Cardiovascular

[The incidence and 1-year prognosis of heart failure following myocardial infarction during hospitalization in patients with first STEMI].

Zhang Y, Wang S, et al. • Zhonghua xin xue guan bing za zhi • 2026

PubMed 42907221 DOI 10.3760/cma.j.cn112148-20260514-00314

TL;DR

In-hospital heart failure occurred in 41.8% of patients with first STEMI in the Henan registry and was a risk factor for 1-year mortality (23.3%), with HFpEF carrying the lowest risk and HF with missing LVEF the highest.

Key Findings

Results

41.8% of patients with first STEMI developed heart failure after MI during hospitalization.

4,737 patients with first STEMI from the Henan STEMI registry (multicentre, prospective, observational, central China) were analyzed after excluding those with prior MI or HF.
1,978 patients (41.8%) developed in-hospital HF following MI.
Median age was 62.8 (52.4, 70.8) years; 1,158 (24.4%) were female.

Results

The in-hospital HF group was distributed across LVEF categories, with HFpEF the most common classified type and over a third lacking LVEF data.

Of 1,978 HF patients: HFrEF 268 (13.5%), HFmrEF 309 (15.6%), HFpEF 707 (35.7%), missing LVEF 694 (35.1%).
LVEF classification used the last in-hospital echocardiogram: HFpEF ≥50%, HFmrEF 41%-49%, HFrEF ≤40%.

Results

One-year mortality was markedly higher in STEMI patients with in-hospital HF than in those without.

3,967 patients (83.7%) completed 1-year follow-up.
Mortality was 23.3% (391/1,680) with HF versus 5.8% (132/2,287) without HF, log-rank P<0.001.

Results

One-year mortality differed across HF subgroups, being highest in HF with missing LVEF and lowest in HFpEF.

HFrEF 29.6% (67/226); HFmrEF 20.8% (53/255); HFpEF 11.7% (72/615); missing LVEF 34.1% (199/584).
Mortality was assessed among patients completing 1-year follow-up.

Results

In-hospital HF following MI was an independent risk factor for 1-year mortality in multivariate Cox frailty models.

HR=2.13, 95%CI: 1.70-2.67 versus the non-HF group.
Cox frailty models were used (accounting for center clustering) with non-HF as the reference.

Results

Among HF subgroups, HFpEF had the lowest adjusted 1-year mortality risk and HF with missing LVEF had the highest, though all exceeded non-HF patients.

HFpEF: HR=1.59, 95%CI: 1.16-2.17.
HF with missing LVEF: HR=2.49, 95%CI: 1.91-3.26.
Reference group was patients without in-hospital HF.

What This Means

This study followed nearly 4,700 people in central China who had their first ST-segment elevation heart attack. About 4 in 10 (41.8%) developed heart failure while still in the hospital. These patients were much more likely to die within a year: 23.3% of those with heart failure died, compared with 5.8% of those without it. The researchers also split heart failure into types based on how well the heart pumped blood on the last ultrasound before discharge. Patients whose pumping function was preserved had the lowest death rate (11.7%), while those with reduced function had a higher rate (29.6%). The highest death rate (34.1%) was in patients with heart failure whose pumping function had not been measured. After adjusting for other factors, in-hospital heart failure roughly doubled the risk of death within a year (HR 2.13). This research suggests that heart failure after a first heart attack is common and signals a worse outlook, and that missing heart function measurements may mark especially high-risk patients. As an observational study, it shows associations rather than cause, and about 16% of patients were lost to 1-year follow-up.

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Citation

Zhang Y, Wang S, Yang W, Qi D, Zhu Z, Wang X, et al.. (2026). [The incidence and 1-year prognosis of heart failure following myocardial infarction during hospitalization in patients with first STEMI].. Zhonghua xin xue guan bing za zhi. https://doi.org/10.3760/cma.j.cn112148-20260514-00314

Key Findings

What This Means

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