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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
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
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15. Valvular Heart Disease
16. Infective Endocarditis
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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
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Characteristics and 1-year prognosis of non-obstructive acute coronary syndrome
Session:
CO9 - Doença Coronária
Speaker:
José Miguel Ramos Viegas
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:
Comunicações Orais
FP Number:
---
Authors:
José Miguel Viegas; António Valentim Gonçalves; Ana Teresa Timóteo; Duarte Cacela; Ramiro Sá Carvalho; António Fiarresga; Lino Patrício ; Luis Bernardes; Lidia De Sousa; Maria De Lurdes Ferreira; Tiago Pereira Da Silva; Sílvia Aguiar Rosa; Dra. Inês Rodrigues; Tiago Mendonça; Rui Cruz Ferreira
Abstract
<p><strong>Introduction:</strong> Among patients admitted at catheterization laboratory with suspicion of acute coronary syndrome (ACS) a minority have no obstructive epicardial coronary disease (MINOCA). The characteristics and outcomes of this subgroup remains unclear.</p> <p><strong>Purpose: </strong>The aim of the present study is to characterize MINOCA patients and assess the 1-year prognosis regarding total mortality.</p> <p><strong>Methods: </strong>A standardized registry was prospectively performed for all ACS patients admitted from January 2006 to August 2017 in a single tertiary care centre. Patients were divided according to have at least one obstructive coronary artery (G1), defined by a stenosis above 50%, or not (G2) and baseline characteristics were compared between the two groups. All-cause mortality at 30 days and at 1 year were also compared using univariate Cox analysis.</p> <p><strong>Results: </strong>From 3765 ACS patients admitted during the study period, 461 (12.2%) were included in G2. G2 patients were older (62.6±13.1 vs 66.2±13.7; p<0.001) and more frequently women (26.3% vs 44.2%; p<0.001). Smoking was more frequent in G1 (40.0% vs 21.9%; p<0.001) but the prevalence of hypertension was higher in G2 (55.2% vs 64.2%; p<0.001). There were no differences regarding dyslipidaemia and diabetes. End-stage chronic kidney disease was higher in G2 (2.4% vs 4.1%; p=0.025). Regarding the clinical evolution during hospitalization, G2 presented more frequently with Killip-Kimball class ≥II (13.9% vs 19.3%; p=0.001), but at release there was no difference in the proportion of patients with left ventricular ejection fraction ≤50% (34.8% vs 32.1%; p=0.286). ACS with ST-segment elevation was more common in G1 (58.8% vs 52.1%; p=0.006), but no differences were found regarding left and right bundle branch block patterns at presentation. In-hospital and 30-day mortality was not significantly different between groups (5.9% vs 7.4%; p=0.205). However, at 1-year follow-up, G2 had a worse outcome regarding total mortality (HR (95%CI); 1.473 (1.103-1.969); p=0.008, figure 1).</p> <p><strong>Conclusion: </strong>MINOCA patients seem not to be a low-risk group of ACS patients, since in this study they had a higher 1-year mortality than ACS patients with obstructive coronary disease. This higher mortality only became apparent after 30 days from the ACS. A systematic diagnostic work-up for further implementation of the most appropriate treatment should be crucial for getting better outcomes with this group of patients.</p>
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