Heart failure and non-ST-segment elevation myocardial infarction: A review for a widespread situation

Abstract Up to 15% of patients with NSTEMI present at admission with heart failure. Scientific evidence for its management is limited but much progress has been made during the last years. Our purpose was to review the last data concerning heart failure in NSTEMI and perform an update on the subject...

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Bibliographic Details
Published in:European journal of internal medicine 2011-12, Vol.22 (6), p.533-540
Main Authors: Franco, E, Núñez-Gil, I.J, Vivas, D, Ruiz Mateos, B, Ibañez, B, Gonzalo, N, Macaya, C, Fernández Ortiz, A
Format: Article
Language:English
Subjects:
Electrocardiography
Heart failure
Heart Failure - diagnosis
Heart Failure - mortality
Heart Failure - therapy
Humans
Internal Medicine
Myocardial infarction
Myocardial Infarction - diagnosis
Myocardial Infarction - mortality
Myocardial Infarction - therapy
NSTEMI
Prognosis
Prognostic
Review
Treatment
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Summary:Abstract Up to 15% of patients with NSTEMI present at admission with heart failure. Scientific evidence for its management is limited but much progress has been made during the last years. Our purpose was to review the last data concerning heart failure in NSTEMI and perform an update on the subject, with the following findings as main highlights. As Killip classes III and IV, Killip class II onset in the context of NSTEMI has also proven bad prognosis significance. Beta-blocker therapy has proven benefit to patients with Killip class II in observational studies and small trials. Angiotensin-converting enzyme inhibitor therapy shows stronger evidence of benefit in patients with heart failure than in patients without it. Eplerenone is indicated for patients with left ventricular dysfunction and heart failure or diabetes mellitus. Implantable cardioverter defibrillators improve survival in patients with severe ventricular dysfunction after a myocardial infarction. Cardiac resynchronization therapy indications must be carefully assessed due to the high rate of implants that do not fulfill guidelines indications. In conclusion, heart failure during a NSTEMI is a common and meaningful situation which warrants careful management and further investigation to reach stronger evidence for clinical recommendations.
ISSN:0953-6205
1879-0828
DOI:10.1016/j.ejim.2011.07.009