Prognostic impact of treatment patterns of in-hospital heart failure on clinical outcomes after myocardial infarction

BACKGROUND: Heart failure is a common complication after acute myocardial infarction (AMI). However, the prognostic impact of patterns of heart failure management during hospitalization remains unclear. METHODS: This multicenter, retrospective study included 2426 patients with AMI undergoing percutaneous coronary intervention. Patients were categorized into three groups: no intravenous (i.v.) heart failure treatment (patients received neither i.v. diuretics nor inotropes/vasopressors), diuretics only (diuretics without inotropes/vasopressors), and inotropes (inotropes/vasopressors with or without diuretics) groups. The primary endpoints included all-cause death during hospitalization and a composite of all-cause death and heart failure rehospitalization after discharge. RESULTS: Overall, 646 patients (26.6%) developed in-hospital heart failure. During hospitalization, the mortality rate was higher in the inotropes group (34.9%), followed by the diuretics only group (5.9%) and the no i.v. heart failure treatment group (2.2%) (P < 0.001). During a median follow-up of 535 days, 196 (9.7%) patients developed the primary endpoint after discharge. A composite of all-cause death and heart failure rehospitalization occurred in 6.5% of the no i.v. heart failure treatment group, while those in the diuretics group (21.2%) and inotropes group (24.3%) had a similar risk of the primary endpoint. CONCLUSION: Heart failure events requiring i.v. treatments during hospitalization were associated with an increased in-hospital mortality, particularly in those treated with inotropes in patients with AMI. Among patients who were discharged alive, however, long-term outcomes did not differ significantly between patients treated with diuretics only and inotropes.