Long-Term Prognosis in Patients with ST-Elevation Myocardial Infarction Complicated by Heart Failure with Preserved Left Ventricular Ejection Fraction

TL;DR

This study shows that heart failure with preserved ejection fraction during a heart attack is a significant predictor of long-term mortality, though less severe than heart failure with reduced ejection fraction.

Contribution

The study identifies HFpEF as an independent predictor of 8-year mortality in STEMI patients, comparing its prognostic impact to HFrEF.

Findings

HFpEF patients had significantly higher 8-year mortality than those without heart failure.

HFpEF mortality was significantly lower than HFrEF mortality.

HFpEF and HFrEF were both independent predictors of 8-year mortality.

Abstract

Background/aim: We aimed to analyze eight-year mortality in patients with ST-elevation myocardial infarction (STEMI) complicated by the development of in-hospital heart failure with preserved ejection fraction (HFpEF). Method: We analyzed 3260 STEMI patients treated with primary PCI (pPCI). Reduced EF was defined as value <50% and preserved EF as value ≥50%. Patients were divided in three groups: without HF, with HFpEF, and with HF with reduced EF (HFrEF). Patients with cardiogenic shock at admission were excluded. Results: In-hospital HF was registered in 759 (23.2%) patients. Among the patients with in-hospital HF, 80 (10.5%) patients had HFpEF. Patients with HFpEF had significantly higher 8-year mortality compared with patients without HF (11.2% vs. 3.5%, respectively, p < 0.001), but significantly lower mortality compared with patients with HFrEF: 11.2% vs. 25.1%, respectively, p < 0.001. In the Cox regression model, HFpEF and HFrEF were independent predictors for 8-year mortality-HFpEF: HR1.85 (95%CI 1.26–4.25); HFrEF: 4.89 (95%CI 3.19–6.42). Conclusion: Development of in-hospital HFpEF in STEMI patients was an independent predictor for long-term mortality. The negative prognostic impact of HFpEF was weaker when compared to the impact of in-hospital HFrEF.

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