Morbidity and Mortality Associated With Heart Failure in Acute Coronary Syndrome: A Pooled Analysis of 4 Clinical Trials

Heart failure (HF) may complicate acute coronary syndrome (ACS) and is associated with a high burden of short- and long-term morbidity and mortality. Only limited data regarding future ischemic events and rehospitalization are available for patients who suffer HF before or during ACS. A secondary an...

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Bibliographic Details
Published in:	Journal of cardiac failure Vol. 29; no. 12; pp. 1603 - 1614
Main Authors:	Goodwin, Nathan P, Clare, Robert M, Harrington, Josephine L, Badjatiya, Anish, Wojdyla, Daniel M, Udell, Jacob A, Butler, Javed, Januzzi, Jr, James L, Parikh, Puja B, James, Stefan, Alexander, John H, Lopes, Renato D, Wallentin, Lars, Ohman, E Magnus, Hernandez, Adrian F, Jones, W Schuyler
Format:	Journal Article
Language:	English
Published:	United States 01-12-2023
Subjects:	Acute coronary syndrome Acute Coronary Syndrome - complications Acute Coronary Syndrome - diagnosis Acute Coronary Syndrome - epidemiology heart failure Heart Failure - drug therapy hospitalization Humans Incidence ischemic events Myocardial Infarction - complications Stroke - etiology heart failure ischemic events hospitalization Acute coronary syndrome
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Summary:	Heart failure (HF) may complicate acute coronary syndrome (ACS) and is associated with a high burden of short- and long-term morbidity and mortality. Only limited data regarding future ischemic events and rehospitalization are available for patients who suffer HF before or during ACS. A secondary analysis of 4 large ACS trials (PLATO, APPRAISE-2, TRACER, and TRILOGY ACS) using Cox proportional hazards models was performed to investigate the association of HF status (no HF, chronic HF, de novo HF) at presentation for ACS with all-cause and cardiovascular death, major adverse cardiovascular event (MACE ), myocardial infarction, stroke, and hospitalization for heart failure (HHF) by 1 year. Cumulative incidence plots are presented at 30 days and 1 year. A total of 11.1% of the 47,474 patients presenting with ACS presented with evidence of acute HF, 55.0% of whom presented with de novo HF. Patients with chronic HF presented with evidence of acute HF at a higher rate than those with no previous HF (40.3% vs 6.9%). Compared to those without HF, those with chronic and de novo HF had higher rates of all-cause mortality (adjusted hazard ratio [aHR] 2.01, 95% confidence interval [CI] 1.72-2.34 and aHR 1.47, 95% CI1.15-1.88, respectively), MACE (aHR 1.47, 95% CI1.31-1-.66 and aHR 1.38, 95% CI1.12-1.69), and HHF (aHR 2.29, 95% CI2.02-2.61 and aHR 1.48, 95% CI 1.20-1.82) at 1 year. In this large cohort of patients with ACS, both prior and de novo HF complicating ACS were associated with significantly higher risk-adjusted rates of death, ischemic events and HHF at 30 days and 1 year. Further studies examining the association between HF and outcomes in this high-risk population are warranted, especially given the advent of more contemporary HF therapies.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-1 content type line 23
ISSN:	1071-9164 1532-8414 1532-8414
DOI:	10.1016/j.cardfail.2023.07.004