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Pacemaker rhythm in acute coronary syndrome - does it influence our approach and prognosis?
Session:
Posters 2 - Écran 8 - Doença Coronária
Speaker:
João Pedro de Sousa Bispo
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:
João De Sousa Bispo; Raquel Menezes Fernandes; Pedro Oliveira De Azevedo; Teresa Faria Da Mota; Nuno Marques; Walter Santos; Jorge Mimoso; Ana Camacho; Ilidio Paulos De Jesus
Abstract
<p><strong>Objectives </strong></p> <p>To determine wether the presence of pacemaker rhythm in patients admited with Acute Coronary Syndrome influences the in-hospital treatment and long-term prognosis.</p> <p> </p> <p><strong>Methods</strong></p> <p>Retrospective study of a data base of patients with ACS from our Centre from 2010 to 2017. We evaluated baseline characteristics, therapeutic strategy, and 1 year mortality rates and complications from patients with pacemaker rhythm compared with other patients. A univariate and multivariate analysis was performed using SPS 24.0.</p> <p> </p> <p><strong>Results</strong></p> <p>Of a total of 3300 ACS, 26 had pacemaker rhythm on presentation. 14 (53,8%) were male, and average age was 79,9 +/- 10,4 years. Admission diagnosis was ACS of undetermined location in 15, Non-ST Segment Elevation Acute Myocardial Infarction (AMI) in 7, and ST Segment Elevation AMI in 4.</p> <p>On Univariate analyses, patients presenting with pacemaker rhythm tended to be older (p<0,001), smoked less (p=0,003), had more frequently hypertension (p=0,001), diabetes (p=0,049), previos history of ACS (p=0,04), coronary by-pass surgery (p=0,001), valve disease (p=0,024), stroke (p<0,001) and peripheral artery disease (p<0,001). During hospital stay, they received less frequently treatment with aspirin (p=0,009), glycoprotein inhibitors (p=0,014), and were more medicated with nitrates (p=0,001), aldosterone antagonists (p=0,003), diuretics (p<0,001), and amiodarone (p=0,001).</p> <p>These patients underwent coronary angiography less frequently (p<0,001) as well as angioplasty (p=0,005). Left ventricle ejection fraction was lower in these patients (FEVE = 47,0 +/- 15,0%, p=0,005). There was no difference in hospital mortality between groups.</p> <p>Upon discharge, they were less medicated with aspirin (p=0,001), clopidogrel (p=0,028), and more medicated with warfarin (p=0,04), other anticoagulants (p=0,024), nitrates (p=0,027), aldosterone antagonists (p=0,009), diuretics (p<0,001), amiodarone (p<0,001). 1-Year mortality was higher in these patients (p=0,029) and showed a non-significant trend towards higher 1-year hospital admissions (p=0,05).</p> <p>However, on multivariate analysis, pacemaker rhythm on admission was not an independent predictor of 1-year mortality or hospital admissions.</p> <p> </p> <p><strong>Conclusion</strong></p> <p>ACS patients with pacemaker rhythm on admission had a worse prognosis during follow-up in our population. Several factors can have contributed to this, since these patients were older and had more previous comorbidities and underwent less frequently coronary angiography and intervention. During hospital stay and post-discharge, they are less medicated with platelet inhibitors, which may also contribute to the worse prognosis.</p>
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