Background
Methods
Statistical analysis
Results
Clinical characteristics
Overall
n = 2609 | ACS-AHF
n = 725 (27.79 %) | NACS-ACS
n = 1884 (72.21 %) |
P value | |
---|---|---|---|---|
Demographics | ||||
Age, years; mean ± SD | 61.34 ± 15 | 62.74 ± 13.1 | 60.80 ± 15.6 | 0.003 |
Male, n (%) | 1717 (65.81) | 535 (73.79) | 1182 (62.74) | <0.001 |
Saudi nationality, n (%) | 2230 (85.47) | 546 (75.31) | 1684 (89.38) | <0.001 |
Medical history | ||||
Heart failure, n (%) | 1670 (64.2) | 315 (43.5) | 1355 (72.2) | <0.001 |
Ischemic heart disease, n (%) | 1376 (53.3) | 433 (60.1) | 943 (50.6) | <0.001 |
PCI, n (%) | 340 (13.1) | 109 (15.0) | 231 (12.3) | 0.064 |
CABG, n (%) | 261 (10.0) | 52 (7.2) | 209 (11.1) | 0.003 |
Rheumatic heart disease, n (%) | 183 (7.1) | 4 (0.5) | 179 (9.6) | <0.001 |
Atrial fibrillation, n (%) | 408 (15.7) | 37 (5.1) | 371 (19.8) | <0.001 |
ICD, n (%) | 229 (8.8) | 31 (4.3) | 198 (10.5) | <0.001 |
CRT, n (%) | 85 (3.3) | 7 (0.8) | 78 (4.1) | <0.001 |
Stroke/TIA, n (%) | 252 (9.7) | 67 (9.2) | 185 (9.8) | 0.637 |
PAD, n (%) | 99 (3.8) | 37 (5.1) | 62 (3.3) | 0.034 |
Anemia, n (%) | 1166 (44.9) | 301 (41.7) | 865 (46.2) | 0.043 |
Chronic lung disease, n (%) | 185 (7.1) | 37 (5.1) | 148 (7.9) | 0.013 |
Chronic kidney disease, n (%) | 771 (29.7) | 163 (22.5) | 608 (32.4) | <0.001 |
Liver disease, n (%) | 91 (3.5) | 9 (1.2) | 82 (4.4) | <0.001 |
Thyroid disorder, n (%) | 172 (6.8) | 28 (4.0) | 144 (7.9) | <0.001 |
Risk factors for atherosclerosis | ||||
Smoking, n (%) | 467 (17.9) | 182 (25.1) | 285 (15.1) | <0.001 |
Hypertension, n (%) | 1831 (70.6) | 506 (70.8) | 1325 (70.5) | 0.914 |
Dyslipidemia, n (%) | 894 (36.4) | 289 (42.7) | 605 (34.0) | <0.001 |
Diabetes mellitus, n (%) | 1668 (64.1) | 518 (72.0) | 1150 (61.1) | <0.001 |
Clinical parameters on presentation | ||||
Acute de novo HF, n (%) | 939 (36.0) | 410 (56.5) | 529 (28.1) | <0.001 |
Acute on chronic HF, n (%) | 1670 (64.0) | 315 (43.4) | 1355 (71.9) | |
BMI, kg/m2; mean ± SD* | 29.16 ± 6.7 | 28.12 ± 5.4 | 29.55 ± 7.1 | <0.001 |
SBP, mean ± SD | 128.7 ± 31.3 | 126.6 ± 29.8 | 129.5 ± 31.9 | 0.038 |
DBP, mean ± SD | 74.10 ± 17.9 | 73.67 ± 17.1 | 74.26 ± 18.2 | 0.454 |
HR, mean ± SD | 88.8 ± 21.0 | 89.7 ± 19.1 | 88.5 ± 21.7 | 0.185 |
Investigations | ||||
Electrocardiography | ||||
Atrial fibrillation/flutter, n (%) | 449 (17.2) | 52 (7.2) | 397 (21.1) | <0.001 |
QRS ≥120 msec, n (%) | 389 (14.9) | 68 (9.4) | 321 (17.1) | <0.001 |
LBBB, n (%) | 305 (11.7) | 62 (8.5) | 243 (12.9) | 0.002 |
Biochemical parameters | ||||
Sodium, mmol/L; mean ± SD | 135.1 ± 5.3 | 135.0 ± 5.4 | 135.2 ± 5.3 | 0.322 |
Potassium, mmol/L; mean ± SD | 4.3 ± 0.7 | 4.2 ± 0.7 | 4.3 ± 0.7 | 0.644 |
Urea, μmol/L; mean ± SD | 11.87 ± 9.1 | 11.11 ± 8.4 | 12.16 ± 9.3 | 0.008 |
Creatinine, μmol/L; median (IQR] | 109.0 (70.0) | 109.0 (62.0) | 109.0 (73.0) | 0.923 |
