P-124: Hypertensives have worse progression of heart failure during acute myocardial infarction than normotensives

Heart failure (HF) strongly affects prognosis in patients with acute myocardial infarction (AMI). The aim of this study was to assess whether there are differences in HF degree and progression during AMI in hypertensives (HT) and normotensives (NT). We studied 507 consecutive patients admitted to 3 coronary care units for AMI. Patients with HT were 237 (mean duration of hypertension 11.9±9.4 years, mean age 69.8±11.2 years, females 42%), while 270 were NT (mean age 63.6±12.0 years, females 18%). Heart failure was evaluated according to Killip classification (class 1-4) on the 1st, 3rd and 7th day after admission. CK-MB peak was 170±159 IU/L in HT and 184±160 IU/L in NT (ns). Over the 1st week of hospitalization HT showed a higher Killip class score (class 2=31%, class 3=8%, class 4=4%) than NT (class 2=30%, class 3=4%, class 4=1%) (p=0.02). After admission, among Killip class 1 patients (n=339), the rate of HF worsening (Killip class score difference) was higher in HT than in NT (7% and 2% respectively, p=0.03). Among the Killip class>1 patients (n=168), the rate of Killip class score improvement was similar in HT and NT patients (46% and 50% respectively, ns). However, HT patients more frequently showed worsening of their score than NT (8% and 1% respectively, p=0.03). Furthermore, in a multivariable regression model including difference in Killip class score during the 1st week of hospitalization as dependent variable and age, gender, BMI, diabetes, CK-MB peak, atrial fibrillation, thrombolysis and history of HT as independent ones, history of HT resulted as an independent predictor of difference in Killip class score (worsening) (T=2.5, p=0.014). In conclusion, this study shows that patients with HT admitted to intensive care unit for AMI have worse progression of HF during hospital stay than NT independently from other clinical confounders.