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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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A. Basics
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01. History of Cardiology
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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Femoral access for coronarography as predictor of worse in-hospital outcome in acute coronary events
Session:
Posters 1 - Écran 6 - Cardiologia de Intervenção
Speaker:
Luís Graça Santos
Congress:
CPC 2019
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.4 Interventional Cardiology - Other
Session Type:
Posters
FP Number:
---
Authors:
Luís Graça Santos; Rita Ribeiro Carvalho; Fernando Montenegro Sá; Catarina Ferreira Ruivo; Alexandre Antunes; Maria De Fátima Saraiva; Joana Correia; Francisco Soares; Sidarth Pernencar; Joao Morais; Em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p><strong>Introduction: </strong>Higher rates of thirty-day mortality, major bleeding and adverse cardiac events are well-established among patients subjected to femoral access use for coronary angiography (CA) after Acute Coronary Syndrome (ACS). However, multicentric data is lacking regarding in-hospital (IH) outcomes.</p> <p><strong>Purpose</strong>: To evaluate whether IH outcomes are influenced by the type of vascular access used for CA in a ACS population.</p> <p><strong>Methods:</strong> A retrospective analysis of data from consecutive ACS patients enrolled in a multicenter national registry from January 2013 to December 2015 was conducted, identifying 6074 who underwent CA. Baseline characteristics, type of ACS, coronary anatomy, therapeutic strategy, IH medication, IH adverse events, left ventricular function evaluation, mortality and length of stay were evaluated. Two groups were defined according to the site of vascular access: Group A – femoral (FA); Group B – radial (RA). Logistic regression analysis were performed, looking for independent predictors of IH mortality, length of stay over 72 hours, and complications (defined as a composite of re-infarction, new onset of heart failure, atrial fibrillation, high degree atrioventricular block, sustained ventricular tachycardia, resuscitated cardiac arrest, ischemic stroke or major bleeding).</p> <p><strong>Results:</strong> Overall, mean age was 65±13 years, 1510 (24.9%) were female, and 2603 (42.9%) presented with ST segment elevation ACS, which was more frequent among FA patients (49.2% vs. 41.6%, p=0.001). Group A included 986 patients (16.2%) and Group B 5088 (83.8%). There were no differences regarding the rate of percutaneous coronary intervention (76.1% vs. 76.4%; p=0.796). All outcomes evaluated were more frequent among Group A (IH mortality: 6.7% vs. 1.2%, p=0.001; length of stay over 72 hours: 66.2 vs. 52.4%, p=0.001; IH complications: 38.7% vs. 18.6%, p=0.001). Multivariate regression showed that FA was independently associated with higher rates of IH complications and longer IH stay but did not predict IH mortality. Left ventricular systolic dysfunction was the only variable that predicted all the outcomes (Table).</p> <p><strong>Conclusion:</strong> In the present series of ACS patients who underwent CA, FA was used solely in 16.2% of the cases and was associated with IH complications and longer hospitalization. Our results support the evidence that RA should be performed in ACS patients, whenever possible, in order to reduce morbidity and costs related to complications and higher lengths of stay.</p>
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