Heart Failure Risk Lingers After ST-Elevation Myocardial Infarction

Despite widespread implementation of guideline-directed medical therapy (GDMT) and percutaneous coronary intervention (PCI), residual heart failure (HF) and mortality risks remain following ST-elevation myocardial infarction (STEMI).1 Presented at the European Society of Cardiology (ESC) Congress 2026 in Munich, Germany, by Rahul Aggarwal, MD, MBA, a cardiology fellow at Harvard Medical School, this retrospective cohort study analyzed adults with STEMI undergoing PCI to determine the degree of lingering HF risk following treatment and identify high-risk subgroups for targeted intervention.1 'We do a lot of trials that study heart failure hospitalizations specifically, but what we're seeing is that there are still a lot of visits for heart failure that are happening in the outpatient setting as well,' Aggarwal told HCPLive in an exclusive interview. 'This represents an area where we really need to have intervention and good therapies to help reduce these rates.' These findings contradict existing data from earlier studies investigating the correlation between STEMI and HF risk. In 2017, a study conducted in the Netherlands found very low long-term contemporary incidence of HF following first STEMI. This study included a much smaller cohort and ultimately concluded that, despite increased risk with higher creatine kinase and left anterior descending artery culprit lesion, HF was not common following first STEMI.2 Evaluating HF Risk After STEMI Aggarwal and colleagues utilized Optum Market Clarity linked electronic health record and claims data between July 2021 and December 2023 to identify patients with STEMI undergoing PCI. The team assessed HF and mortality outcomes both overall and in clinical subgroups, including anterior STEMI, anterior STEMI LAD/left main culprit vessel, and patients without prior HF or MI.1 A total of 63,276 patients with STEMI were included in the study, with a median age of 64.2 years. Cardiovascular risk burden was high among these patients, with 60.9% having hypertension, 32.5% having type 2 diabetes, and 6.9% with a prior myocardial infarction. After 1 year, HF hospitalization had occurred in 8.21% of patients (95% CI, 8-8.43) while all-cause mortality occurred in 8.5% (95% CI, 8.29-8.72).1 Independent predictors of hospitalization included prior HF (HR, 1.96; 95% CI, 1.82-2.1), prior MI (HR, 1.16; 95% CI, 1.07-1.25), anterior STEMI (HR, 1.54; 95% CI, 1.47-1.63), and chronic kidney disease (HR, 1.5; 95% CI, 1.4-1.6). Mortality was strongly associated with cardiogenic shock (HR, 2.95; 95% CI, 2.77-3.14), cardiac arrest (HR, 2.92; 95% CI, 2.71-3.14), and anterior STEMI (HR, 1.09; 95% CI, 1.04-1.15).1 Aggarwal and colleagues found that patients with anterior STEMI represented a higher-risk group, with greater risk for hospitalization (10.36% [95% CI, 9.98-10.74] vs. 8.21%; relative increase 26%) and mortality (9.54% [95% CI, 9.18-9.91] vs. 8.5%; relative increase 12%). Additionally, in-hospital complications were more common among patients with anterior STEMI, including HF (58.9% vs 44.5%) and cardiogenic shock (17.7% vs 14.5%). HF outpatient encounters were also more frequent, occurring in 37.5% of all patients and 50.3% of anterior STEMI patients within 1 year.1 Ultimately, Aggarwal and colleagues concluded that patients with prior STEMI exhibit substantial residual risk of HF, particularly among those with anterior MI. The study highlights the need for risk-guided surveillance strategies to mitigate downstream HF and mortality.1 'I think being able to identify those patients who are not fully at clinical phenotypes or don't have congestion yet, for example, but have multiple of these risk factors that put them in a pre-heart-failure stage or a pre-stage to having clinical symptoms, and appropriately giving guideline-directed medical therapy at that time can reduce the rates of having downstream end outcomes such as mortality or heart failure hospitalizations,' Aggarwal said. Editors' Note: Aggarwal reports disclosures with Bristol Myers Squibb, Pfizer, Novartis, and Lexicon. References