Hospital and 4-year mortality predictors in patients with acute pulmonary edema with and without coronary artery disease

Abstract

Long-term prognosis of acute pulmonary edema () remains ill defined. We evaluated demographic, echocardiographic, and angiographic data of 806 consecutive patients with with () and without coronary artery disease (non-) admitted from 2000 to 2010. Differences between hospital and long-term mortality and its predictors were also assessed. patients (n=638) were older and had higher incidence of diabetes and peripheral vascular disease than non- (n=168), and lower ejection fraction. Hospital mortality was similar in both groups (26.5% vs 31.5%; P =0.169) but recurrence was higher in patients (17.3% vs 6.5%; P <0.001). Age, admission systolic blood pressure, recurrence of , and need for inotropics or endotracheal intubation were the main independent predictors of hospital mortality. In contrast, overall mortality (70.0% vs 57.1%; P =0.002) and readmission for nonfatal heart failure after a 45-month follow-up (10-140; 17.3% vs 7.6%; P =0.009) were higher in than in non- patients. Age, peripheral vascular disease, and peak creatine kinase during index hospitalization, but not ejection fraction, were the main independent predictors of overall mortality, whereas coronary revascularization or valvular surgery were protective. These interventions were mostly performed during hospitalization index (294 of 307; 96%) and not intervened patients showed a higher risk profile. Long-term mortality in is high and higher in than in non- patients. Considering the different in-hospital and long-term mortality predictors herein described, which do not necessarily involve systolic function, it is conceivable that a more aggressive interventional program might improve survival in high-risk patients