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Popovic B, Sorbets E, Abtan J, et al. Outcomes in non-ST-segment elevation myocardial infarction patients according to heart failure at admission: Insights from a large trial with systematic early invasive strategy. Eur Heart J Acute Cardiovasc Care. 2020;doi: 10.1177/2048872619896205.
Popovic, B., Sorbets, E., Abtan, J., Cohen, M., Pollack, C. V., Bode, C., Wiviott, S. D., Sabatine, M. S., Mehta, S. R., Ruzyllo, W., Rao, S. V., French, W. J., Kerkar, P., Kiss, R. G., Estrada, J. L. N., Elbez, Y., Ducrocq, G., & Steg, P. G. (2020). Outcomes in non-ST-segment elevation myocardial infarction patients according to heart failure at admission: Insights from a large trial with systematic early invasive strategy. European heart journal. Acute cardiovascular care, . https://doi.org/10.1177/2048872619896205
Popovic, Batric, et al. "Outcomes in non-ST-segment elevation myocardial infarction patients according to heart failure at admission: Insights from a large trial with systematic early invasive strategy." European heart journal. Acute cardiovascular care vol. (2020). doi: https://doi.org/10.1177/2048872619896205
Popovic B, Sorbets E, Abtan J, Cohen M, Pollack CV, Bode C, Wiviott SD, Sabatine MS, Mehta SR, Ruzyllo W, Rao SV, French WJ, Kerkar P, Kiss RG, Estrada JLN, Elbez Y, Ducrocq G, Steg PG. Outcomes in non-ST-segment elevation myocardial infarction patients according to heart failure at admission: Insights from a large trial with systematic early invasive strategy. Eur Heart J Acute Cardiovasc Care. 2020 Oct 20; doi: 10.1177/2048872619896205. Epub 2020 Oct 20. PMID: 33609103.
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Eur Heart J Acute Cardiovasc Care. 2020 Oct 20; doi: 10.1177/2048872619896205. Epub 2020 Oct 20.

Outcomes in non-ST-segment elevation myocardial infarction patients according to heart failure at admission: Insights from a large trial with systematic early invasive strategy.

European heart journal. Acute cardiovascular care

Batric Popovic, Emmanuel Sorbets, Jeremie Abtan, Marc Cohen, Charles V Pollack, Christoph Bode, Stephen D Wiviott, Marc S Sabatine, Shamir R Mehta, Witold Ruzyllo, Sunil V Rao, William J French, Prafulla Kerkar, Robert G Kiss, Jose Luis N Estrada, Yedid Elbez, Gregory Ducrocq, Philippe Gabriel Steg

Affiliations

  1. Université de Lorraine, CHRU de Nancy, Département de cardiologie, Nancy, France.
  2. Université de Paris, puis APHP, Hotel Dieu, Centre de diagnostic et de Thérapeutique; French Alliance for Cardiovascular Trials (FACT); INSERM LVTS-U1148.
  3. APHP, Department of cardiology, Hôpital Bichat, France; French Alliance for Cardiovascular Trials (FACT); INSERM LVTS-U1148; DHU FIRE, University of Paris.
  4. Division of Cardiology, Newark Beth Israel Medical Center, Mount Sinai School of Medicine, Newark, New Jersey, USA.
  5. Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, USA.
  6. Sidney Kimmel Medical College, USA.
  7. Medizinische Universitatsklinik, Freiburg, Germany.
  8. Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  9. Institute of Cardiology, Warsaw, Poland.
  10. The Duke Clinical Research Institute, Durham, North Carolina, USA.
  11. David Geffen School of Medicine at UCLA, Torrance, California, USA.
  12. Seth GS Medical College, India.
  13. KEM Hospital Parel, India.
  14. Department of Cardiology, Military Hospital, Budapest, Hungary.
  15. Hospital Italiano de Buenos Aires, Buenos Aires, Argentina.
  16. NHLI Imperial College, ICMS Royal Brompton Hospital London, United Kingdom.

PMID: 33609103 DOI: 10.1177/2048872619896205

Abstract

BACKGROUND: Previous studies published before the era of systematic early invasive strategy have reported a higher mortality in non-ST-segment elevation myocardial infarction patients with heart failure. The aim of our study was to compare the clinical characteristics, outcomes and causes of death of patients according to their heart failure status at admission in a large non-ST-segment elevation myocardial infarction population with planned early invasive management.

METHODS: We performed a post-hoc analysis of the Treatment of Acute Coronary Syndrome with Otamixaban randomised trial which included non-ST-segment elevation myocardial infarction patients with systematic coronary angiography within 72 h. Patients were categorised according to presence or absence of heart failure (Killip grade ≥2) at admission.

RESULTS: A total of 13,172 patients were enrolled, of whom 944 (7.2%) had heart failure. At day 30, death occurred in 213 patients (1.6%) and cardiovascular death was the dominant cause of death in both groups ((with vs without heart failure) 78.8% vs 78.4%, p = 0.94). At six months, death occurred in 90/944 (9.5%) patients with heart failure and 258/12228 patients without heart failure (2.1%) (p < 0.001). After adjustment on Global Registry of Acute Coronary Events risk score, heart failure was an independent predictor of all-cause mortality at day 30 (odds ratio: 1.58; 95% confidence interval, 1.06-2.36, p = 0.02) and at day 180 (odds ratio: 1.77; 95% confidence interval, 1.3-2.42, p < 0.001) as well as of ischaemic complications (cardiovascular death, myocardial infarction, stent thrombosis or stroke at day 30 (odds ratio: 1.28; 95% confidence interval, 1.01-1.62, p = 0.04).

CONCLUSION: Non-ST-segment elevation myocardial infarction patients with heart failure at admission still have worse outcomes than those without heart failure, even with systematic early invasive strategy. Further efforts are needed to improve the prognosis of these high risk patients.

© The European Society of Cardiology 2020.

Keywords: Non-ST-segment elevation myocardial infarction; coronary angiography; heart failure; prognosis

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