Characteristics and Risk Factors for Development Heart Failure in Mexican Obese Patients with Acute Myocardial Infarction Lacking Coronary Intervention

Abstract

Background: Acute ischemic heart disease causes myocardial infarction due to obstruction blood flow in coronary arteries caused by accumulation atherosclerotic plaque. Heart failure is frequent complication when coronary intervention is not performed, increasing risk of mortality, particularly in low and middle income countries due to limited access healthcare services and high prevalence factors associated with ischemic heart disease, such as age ≥45 years in men and ≥55 years in women, systemic arterial hypertension (SAH), diabetes, dyslipidemia, obesity and alcohol and/or tobacco use. The prevalent demographic and epidemiological characteristics in Mexico, and its Northeast Region, favor incidence acute myocardial infarction. However, lack available resources in public institutions hinder coronary intervention, resulting in risk heart failure and mortality. It was hypothesized that patients with acute myocardial infarction without coronary intervention and development of heart failure would be aged 34-59; present chronic comorbidities; alcohol-tobacco consumption; and record cardiovascular risk factors. The results our research will indicate clinical-demographic conditions, allowing establishment of epidemiological bases aimed at improving quality care and optimization institutional resources. Aim: To know characteristics and risk factors for development heart failure in Mexican obese patients with acute myocardial infarction lacking coronary intervention. Methods: Retrospective and analytical study was conducted in patients both sexes and aged ≥34 years from Northeast Mexico with acute myocardial infarction lacking coronary intervention and developing heart failure. The study included all patients who met selection criteria [recording information in clinical record] and who were admitted to emergency department, internal medicine, hospitalization and intensive care unit of a Level II Public Hospital between March 2022 and August 2025. Patients were divided into two groups according to their BMI (kg/m2) [a.- ≤29.9; b.- ≥30].. Patients with reperfusion criteria and/or those referred from other medical units were excluded. Data collected included demographic information; Chronic Degenerative Comorbidities (CDC); alcohol-tobacco consumption; cardiovascular risk; thrombolysis; New York Heart Association (NYHA) scores; Left Ventricular Ejection Fraction (LVEF); B-type Natriuretic Peptide (BNP); and Framingham Criteria for Congestive Heart Failure (CHF). Descriptive statistics [median, frequencies, percentage] and inferential [Odds Ratio; Binary Logistic Regression (BLR); 95% confidence interval (CI)] were used with SPSS, version 25. Results: 27 records were reviewed. Men comprised 74.1%. The median age (years) and BMI (kg/m²) were 55.0 [25th percentile (p25): 48.5; 75th percentile (p75): 62.0] and 30.0 [p25: 24.0; p75: 34.0] respectively. The presence of CDC and alcohol-tobacco consumption was recorded in 88.9% and 66.7%. Cardiovascular risk was identified in 63.0%. Dyslipidemia and arrhythmia were present in 63.0% and 7.5%. The median LVEF (%) and BNP (pg/mL) values ​​were 41.0 [p25: 28.0; p75: 48.5] and 57.0 [p25:49.0; p75: 233.0]. In CHF, 74.1% met major criteria. No significant risk factors were identified in obese patients. Similarly, LFEVI, NYHA and CHF classifications were not significant [p>0.05]. BLR indicated that demographic and epidemiological variables did not increase the probability of registering LVEF value <51.0% and major criteria in CHF. Conclusion: Patients from Northeast Mexico with acute myocardial infarction lacking coronary intervention and developing heart failure were primarily male. The 34-59 age group predominated. Obesity was majority patients. Systemic arterial hypertension (SAH), diabetes, dyslipidemia and alcohol/tobacco use were frequent. NYHA class II was common. Patients commonly had LVEF <51.0%. BNP (pg/mL) <100 was frequent in non-obese patients, while ≥50 pg/mL was observed in half those with obesity. Most met major criteria for coronary heart failure. The limited number patients studied did not allow the identification of factors associated with cardiac markers. The demographic and epidemiological characteristics of Mexico and especially those prevalent in the Northeast region, demand timely and efficient care for these patients. Therefore, it is essential to continue with related studies that integrate a larger number of patients, variables and study period.