Current approaches to risk assessment of chronic heart failure after myocardial infarction

In the last decade, there has been an increase in the number of survivors of myocardial infarction (MI). However, the risk of developing chronic heart failure (CHF) remains high in this category of patients. Population aging and comorbidity further contribute to adverse outcomes. Optimization of approaches to identify predictors of postinfarction CHF is an important clinical task of modern medicine.

The aim of the investigation is to develop a method to assess the risk of CHF development after MI.

Material and Methods. The present analysis included 186 patients who underwent MI from January 2019 to January 2020: 86 patients with signs of CHF above functional class (FC) 2 (NYHA) (mean age 64.3 years) and 100 patients without signs of CHF or with CHF 1 (NYHA) (mean age 62.6 years) by day 30 of MI. A mathematical model of CHF risk after MI was built by factor and correlation analysis methods.

Results. A method for assessing CHF risk after a previous MI was developed. The proposed formula is programmed in Excel table processor and includes 5 indicators: presence of atrial fibrillation, Killip class of acute heart failure, triglycerides level, ST-segment elevation of electrocardiogram, left ventricular ejection fraction less than 45 %. The authors’ approach allows long-term personalized monitoring, taking into account the ranked contribution of each factor in a particular patient; it is characterized by high sensitivity, specificity, and accuracy.

Conclusion. The present study investigated the factors of formation of postinfarct chronic heart failure syndrome. An original mathematical formula for CHF risk estimation, including routine indices of MI patients, has been proposed. The approach allows personalized management of selected cohorts of patients – with increased and standard risk of postinfarction CHF.

1. Bahit M., Kochar A., Granger C. Post-Myocardial Infarction Heart Failure. J. Am. Coll. Cardiol HF, 2018 Mar; 6 (3): 179–186. https://doi.org/10.1016/j.jchf.2017.09.015

2. Ларина В.Н., Скиба И.К., Скиба А.С. Краткий обзор обновлений клинических рекомендаций по хронической сердечной недостаточности Европейского общества кардиологов 2021 года. Рос. кардиол. журн., 2022; 27 (2): 4820. https://doi.org/10.15829/1560-4071-2022-4820

3. Эрлих А.Д. 12-месячные исходы у пациентов с острым коронарным синдромом, включенных в российский регистр «РЕКОРД-3». Рос. кардиол. журн., 2018; (3): 23–30. https://doi.org/10.15829/1560-4071-2018-3-23-30

4. James S.K., Lindahl B., Siegbahn A., Stridsberg M., Venge P., Armstrong P., Barnathan E.S., Califf R., Topol E.J., Simoons M.L., Wallentin L. N-terminal pro-brain natriuretic peptide and other risk markers for the separate prediction of mortality and subsequent myocardial infarction in patients with unstable coronary artery disease: a Global Utilization of Strategies To Open occluded arteries (GUSTO)-IV substudy. Circulation, 2003; 108 (3): 275–281. doi: 10.1161/01.CIR.0000079170.10579.DC

5. Ibanez B., James S., Agewall S., Antunes M.J., Bucciarelli-Ducci C., Bueno H., Caforio A.L.P., Crea F., Goudevenos J.A., Halvorsen S., Hindricks G., Kastrati A., Lenzen M.J., Prescott E., Roffi M., Valgimigli M., Varenhorst C., Vranckx P., Widimský P.; ESC Scientific Document Group. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur. Heart J., 2018; 39 (2): 119–177. doi.org/10.1093/eurheartj/ehx393

6. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC). Eur. Heart J., 2016; 37: 267–315.

