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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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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
14. Acute Cardiac Care
15. Valvular Heart Disease
16. Infective Endocarditis
17. Myocardial Disease
18. Pericardial Disease
19. Tumors of the Heart
20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
37. Miscellanea
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Myocardial infarction with non-obstructive coronary arteries , not so good as expected– stratifying risk of a “new” clinical entity using an “old” tool
Session:
Posters 1 - Écran 1 - Doença Coronária
Speaker:
Pedro Teixeira Carvalho
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:
Pedro Teixeira Carvalho; Mariana Caçoilo; Vera Afreixo; Mesquita Bastos; Lisa Maria Ferraz; Manuela Vieira; José Nobre Santos
Abstract
<p><strong>Introduction</strong></p> <p>It is increasingly recognized that there is a group of myocardial infarction patients with no angiographic obstructive coronary artery disease (≥ 50% diameter stenosis in a major epicardial vessel), and the term myocardial infarction with non-obstructive coronary arteries (MINOCA) has been coined for this entity.</p> <p><strong>Objectives</strong></p> <p>The aim of this study was to evaluate the clinical characteristics, natural history and outcome of a cohort of patients with myocardial infarction with non-obstructive coronary arteries (MINOCA) and evaluate if the GRACE score correctly stratifies prognosis in these patients.</p> <p><strong>Methods:</strong></p> <p>This was a retrospective, observational and single centre cohort study involving patients with MINOCA admitted in a Cardiology ward between January 2014 and December 2017. Data was collected regarding medical history, results of medical tests, drug therapy, complications during hospital stay and the final diagnosis of the MINOCA.</p> <p>The clinical follow-up lasted one year, during which the occurrence of major adverse cardiovascular events (MACE) – all-cause mortality and hospitalization due to myocardial infarction, stroke, acute limb ischemia or heart failure - was evaluated.</p> <p><strong>Results:</strong></p> <p>Of the 67 patients with MINOCA included in the study, 45% were female (66 ± 11,8 years). On discharge, most patients received a prescription for an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker (74%), a beta-blocker (61%), aspirin (59%) and a statin (78%); 24% received double anti-aggregation. The final diagnosis of the MINOCA was discovered in 22,4% of the patients and cardiac magnetic resonance imaging added diagnostic value in 64,7% of the patients who performed it.</p> <p>During the one-year follow-up period, MACE occurred in 7,6% of the patients and 4,6% died. A more elevated GRACE score calculated on patient admission was associated with the occurrence of heart failure during hospital stay and MACE during follow-up. The ROC curves showed a good capacity of the GRACE score for the prediction of these events, with score cut-offs suggested by the Youden index of 113 for prediction of MACE (area under curve (AUC): 0,783) and 137 for heart failure during hospitalization (AUC: 0,790) and one-year mortality (AUC: 0,892).</p> <p><strong>Conclusion:</strong></p> <p>The MINOCA population includes patients with diverse definitive diagnoses and the prognosis is not entirely benign. This study reinforces the importance of MINOCA as a working diagnosis, which should prompt an active approach by the clinician to obtain the definitive diagnosis and provide specific therapy. The GRACE score can be used for risk stratification in patients with MINOCA, with similar cut-offs as those used for non-ST elevation acute coronary syndrome.</p>
Slides
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