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Clinical profile and predictors of 30-day all-cause mortality of STEMI patients receiving fibrinolytic therapy in an Ultra-Peripheral region
Session:
SESSÃO DE POSTERS 32 - DOENÇAS CARDIOVASCULARES - EAM COM SUPRADESNIVELAMENTO DO SEGMENTO ST
Speaker:
Margarida Câmara Farinha
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:
Margarida Câmara Farinha; Inês Coutinho Dos Santos; Fabiana Duarte; André Viveiros Monteiro; Luís Oliveira; António Fontes; Santos Serena; Emília Santos; Nuno Pelicano; Miguel Pacheco; Anabela Tavares; Dinis Martins
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Background:</strong> In remote locations, fibrinolysis remains a valuable intervention in ST-Elevation Myocardial Infarction (STEMI) patients. Despite its effectiveness, mortality rates remain high among these patients. Despite its timely administration, some patients still face poor outcomes. Understanding the factors associated with mortality is crucial for improving care and enhancing clinical outcomes. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Purpose:</strong> To assess demographics and outcomes of STEMI patients who underwent fibrinolysis in an ultra-peripheral center and to determine key predictors of 30-day mortality. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Methods:</strong> We retrospectively enrolled consecutive STEMI patients who underwent fibrinolysis and were subsequently transferred to our center for facilitated or rescue percutaneous coronary intervention (PCI) between 2020 and 2023. Demographic information and mortality outcomes were examined. A logistic regression analysis was conducted to determine the key factors associated with 30-day all-cause mortality.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Results:</strong> The study included 154 patients with an average age of 61.3 ± 12.6 years, of whom 71.0% were men. Overweight or obesity was observed in 73.4% of the cohort, while 69.7% had hypertension, 65.7% presented with dyslipidaemia, and 30.3% had diabetes. Additionally, 56.0% were active smokers, and 13.4% reported a prior history of acute coronary syndrome. Tenecplase was the fibrinolytic agent used in 83.8% of cases. The antiplatelet of choice in the peri-thrombolytic phase was clopidogrel in 50.6%. The infarct-related artery was the left anterior descending artery in 48.3% of patients, and multivessel disease was present in 33.3%. Killip class III/IV was found in 18.3% of patients. Reperfusion criteria were met in 65.1% of patients after fibrinolysis. The median time from symptoms to fibrinolysis was 3.01 hours (IQR 1.63–5.65) and from fibrinolysis to PCI was 6.38 hours (IQR 3.23–11.07). Mortality occurred in 6.5% of patients and 28.5% had haemorrhagic complications. The analyses revealed that age≥75 years (OR 2.066, p= 0.003), a prior history of acute coronary syndrome (OR 1.674, p =0.016), peripheral arterial disease (OR 1.748, p=0.022), chronic kidney disease (OR 2.127, p=0.007) and Killip class ≥II (OR 3.619, p<0.001) were independent predictors of 30-day mortality. Following fibrinolysis, congestive heart failure (OR 3.415, p<0.001) and atrial fibrillation (OR 1.748, p=0.022) were found to also effect mortality. </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Aptos,sans-serif"><strong>Conclusion:</strong> Despite challenges, fibrinolysis remains a valuable and impactful treatment option for STEMI patients in remote locations without timely access to PCI. Advanced age, previous coronary disease, and Killip class were identified as independent predictors of 30-day mortality. </span></span></p>
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