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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
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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
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Cardiac arrest: which patients can benefit from coronary angiography?
Session:
Posters 1 - Écran 1 - Doença Coronária
Speaker:
Joana Margarida Nunes Rigueira
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.5 Acute Cardiac Care – Cardiac Arrest
Session Type:
Posters
FP Number:
---
Authors:
Joana Rigueira; P. Carrilho Ferreira; Inês Aguiar Ricardo; Sara Couto Pereira; Rafael Santos; Afonso Nunes Ferreira; Tiago Graça Rodrigues; Nelson P. Cunha; Pedro Morais; Pedro Silvério António; Fausto José Pinto; Pedro Canas Da Silva
Abstract
<p><strong>Background</strong>: The identification of the cardiac arrest’s (CA) etiology and the survival probability is challenging. Studies show an association between coronary angiography (CAT) and survival, but the available data are limited and incomplete with respect to the selection of these patients(pts).</p> <p><strong>Purpose</strong>: to identify predictors of coronary disease(CD) in a sample of pts submitted to CAT in the context of CA and look for relationship between CD and death.</p> <p><strong>Methods</strong>: A single-center retrospective study including consecutive pts submitted to CAT in the context of CA from January 2015-July 2018. Demographic, clinical, echocardiographic, ECG and angiographic data were evaluated. The results were obtained using logistic regression.</p> <p><strong>Results</strong>: 121 pts (mean age 63.2 ± 13 years, 76% men) were included. The most frequent comorbidities were: hypertension (63.2%) and dyslipidemia (42.2%). Most of CAs have shockable-rythms (69.4%) and the mean CA duration was 16 ± 17 min.<br /> On average, patients underwent CAT 1.3 ± 3 days after CA. The most common cause of CA was myocardial infarction (MI) (65.3%), type 1 in 59.4%, and with ST elevation in 36.4%.<br /> 70.6% of the pts had significant elevation (> 5x the upper limit of normality) of troponin (Tn) and 53.7% had wall motion abnormalities (WMA) on the echocardiogram.<br /> Significant CD was recorded in 75.4%pts, predominantly involving the anterior descending (55%) and the right coronary (44.9%) arteries.<br /> The Tn value presented moderate capacity to predict CD (AUC 0.67 p = 0.022), best cut-off was 168ng / L (Sens=60.4%, Spec=72.7%).<br /> There were independent predictors of CD: hypertension (OR 2.43, p = 0.045), post-CA rhythm other than AF/flutter (OR 4.77 p = 0.032), presence of WMA (OR 36.27, p = 0.001), ST elevation (OR 11.1, p = 0.002) and TnThs> 168ng / L (OR 4.06, p = 0.012).<br /> There was no association between the presence of CD and mortality, however, a trend towards higher mortality was observed in the group of patients with left main and circumflex disease (p = 0.085 and 0.065, respectively). In patients with CD, angioplasty had no impact on prognosis.</p> <p><strong>Conclusion</strong>: This study supports the current recommendations, suggesting that patients with the highest suspicion of MI (Tn elevation, especially TnThs> 168ng / L, WMA and ST elevation) are those who will benefit most from CAT. In our population, hypertensive pts with post-CA rhythm other than AF/flutter had a higher probability of significant CD. On the other hand, there was no relationship between the presence of CD and death suggesting the need for prospective studies with a greater number of pts to assess the value of CAT in this population.</p>
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