[The incidence and 1-year prognosis of heart failure following myocardial infarction during hospitalization in patients with first STEMI].

Abstract

Objective: To investigate the incidence of in-hospital heart failure (HF) following myocardial infarction (MI) and 1-year mortality in patients with first ST-segment elevation myocardial infarction (STEMI), and to compare the 1-year mortality risk among different types of HF. Methods: Data were derived from the Henan STEMI registry, which was a multicentre, prospective, observational study in central China. After excluding patients with a history of MI or HF, patients with first STEMI were divided into the HF and non-HF groups according to the occurrence of in-hospital HF. Based on the left ventricular ejection fraction (LVEF) measured on the last echocardiogram during hospitalization, patients with HF were classified into HF with preserved ejection fraction (HFpEF, LVEF≥50%), HF with mildly reduced ejection fraction (HFmrEF, LVEF 41%-49%), HF with reduced ejection fraction (HFrEF, LVEF≤40%), and HF with missing LVEF. Survival analysis was performed using the Kaplan-Meier method, and differences between groups were assessed with the log-rank test. Multivariate Cox frailty models were used to analyze the associations of HF status (present vs. absent) and different LVEF subgroups with 1-year mortality, using the non-HF group as the reference. Results: A total of 4 737 patients with first STEMI were included in the final analysis, with a median age of 62.8 (52.4, 70.8) years, of whom 1 158 (24.4%) were female. During hospitalization, 1 978 cases (41.8%) developed HF following MI, including 268 (13.5%) with HFrEF, 309 (15.6%) with HFmrEF, 707 (35.7%) with HFpEF, and 694 (35.1%) with missing LVEF. A total of 3 967 (83.7%) patients completed the 1-year follow-up. The 1-year mortality was significantly higher among STEMI patients complicated by HF than in those without (23.3% (391/1 680) vs. 5.8% (132/2 287), log-rank P<0.001). Specifically, the rates were 29.6% (67/226) for HFrEF, 20.8% (53/255) for HFmrEF, 11.7% (72/615) for HFpEF and 34.1% (199/584) for HF with missing LVEF. Multivariate Cox frailty models identified in-hospital HF following MI as a risk factor for 1-year mortality (HR=2.13, 95%CI: 1.70-2.67). Notably, HFpEF was associated with the lowest risk of 1-year mortality (HR=1.59, 95%CI: 1.16-2.17), while the HF group with missing LVEF carried the highest risk (HR=2.49, 95%CI: 1.91-3.26). Conclusions: The incidence of HF following first STEMI during hospitalization was 41.8%, with a corresponding 1-year mortality of 23.3%. In-hospital HF following MI is a risk factor for 1-year mortality in patients with STEMI. Prognosis differed notably across HF subgroups: HFpEF was associated with the lowest risk, whereas patients with missing LVEF had the worst outcome.