Outcomes of acute heart failure associated with acute coronary syndrome versus other causes

Abstract

Background: By and large, prior registries and randomized trials have not distinguished between acute heart failure (AHF) associated with acute coronary syndrome (ACS) versus other causes.

Aims: To examine whether the treatments and outcomes of ACS-associated AHF are different from non-ACS-associated AHF.

Methods: We examined in a prospective, nationwide hospital-based survey the adjusted outcomes of AHF patients with and without ACS as its principal cause.

Results: Of the 4102 patients in our national heart failure survey, 2336 (56.9%) had AHF, of whom 923 (39.5%) had ACS-associated AHF. These patients were more likely to receive intravenous inotropes and vasodilators and to undergo coronary angiography and revascularization, but less likely to receive intravenous diuretics. The unadjusted in-hospital, 30-day, one-year, and four-year mortality rates for AHF patients with or without ACS were 6.5% versus 5.0% (P = 0.13), 10.3% versus 7.5% (P = 0.02), 26.6% versus 31.0% (P = 0.02), and 55.3% versus 63.3% (P = 0.0001), respectively. In the multivariate analysis, the adjusted mortality risk for patients with ACS at the respective time points were 1.46 (0.99–2.10), 1.67 (1.22–2.30), 1.02 (0.86–1.20), and 0.93 (0.82–1.04).

Conclusions: Patients with ACS-associated AHF seem to have a unique clinical course and perhaps should be distinguished from other AHF patients in future trials and registries.

Keywords::

• Acute heart failure
• acute coronary syndrome
• outcome

Declaration of interest: The authors report no conflicts of interest. The authors alone are responsible for the writing and content of the paper.