Prognosticators of heart failure in patients after treatment because of acute coronary syndrome

Abstract

Aim of the study was to identify frequency and predictors of heart failure in patients treated for acute coronary syndrome (ACS). Patients and methods: Patients with ACS treated medically or with PCI, were extracted from the hospital registry. Analyzed variables: age, gender, risk factors, SBP and HR at hospital admition, type of MI, location, CAD severity, LV function, type of treatment, in-hospital morbidity, pharmacologic treatment post discharge, time to event. Statistical analyze: descriptive and comparative analyze, uni and multivariate regression analyze, Caplan-Meier event free survival analyze. Results: 437 patients treated for ACS, at mean age 63,2±11,1 years, 294(67,3%) males and 143(32,7%) females, were followed up for mean 17,3±10,3 months. A total of 128(29,3%) patients had 136 cardiac events (CE), 32(25%) of whom heart failure (HF). Mean time to HF was 5,9±7,4 (SE), CI(3,3-8,6) (Figure 1). As univariate predictors of HF in ACS treated patients we identified: length of hospitalization (for ACS treatment) 3,9±2,2 vs 5±2,5 days (beta .169, p=0,009); diuretic utilization during ACS hospitalization (beta 1.992, p=0,001); EF (%) (beta -0.092, p=0,001); reduced EF (<40%) had OR for HF 3.282 (CI 1,129-9,542, p=0,011); receiving PPCI (beta -1.584, p=0,011, exp(B) 0.205); known DM (beta0.741, p=0,007, exp(B) 2,098); previous MI (beta 0.832, p=0,068, exp(B) 2,297); statin therapy prior ACS (beta-0.955, p=0,028, exp(B) 0,385); PCI performed (beta-0.990, p=0,043, exp(B) 0,372); in-hospital morbidity (beta 0.868, p=0.028, exp(B) 2,382). In multivariate analyze (binary logistic regression) four independent predictors were identified: known diabetes (p=0,004), PCI treatment for ACS (p=0,006), diuretic therapy during ACS hospitalization (p=0,004) and LV function (p=0,024). Conclusion: Predictors of HF development in pts. after ACS, seems to be preexisting DM, need for diuretic therapy during ACS event, and reduced LV systolic function as negative ones, but, receiving PCI (myocardial revascularization) is the most important positive predictor.