Predictors of heart failure in non-ST segment elevation acute coronary syndrome
L Sousa Azevedo, I Martins Moreira, I Nobrega Fernandes, P Sousa Mateus, S Leao, I MoreiraAbstract
Introduction
Ischemic heart disease is a leading cause of heart failure (HF) worldwide, and acute coronary syndromes (ACS) represent a major clinical setting in which HF frequently develops. Among ACS presentations, non–ST-segment elevation acute coronary syndromes (NSTE-ACS) account for most cases and are commonly complicated by HF, which significantly worsens prognosis and clinical outcomes.
Objective
To identify predictors of the occurrence of heart failure during hospital stay in patients with non-ST elevation acute coronary syndrome (NSTE-ACS).
Methods
This retrospective observational study included patients admitted to our center with NSTE-ACS between October 2010 and July 2025, all of whom were recorded in a national registry. Individuals with a previous diagnosis of heart failure were excluded. The cohort was divided into two groups based on whether patients developed de novo heart failure during the hospitalization. Differences between groups were assessed using the chi-square test for categorical variables and median-comparison tests for continuous variables. The impact of each variable on the occurrence of heart failure was evaluated using binary logistic regression adjusted for potential confounders. For the regression analysis, non-smokers and former smokers were combined into a single category.
Results
A total of 678 patients were included, of whom 486 (71.6%) were male, with a median age of 67 years. During hospitalization, 85 patients (4.8%) developed heart failure. Significant differences between groups were observed for age (p<0.001), smoking status (p=0.049), arterial hypertension (p=0.002), diabetes mellitus (p=0.01), valvular heart disease (p=0.004), chronic obstructive pulmonary disease (COPD) (p<0.001) and hemoglobin at admission (p=0.006] (table 1). In the multivariable logistic regression analysis adjusted for confounders arterial hypertension (OR = 2.550; 95% CI 1.121–5.799; p = 0.026), valvular heart disease (OR = 4.599; 95% CI 1.144–18.488; p = 0.032), and COPD (OR = 4.286; 95% CI 1.722–10.669; p = 0.002) were independent predictors for the occurrence of heart failure.
Conclusions
In our study, arterial hypertension, valvular heart disease, and COPD were associated with an increased likelihood of developing HF during hospital stay. These findings highlight patient subgroups who may benefit from closer monitoring during hospitalization to ensure timely and appropriate management.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.