Heart failure hospitalizations after PCI: a warning sign of ‘exceptionally high risk’
Heart failure hospitalizations after percutaneous coronary intervention (PCI) are associated with an increased risk of long-term mortality, according to new research published in JACC: Cardiovascular Interventions.[1]
“Contemporary clinical guidelines and quality metrics after PCI commonly incorporate nonfatal adverse events (eg, heart failure hospitalization, acute coronary syndrome and major bleeding) into composite endpoints while implicitly conferring equivalent clinical significance to each component,” wrote first author Takahiro Suzuki, MD, a researcher with the department of cardiology at Keio University School of Medicine in Tokyo, and colleagues. “Although this simplification facilitates trial design and benchmarking, it may obscure important heterogeneity in their associations with subsequent all-cause mortality.”
To learn more about how these different adverse events affect long-term mortality after PCI, Suzuki et al. tracked data from more than 10,000 patients. All patients were treated at one of 15 different facilities in Japan from 2008 to 2021. The mean age was 69 years old, 77.5% were men and the median follow-up period was 730 days.
Heart failure hospitalizations were defined as 1) patients with at least one characteristic symptom—like dyspnea or edema—and at least two confirmed findings during a closer examination or 2) patients who received heart failure-specific interventions. Patients who developed heart failure symptoms during treatment for a heart attack were not categorized as heart failure hospitalizations; their primary diagnosis for the sake of this study was the heart attack, not the symptoms that developed later on.
Overall, heart failure hospitalizations occurred in 4.7% of patients, acute coronary syndrome occurred in 3.4% and major bleeding events occurred in 2.5%.
Among patients who died in the first two years after treatment, the median time to death was 306 days. Mortality rates were 25.4% for patients experiencing a heart failure hospitalization, 9.3% for those diagnosed with a major bleeding event and 8.8% for those diagnosed with an acute coronary syndrome.
The study’s authors performed several different analyses, and heart failure hospitalizations were consistently associated with a greater risk of patient mortality than the other nonfatal adverse outcomes. In one fully adjusted Cox proportional hazard model, heart failure hospitalizations accounted for 20.1% of the total mortality burden among these patients, much higher than acute coronary syndrome (4.3%) and major bleeding (2.9%).
“The present study suggests that post-PCI patients who experience heart failure hospitalizations should be considered at exceptionally high risk and may benefit from enhanced follow-up and intervention strategies,” the authors wrote. “Proactive measures, including closer monitoring and optimizing heart failure management, could potentially improve survival outcomes in this vulnerable group.”
Click here to read the full analysis in JACC: Cardiovascular Interventions, an American College of Cardiology journal.
Michael has more than 19 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.