Author + information
- Received December 18, 2012
- Revision received January 29, 2013
- Accepted February 12, 2013
- Published online June 1, 2013.
- Maria Cecilia Bahit, MD∗,
- Renato D. Lopes, MD, PhD†∗ (, )
- Robert M. Clare, MS†,
- L. Kristin Newby, MD, MHS†,
- Karen S. Pieper, MS†,
- Frans Van de Werf, MD, PhD‡,
- Paul W. Armstrong, MD§,
- Kenneth W. Mahaffey, MD†,
- Robert A. Harrington, MD‖,
- Rafael Diaz, MD¶,
- E. Magnus Ohman, MD†,
- Harvey D. White, DSc#,
- Stefan James, MD, PhD∗∗ and
- Christopher B. Granger, MD†
- ↵∗Reprint requests and correspondence:
Dr. Renato D. Lopes, Duke Clinical Research Institute, Duke University Medical Center, Box 3850, 2400 Pratt Street, Room 0311 Terrace Level, Durham, North Carolina 27705.
Objectives This study sought to describe the occurrence and timing of heart failure (HF), associated clinical factors, and 30-day outcomes in patients with non–ST-segment elevation acute coronary syndromes (NSTE-ACS).
Background Little is known about HF-complicating NSTE-ACS.
Methods Using pooled patient-level data from 7 clinical trials from 1994 to 2008, we describe the occurrence and timing of HF, associated clinical factors, and 30-day outcomes in NSTE-ACS patients. HF at presentation was defined as Killip classes II to III; patients with Killip class IV or cardiogenic shock were excluded. New in-hospital cases of HF included new pulmonary edema. After adjusting for baseline variables, we created logistic regression models to identify clinical factors associated with HF at presentation and to determine the association between HF and 30-day mortality.
Results Of 46,519 NSTE-ACS patients, 4,910 (10.6%) had HF at presentation. Of the 41,609 with no HF at presentation, 1,194 (2.9%) developed HF during hospitalization. A total of 40,415 (86.9%) had no HF at any time. Patients presenting with or developing HF during hospitalization were older, more often female, and had a higher risk of death at 30 days than patients without HF (adjusted odds ratio [OR]: 1.74; 95% confidence interval: 1.35 to 2.26). Older age, higher presenting heart rate, diabetes, prior myocardial infarction (MI), and enrolling MI were significantly associated with HF during hospitalization.
Conclusions In this large cohort of NSTE-ACS patients, presenting with or developing HF during hospitalization was associated with an increased risk of 30-day mortality. Research targeting new strategies to prevent and manage HF in this high-risk population is needed.
This work was supported internally by the Duke Clinical Research Institute. Dr. Lopes has a financial relationship with Bristol-Myers Squibb. Dr. Newby is a consultant to AstraZeneca, Biosite Inc., Biosite Diagnostics, CV Therapeutics, Daiichi Sankyo, Mosby, Novartis Pharmaceutical Company, Proctor and Gamble, Roche Diagnostic Corp., and Scios; and has received grant support from Adolor Corporation, AstraZeneca, BG Medicine, Bisoite Inc., Biosite Diagnostics, Bristol-Myers Squibb, Medicure, Sanofi-Aventis, and Schering Plough Corporation. Dr. Mahaffey has financial relationships with Amylin, AstraZeneca, Baxter, Cordis, Eli Lilly, GlaxoSmithKline, Ikaria, Johnson & Johnson, Luipold, Medtronic, Merck, Novartis, Pozen, Regado, Roche Diagnostic, Schering-Plough, Abbott Vascular, Amgen, Boehringer Ingleheim, Cubist PharmaCeuticals, Daiichi Sankyo, Edwards Lifesciences, Guidant, Portola, Novartis, Sanofi, The Medicines Company, Adolor, Bayer Healthcare, Bristol-Myers Squibb, Exeter Group, Genentech, Orexigen, Ortho McNeill, WebMD, Elsevier, Biotronik, Forest, Gilead Science, Pfizer, Polymedix, St. Jude Medical, Dialouges, Haemonetics, Johns Hopkins University, South East Area Health Education Center, and Sun Pharma. Dr. Ohman is a consultant for AstraZeneca, Boehringer-Ingelheim, Bristol-Myers Squibb, Gilead Sciences, Janssen Pharmaceuticals, Liposcience, Merck, Pozen Inc., Roche, Sanofi-Aventis, The Medicines Co., and WebMD; and has received research grants from Daiichi Sankyo, Eli Lilly & Co., and Gilead Sciences. Dr. White has financial relationships with Aventis, Eli Lilly, The Medicines Company, U.S. National Institutes of Health, Pfizer, Roche, Johnson & Johnson, Schering-Plough, Merck Sharpe & Dohme, Astra Zeneca, GlaxoSmithKline, Daiichi Sankyo Pharma Development, and Bristol-Myers Squibb. Dr. Granger has financial relationships with Boehringer Ingelheim, Bristol-Myers Squibb, GlaxoSmithKline, Hoffmann-La Roche, Lilly, Pfizer, Sanofi-Aventis, Takeda, The Medicines Company, and AstraZeneca. Anthony N. DeMaria, MD, acted as Guest Editor for this article.
- Received December 18, 2012.
- Revision received January 29, 2013.
- Accepted February 12, 2013.
- American College of Cardiology Foundation