Incidence and Prognostic Impact of Heart Failure Hospitalization During Follow-Up After Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction

The incidence of heart failure (HF) hospitalization and its impact on long-term outcomes have not been well evaluated in contemporary patients with ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PCI). The Coronary Revascularization Demonstrating Outcome Study in Kyoto Acute Myocardial Infarction (AMI) Registry is a multicenter registry enrolling 5,429 consecutive patients with AMI undergoing PCI from 2005 to 2007. The present study population consisted of 3,682 patients with STEMI who underwent primary PCI within 24 hours of symptom onset and discharged alive. The incidence of HF hospitalization was 4.4%/year during the first year after the index STEMI, which attenuated to approximately 1.0%/year beyond 1 year to 5 years with the median follow-up period of 1,956 days. The independent risk factors for HF hospitalization within 1 year included older age, previous myocardial infarction, HF at STEMI, left ventricular dysfunction, anterior AMI, and onset-to-balloon time >3 hours, use of β blocker, and nonuse of statin at discharge. By the landmark analysis at 1 year, the cumulative incidences of all-cause death and HF hospitalization beyond 1 year and up to 5 years were significantly higher in patients with HF hospitalization within 1 year of STEMI than in patients without (36.3% vs 10.1%, p <0.001, and 40.4% vs 4.3%, p <0.001, respectively). Even after adjusting for confounders, HF hospitalization within 1 year remained independently associated with a higher risk for death and HF hospitalization beyond 1 year (hazard ratio 1.64, 95% CI 1.02 to 2.52, p = 0.04 and HR 5.72, 95% CI 3.46 to 9.22, p <0.001, respectively). In conclusion, HF hospitalization within 1 year was independently associated with a higher risk for all-cause death and HF hospitalization beyond 1 year.