摘要
Aims To define the clinical characteristics, co morbidities, treatment, and c linical outcomes of patients with varying degrees of heart failure(HF) complicat ing ST elevation myocardial infarction (STEMI), and to identify patients at hig h risk for HF following fibrinolysis. Methods and results 15,078 STEMI patients enrolled in a worldwide fibrinolytic trial (InTIME II) were categorised into on e of four hierarchical, mutually exclusive groups of HF: shock (n=719, 5%); sev ere HF (n=1082, 7%); mild HF (n=1619, 11%); no HF (n=11,658, 77%). In a multi variable model, anterior MI (OR 1.8, 95%CI [1.6; 1.9]), age ≥65 (OR 1.8 [1. 6; 2.0]), prior HF (OR 3.3 [2.6; 4.2]), and creatinine clearance< 60 mL/min (OR 1.8 [1.6; 2.1]) were the four most powerful correlates of HF. Although 30-daymor ta litywas sixfold higher for patients with HF(18.9%vs. 3.1%, p< 0.0001), these p atients were less likely to undergo angiography(30%vs. 40%, p< 0.0001) and rev ascularisation(19%vs. 25%, p< 0.0001), than patients without HF. Likewise, ang iotensin inhibitors and β blockers were not optimally utilised in patients wi th HF following MI. ConclusionsDuring the index admission following fibrinolysis 23%of patients had HF. Despite a higher risk profile, patients with more sever e HF were treated less aggressively than patients without HF.
Aims To define the clinical characteristics, co morbidities, treatment, and c linical outcomes of patients with varying degrees of heart failure(HF) complicat ing ST elevation myocardial infarction (STEMI), and to identify patients at hig h risk for HF following fibrinolysis. Methods and results 15,078 STEMI patients enrolled in a worldwide fibrinolytic trial (InTIME II) were categorised into on e of four hierarchical, mutually exclusive groups of HF: shock (n=719, 5%); sev ere HF (n=1082, 7%); mild HF (n=1619, 11%); no HF (n=11,658, 77%). In a multi variable model, anterior MI (OR 1.8, 95%CI [1.6; 1.9]), age ≥65 (OR 1.8 [1. 6; 2.0]), prior HF (OR 3.3 [2.6; 4.2]), and creatinine clearance< 60 mL/min (OR 1.8 [1.6; 2.1]) were the four most powerful correlates of HF. Although 30-daymor ta litywas sixfold higher for patients with HF(18.9%vs. 3.1%, p< 0.0001), these p atients were less likely to undergo angiography(30%vs. 40%, p< 0.0001) and rev ascularisation(19%vs. 25%, p< 0.0001), than patients without HF. Likewise, ang iotensin inhibitors and β blockers were not optimally utilised in patients wi th HF following MI. ConclusionsDuring the index admission following fibrinolysis 23%of patients had HF. Despite a higher risk profile, patients with more sever e HF were treated less aggressively than patients without HF.