eGFR, ml/min/1.73 m2; median (IQR) | 57.28 (43.5) | 56.32 (41.9) | 57.82 (44.1) | 0.444 |
Hemoglobin, g/dL; mean ± SD | 12.43 ± 2.2 | 12.76 ± 2.3 | 12.31 ± 2.2 | <0.001 |
RBS, mmol/L; mean ± SD | 10.01 ± 5.7 | 11.43 ± 6.2 | 9.45 ± 5.4 | <0.001 |
NT-Pro-BNP, pmol/L; n (%) | 435 (16.7) | 101 (13.9) | 334 (17.7) | 0.019 |
NT-Pro-BNP, pmol/L; median (IQR) | 675.0 (668) | 999.0 (1679) | 631.5 (684) | <0.001 |
Positive troponin, n (%) | 867 (37.4) | 693 (98.6) | 174 (10.8) | <0.001 |
Echocardiography | ||||
Left ventricular EF >55 %, n (%) | 341 (13.7) | 50 (7.2) | 291 (16.2) | <0.001 |
Left ventricular EF 40–54.9 % | 334 (13.4) | 113 (16.2) | 221 (12.3) | <0.001 |
Left ventricular EF 30–9.9 % | 632 (25.3) | 258 (37.1) | 374 (20.8) | <0.001 |
Left ventricular EF <30 % | 1187 (47.6) | 275 (39.5) | 912 (50.7) | <0.001 |
Hospital procedures and medical therapy
Overall
n = 2609 | ACS-AHF
n = 725 (27.79 %) | NACS-ACS
n = 1884 (72.21) |
P value | |
---|---|---|---|---|
Hospital procedures and therapies | ||||
IV nitroglycerine, n (%) | 725 (27.8) | 397 (54.8) | 328 (17.4) | <0.001 |
Dopamine, n (%) | 468 (17.9) | 156 (21.5) | 312 (16.6) | 0.003 |
Invasive ventilation (%) | 289 (11.1) | 106 (14.6) | 183 (9.7) | <0.001 |
IABP, n (%) | 86 (3.3) | 57 (7.9) | 29 (1.5) | <0.001 |
Cardiac pacing, n (%) | 36 (1.38) | 18 (2.48) | 18 (0.96) | 0.003 |
Hospital ICD, n (%) | 150 (5.75) | 32 (4.41) | 118 (6.26) | 0.069 |
Hospital CRT, n (%) | 68 (2.61) | 9 (1.24) | 59 (3.13) | 0.007 |
CAG performed, n (%) | 764 (29.3) | 338 (46.6) | 426 (22.6) | <0.001 |
Normal coronaries, n (%) | 183 (24.0) | 9 (2.7) | 174 (40.9) | <0.001 |
Non-significant CAD | 82 (10.7) | 14 (4.1) | 68 (16.0) | <0.001 |
Single-vessel CAD, n (%) | 105 (13.7) | 56 (16.6) | 49 (11.5) | 0.043 |
Double-vessel CAD, n (%) | 116 (15.2) | 77 (22.8) | 39 (9.2) | <0.001 |
LM or three-vessel CAD, n (%) | 263 (34.4) | 179 (53.0) | 84 (19.7) | <0.001 |
Discharge medications | ||||
Aspirin, n (%) | 1989 (76.2) | 633 (87.3) | 1356 (72.0) | <0.001 |
Warfarin, n (%) | 484 (18.5) | 56 (7.7) | 428 (22.7) | <0.001 |
Statin, n (%) | 1813 (69.5) | 605 (83.4) | 1208 (64.1) | <0.001 |
Lasix, n (%) | 2048 (78.5) | 546 (75.3) | 1502 (79.7) | 0.014 |
Metolazone, n (%) | 115 (4.4) | 17 (2.3) | 98 (5.2) | 0.001 |
Hydralazine, n (%) | 300 (11.5) | 61 (8.4) | 239 (12.7) | 0.002 |
Long-acting nitrates, n (%) | 252 (9.7) | 103 (14.2) | 149 (7.9) | <0.001 |
Amiodarone, n (%) | 75 (2.9) | 14 (1.9) | 61 (3.2) | 0.074 |
Βeta-blockers, n (%) | 2180 (83.0) | 635 (87.6) | 1545 (82.0) | <0.001 |
ACEI, n (%) | 1554 (59.6) | 463 (63.9) | 1091 (57.9) | 0.006 |
ARBI, n (%) | 388 (14.9) | 95 (13.1) | 293 (15.5) | 0.115 |
AA, n (%) | 999 (38.4) | 191 (26.3) | 808 (42.9) | <0.001 |
Hospital course
Overall
n = 2609 | ACS-AHF
n = 725 (27.79 %) | NACS-ACS
n = 1884 (72.21) |
P value | |
---|---|---|---|---|
Hospital course and outcomes | ||||
