Long-term prognosis and a nomogram model for postoperative acute heart failure in patients with acute myocardial infarction

Background Undefined adequate hydration may increase the risk of postoperative acute heart failure (AHF) while reducing the risk of contrast-induced acute kidney injury (CI-AKI) in patients with acute myocardial infarction (AMI). No relevant study exists regarding the association of postoperative AHF and long-term prognosis. This study is to evaluate the all-cause long-term mortality and establish a nomogram model for predicting postoperative AHF in this patient group. Methods In this prospective observational study, 1312 AMI patients undergoing coronary angiography (CAG) were included in the final analysis. Patients were assigned into a non-postoperative AHF-group (n=1235) or a postoperative AHF-group (n=77). The diagnosis of postoperative AHF was based on assessing symptom history, prior cardiovascular history, and potential cardiac and non-cardiac precipitants. Results The overall incidence of postoperative AHF was 77/1312 (5.9%). The incidence of all-cause long-term mortality was significantly higher in the postoperative AHF-group than in the non-postoperative AHF-group (50.6% vs. 17.0%, P<0.01). The median follow-up period was 7.0 years (interquartile range: 5.5 – 8.7). After adjusting for female, LVEF, eGFR, anemia, hypertension, diabetes mellitus, and PCI, postoperative AHF was the strongest predictor of all-cause long-term mortality (hazard ratio: 3.11; 95% CI: 1.83 – 5.30; P<0.01). A nomogram developed based on the four variables was with the AUC 0.83 on internal validation. Calibration curve showed that the predicted and actual probabilities of postoperative AHF were fitted well. Conclusions In patients with AMI undergoing CAG, postoperative AHF is the strongest predictor of all-cause long-term mortality. The nomogram showed an effective value of predicting postoperative AHF using preoperative predictions.