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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
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
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15. Valvular Heart Disease
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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
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Occluded non-culprit artery and revascularization in ACS patients.
Session:
CO9 - Doença Coronária
Speaker:
José P. Guimarães
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
José P. Guimarães; FM Gonçalves; S Borges; M Moz; J Trigo; PS Mateus; JI Moreira
Abstract
<p><strong>Background:</strong><br /> In ACS patients, the presence of a concurrent occlusion in a non-culprit artery has prognostic impact; however there is doubt regarding the best revascularization strategy in these patients.</p> <p><strong>Objective:</strong><br /> To characterize ACS patients with non-culprit occluded vessels (NCO) regarding its prognosis and the revascularization strategy impact.</p> <p><strong>Methods:</strong><br /> Retrospective study of patients with ACS periodically included in our center registry between October/2012 and November/2017. Patients with previous coronary artery bypass surgery (CABG) or who did not undergo coronariography were excluded. The primary endpoint was a composite of infarction, stroke, unplanned revascularization, heart failure and cardiovascular (CV) death (MACCE) in the follow-up.</p> <p><strong>Results:</strong><br /> We included 560 patients (66±13 years, 76% male, 47% STEMI) and 52 (9.3%) had NCO (Right coronary artery 51%; Circumflex 41%; Left anterior 8%). These patients had more CV risk factors (HTA: 80% vs 62%, p=.009; dyslipidemia: (70% vs 53%, p=.02) and comorbidities, namely: Cerebrovascular disease (17% vs 7%, p=.006); Peripheral arterial disease (7.7% vs 2.6%, p=.04); Chronic kidney disease (CKD) (9.8% vs 1.2%, p<.001) and COPD (13.5% vs 3.8%, p=.002).</p> <p>They presented less frequently with STEMI (33% vs 49%, p=.027) and there were no differences regarding GRACE score (p=.399). During hospitalization they had more heart failure (KK≥II: 31% vs 19%, p=.042) but there were no differences in ejection fraction (EF<40%: 19% vs 21%, p=.817). Fifteen (29%) NCO patients were treated with CABG with no differences in CABG rate when comparing with no-NCO patients with 3 vessel disease (p=.537).</p> <p>During a median follow-up of 43 months (IQR: 25-60), 69 (12.8%) patients died (7.1% from CV causes), 30 (5.6%) had unplanned revascularization (53% after infarction) and 133 (24.8%) had MACE.</p> <p>NCO patients had a higher incidence of MACCE (non-adjusted HR: 2.50, 95%CI: 1.60-3.90, p<.001), however when stratifying by CABG treatment only patients with NCO and no CABG showed a worse prognosis (Image 1).</p> <p>In multivariate analysis, after adjusting for age, hypertension, dyslipidemia, COPD, CKD and ejection fraction NCO was an independent predictor of MACE only in patients with no CABG (NCO and no CABG: HR 5.13, 95%CI: 1.47-17.95, p=.01; NCO and CABG: HR 1.46, 95%CI: 0.38-5.6, p=.0.58).</p> <p><strong>Conclusion:</strong><br /> NCO patients had more comorbidities and a worse long term prognosis. However, CABG showed a protective effect, suggesting a beneficial prognostic impact of this treatment strategy in these patients.</p>
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