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Curso de Atualização em Medicina Cardiovascular 2019
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Complete revascularization on patients presenting with cardiogenic shock: real life data
Session:
Posters 1 - Écran 1 - Doença Coronária
Speaker:
Joana Chin
Congress:
CPC 2019
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:
Posters
FP Number:
---
Authors:
Inês Grácio De Almeida; Joana Chan Chin; Hugo Miranda; Helder Santos; Catarina Santos De Sousa; Samuel Almeida; João Tavares; RNSCA-ProACS
Abstract
<p><strong>Introduction: </strong>The CULPRIT-SHOCK trial showed that immediate multivessel percutaneous coronary intervention (PCI) increased the risk of death or severe renal failure at 30 days on patients (P) presenting with cardiogenic shock (CS).</p> <p><strong>Objective: </strong>Evaluation of prognostic impact of complete revascularization (CR) on P admitted with ST segment elevation myocardial infarction (STEMI) in CS and multivessel disease (MVD).</p> <p><strong>Material and methods: </strong>Retrospective analysis of P data admitted due to STEMI and CS and MVD at multicentric registry between 2000-2018. Compared demographic and clinical characteristics of P who were submitted to CR (group 1 – G1) <em>versus</em> who did not (group 2 – G2) and evaluated its prognostic impact.</p> <p><strong>Results: </strong>Admitted 7919 P with STEMI, which 295 (3.7%) on CS. 46.8% of the P on CS had MVD, 69.6% were submitted to CR. G1 P were younger (61±11 vs 73±12 years, p<0.001). The STEMI location was predominantly anterior (80%) in G1 and inferior in G2 (50%). The stablished timings symptoms start - reperfusion therapy and first medical contact - reperfusion were not statistically different between groups. 20% of G1 P did more than one coronarography during hospitalization. , so we can infer that on the others 80% the CR was performed during the <em>index</em> procedure. The anterior descendent was the artery more frequently involved in both groups (80 vs 89.8%) being the <em>culprit</em> lesion in 47.4% of G1 P and in 27.7% of G2 P, where the most frequently was the right coronary (43.4%, p <0.001). The majority of G1 P (95%) had 2-vessel disease; in G2 53.4% had 2-vessel disease and 46.6% 3-vessel disease (p<0.001). All the G1 P did PCI; in G2, 96.6% did PCI and 3.4% had a hybrid technique (in 2.3% coronary artery bypass grafting planned after hospital discharge). Other interventions during hospitalization were needed, namely non-invasive ventilation (35 vs 21.6%), invasive ventilation (30 vs 34.1%), intra-aortic pump (20 vs 17%) and temporary pacemaker (5 vs 25%), not statistically significant. The stablished endpoints were reinfarction rate (5% between G1 P vs 0%), AHF (70 vs 83%), stroke (5.3 vs 0%) and in hospital death (35 vs 37.5%), not statistically significant.</p> <p><strong>Conclusion: </strong>Although the evaluated endpoints are different and measured at different timings, our results do not appear to follow the trends presented in CULPRIT-SHOCK trial probably as a result of the small sample size and the shorter follow up time. </p> <p> </p>
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