
Figure 9
Sensitivity analysis of the effect of hypertension on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 10
Figure 10
Meta-analysis of the effect of prior myocardial infarction on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 11
Figure 11
Sensitivity analysis of the effect of prior myocardial infarction on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 12
Figure 12
Meta-analysis of the effect of anterior wall myocardial infarction on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 13
Figure 13
Meta-analysis of the effect of decreased admission LVEF on the development of HF after PCI in ACS patients (LVEF: left ventricular ejection fraction, HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 14
Figure 14
Sensitivity analysis of the effect of decreased admission LVEF on the development of HF after PCI in ACS patients (LVEF: left ventricular ejection fraction, HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 15
Figure 15
Meta-analysis of the effect of white cell count on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 16
Figure 16
Meta-analysis of the effect of atrial fibrillation on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 17
Figure 17
Meta-analysis of the effect of complete revascularization on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 18
Figure 18
Meta-analysis of the effect of admission heart rate on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 19
Figure 19
Meta-analysis of the effect of PTX3 concentration on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 20
Figure 20
Meta-analysis of the effect of myocardial contractility on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 21
Figure 21
Sensitivity analysis of the effect of myocardial contractility on the development of HF after PCI in ACS patients (HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 22
Figure 22
Begg’s anecdotal correlation test for the effect of age and diabetes mellitus on the development of HF after PCI in ACS patients (A: age, B: diabetes mellitus; HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
Figure 23
Figure 23
Egger regression test for the effect of age and diabetes mellitus on the development of HF after PCI in ACS patients (A: age, B: diabetes mellitus; HF: heart failure, PCI: percutaneous coronary intervention, ACS: acute coronary syndrome).
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