In-hospital outcomes of percutaneous coronary intervention in acute coronary syndrome patients with heart failure: a real-world observational study from the CCC-ACS registry

Acute coronary syndrome (ACS) is a leading cause of heart failure (HF). However, the association between percutaneous coronary intervention (PCI) and in-hospital outcomes among ACS patients with varying degrees of left ventricular ejection fraction (LVEF) and HF remains unclear. This prospective nationwide registry study included 4,694 ACS patients with HF (ACS-HF) at admission. Patients were categorized into three subgroups according to LVEF and stratified by PCI receipt during hospitalization. The primary outcome was all-cause death, and the secondary outcome was major adverse cardiovascular and cerebrovascular events (MACCE). PCI was associated with a lower risk of in-hospital all-cause death (HR, 0.52; 95% CI, 0.38–0.72; P < 0.001) and MACCE (HR, 0.62; 95% CI, 0.48–0.81; P < 0.001) before propensity score matching (PSM), particularly in ACS-HFmrEF and ACS-HFpEF subgroups. After PSM, PCI remained associated with a lower risk of all-cause death (HR, 0.65; 95% CI, 0.45–0.93; P = 0.018) and MACCE (HR, 0.65; 95% CI, 0.48–0.88; P = 0.005) in the overall ACS-HF cohort. However, in ACS-HFrEF patients, the association between PCI and outcomes was not statistically significant for all-cause death (HR, 0.82; 95% CI, 0.47–1.42; P = 0.481) or MACCE (HR, 0.77; 95% CI, 0.48–1.23; P = 0.267). In this large, nationwide registry, PCI was associated with more favorable short-term, in-hospital outcomes in ACS patients with HF, especially among those with preserved or mildly reduced EF. No significant association was observed in ACS-HFrEF patients, highlighting the need for further prospective studies to clarify the underlying mechanisms and long-term impact. ClinicalTrials.gov Identifier: NCT02306616. Central Illustration: In-hospital outcomes of percutaneous coronary intervention in acute coronary syndrome patients with different ejection fraction–based heart failure phenotypes. This figure illustrates the in-hospital outcomes of percutaneous coronary intervention (PCI) among patients with acute coronary syndrome (ACS) across different heart failure (HF) phenotypes after propensity score matching (PSM). It presents the cumulative incidence of all-cause death and major adverse cardiovascular and cerebrovascular events (MACCE) across three left ventricular ejection fraction (LVEF) categories: heart failure with reduced ejection fraction (HFrEF, LVEF≤40%), mildly reduced ejection fraction (HFmrEF, LVEF 41–49%), and preserved ejection fraction (HFpEF, LVEF ≥50%). PCI was associated with lower in-hospital mortality and MACCE in patients with HFmrEF and HFpEF, whereas no significant difference was observed in those with HFrEF. (Abbreviations: PCI, percutaneous coronary intervention; MACCE, major adverse cardiovascular and cerebrovascular events; LVEF, left ventricular ejection fraction; HFrEF, heart failure with reduced ejection fraction; HFmrEF, heart failure with mildly reduced ejection fraction; HFpEF, heart failure with preserved ejection fraction.)