P-522: Clinical signs of heart failure in hypertensive and normotensive patients during acute myocardial infarction

Heart failure (HF) strongly affects manegment and prognosis in the patients with acute myocardial infarction (AMI). The aim of this study was to assess whether there are difference in HF degree in hypertensive (HT) and normotensive (NT) patients during AMI. We studied 507 consecutive patients admitted to 3 coronary care units for AMI. Patients with HT were 237 (mean duration 11.9±9.4 years, mean age 69.8±11.2 years, females 42%). NT were 270 (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 an 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) while 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). Conclusion. This study shows that patients with HT admitted to intensive care unit for AMI have more severe signs of HF and have a worse behavior in the subsequent days than NT.