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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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01. History of Cardiology
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05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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Revascularization strategies in patients with acute myocardial infarction and cardiogenic shock – Results from the Portuguese Registry on Acute Coronary Syndromes (ProACS
Session:
Posters 2 - Écran 1 - Doença Coronária
Speaker:
Sofia Alegria
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:
Posters
FP Number:
---
Authors:
Sofia Alegria; Ana I. Marques; Ana Rita F. Pereira; Alexandra Briosa; Daniel Sebaiti; Ana Catarina Gomes; Gonçalo Jácome Morgado; Rita Calé; Cristina Dantas Martins; Inês Rangel; Helder Pereira; em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p><strong>Background: </strong>In patients with acute myocardial infarction (MI) and cardiogenic shock (CS), revascularization of the culprit artery is associated with an improvement in prognosis. However, a significant proportion of patients present with multivessel disease (MVD). Although the previous guidelines recommended complete revascularization during the index procedure, recent data challenged this strategy, so the more recent guidelines favour the revascularization of the culprit artery only.</p> <p><strong>Purpose: </strong>To compare outcomes associated with different revascularization strategies in patients with MI and CS.</p> <p><strong>Methods</strong>: Observational retrospective study of patients admitted with acute MI, CS, and MVD, included in the ProACS between October 2010 and January 2018. Three revascularization strategies were considered: complete during the index procedure – group 1; complete staged during the index hospitalization – group 2; and incomplete during the index hospitalization – group 3). Considering the small number of patients in group 2, the comparison was performed between groups 1-2 and group 3 (complete vs incomplete revascularization during the index hospitalization). The primary endpoint was a composite of in-hospital death or reinfarction.</p> <p><strong>Results: </strong>Of 16.634 patients with acute MI included, 329 presented with CS, of which 127 were submitted to coronary angiography and had MVD, and were considered in this analysis (21% in group 1-2 and 79 % in group 3). Most patients were male (69%), with a mean age of 70±12 years and 36% were admitted to non-percutaneous coronary intervention centres. The most common diagnosis was STEMI (93%). The primary endpoint occurred in 36.9% of patients and in-hospital mortality was 34.2%.</p> <p>Patients in groups 1-2 were younger (62±10 vs 73±11 years), had a higher prevalence of smoking habits (46 vs 17%) and family history of premature coronary artery disease (13 vs 1% (p<0.05 in all). On admission patients in groups 1-2 were more often in sinus rhythm (96 vs 75%) and presented a lower median value of BNP (100 vs 471 (p<0.02 in both).</p> <p>The primary endpoint occurred in 36% of the patients in groups 1-2 and 38% of the patients in group 3 (p=0.712). The rates of in-hospital mortality, stroke, and major bleeding were also similar between groups, while there was a higher rate of reinfarction in patients submitted to complete revascularization (7 vs 0%; p=0.044).</p> <p>The predictors of in-hospital mortality were the presence of left ventricle systolic dysfunction on admission (OR 40.52), while therapy with angiotensin-converting enzyme inhibitors during hospitalization had a protective effect (OR 0.11).</p> <p><strong>Conclusions: </strong>Among patients with acute MI, CS and MVD included in the ProACS, there was no significant difference between complete and incomplete revascularization during the index hospitalization, regarding the occurrence of the composite endpoint of in-hospital death or reinfarction.</p>
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