Copyright © 2004 by the European Society of Cardiology.
Clinical research
Severity of heart failure, treatments, and outcomes after fibrinolysis in patients with ST-elevation myocardial infarction
a Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
b TIMI Study Group, Brigham and Women's Hospital, Cardiovascular Medicine, 350 Longwood Avenue, 1st Floor Offices, Boston, MA 02115, USA
Received February 5, 2004;
revised April 28, 2004;
accepted May 5, 2004
* Corresponding author. Tel.: +1-617-278-0145; fax: +1-617-734-7329
rgiugliano{at}partners.org
Aims To define the clinical characteristics, co-morbidities, treatment, and clinical outcomes of patients with varying degrees of heart failure (HF) complicating ST-elevation myocardial infarction (STEMI), and to identify patients at high risk for HF following fibrinolysis.
Methods and results 15,078 STEMI patients enrolled in a worldwide fibrinolytic trial (InTIME-II) were categorised into one of four hierarchical, mutually exclusive groups of HF: shock (
, 5%); severe HF (
, 7%); mild HF (
, 11%); no HF (
, 77%). In a multivariable 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-day mortality was sixfold higher for patients with HF (18.9% vs. 3.1%, 
), these patients were less likely to undergo angiography (30% vs. 40%, ) and revascularisation (19% vs. 25%, ), than patients without HF. Likewise, angiotensin-inhibitors and ß-blockers were not optimally utilised in patients with HF following MI.
Conclusions During the index admission following fibrinolysis 23% of patients had HF. Despite a higher risk profile, patients with more severe HF were treated less aggressively than patients without HF.
Key Words: Heart failure • Acute myocardial infarction • STEMI • Fibrinolysis • Revascularisation • Cardiogenic shock
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