| Abstract
| - Aims To define the clinical characteristics, co-morbidities, treatment, and clinical outcomes of patients with varying degrees of heart failure (HF) complicating ST-elevation myocardial infarction (STEMI), and to identify patients at high risk for HF following fibrinolysis. Methods and results 15,078 STEMI patients enrolled in a worldwide fibrinolytic trial (InTIME-II) were categorised into one of four hierarchical, mutually exclusive groups of HF: shock (\batchmode \documentclass[fleqn,10pt,legalpaper]{article} usepackage{amssymb} usepackage{amsfonts} usepackage{amsmath} \pagestyle{empty} \begin{document} \(n=719\) end{document}, 5%); severe HF (\batchmode \documentclass[fleqn,10pt,legalpaper]{article} usepackage{amssymb} usepackage{amsfonts} usepackage{amsmath} \pagestyle{empty} \begin{document} \(n=1082\) end{document}, 7%); mild HF (\batchmode \documentclass[fleqn,10pt,legalpaper]{article} usepackage{amssymb} usepackage{amsfonts} usepackage{amsmath} \pagestyle{empty} \begin{document} \(n=1619\) end{document}, 11%); no HF (\batchmode \documentclass[fleqn,10pt,legalpaper]{article} usepackage{amssymb} usepackage{amsfonts} usepackage{amsmath} \pagestyle{empty} \begin{document} \(n=11,658\) end{document}, 77%). In a multivariable model, anterior MI (OR 1.8, 95% CI [1.6; 1.9]), age ⩾65 (OR 1.8 [1.6; 2.0]), prior HF (OR 3.3 [2.6; 4.2]), and creatinine clearance \batchmode \documentclass[fleqn,10pt,legalpaper]{article} usepackage{amssymb} usepackage{amsfonts} usepackage{amsmath} \pagestyle{empty} \begin{document} \({<}\) end{document}60 mL/min (OR 1.8 [1.6; 2.1]) were the four most powerful correlates of HF. Although 30-day mortality was sixfold higher for patients with HF (18.9% vs. 3.1%, \batchmode \documentclass[fleqn,10pt,legalpaper]{article} usepackage{amssymb} usepackage{amsfonts} usepackage{amsmath} \pagestyle{empty} \begin{document} \(p{<}0.0001\) end{document}), these patients were less likely to undergo angiography (30% vs. 40%, \batchmode \documentclass[fleqn,10pt,legalpaper]{article} usepackage{amssymb} usepackage{amsfonts} usepackage{amsmath} \pagestyle{empty} \begin{document} \(p{<}0.0001\) end{document}) and revascularisation (19% vs. 25%, \batchmode \documentclass[fleqn,10pt,legalpaper]{article} usepackage{amssymb} usepackage{amsfonts} usepackage{amsmath} \pagestyle{empty} \begin{document} \(p{<}0.0001\) end{document}), than patients without HF. Likewise, angiotensin-inhibitors and β-blockers were not optimally utilised in patients with HF following MI. Conclusions During the index admission following fibrinolysis 23% of patients had HF. Despite a higher risk profile, patients with more severe HF were treated less aggressively than patients without HF.
|
