PREVALENCE AND PREDICTIVE FACTORS OF HEART FAILURE AFTER NON ST SEGMENT ELEVATION MYOCARDIAL INFARCTION

Introduction. Coronary artery disease is the most frequent etiology of heart failure (HF) and the prevalence of HF after ST segment elevation myocardial infarction is estimated between 18 and 37 %. Little is known about the prevalence of HF complicating Non ST Segment Elevation Myocardial Infarction (NSTEMI). The aim of the present study was 1) to establish the proportion of HF patients two years after a NSTEMI and 2) to determine the risk factors associated with this complication.
Méthods. Patients were selected from the RICO survey database. The patients who had been admitted for NSTEMI in the ICU of Dijon hospital between November 2003 and July 2004, who were living in the city of Dijon and its suburbs, and whose LVEF at discharge was >45% were included. Clinical examination, echocardiography and Nt-proBNP level evaluation were performed on average 27 months after the acute coronary syndrome.
Results. 105 patients were included: mean age was 64  1.2 years, 75% were men. At follow up, 14 patients (13%) presented with symptoms of HF. They had a lower LVEF (38  2 vs 60  1 % , p<0.001) and  higher Nt-proBNP levels (1631  706 pg/ml vs 304  87 pg/ml, p < 0,05) than the others. In univariate analysis, factors associated with HF were age (70  4 vs 62  1 yrs, p = 0.045), prior coronary artery bypass (36 vs 9 %, p = 0.016), LVEF on admission (52  2 vs 62  1 %, p < 0.001), lesion of the left anterior descending coronary artery (100 vs 73 %, p = 0.035), glomerular filtration rate (54  6 vs 71  3 ml/min, p = 0.035) and plasma level of Nt-proBNP on admission (356  93 vs 144  44 pg/ml, p <0.001).
Conclusion. HF is a frequent complication of NSTEMI. Nt-proBNP level could help to identify high risk patients for this complication.
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