Risk Factors and Outcomes of Heart Failure Following First-Episode Acute Myocardial Infarction: 161,384 Cases

This retrospective cohort study analyzed 161,384 patients hospitalized for a first acute MI in Taiwan to characterize the incidence, risk factors, and mortality outcomes of heart failure complicating the index MI in the PCI era.

Heart failure developed in 23.6% of patients during the index AMI hospitalization. Independent risk factors for in-hospital HF included female sex (OR 1.64), age ≥65 years (OR 2.32), diabetes (OR 1.54), and presentation with VT/VF (OR 2.21). Development of in-hospital HF was associated with 85% higher mortality risk (HR 1.85). PCI and CABG reduced mortality by 52%, and guideline-directed medical therapy (antiplatelets, ACE inhibitors/ARBs, beta-blockers) substantially improved survival.

The result that approximately one quarter of first MI patients develop in-hospital heart failure is consistent with contemporary literature and reflects the downstream consequence of extensive myocardial necrosis. For CAD prevention, this data quantifies the functional cost of allowing subclinical disease to progress to a first MI — particularly in older, diabetic, and female patients who carry the highest HF risk at presentation.

The study’s primary clinical relevance to primary prevention: MI is not a survivable endpoint in the same way that guideline-based risk calculations sometimes frame it. A first MI carries a 23% chance of acute heart failure and a substantially elevated long-term mortality trajectory regardless of guideline-directed therapy after the event.

We rate the evidence moderate. A large real-world retrospective cohort in 161,384 Taiwanese AMI patients characterizing heart failure complication rates and mortality consequences — reinforcing the downstream burden that prevention of first MI is designed to avert.