7. Мареев В.Ю., Фомин И.В., Агеев Ф.Т., Беграмбекова Ю.Л., Васюк Ю.А., Гарганеева А.А., Гендлин Г.Е., Глезер М.Г., Готье С.В., Довженко Т.В., Кобалава Ж.Д., Козиолова Н.А., Коротеев А.В., Мареев Ю.В., Овчинников А.Г., Перепеч Н.Б., Тарловская Е.И., Чесникова А.И., Шевченко А.О., Арутюнов Г.П., Беленков Ю.Н., Галявич А.С., Гиляревский С.Р., Драпкина О.М., Дупляков Д.В., Лопатин Ю.М., Ситникова М.Ю., Скибицкий В.В., Шляхто Е.В. Клинические рекомендации ОССН – РКО – РНМОТ. Сердечная недостаточность: хроническая (ХСН) и острая декомпенсированная (ОДСН). Диагностика, профилактика и лечение. Кардиология, 2018; 58 (S6). ISSN 0022-9040. [Mareev V.Yu., Fomin I.V., Ageev F.T., Begrambekova Yu.L., Vasyuk Yu.А., Garganeeva А.А., Gendlin G.Е., Glezer М.G., Got’e S.V., Dovzhenko Т.V., Kobalava Zh.D., Koziolova N.А., Korote- ev А.V., Mareev Yu.V., Ovchinnikov А.G., Perepech N.B., Tarlovskaya Е.I., Chesnikova А.I., Shevchenko А.О., Arutyunov G.P., Belenkov Yu.N., Galyavich А.S., Gilyarevskii S.R., Drapkina О.М., Duplyakov D.V., Lopatin Yu.М., Sitnikova М.Yu., Skibictkii V.V., Shlyakhto Е.V. Russian Heart Failure Society, Russian Society of Cardiology. Russian Scientific Medical Society of Internal Medicine Guidelines for Heart failure: chronic (CHF) and acute decompensated (ADHF). Diagnosis, prevention and treatment. Kardiologiya, 2018; 58 (6S): 8–158. (In Russ.) https://doi.org/10.18087/cardio.2475

8. Юнкеров В.И., Григорьев С.Г. Математико-статистическая обработка данных медицинских исследований. Санкт-Петербург, 2002. 267 с.

9. Воскобойников Ю.Е. Эконометрика в Excel: парные и множественные регрессионные модели. Санкт-Петербург: Лань, 2016. 260 с.

10. Jering K.S., Claggett B., Pfeffer M.A., Granger C., Køber L., Lewis E.F., Maggioni A.P., Mann D., McMurray J.J.V., Rouleau J.L., Solomon S.D., Steg P.G., van der Meer P., Wernsing M., Carter K., Guo W., Zhou Y., Lefkowitz M., Gong J., Wang Y., Merkely B., Macin S.M., Shah U., Nicolau J.C., Braunwald E. Prospective ARNI vs. ACE inhibitor trial to DetermIne Superiority in reducing heart failure Events after Myocardial Infarction (PARADISEMI): design and baseline characteristics. European Journal of Heart Failure, 2021; 23 (6): 1040–1048. doi: 10.1002/ejhf.2191.Epub 2021 Apr 22

11. Sulo G., Igland J., Vollset S.E., Nygård O., Ebbing M., Sulo E., Egeland G.M., Tell G.S. Heart failure complicating acute myocardial infarction; burden and timing of occurrence: a nation-wide analysis including 86 771 patients from the Cardiovascular Disease in Norway (CVDNOR) Project. J. Am. Heart Associat., 2016; 5 (1): e002667. doi: 10.1161/JAHA.115.002667

12. Granger C.B., Goldberg R.J., Dabbous O., Pieper K.S., Eagle K.A., Cannon C.P., van de Werf F., Avezum A., Goodman S.G., Flather M.D., Fox K.A. Predictors of hospital mortality in the global registry of acute coronary events. Arch. Internal Med., 2003; 163 (19): 2345–2353. doi: 10.1001/archinte.163.19.2345

13. Juillière Y., Cambou J.P., Bataille V., Mulak G., Galinier M., Gibelin P., Benamer H., Bouvaist H., Méneveau N., Tabone X., Simon T., Danchin N.; FAST-MI Investigators. Heart failure in acute myocardial infarction: a comparison between patients with or without heart failure criteria from the FAST-MI registry. Revista Española de Cardiología (English Edition). 2012; 65 (4): 326–333. doi: 10.1016/j.recesp.2011.10.027