Recurrent CHF, n (%) | 816 (31.3) | 251 (34.6) | 565 (30.0) | 0.022 |
Overall shock, n (%) | 228 (8.7) | 94 (13.0) | 134 (7.1) | <0.001 |
Cardiogenic, n (%) | 169 (74.1) | 73 (77.7) | 96 (71.6) | 0.132 |
Non-cardiogenic, n (%) | 22 (9.6) | 11 (11.7) | 11 (8.2) | |
Mixed, n (%) | 37 (16.2) | 10 (10.6) | 27 (20.1) | |
VT/VF requiring therapy, n (%) | 110 (4.2) | 45 (6.2) | 65 (3.4) | 0.002 |
AF requiring therapy, n (%) | 156 (6.0) | 25 (3.4) | 131 (6.9) | <0.001 |
Sepsis, n (%) | 196 (7.5) | 68 (9.4) | 128 (6.8) | 0.025 |
Major bleeding, n (%) | 38 (1.5) | 14 (1.9) | 24 (1.4) | 0.209 |
Stroke/TIA, n (%) | 48 (1.8) | 23 (3.2) | 25 (1.3) | 0.002 |
Hospital stay, days; mean ± SD | 12.3 ± 14.6 | 13.1 ± 15.38 | 12.0 ± 14.3 | 0.083 |
Hospital stay, days; median (IQR) | 8.0 (9.0) | 8.0 (10.0) | 8.0 (9.0) | 0.111 |
All-cause mortality | ||||
Hospital, n (%) | 170 (6.5) | 64 (8.8) | 106 (5.6) | 0.003 |
1 month, n (%) | 212 (8.1) | 73 (10.1) | 139 (7.4) | 0.044 |
1 year, n (%) | 509 (19.5) | 147 (20.3) | 362 (19.2) | 0.568 |
2 years, n (%) | 615 (23.6) | 171 (23.6) | 444 (23.6) | 0.680 |
3 years, n (%) | 635 (24.3) | 175 (24.1) | 460 (24.4) | 0.671 |
Mortality
Covariate | Crude OR (95 % CI) |
P value | Adjusted OR (95 % CI) |
P value |
---|---|---|---|---|
Recurrent heart failure | 1.24 (1.03–1.48) | 0.022 | 1.66 (1.33–2.06) | <0.001 |
Overall shock | 1.95 (1.47–2.57) | <0.001 | 1.85 (1.31–2.60) | <0.001 |
Stroke/TIA | 2.44 (1.37–4.32) | 0.002 | 1.87 (0.98–3.56) | 0.055 |
All-cause mortality | ||||
Hospital | 1.62 (1.17–2.24) | 0.003 | 1.61 (1.08–2.39) | 0.019 |
1-month | 1.40 (1.04–1.89) | 0.026 | 1.36 (0.9–1.95) | 0.093 |
1-year | 1.07 (0.86–1.32) | 0.548 | 1.16 (0.89–1.51) | 0.252 |
2-year | 1.00 (0.81–1.22) | 1.000 | 1.10 (0.85–1.40) | 0.462 |
3-year | 0.98 (0.80–1.20) | 0.871 | 1.07 (0.83–1.35) | 0.600 |
Odds ratio | 95 % CI Lower bound | 95 % CI Upper bound |
P value | |
---|---|---|---|---|
Acute heart failure with ACS | ||||
Age (for every 1 year increase) | 1.02 | 1.00 | 1.04 | 0.015 |
eGFR (for every 5 mL/min/1.73 m2 decrease) | 1.09 | 1.03 | 1.16 | <0.001 |
HR (for every 5 beats/min increase) | 1.09 | 1.03 | 1.15 | 0.004 |
Mild LV dysfunction EF 40 %–49.9 % | 1.02 | 0.36 | 2.87 | 0.976 |
Moderate LV dysfunction EF 30–39.9 % | 2.37 | 0.96 | 5.82 | 0.060 |
Severe LV dysfunction EF <30 % | 2.78 | 1.14 | 6.78 | 0.024 |
Acute heart failure without ACS | ||||
Age (for every 1 year increase) | 1.03 | 1.02 | 1.04 | <0.001 |
Diabetes mellitus | 0.61 | 0.46 | 0.83 | 0.001 |
Hypertension | 1.45 | 1.04 | 2.01 | 0.027 |
Stroke/TIA | 1.54 | 1.06 | 2.25 | 0.025 |
RBS (for every 1 mmol/L increase) | 1.03 | 1.01 | 1.06 | 0.006 |
SBP (for 1 mmHg increase) | 0.99 | 0.99 | 1.00 | <0.001 |
Urea (for every 1 μmol/L increase) | 1.05 | 1.03 | 1.06 | <0.001 |
Hemoglobin (for every 1 g/dL increase) | 0.88 | 0.83 | 0.93 | <0.001 |