Prognostic impact of treatment patterns of in-hospital heart failure on clinical outcomes after myocardial infarction.

BACKGROUND

Heart failure is a common complication after acute myocardial infarction (AMI). However, the prognostic impact of patterns of heart failure management during hospitalization remains unclear.

METHODS

This multicenter, retrospective study included 2426 patients with AMI undergoing percutaneous coronary intervention. Patients were categorized into three groups: no intravenous (i.v.) heart failure treatment (patients received neither i.v. diuretics nor inotropes/vasopressors), diuretics only (diuretics without inotropes/vasopressors), and inotropes (inotropes/vasopressors with or without diuretics) groups. The primary endpoints included all-cause death during hospitalization and a composite of all-cause death and heart failure rehospitalization after discharge.

RESULTS

Overall, 646 patients (26.6%) developed in-hospital heart failure. During hospitalization, the mortality rate was higher in the inotropes group (34.9%), followed by the diuretics only group (5.9%) and the no i.v. heart failure treatment group (2.2%) ( P  < 0.001). During a median follow-up of 535 days, 196 (9.7%) patients developed the primary endpoint after discharge. A composite of all-cause death and heart failure rehospitalization occurred in 6.5% of the no i.v. heart failure treatment group, while those in the diuretics group (21.2%) and inotropes group (24.3%) had a similar risk of the primary endpoint.

CONCLUSION

Heart failure events requiring i.v. treatments during hospitalization were associated with an increased in-hospital mortality, particularly in those treated with inotropes in patients with AMI. Among patients who were discharged alive, however, long-term outcomes did not differ significantly between patients treated with diuretics only and inotropes.