Incidencia y factores predictores de desarrollo de insuficiencia cardíaca tras un síndrome coronario agudo

Abstract

Introduction: The incidence of heart failure (HF) has increased exponentially in recent decades and its main cause is coronary heart disease. Acute coronary syndrome (ACS) is the most frequent form of presentation of coronary disease. After an ACS, the incidence of HF increases up to 30%. The development of in-hospital HF during ACS is one of the factors associated with the development of HF after hospital discharge. The development of HF as a complication of ACS significantly worsens the prognosis. However, despite the many advances in the treatment of ACS, there is still a high incidence of HF in patients with ACS in our population. There are clinical, analytical, echocardiographic, and coronary angiographic determinants that help estimate the risk of HF in patients with ACS. Therefore, we believe it is important to determine the factors associated with the appearance of HF after ACS both during hospitalization for ACS and after hospital discharge in unselected patients in our environment and to clarify how HF modifies the natural history of the disease. Aims: (1) To determine the incidence and temporal evolution of the in-hospital HF event and HF in the first year of follow-up after discharge in patients admitted for ACS. (2) To describe the characteristics of the patients who develop the in-hospital HF event and are admitted for HF in the first year of follow-up after discharge in patients admitted for ACS. (3) To identify the factors associated with the development of the in-hospital HF event and admission for HF in the first year of follow-up after discharge in patients admitted for ACS. (4) To assess the impact on in-hospital mortality and in the first year of follow-up after discharge from the in-hospital HF event in patients admitted for ACS. Methods: Observational unicentre study with 2966 admissions due to ACS (2533 patients) between January 2011 and December 2019. No exclusion criteria were included. Results: The incidence of in-hospital HF was 22.7%. Patients who developed in-hospital HF after an ACS showed different characteristics from patients who did not develop this complication. During the first year of follow-up after ACS, the incidence rate of admissions for HF was 6.4 admissions per 100 patient-years. The incidence of HF, both in-hospital and after hospital discharge, remained stable throughout the study period. We have identified multiple factors that are independently associated with the development of intrahospital HF and after hospital discharge. Conclusions: The development of HF as a complication of ACS, both in-hospital and after hospital discharge, is frequent. The development of in-hospital HF after an ACS is independently associated with an increased risk of mortality both during admission and during the first year of follow-up after discharge.