P5537Clinical outcomes, mortality, and causes of death in patients with NSTEMI according to heart failure at admission: insights from a large contemporary revascularization trial

Abstract

Background: Patients with non‐ST‐elevation myocardial infarction (NSTEMI) and heart failure (HF) are recognized as a high‐risk subgroup; mortality in patients without HF is low. In historical cohorts, revascularization has been underused in patients with HF. Outcomes of these patients in the current era of widespread revascularization are unknown. Purpose: We describe the clinical characteristics, outcomes, and causes of death in patients according to HF status in a large NSTEMI population scheduled to undergo systematic coronary angiography (CAG). Methods: The TAO (Treatment of Acute Coronary Syndrome with Otamixaban) trial randomized NSTEMI patients with systematic CAG scheduled within 72 h to heparin + eptifibatide vs otamixaban. In a post hoc analysis, patients were cate‐gorized according to presence or absence of HF (Killip grade >2) at admission Events were adjudicated and causes of death were categorized. Results: A total of 13,184 NSTEMI patients were enrolled, of whom 944 (7.2%) had HF at admission (Killip 2 in 85.1% of cases). Useof invasive procedures was, per protocol, almost universal in both HF and non HF patients (98.3% vs 99.3% [with vs without HF] p<0.0003), with more frequent coronary revascularization (PCI or CABG) in no HF group (63.1% vs 81.1%, p<0.001). At day 30, death oc‐curred in 57/944 (6%) patients with HF and 156/12228 patients (1.3%) without HF Cardiovascular death (CV) was the dominant cause of death (78.8% vs 78.4%, p=0.94) and the distribution of the causes of CV death including worsening HF (22.6% vs 26%, p=0.65) and no CV death did not differ according to baseline HF status. At six months follow‐up, mortality remained higher in patients presenting with HF (9.5% vs 2.1%, p<0.0001). The composite ischemic criteria of CV death, MI, stent thrombosis, and stroke at day 30 was significantly higher in patients with HF (12.2% vs 7.1%, p<0.0001). After adjustment, HF was an independent predictor of all‐cause mortality at day 30 (OR: 1.58; 95% CI, 1.06‐2.36, p=0.023) and at day 180 (OR: 1.77; 95% CI, 1.3‐2.42, p=0.0003). Moreover, HF was an independent predictor of composite ischemic criteria of CV death, MI, stent thrombosis, and stroke at day 30 (OR 1.28; 95% CI, 1.01‐1.62, p=0.044). [Table Presented] Conclusion: In this large cohort of NSTEMI patients managed invasively, HF at admission was associated with mortality and composite ischemic criteria. How‐ever, the majority of deaths occurred in patients without HF and causes of death did not differ according to HF status. Further efforts to reduce mortality in NSTEM patients need therefore to address both patients with and without HF Funding Acknowledgements: TAO trial was sponsored and funded by SANOFI.