(9) Heart Failure Following ST-Segment Elevation (STEMI) and Non-ST-Segment Elevation Myocardial Infarction (NSTEMI): Incidence, Characteristics and Its Impacts on Mortality in Taiwan

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 683

Presenting Author(s)

HuiMin Chuang
– Taiwan Drug Relief Foundation, Taipei City, Taiwan

Co-Author(s)

Shih-Tsung Huang, PharmD
– Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
Fei-Yuan Hsiao
– Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan (Republic of China)

Background: Heart failure (HF) is a frequent complication following acute myocardial infarction (AMI) and has a significant impact on prognosis of patients survived from AMI. However, studies on the incidence and associated clinical outcomes following ST-segment elevation (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI) are very limited.

Objectives: We aimed to investigate the incidence, characteristics and its impact on mortality of post-AMI HF in both STEMI and NSTEMI patients.

Methods: A nationwide cohort study was conducted using Taiwan’s National Health Insurance Research Database from 2014 to 2019. Patients admitted for incident AMI were included. We further captured cases with documented in-hospital HF or post-discharge HF during the 1-year post-AMI follow-up period. The rate and timing of HF occurrence were assessed. Logistic regression and cox proportional hazard models were adopted to examine the impacts of post-AMI HF on in-hospital and one-year mortality after discharge from the index AMI event, respectively.

Results: A total of 71,489 patients (mean age 66.3±13.2, female 25%) with an incident AMI were identified during 2014 to 2018, in which 9,198 (13%) patients developed in-hospital HF. The proportion of patients developed in-hospital HF was higher in NSTEMI patients (16%) as compared to STEMI patients (10%). Of 55,899 patients survived from the index AMI event and discharged without in-hospital HF, 2,748 (4%) patients were admitted for HF at 1-year of follow-up and the rate of post-discharge HF was comparable in STEMI and NSTEMI (4%). The incidence of HF after AMI was highest in the first month with a decrease afterward. Female gender, older age and NSTEMI were at higher risk of developing post-AMI HF. Noteworthy, post-discharge HF was associated with an increased risk of 1-year mortality in both STEMI(adjusted HR: 2.45, 95%[CI] 2.12-2.80) and NSTEMI (adjusted HR: 2.35, 95% [CI] 2.15-2.57) patients.

Conclusions: Our findings suggest that the proportion of patients developed in-hospital HF was higher in NSTEMI than STEMI patients. As post-AMI HF was associated with increased risk of 1-year mortality, optimizing HF management plan for these patients is crucial.