Open AccessRecovery free of heart failure after acute coronary syndrome and coronary revascularization
Author(s) -
Falkenham Alec,
Saraswat Manoj K.,
Wong Chloe,
Gawdat Kareem,
Myers Tanya,
Begum Jahanara,
Buth Karen J.,
Haidl Ian,
Marshall Jean,
Légaré JeanFrancois
Publication year - 2018
Publication title -
esc heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.787
H-Index - 25
ISSN - 2055-5822
DOI - 10.1002/ehf2.12197
Subject(s) - medicine , hazard ratio , cardiology , heart failure , acute coronary syndrome , atrial fibrillation , proportional hazards model , coronary artery disease , revascularization , prospective cohort study , myocardial infarction , confidence interval
Aims Previous studies have examined risk factors for the development of heart failure (HF) subsequent to acute coronary syndrome (ACS). Our study seeks to clarify the clinical variables that best characterize patients who remain free from HF after coronary artery bypass grafting (CABG) surgery for ACS to determine novel biological factors favouring freedom from HF in prospective translational studies. Methods and results Nova Scotia residents (1995–2012) undergoing CABG within 3 weeks of ACS were included. The primary outcome was freedom from readmission to hospital due to HF. Descriptive statistics were generated, and a Cox proportional hazards model assessed outcome with adjustment for clinical characteristics. Of 11 936 Nova Scotians who underwent isolated CABG, 3264 (27%) had a recent ACS and were included. Deaths occurred in 210 (6%) of subjects prior to discharge. A total of 3054 patients were included in the long‐term analysis. During follow‐up, HF necessitating readmission occurred in 688 (21%) subjects with a hazard ratio of 12% at 2 years. The adjusted Cox model demonstrated significantly better freedom from HF for younger, male subjects without metabolic syndrome and no history of chronic obstructive pulmonary disease, renal insufficiency, atrial fibrillation, or HF. Conclusions Our findings have outlined important clinical variables that predict freedom from HF. Furthermore, we have shown that 12% of patients undergoing CABG after ACS develop HF (2 years). Our findings support our next phase in which we plan to prospectively collect blood and tissue specimens from ACS patients undergoing CABG in order to determine novel biological mechanism(s) that favour resolution of post‐ACS inflammation.