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Prevalence and prognostic impact of left ventricular systolic dysfunction or pulmonary congestion after acute myocardial infarction

Hamilton, Eleonora ; Desta, Liyew ; Lundberg, Anna ; Alfredsson, Joakim ; Christersson, Christina ; Erlinge, David LU orcid ; Kellerth, Thomas ; Lindmark, Krister ; Omerovic, Elmir and Reitan, Christian LU , et al. (2023) In ESC Heart Failure 10(2). p.1347-1357
Abstract

Aims: The aim was to describe the prevalence, characteristics, and outcome of patients with acute myocardial infarction (MI) developing left ventricular (LV) systolic dysfunction or pulmonary congestion by applying different criteria to define the population. Methods and results: In patients with MI included in the Swedish web-system for enhancement and development of evidence-based care in heart disease (SWEDEHEART) registry, four different sets of criteria were applied, creating four not mutually exclusive subsets of patients: patients with MI and ejection fraction (EF) < 50% and/or pulmonary congestion (subset 1); EF < 40% and/or pulmonary congestion (subset 2); EF < 40% and/or pulmonary congestion and at least one high-risk... (More)

Aims: The aim was to describe the prevalence, characteristics, and outcome of patients with acute myocardial infarction (MI) developing left ventricular (LV) systolic dysfunction or pulmonary congestion by applying different criteria to define the population. Methods and results: In patients with MI included in the Swedish web-system for enhancement and development of evidence-based care in heart disease (SWEDEHEART) registry, four different sets of criteria were applied, creating four not mutually exclusive subsets of patients: patients with MI and ejection fraction (EF) < 50% and/or pulmonary congestion (subset 1); EF < 40% and/or pulmonary congestion (subset 2); EF < 40% and/or pulmonary congestion and at least one high-risk feature (subset 3, PARADISE-MI like); and EF < 50% and no diabetes mellitus (subset 4, DAPA-MI like). Subsets 1, 2, 3, and 4 constituted 31.6%, 15.0%, 12.8%, and 22.8% of all patients with MI (n = 87 177), respectively. The age and prevalence of different co-morbidities varied between subsets. For median age, 70 to 77, for diabetes mellitus, 22 to 33%; for chronic kidney disease, 22 to 38%, for prior MI, 17 to 21%, for atrial fibrillation, 7 to 14%, and for ST-elevations, 38 to 50%. The cumulative incidence of death or heart failure hospitalization at 3 years was 17.4% (95% CI: 17.1–17.7%) in all MIs; 26.9% (26.3–27.4%) in subset 1; 37.6% (36.7–38.5%) in subset 2; 41.8% (40.7–42.8%) in subset 3; and 22.6% (22.0–23.2%) in subset 4. Conclusions: Depending on the definition, LV systolic dysfunction or pulmonary congestion is present in 13–32% of all patients with MI and is associated with a two to three times higher risk of subsequent death or HF admission. There is a need to optimize management and improve outcomes for this high-risk population.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Heart failure, Left ventricular dysfunction, Mortality, Myocardial infarction, Prevalence
in
ESC Heart Failure
volume
10
issue
2
pages
1347 - 1357
publisher
John Wiley & Sons Inc.
external identifiers
  • scopus:85147179498
  • pmid:36732932
ISSN
2055-5822
DOI
10.1002/ehf2.14301
language
English
LU publication?
yes
id
fe07f506-18d5-4cf3-bd79-8da856b636f4
date added to LUP
2023-02-13 09:31:05
date last changed
2024-04-18 18:14:26
@article{fe07f506-18d5-4cf3-bd79-8da856b636f4,
  abstract     = {{<p>Aims: The aim was to describe the prevalence, characteristics, and outcome of patients with acute myocardial infarction (MI) developing left ventricular (LV) systolic dysfunction or pulmonary congestion by applying different criteria to define the population. Methods and results: In patients with MI included in the Swedish web-system for enhancement and development of evidence-based care in heart disease (SWEDEHEART) registry, four different sets of criteria were applied, creating four not mutually exclusive subsets of patients: patients with MI and ejection fraction (EF) &lt; 50% and/or pulmonary congestion (subset 1); EF &lt; 40% and/or pulmonary congestion (subset 2); EF &lt; 40% and/or pulmonary congestion and at least one high-risk feature (subset 3, PARADISE-MI like); and EF &lt; 50% and no diabetes mellitus (subset 4, DAPA-MI like). Subsets 1, 2, 3, and 4 constituted 31.6%, 15.0%, 12.8%, and 22.8% of all patients with MI (n = 87 177), respectively. The age and prevalence of different co-morbidities varied between subsets. For median age, 70 to 77, for diabetes mellitus, 22 to 33%; for chronic kidney disease, 22 to 38%, for prior MI, 17 to 21%, for atrial fibrillation, 7 to 14%, and for ST-elevations, 38 to 50%. The cumulative incidence of death or heart failure hospitalization at 3 years was 17.4% (95% CI: 17.1–17.7%) in all MIs; 26.9% (26.3–27.4%) in subset 1; 37.6% (36.7–38.5%) in subset 2; 41.8% (40.7–42.8%) in subset 3; and 22.6% (22.0–23.2%) in subset 4. Conclusions: Depending on the definition, LV systolic dysfunction or pulmonary congestion is present in 13–32% of all patients with MI and is associated with a two to three times higher risk of subsequent death or HF admission. There is a need to optimize management and improve outcomes for this high-risk population.</p>}},
  author       = {{Hamilton, Eleonora and Desta, Liyew and Lundberg, Anna and Alfredsson, Joakim and Christersson, Christina and Erlinge, David and Kellerth, Thomas and Lindmark, Krister and Omerovic, Elmir and Reitan, Christian and Jernberg, Tomas}},
  issn         = {{2055-5822}},
  keywords     = {{Heart failure; Left ventricular dysfunction; Mortality; Myocardial infarction; Prevalence}},
  language     = {{eng}},
  number       = {{2}},
  pages        = {{1347--1357}},
  publisher    = {{John Wiley & Sons Inc.}},
  series       = {{ESC Heart Failure}},
  title        = {{Prevalence and prognostic impact of left ventricular systolic dysfunction or pulmonary congestion after acute myocardial infarction}},
  url          = {{http://dx.doi.org/10.1002/ehf2.14301}},
  doi          = {{10.1002/ehf2.14301}},
  volume       = {{10}},
  year         = {{2023}},
}