Aim of this study will be to analyze incidence, predictors and prognosis of de-novo heart failure occurring at 12 months follow-up in the subset of patients with left ventricular ejection fraction >50% after ST-elevation acute myocardial infarction (STEMI) and without history of previous heart failure (HF). The large database of "Acute Myocardial Infarction Cardiac Imaging" (AMICI) trial will be analyzed. This is a multicentre, prospective, longitudinal study conducted in a cohort of acute STEMI patients studied with cardiac magnetic resonance (CMR). Between May 2005 and May 2014, 512 acute STEMI patients from three tertiary referral centres [244 at University Hospitals Leuven, Leuven, Belgium (Centre A), 157 at La Sapienza University Hospital, Rome, Italy (Centre B), and 111 at Fondazione G. Monasterio, Pisa, Italy (Centre C)] were screened for study enrolment
Inclusion Criteria: All patients consecutively admitted to the cardiology departments of our tertiary hospitals, undergoing primary PCI for ST-segment elevation myocardial infarction, in which cardiac MR was performed within 5 days from admission. Only patients with LVEF > 50% after STEMI and without history of previous HF will be included in this study.
Exclusion Criteria:Patients died in hospital and those with no data on vital status and/or on HF status during follow-up, patients with history of HF, Killip III at admission, in-hospital HF, LVEF
Clinical Endpoints:
- Primary endpoint:
Incidence and determinants of de novo HF at 1 year follow-up
- Secondary endpoints:
- Major adverse coronary events at 1 year follow-up in patients with normal LVEF after STEMI
- Incidence and determinants of LV remodeling at 1 year follow up in these subset of patients
Improvements in the treatment of acute myocardial infarction (AMI), especially use of reperfusion therapy, have led to larger numbers of survivors. In patients who would have survived despite reperfusion therapy, use of this treatment should lead to greater myocardial salvage and a reduced extent of ventricular injury in many. The net consequence of this treatment on the early and later risk of developing heart failure after AMI is uncertain. There has been concern, however, that an increasing pool of survivors of AMI might fuel an epidemic of heart failure. Although we have a substantial amount of data on the rates
of heart failure overall, rates of heart failure after AMI have been less well studied. Furthermore, the clinical trials, registries and epidemiological studies that have reported the rate of heart failure after AMI have used different case ascertainment and diagnostic criteria. Registries provide further confirmation that this complication of AMI is common occurring in about 20% of individuals at admission with about 8% developing heart failure subsequently. The Valsartan in Acute Myocardial Infarction trial (VALIANT) registry of 5566 patients with AMI admitted to 84 hospitals in 9 countries, reported that heart failure after admission occurred in 23% of patients, with 24% being discharged on a diuretic. These clinical trials and registries, despite methodological differences, tend to agree that heart failure is a common occurrence after AMI and we will continue to see this complication despite the changes in the epidemiology of acute coronary syndromes. Clearly, reducing the incidence of HF is an important goal of treating myocardial infarction because it may improve well-being as well as extend life. In most patients in whom HF develops after a myocardial infarction, it occurs shortly after an initial or recurrent coronary event, suggesting these as possible therapeutic targets. It may be premature to declare the battle against heart failure after myocardial infarction as lost. Continued vigilance on this front and further robust studies will be required to monitor the impact of beneficial therapies on rates of heart failure after AMI if we are to win the war on heart failure.