The Association Between Admission Heart Failure and In-Hospital Outcomes in ST-Elevation Myocardial Infarction Patients Undergoing Primary Percutaneous Coronary Intervention

BACKGROUND: The Global Registry of Acute Coronary Events (GRACE) study showed that admission HF is associated with longer hospital stay and higher mortality in ST-elevation myocardial infarction (STEMI) patients. No data are available on the effect of heart failure (HF) on the length of cardiac care unit (CCU) stay and in-hospital major adverse cardiac events (MACEs). The link between the severity of HF and the in-hospital prognosis is not established. Therefore, we aimed to investigate the unstudied outcomes in HF patients as well as to compare the outcomes across the spectrum of HF presentations. METHODS: We studied 210 STEMI patients presenting to a single primary percutaneous coronary intervention (PPCI) center in a retrospective cohort pattern. We excluded those who received fibrinolysis, those who had chest pain for more than 24 h and those with previous stents and presenting with stent thrombosis. All the procedures followed the ethical standards of Alexandria University and the Helsinki Declaration. RESULTS: STEMI patients with HF had significantly longer CCU stay (mean value of 3.6 vs. 2.87 days, P = 0.009), higher in-hospital MACE (55% vs. 4.7%, P < 0.001) and higher mortality (15% vs. 0.53%, P < 0.001). Multivariate logistic regression analysis revealed that HF is an independent predictor of in-hospital mortality (odds ratio (OR) = 9.11, 95% confidence interval (CI): 1.66 - 49.9, P = 0.01). The patients with severe HF on admission (Killip III and IV) tended to stay longer in the CCU (4.13 ± 1.89 days vs. 3.25 ± 1.54 days, P = 0.069) and the hospital (5.88 ± 3.09 vs. 4.42 ± 2.47 days, P = 0.077), compared to those with mild HF (Killip II). There was a tendency for a higher incidence of in-hospital MACE (75% vs. 33%, P = 0.068) and mortality (16.7% vs. 12.5%, P = 0.798) in the former group compared to the latter. The differences among HF subgroups did not reach the point of statistical significance though. CONCLUSIONS: The presence of HF on the admission of STEMI patients undergoing PPCI is associated with longer CCU stay, higher in-hospital MACE and mortality.