Acute heart failure with and without acute coronary syndrome: clinical correlates and prognostic impact (From the HEARTS registry)

BMC Cardiovascular Disorders

Research Article

Mushabab Al-Murayeh¹  Hussam AlFaleh²  Ahmad Hersi²  Khalid F. AlHabib²  Anhar Ullah²  Waleed Al Habeeb²  Tarek S. Kashour³  Layth Mimish⁴  Asif Malik⁵  Abdelfatah A. Elasfar⁶  Saleh Al Ghamdi⁷  Ahmed Abuosa⁸  Gamal A. Hussein⁹  Abdullah Ghabashi^1,10  Ali Almasood^1,11 

[1] Armed Forces Hospital Southern Region, Khamis Mushayt, Saudi Arabia;Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia;Department of Cardiac Sciences, College of Medicine, King Saud University, Riyadh, Saudi Arabia;Cardiac Sciences, King Khalid University Hospital, College of Medicine, King Saud University, P.O. Box 7805, 11472, Riyadh, Saudi Arabia;King Abdulaziz University Hospital, King Abdulaziz University, Jeddah, Saudi Arabia;King Fahad General Hospital, Jeddah, Saudi Arabia;King Salman Heart Center, King Fahd Medical City, Riyadh, Saudi Arabia;Madina Cardiac Center, Al Madina Al Monaoarah, Saudi Arabia;National Guard Hospital, Jeddah, Saudi Arabia;North West Armed Forces Hospital, Tabuk, Saudi Arabia;Prince Sultan Cardiac Center, Hafouf, Saudi Arabia;Prince Sultan Cardiac Center, Riyadh, Saudi Arabia;

关键词: Heart failure complications/mortality/physiopathology;    Acute coronary syndrome complications/mortality/physiopathology;    Hospital Mortality;    Saudi Arabia/epidemiology;    Prospective Studies;   

DOI  :  10.1186/s12872-016-0267-6

 received in 2015-10-23, accepted in 2016-04-29,  发布年份 2016

来源: Springer

【 摘 要 】

BackgroundLittle is know about the outcomes of acute heart failure (AHF) with acute coronary syndrome (ACS-AHF), compared to those without ACS (NACS-AHF).MethodsWe conducted a prospective registry of AHF patients involving 18 hospitals in Saudi Arabia between October 2009 and December 2010. In this sub-study, we compared the clinical correlates, management and hospital course, as well as short, and long-term outcomes between AHF patients with and without ACS.ResultsOf the 2609 AHF patients enrolled, 27.8 % presented with ACS. Compared to NACS-AHF patients, ACS-AHF patients were more likely to be old males (Mean age = 62.7 vs. 60.8 years, p = 0.003, and 73.8 % vs. 62.7 %, p < 0.001, respectively), and to present with De-novo heart failure (56.6 % vs. 28.1 %, p < 0.001). Additionally they were more likely to have history of ischemic heart disease, diabetes, dyslipidemia, and less likely to have chronic kidney disease (p < 0.001 for all comparisons). The prevalence of severe LV systolic dysfunction (EF < 30 %) was higher in ACS-AHF patients. During hospital stay, ACS-AHF patients were more likely to develop shock (p < 0.001), recurrent heart failure (p = 0.02) and needed more mechanical ventilation (p < 0.001). β blockers and Angiotensin Converting Enzyme inhibitors were used more often in ACS-AHF patients (p = 0.001 and, p = 0.004 respectively). ACS- AHF patients underwent more coronary angiography and had higher prevalence of multi-vessel coronary artery disease (p < 0.001 for all comparisons). The unadjusted hospital and one-month mortality were higher in ACS-AHF patients (OR = 1.6 (1.2–2.2), p = 0.003 and 1.4 (1.0–1.9), p = 0.026 respectively). A significant interaction existed between the level of left ventricular ejection fraction and ACS-AHF status. After adjustment, ACS-AHF status was only significantly associated with hospital mortality (OR = 1.6 (1.1–2.4), p = 0.019). The three-years survival following hospital discharge was not different between the two groups.ConclusionAHF patients presenting with ACS had worse hospital prognosis, and an equivalent long-term survival compared to AHF patients without ACS. These findings underscore the importance of timely recognition and management of AHF patients with concomitant ACS given their distinct presentation and underlying pathophysiology compared to other AHF patients.

【 授权许可】

CC BY   
© AlFaleh et al. 2016