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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
G. Aortic Disease, Peripheral Vascular Disease, Stroke
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L. Cardiovascular Pharmacology
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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
37. Miscellanea
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The timing of new-onset atrial fibrillation during hospitalization and its prognostic relevance in ACS patients
Session:
Posters 2 - Écran 1 - 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:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
José P. Guimarães; FM Gonçalves; S Borges; M Moz; PS Mateus; J Trigo; JI Moreira
Abstract
<p><strong>Background:</strong><br /> New-onset (New) atrial fibrillation (AF) in Acute Coronary Syndrome (ACS) patients (pts) is a well-established marker of worse prognosis. The impact of the timing where AF occurs during hospitalization isn’t well studied and it could provide valuable information for prognostic and treatment decisions.</p> <p><strong>Objective:</strong><br /> Compare the presence of early-onset AF (EAF), late-onset AF (LAF) and no AF in ACS pts and evaluate its long term prognostic impact.</p> <p><strong>Methods:</strong><br /> Retrospective study of pts with ACS periodically included in our center registry between October/2012 and November/2017. Pts with AF present at hospital admission and pts who died in the first 24 hours were excluded. Pts were classified as having no AF; EAF (first 24 hours of hospitalization) and LAF (after 24 hours). The primary endpoint was a composite of cardiovascular (CV) death, infarction and stroke (MACE) in the follow-up.</p> <p><strong>Results:</strong><br /> We included 571 pts (66±13 years; 74% males; 45% STEMI) and 39 (6.9%) had New AF, 18 (3.2%) with EAF and 21 (3.7%) with LAF. Pts with New AF, particularly LAF, were older (LAF: 75±9; EAF: 73±13; No AF: 65±13; p<.001), had more hypertension (86%, 78%, 63%; p=.046), dyslipidemia (91%, 33%, 55%; p=.001), cerebrovascular disease (38%, 17%, 37%; p<.001) and COPD (24%, 6%, 4%; 2=.002).</p> <p>At admission, pts with New AF had a higher GRACE risk score (high risk GRACE: 71%, 89%, 36%; p<.001) with no differences between EAF and LAF (p=.247). During hospitalization New AF pts had a higher Killip class (≥2: 71%, 56%, 20%; p<.001) and lower ejection fraction (EF) (44±15%, 49±13% 51±11%; p=.05). In New AF patients, the most frequent culprit artery was the right coronary in EAF (50%) and the anterior descending in LAF (60%; p=.043) and there were no differences in discharge hypocoagulation (p=.141).</p> <p>During a median follow-up of 44 months (IQR: 24-60), 78 (14.2%) pts died (7.5% from CV causes) and 87 (15.2%) had MACE. Pts with LAF had a higher risk of MACE than those with no AF (p=.001) but not those with EAF (p=.78).</p> <p>In multivariate analysis, after adjusting for GRACE and EF, only the presence of LAF was an independent predictor of MACE (LAF: HR 2.54 CI95% 1.15-5.59, p=.021; EAF: HR 0.74 95%CI 0.24-2.50, p=.67).</p> <p><strong>Conclusion:</strong><br /> In this study, pts with EAF and LAF were clearly different. LAF pts had more comorbidities and a significantly worse long term prognosis. This information could be considered when deciding hypocoagulation, however, randomized clinical trials are lacking.</p>
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