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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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32. Cardiovascular Nursing
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Outcomes of complete revascularization on patients presenting with STEMI
Session:
Posters 3 - Écran 1 - Doença Coronária
Speaker:
Inês Grácio Almeida
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:
Inês Grácio De Almeida; Hugo Miranda; Helder Santos; Joana Chan Chin; Catarina Santos De Sousa; Samuel Almeida; João Tavares; Registo Nacional de Síndrome Coronária Aguda, Pro-ACS
Abstract
<p><strong>Introduction: </strong>40-50% of patients (P) presenting with ST segment elevation myocardial infarction (STEMI) have multivessel disease (MVD). The PRAMI, CvLPRIT and DANAMI-3 PRIMULTI trials showed that complete revascularization (CR) was associated to better outcomes.</p> <p><strong>Objective: </strong>Evaluation of prognostic impact of CR in P admitted with STEMI and MVD.</p> <p><strong>Material and methods: </strong>Retrospective analysis of P data admitted with STEMI and MVD at multicentric registry between 2000-2018. Compared demographic and clinical characteristics of P submitted to CR (group 1-G1) <em>versus</em> who did not (group 2-G2). A Cox multivariate regression was performed to evaluate predictor factors of stablished endpoints in-hospital and at 1-year (1y). Survival was evaluated through Kaplan-Meier curve (Log-rank test).</p> <p><strong>Results: </strong>Admitted 7919 P with STEMI. 2924 P performed a coronariography with MVD documentation, 21.7% were submitted to CR. G1 P were younger (63±12 vs 66±13 years, p<0.001). The STEMI location was predominantly inferior in both groups (51.7 vs 56.1%). 32.1% of G1 P did more than one coronary procedure during hospitalization. The anterior descendent was the artery more frequently involved in both groups (79.5 vs 85.6%). The majority of P in the both groups had 2-vessel disease: 67 vs 85.7%. 33% of G1 P and 14.3% of G2 had 3-vessel disease. The culprit lesion was localized at descent anterior artery in 40.3% of G1 P and 39.1% of G2; and at right coronary in 35.4% of G1 and 40.4% of G2. All P of G1 performed percutaneous coronary angioplasty (although 0.2% had coronary artery bypass grafting (CABG) planned after hospital discharge). On G2, 4.6% did a hybrid technique during hospitalization, 3% stayed with CABG planned after discharge. The in-hospital evaluated endpoints were: reinfarction rate (1.7% between G1 vs 1.1%, p 0.238); acute heart failure (15 vs 22.7%, p <0.001); stroke (0.8 vs 0.7%, p 0.795) and death (3.6 vs 6.1%, p 0.017). 1y mortality rate was 5.6%. Predictor factors for 1y mortality, evaluated through Cox multivariate regression, were: age ≥ 75 years (<em>odds ratio</em> (OR) 3.087, p <0.001, confidence interval (CI) 1.661-5.737); acute heart failure (OR 3.574, p <0.001, CI 1.898-6.730); heart rate > 100bpm (OR 2.708, p 0.005, CI 1.342-5.461) and ejection fraction <50% (OR 2.873, p 0.004, CI 1.403-5.881).</p> <p><strong>Conclusion: </strong>Our results are in accordance to data available from clinical trials, showing that acute heart failure and mortality rates are statistically significant lower in P submitted to CR, however in our study it was not predictor of 1y mortality.</p>
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