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Aims To define the clinical characteristics, co morbidities, treatment, and c linical outcomes of patients with varying degrees of heart failure(HF) complicat ing ST elevation myocardial infarction (STEMI), and to identify patients at hig h risk for HF following fibrinolysis. Methods and results 15,078 STEMI patients enrolled in a worldwide fibrinolytic trial (InTIME II) were categorised into on e of four hierarchical, mutually exclusive groups of HF: shock (n=719, 5%); sev ere HF (n=1082, 7%); mild HF (n=1619, 11%); no HF (n=11,658, 77%). In a multi variable model, anterior MI (OR 1.8, 95%CI [1.6; 1.9]), age ≥65 (OR 1.8 [1. 6; 2.0]), prior HF (OR 3.3 [2.6; 4.2]), and creatinine clearance< 60 mL/min (OR 1.8 [1.6; 2.1]) were the four most powerful correlates of HF. Although 30-daymor ta litywas sixfold higher for patients with HF(18.9%vs. 3.1%, p< 0.0001), these p atients were less likely to undergo angiography(30%vs. 40%, p< 0.0001) and rev ascularisation(19%vs. 25%, p< 0.0001), than patients without HF. Likewise, ang iotensin inhibitors and β blockers were not optimally utilised in patients wi th HF following MI. ConclusionsDuring the index admission following fibrinolysis 23%of patients had HF. Despite a higher risk profile, patients with more sever e HF were treated less aggressively than patients without HF.
Aims To define the clinical characteristics, co morbidities, treatment, and cinical outcomes of patients with varying degrees of heart failure (HF) complicating ST elevation myocardial infarction (STEMI), and to identify patients at hig h risk for HF following fibrinolysis. Methods and results 15,078 STEMI patients enrolled in a worldwide fibrinolytic trial (InTIME II) were categorized into on e of four hierarchical, mutually exclusive groups of HF: shock (n = 719, 5%); sevre HF (n = 1082, 7 no HF (n = 11,658, 77%). In a multi-variable model, anterior MI (OR 1.8, 95% CI [1.6; 1.9]), age ≥65 (OR 1.8 [1.6; 2.0]), prior HF (OR 3.3 [2.6; 4.2]) and creatinine clearance <60 mL / min (OR 1.8 [1.6; 2.1]) were the four most powerful correlates of HF. These patients were less likely to undergo angiography (30% vs. 40%, p <0.0001) and rev ascularisation (30.9% vs 3.1%, p < 19% vs. 25%, p <0.0001), than Patients without HF. Likewise, angiotensin inhibitors and β blockers were not optimally utilized in patients wi th HF following MI. ConclusionsDuring the index admission following fibrinolysis 23% of patients had HF. Despite a higher risk profile, patients with more sever eHF were treated less aggressively than patients without HF.