Heart failure following STEMI: a contemporary cohort study of incidence and prognostic factors

Johannes M I H Gho, Pieter G Postema, Maartje Conijn, Nienke Bruinsma, Jonas S S G de Jong, Connie R Bezzina, Arthur A M Wilde, Folkert W Asselbergs, Johannes M I H Gho, Pieter G Postema, Maartje Conijn, Nienke Bruinsma, Jonas S S G de Jong, Connie R Bezzina, Arthur A M Wilde, Folkert W Asselbergs

Abstract

Objective: The aim of the current study was to determine the contemporary incidence, risk factors and prognosis of heart failure (HF) after ST-elevation myocardial infarction (STEMI).

Methods: We used the Arrhythmia Genetics in the Netherlands observational cohort study to identify patients with a first STEMI from 2001 onwards (n=1459). HF during follow-up was defined as hospitalisation for HF or an outpatient clinic visit for HF. Cox regression was performed to estimate the relationship between baseline covariates and the onset of HF.

Results: Follow-up was completed for 1360 (93.2%) patients with an overall median follow-up time of 6.7 years, 1232 (90.6%) of these patients had undergone primary percutaneous coronary intervention (PCI). A total of 85 patients (6.3%) developed HF during follow-up. HF cases were significantly older at their index MI (59.9 vs 57.2 years, P<0.001) and more commonly had a history of atrial fibrillation (6.1% vs 1.4%, P=0.001) than controls without HF. The crude incidence rate of HF after STEMI was 9.7 (95% CI 7.7 to 11.8) per 1000 person-years. In multivariable analysis, peak creatine kinase MB (CK-MB) levels (HR 1.11 per 100 U/L (95% CI 1.11 to 1.22)) and a left anterior descending artery (LAD) culprit lesion (HR 2.88 (95% CI 1.53 to 5.40)) were risk factors associated with HF.

Conclusions: We found a relatively low long-term contemporary incidence of HF after a first STEMI in the current PCI era in comparison with other reports. Higher CK-MB levels and a LAD culprit lesion at index STEMI were important risk factors for the development of HF after STEMI.

Trial registration number: NCT03007199; Results.

Keywords: Acute coronary syndrome; Epidemiology; Heart failure.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Flow chart. AGNES, Arrhythmia Genetics in the NEtherlandS; HF, heart failure; MI, myocardial infarction.
Figure 2
Figure 2
Kaplan-Meier curve showing the time until onset of heart failure in 5-year follow-up. The inset shows the portion of the graph with 100%–90% free of heart failure. STEMI, ST-elevation myocardial infarction.
Figure 3
Figure 3
Kaplan-Meier curve showing the overall unadjusted 5-year survival after a first STEMI. The inset shows the portion of the graph with 100%–90% cumulative survival. STEMI, ST-elevation myocardial infarction.

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