Heart failure after myocardial infarction in the era of primary percutaneous coronary intervention: Mechanisms, incidence and identification of patients at risk

Abstract

Myocardial infarction (MI) remains the most common cause of heart failure (HF) worldwide. For almost 50 years HF has been recognised as a determinant of adverse prognosis after MI, but efforts to promote myocardial repair have failed to translate into clinical therapies. Primary percutaneous coronary intervention (PPCI) has driven improved early survival after MI, but its impact on the incidence of downstream HF is debated. The effects of PPCI are confounded by the changing epidemiology of MI and HF, with an ageing patient demographic, an increasing proportion of non-ST-elevation myocardial infarction, and the recognition of HF with preserved ejection fraction. Herein we review the mechanisms of HF after MI and discuss contemporary data on its incidence and outcomes. We review current and emerging strategies for early detection of patients at risk of HF after MI, with a view to identification of patient cohorts for novel therapeutic agents.

Keywords: Angioplasty; Heart failure; Myocardial infarction; Percutaneous coronary intervention; ST-elevation myocardial infarction

Core tip: Heart failure (HF) is a major cause of late morbidity and mortality after myocardial infarction. Several approaches exist for early identification of patients at risk of HF, including clinical and angiographic scoring, cardiac imaging, and invasive coronary physiology, but these are currently poorly integrated. Here we provide an overview of the incidence, mechanisms, and outcomes of HF following myocardial infarction in the era of primary percutaneous coronary intervention, and discuss HF risk-stratification for the individual patient. Looking ahead, accurate and early prediction of HF will allow targeting of novel therapeutic agents to high-risk patients before ventricular remodelling and clinical HF have become established.