PURPOSE:To identify independent heart failure (HF) predictors post acute coronary syndromes (ACS).
METHODS:Prospective study of 1329 patients consecutively admitted in a single coronary care unit. A clinical follow up was performed at one year.
RESULTS:Mean age of the population was 67.0±12.0 years. Mean time between ACS and HF was 123.5±115.4 days; 6.0% had at least one admission for HF in the year following the ACS and 1.4% more than one. On univariate analysis variables associated with HF on follow up were: age, previous infarction, non-ST elevation acute myocardial infarction, atrial fibrillation, higher cardiac biomarkers and blood sugar on admission, lower left ventricular ejection fraction (LVEF), creatinine clearance, total and LDL cholesterol, incomplete revascularization and HF at discharge. An invasive strategy (OR 0.4, CI 0.3–0.7), normal ECG (OR 0.32, CI 0.2–0.7), unstable angina (OR 0.2, CI (0.006–0.6), and beta blocker use (OR 0.4, CI 0.3–0.7) were associated with lower HF incidence at follow-up. On multivariate regression analysis we identified LVEF lower than 46.5 (OR 4.9, CI 2.2–11.1), LDL cholesterol under 141.5 (OR 3.7, CI 1.3–10.6), age over 68.5 (OR 3.3, CI 1.2–8.9), killip class greater than 1 (OR 3.3, CI1.4–7.5), and admission blood sugar level over 185.5 (OR 2.2 CI 1.0–5.1) as independent predictors of a rehospitalization for HF one year after an ACS (C statistics for the validation cohort of 0.86).
CONCLUSION:Conclusion: The majority of the independent predictors of HF post-ACS are non-modifiable, which definitely support the importance of prevention and treatment of cardiovascular risk factors in order to optimize prognosis after ACS.
CLINICAL IMPLICATIONS:We note the relation between LVEF, age, and metabolic markers with the development of heart failure after the ACS.
DISCLOSURE:Rogerio Teixeira, No Financial Disclosure Information; No Product/Research Disclosure Information