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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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Neutrophil-to-lymphocyte ratio: a novel prognostic marker in recuperated out-of-hospital cardiac arrest due to coronary artery disease
Session:
Posters 4 - Écran 1 - Doença Coronária
Speaker:
Maria Trêpa
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.5 Acute Cardiac Care – Cardiac Arrest
Session Type:
Posters
FP Number:
---
Authors:
Maria Trêpa; Samuel Bastos ; Marta Fontes Oliveira; Raquel Baggen Santos; Ricardo Costa; André Dias De Frias; Bruno Brochado; André Luz; João Brum Silveira; Anibal Albuquerque ; Mário Silva Santos; Severo Torres
Abstract
<p>Introduction</p> <p>Recuperated out-of-hospital cardiac arrest (rOHCA) population is wide and heterogenous. Few studies focused specifically on outcomes in the rOHCA subgroup with proven significant coronary artery disease (SigCAD). Furthermore, the neutrophil-to-lymphocyte ratio (NLR), a marker of inflammation, is associated with prognosis in acute coronary syndromes but no data exists in patients with SigCAD presenting after rOHCA. </p> <p>Our aim was to assess the prognostic significance of NLR ratio in this specific subgroup of patients.</p> <p>Methods</p> <p>Retrospective observational study of rOHCA patients submitted to coronary angiography. SigCAD was defined as >70% stenosis in major vessels or >50% in left main or performance of percutaneous coronary intervention (PCI). The finding of SigCAD was used to establish a coronary cause for OHCA and only those patients were included for further analysis.</p> <p>Logistic regression and receiver operator curves (ROC) models were used for statistical analysis.</p> <p>Results</p> <p>63 patients were included, median age was 63 years old (yo) and 84% were male. In-hospital mortality was 36%. In coronary angiography, 90% had at least 1 suboclusive lesion and 73% had a recent total occlusion; 72% underwent PCI. The median NLR at 24h was 8 (interquartile range: 6.5).</p> <p> Patients with higher NLR were older (57±11yo vs 65±13, p= 0.02), more likely to be non-smokers (74% vs 47%, p=0.04) and to have a higher GRACE score measured at 24h (151±35 vs 172±31, p= 0.04). No statistically significant difference were found between groups regarding to other clinical characteristics, initial arrest rhythm, EKG changes, initial lactate and troponin values and extent of CAD.</p> <p>Univariates predictors of in-hospital mortality were: At admission, pH<7.2 (63% vs 34%, p=0.04) and a non-shockable rhythm (75% vs 34%, p=0.02). At 24 hours, a lactate value >1.7mmol/L (33% vs 66%, p= 0.03), and NLR>8 (13% vs 55% p<0.01).</p> <p>In multivariate analysis (table 1), including all aforementioned significant predictors, only a 24h NLR>8 remained an independent predictor of in-hospital mortality (p=0.01) increasing the of death risk by 12 fold.</p> <p>In ROC analysis a 24h NLR>8 demonstrated a moderate discriminative performance (area under the curve: 0.7) to identify those patients who eventually died.</p> <p>Conclusion</p> <p>A 24h NLR>8 in rOHCA patients with SigCAD is significantly associated with in-hospital mortality, even after adjustment for other classical prognostic markers. Our findings suggest inflammation as a critical pathophysiological mechanism and NLR as a novel and simple to use marker, that can improve prognostic evaluation in these patients. </p>
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