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Heart failure and cardiomyopathies
Original research article
Heart failure following STEMI: a contemporary cohort study of incidence and prognostic factors
  1. Johannes M I H Gho1,
  2. Pieter G Postema2,
  3. Maartje Conijn1,
  4. Nienke Bruinsma2,
  5. Jonas S S G de Jong2,3,
  6. Connie R Bezzina2,
  7. Arthur A M Wilde2 and
  8. Folkert W Asselbergs1,4,5
  1. 1 Department of Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
  2. 2 Department of Clinical and Experimental Cardiology, Heart Center, Academic Medical Center, Amsterdam, The Netherlands
  3. 3 Heart Center, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands
  4. 4 Durrer Center for Cardiogenetic Research, ICIN-Netherlands Heart Institute, Utrecht, The Netherlands
  5. 5 Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK
  1. Correspondence to Professor Folkert W Asselbergs; f.w.asselbergs{at}umcutrecht.nl

Abstract

Objective The aim of the current study was to determine the contemporary incidence, risk factors and prognosis of heart failure (HF) after ST-elevation myocardial infarction (STEMI).

Methods We used the Arrhythmia Genetics in the Netherlands observational cohort study to identify patients with a first STEMI from 2001 onwards (n=1459). HF during follow-up was defined as hospitalisation for HF or an outpatient clinic visit for HF. Cox regression was performed to estimate the relationship between baseline covariates and the onset of HF.

Results Follow-up was completed for 1360 (93.2%) patients with an overall median follow-up time of 6.7 years, 1232 (90.6%) of these patients had undergone primary percutaneous coronary intervention (PCI). A total of 85 patients (6.3%) developed HF during follow-up. HF cases were significantly older at their index MI (59.9 vs 57.2 years, P<0.001) and more commonly had a history of atrial fibrillation (6.1% vs 1.4%, P=0.001) than controls without HF. The crude incidence rate of HF after STEMI was 9.7 (95% CI 7.7 to 11.8) per 1000 person-years. In multivariable analysis, peak creatine kinase MB (CK-MB) levels (HR 1.11 per 100 U/L (95% CI 1.11 to 1.22)) and a left anterior descending artery (LAD) culprit lesion (HR 2.88 (95% CI 1.53 to 5.40)) were risk factors associated with HF.

Conclusions We found a relatively low long-term contemporary incidence of HF after a first STEMI in the current PCI era in comparison with other reports. Higher CK-MB levels and a LAD culprit lesion at index STEMI were important risk factors for the development of HF after STEMI.

Trial registration number NCT03007199; Results.

  • Heart failure
  • Acute coronary syndrome
  • Epidemiology

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/openhrt-2016-000551

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    Footnotes

    • JMIHG and PGP shared first authorship.

    • Contributors JMIHG designed the current study, performed data collection and analyses, and drafted and revised the manuscript. PGP verified endpoints in the adjudication committee and revised the manuscript critically for important intellectual content. MC performed data collection and analyses and drafted the manuscript. NB performed data collection and critically reviewed and revised the manuscript. JSSGdJ was involved with data collection and analyses in the primary study and critically reviewed and revised the manuscript. CRB and AW conceived the parent study, monitored data collection and critically reviewed and revised the manuscript. FWA designed the current study, verified endpoints in the adjudication committee and revised the manuscript critically for important intellectual content. He is guarantor. All authors gave final approval of the version to be published.

    • Funding This work was supported by a Dekker scholarship-Junior Staff Member 2014T001 – Netherlands Heart Foundation to [FWA] and a clinical fellowship to [FWA] from the Netherlands Organization for Health Research and Development (ZonMw grant 90700342) and UCL Hospitals NIHR Biomedical Research Centre [FWA].

    • Competing interests None declared.

    • Ethics approval All patients or their legal representative gave written informed consent for inclusion, and collection of information during follow-up was also approved by the institutional ethics committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement There are no additional data available for this paper.