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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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Lipoprotein-associated phospholipase A2 predicts heart failure readmission in coronary heart disease
Session:
CO3 - Doença Coronária
Speaker:
Cátia Santos Ferreira
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.2 Coronary Artery Disease – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Cátia Santos Ferreira; Rui Baptista; João André Ferreira; James Milner; J Almeida; Sofia S. Martinho; Anália Carmo; João Pego; Lino Gonçalves
Abstract
<p>BACKGROUND: Lipoprotein-associated phospholipase A2 (Lp-PLA2), a vascular-specific inflammatory biomarker,is involved in multiple stages of atherosclerosis. Lp-PLA2 is associated with coronary heart disease (CHD) and stroke. After an admission for an acute cardiovascular event, the prognosis of patients with CHD is often difficult to stratify. We analysed the association between Lp-PLA2 and short-term adverse outcomes in patients with CHD.</p> <p>POPULATION AND METHODS: We conducted a prospective, observational cohort study, including 108 patients with CHD admitted to a Cardiac Care Unit from January to April of 2018. Two groups were created: group 1 (G1) with Lp-PLA2 <200ng/ml (n=89) and group 2 (G2) with Lp-PLA2 ≥200ng/ml (n=19). This cut-off was predefined, considering Lp-PLA2 ≥200ng/ml portend a moderate- to high- risk of cardiovascular disease. Patients were followed for a median (interquartile range) period of 7 (7-8) months. </p> <p>RESULTS: Demographic data was similar among groups except for age (G1: 68±13 vs G2: 61±13 years, p=0.03), LDL cholesterol (G1: 111±36 vs G2: 167±45 mg/dL, p=0.01) and smoking habits (G1: 18% vs G2: 42% smokers, p=0.02). The majority of the patients were admitted for acute coronary syndrome (40.7% for ST-Elevation MI (STEMI), 37% for non-STEMI and 12% for unstable angina), while 4.6% presented with heart failure (HF), 4.6% with ventricular arrhythmias and 0.9% with pericarditis. Globally, the in-hospital mortality was 4.6% and was not associated with Lp-PLA2. At follow-up (FU), there were 2 MI, 3 unscheduled revascularizations, 8 HF hospitalizations, no strokes, and 4 deaths. Lp-PLA2 was not associated with MI, revascularization, stroke and mortality. However, patients with a Lp-PLA2≥ 200ng/ml had a 22-fold risk of admission due to decompensated HF, after adjusting for age, gender, LDL, smoking status, left ventricular ejection fraction and prior HF hospitalization (HR 21.9; 95%CI 1.1-231.1, p=0.01). Among the patients with prior HF hospitalization (n=8), only 3 had a readmission; conversely, the remaining 5 patients with decompensated HF at FU never had an HF admission before. </p> <p>CONCLUSION: In this prospective cohort of patients with CHD, Lp-PLA2 levels ≥200ng/ml were associated with a significantly increased risk of 6-month readmission due to decompensated HF. Further studies are warranted to understand if LpA2 is on the causal pathway of HF or if it only specifically reflects a higher inflammatory state that is present in severe HF.</p>
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