Epidemiología de la insuficiencia cardiaca en el infarto de miocardio tratado con angioplastia primaria: análisis de registro Codi IAM

Introduction and objectives: The epidemiology of heart failure (HF) that complicates ST-segment elevation myocardial infarction (STEMI) is not well defined. Our aim was to analyze the epidemiology and prognosis of HF that complicates STEMI treated with primary percutaneous coronary intervention (PCI). Methods: Multicentre registry of 14 070 patients with STEMI treated with primary PCI from January 2010 to December 2015. Results: Patients with HF were older, more frequently female, and diabetic and had chronic ischaemic heart disease. Only 10.3% of patients with STEMI treated with primary PCI had HF on admission and the majority of them had the mildest form (Killip–Kimball II 77.8%). HF was associated with high mortality (30-day mortality was 2.9% of patients in Killip–Kimball I, 9.5% of Killip–Kimball II and 17.4% in Killip–Kimball III, P < .005, and 1-year mortality in patients who survived 30 days was 2.9%, 9.3% and 14.3%, P < .005, respectively). Both the presence of Killip–Kimball class II and III were independently associated with 30-day and 1-year mortality in 30-day survivors. Up to 6% and 15% of patients in Killip–Kimball II and III on admission worsened to cardiogenic shock, and the onset of cardiogenic shock during hospitalization was independently associated with mortality at 30-day and 1-year follow-up. Conclusions: HF complicates 10.3% of patients with STEMI treated with primary PCI and it was associated with a higher risk of developing cardiogenic shock and with 30-day and 1-year mortality in 30-day survivors. In this high-risk population, primary PCI and posterior medical treatment should be prioritized to avoid worsening of HF.