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Trends in Primary Angioplasty Outcomes: Mortality, Procedural Advancements, and Lesion Type Evolution Over Time
Session:
SESSÃO DE POSTERS 32 - DOENÇAS CARDIOVASCULARES - EAM COM SUPRADESNIVELAMENTO DO SEGMENTO ST
Speaker:
Ana Raquel Carvalho Santos
Congress:
CPC 2025
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Raquel Carvalho Santos; André Ferreira; André Grazina; Pedro Brás; Tiago Mendonça; Luis Morais; Ruben Ramos; António Fiarresga; Lidia Sousa; Inês Rodrigues; Duarte Cacela; Rui Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">Primary angioplasty has advanced over the past two decades, with improvements in procedural techniques, patient care, and post-procedural strategies. This study analyzes trends in mortality, procedural changes, lesion characteristics, and the use of mechanical support over time.</span></span></p> <p style="text-align:justify"><br /> <span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">We conducted a retrospective analysis of primary angioplasty data from 2002 to 2023, grouped into three periods: 2002–2009, 2010–2019, and 2020–2023. Data were analyzed for mortality rates (30-day [30d], 1-year [1y], 3-year [3y], and 5-year [5y]), procedural changes (complete revascularization, access route, IIb/IIIa inhibitors), lesion types (including bifurcation lesions), usage of IABP, Impella, ECMO, mechanical ventilation [MV] and cardiac arrest. </span></span></p> <p style="text-align:justify"><br /> <span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">30d Mortality remained stable, with slight reduction in 2020–2022. 1y Mortality showed significant reduction (p<0.0001), reflecting advancements in PCI. 3y and 5y Mortality showed substantial decreases in 2020–2022 (p<0.01), indicating long-term survival improvements. Complete Revascularization increased, reducing follow-up interventions. A significant shift from trans-femoral to trans-radial access was observed (p<0.0001), reflecting safer techniques. The use of IIb/IIIa inhibitors declined significantly, aligned with evolving guidelines. Major complications decreased (p<0.01).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">The use of IABP and Impella was more frequent in earlier periods, reflecting higher reliance on mechanical circulatory support. However, in 2020–2022, both devices were used less frequently. ECMO use also declined, reflecting improvements in patient stabilization techniques and a reduced need for invasive mechanical support. MV and cardiac arrest incidents decreased across periods (p<0.01).<br /> Regarding Lesion Types, proximal right coronary artery remained the most common lesion, while proximal circumflex artery and proximal left anterior descending artery increased in 2010–2019 before declining in 2020–2022, reflecting changes in treatment approaches. The incidence of bifurcation lesions decreased.</span></span></p> <p style="text-align:justify"><br /> <span style="font-size:11pt"><span style="font-family:Aptos,sans-serif">This study demonstrates significant improvements in mortality, procedural safety, and patient outcomes in primary angioplasty over the past two decades. Advances in PCI, including trans-radial access and complete revascularization, have reduced complications and improved survival. The decline in IIb/IIIa inhibitors, IABP, Impella, ECMO, and MV, along with evolving lesion management, highlights continued progress in PCI techniques and post-procedural care.</span></span></p>
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