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CPC 2019
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
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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
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Identifying low-risk patients eligible for early discharge after ST-segment elevation myocardial infarction
Session:
Posters 3 - Écran 1 - Doença Coronária
Speaker:
Pedro Miguel Oliveira Azevedo
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.6 Acute Coronary Syndromes - Clinical
Session Type:
Posters
FP Number:
---
Authors:
Pedro Oliveira De Azevedo; Raquel Menezes Fernandes; Teresa Faria Da Mota; João De Sousa Bispo; João Pedro Moura Guedes; Daniela Carvalho; Dina Bento; Salomé Pereira; Jorge Mimoso; Ilidio Paulos De Jesus
Abstract
<p><strong>Introduction:</strong> Early discharge after ST-segment elevation myocardial infarction (STEMI) should be considered in low-risk patients after successful revascularization to reduce healthcare costs and improve resource use. The Zwolle and PAMI-II criteria are recommended by current guidelines for the identification of patients eligible for early discharge, but there have been significant advances in medical care since their description. We hypothesize that a new risk score, FASTEST, could better identify patients at low risk of adverse events.</p> <p><strong>Methods:</strong> We retrospectively reviewed 1692 patients with STEMI hospitalized from 2010 to 2017. Patients who underwent primary PCI and received complete revascularization were analyzed (n=1353). The FASTEST score awards 1 point for each: femoral access, age>65, LVEF>50%, TIMI<3; creatinine > 1.5 mg/dl; stenosis of the left main coronary artery; and Killip ≥2. Low risk is defined as FASTEST 0. The Zwolle score (low-risk ≤3), PAMI-II (low risk aged <70, LVEF >45%, 1or2-vessel disease, successful PCI, and no persistent arrhythmias), GRACE score (low risk ≤ 108) and TIMI score (low risk ≤ 1) were calculated for comparison. In-hospital mortality, 1-year mortality and 1-year hospitalization were compared between low-risk patients according to different scores.</p> <p><strong>Results:</strong> 1353 were included (80.5% male, mean age 62.4±13 years) and 49% with anterior STEMI. The frequency of low-risk patients was: FASTEST 513 (38%); GRACE 103 (7.6%); Zwolle 1194 (88.4%); PAMI 626 (46.3%) and TIMI 375 (27.7%). In-hospital mortality was 3%. Discrimination by AUC for in-hospital mortality was 0.93 for FASTEST, significantly higher than Zwolle (0.85, p=0.02) and similar to TIMI (0.86, p=0.05) and GRACE (0.9, p=ns). Low-risk FASTEST, GRACE or PAMI had 0 in-hospital mortality, compared with 2 (0.5%) for TIMI and 13 (1.1%) for Zwolle (p=0.02 for comparison). Serious complications (composite of heart failure, re-infarction, mechanical complication, major hemorrhage, complete AV block, ventricular tachycardia or fibrillation, and stroke) occurred in 293 (21.7%) patients. In low-risk patients, complications were: FASTEST 46 (9.0%); GRACE 2 (1.9%, p<0.05 for comparison); PAMI-II 39 (6.2%); Zwolle 181 (15.2%) and TIMI 43 (11.5%). 1-year mortality in low-risk patients was: FASTEST 0.9%; GRACE 0; PAMI 0.7%; Zwolle 4.3% and TIMI 0.6%. 1-year hospitalization was: FASTEST 8.1%; GRACE 13%; PAMI 9.3%; Zwolle 14.2% and TIMI 8.9%.</p> <p><strong>Conclusion:</strong> FASTEST classified 38% of patients as low-risk and showed excellent discrimination for in-hospital mortality (0 patients) and 1-year outcome, although almost 1 in 10 patients had an adverse event during hospitalization. GRACE classified only 7.6% as low risk but demonstrated the best overall accuracy for in-hospital mortality (0) and complications (1.9%). Zwolle performed significantly worse and its use should not be recommended.</p>
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