Heart failure in patients with non ST elevation acute coronary syndromes: clinical landscape, predictors and in-hospital outcomes

Abstract

Funding Acknowledgements Type of funding sources: None. Background Heart failure(HF) in patients with NSTE-ACS is associated with high mortality and morbidity, it is needed to identify patients who are at risk for developing this complication to guide the management strategy. Little is known about patientsꞌ baseline characteristics and predictors of HF complicating NSTE-ACS particularly in Middle East. Purpose To determine the prevalence of heart failure in NSTE-ACs and to study its predictors and in-hospital outcomes. Methods The study prospectively included admitted patients with NSTE-ACS and identified those who developed HF during index hospitalization. HF is defined in this study as either clinical HF (KILLIP class≥2) or by echocardiographic evidence of left ventricular dysfunction (EF < 50%). Patients data were collected including demographics and investigation results. Predictors of clinical HF during hospitalization were evaluated using multivariate regression analysis. Besides HF; other In- hospital outcomes including death or stroke were recorded. Results A total of 280 patients with NSTE-ACS were enrolled in the study, among whom 96 patients (34.28%) had evidence of HF during hospitalization (either clinical or echocardiographic), clinical HF (KILLIP class≥2) was evident in 55 patients (56.25%). Baseline characteristics of patients with HF were as following: males (78.2%) and females (21.8%), they had HT, IHD, DM and smoking in 67.77%, 65.56%, 56.2% and 27% respectively, history of prior revascularization (PCI or CABG) reported in 21.8%. At presentation: Dyspnoea reported in 56.25%, mean HR was 89.3 ± 22.6, mean SBP was 135.78 ± 25.05. Serum troponin was positive in 56.25%, mean EF was 40.64 ± 6.9, preserved EF with clinical evidence of HF recorded in 7.29%. Main predictors of clinical HF (KILLIP class≥2) during index hospitalization were dyspnoea at presentation, EF < 50%, high GRACE risk score >140. Main arrhythmia reported in HF patients were AF in 10.4%, frequent PVCs in 7.29%, VT/VF in 4.16% CHB in 1.04%. In-hospital mortality of HF patients was 4.16% and stroke developed in 2.08% of patients. Conclusion Heart failure in the context of NSTE-ACS tend to occur in patients with other comorbidities like hypertension and prior IHD and in those with higher risk class at presentation. Looking forward; particularly in emerging countries; further researches are crucial to provide predictors for early recognition of those at higher risk for this complication and to guide therapy plan accordingly in order to optimise patientsꞌ outcomes. Abstract Figure.

To determine the frequency of triple vessel coronary artery disease in patients admitted with acute coronary syndrome.

“…18 The patients having raised GRACE and TIMI have more association to significant angiographic lesion along with increased CABG referral in comparison to low risk patients. 19…”