De novo heart failure in patients hospitalized with ST-segment elevation myocardial infarction in contemporary China

Background and purpose: With the implementation of the Chest Pain Centers program, significant advancements have been achieved in managing risk factors and providing coronary interventional treatments in China. However, a notable gap exists in understanding the occurrence of de novo heart failure (HF) following ST-segment elevation myocardial infarction (STEMI). This study aimed to describe the incidence, clinical characteristics, related factors, and prognostic significance of de novo HF after STEMI in contemporary China. Methods: This cohort study used data from the Chinese Cardiovascular Association Database, which included patients hospitalized with a discharge diagnosis of STEMI between January 1, 2020, and December 31, 2021, who had no history of HF. The primary outcomes were all-cause mortality at 7 and 30 days obtained by linking to the Chinese Center for Disease Control and Prevention. Results: Among 373,835 STEMI patients included, the mean age was 62.4 ± 13.0 years, with 23.5% being women. The incidence of de novo HF was 10.6%. Patients who developed de novo HF were older, more likely to be female, had a higher burden of comorbidities, were less frequently treated with reperfusion therapy, had longer delay in reperfusion time, and had a higher risk of 7-day all-cause mortality (adjusted hazard ratio [HR]: 2.29, 95% confidence interval [95% CI]: 2.20–2.38, P < 0.001) and 30-day all-cause mortality (adjusted HR: 2.40, 95% CI: 2.33–2.48, P < 0.001). Independent factors associated with a higher likelihood of de novo HF in STEMI patients included older age, female, delayed reperfusion, elevated cardiac troponin, and a higher number of comorbidities. Conclusions: In contemporary China, de novo HF occurs in approximately 1 of 10 STEMI patients, and is associated with a worse prognosis. Reducing delays to reperfusion therapy is vital to reduce the risk for incident HF.