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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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A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
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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
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Secondary prevention in patients with myocardial infarction and nonobstructive coronary artery disease: characterization and impact on 1-year outcomes
Session:
Posters 4 - Écran 2 - 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:
13.5 Acute Coronary Syndromes – Prevention
Session Type:
Posters
FP Number:
---
Authors:
Pedro Oliveira De Azevedo; Teresa Faria Da Mota; João De Sousa Bispo; João Pedro Moura Guedes; Daniela Carvalho; Nuno Marques; Walter Santos; Jorge Mimoso; Ilidio Paulos De Jesus; Em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p><strong>Introduction:</strong> Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs in 5% to 10% of all patients with myocardial infarction. Although these patients are often treated as if they had obstructive coronary artery disease (OCAD), optimal medical therapy for secondary prevention in MINOCA patients have not been prospectively studied.</p> <p><strong>Purpose:</strong> We aim to characterize and assess the impact of discharge medication on 1-year mortality or hospitalization in patients with MINOCA.</p> <p><strong>Methods:</strong> Retrospective and observational study of consecutive patients with acute myocardial infarction (AMI) recorded in the Portuguese Registry of Acute Coronary Syndromes (ProACS) between 2010 and 1017. All patients who underwent coronary angiography and had no obstructive lesions (defined as ≥50% diameter stenosis) were included for analysis (n=829, 4.8% of a total of 17213 patients in the registry). Patient demographics, clinical characteristics and medication at discharge were analyzed. The association between treatment and outcome was estimated by comparing treated and untreated groups using Cox proportional hazard models. The exposures considered were treatment at discharge with statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (ACEi/ARBs), beta-blockers (BB), aspirin (ASA) or dual antiplatelet therapy (DAPT). The outcomes evaluated were 1-year all-cause mortality and 1-year hospitalization due to cardiovascular disease (CVD)</p> <p><strong>Results:</strong> 829 patients (54% male, mean age 65±13 years) were included. 67% had hypertension, 20% diabetes mellitus, 45% had hyperlipidemia, 6% had familiar history of AMI, 66% were overweight, 23% were current smokers, 5.5% had previously diagnosed heart failure, 4.3% valvular heart disease, 8% cerebrovascular disease and 4.7% chronic kidney failure. The admission diagnosis was most frequently non-ST elevation MI (79.3%) and mean left ventricular ejection fraction was 56±12. 4 patients died during hospitalization (0.5%). At discharge, aspirin was prescribed in 85.7% patients, clopidogrel in 54.8%, ticagrelor in 7.5%, DAPT in 57.7%, ACEi/ARB in 79.2%, beta-blocker in 69% and statins in 90.2%. 1-year mortality and 1-year CVD hospitalization was 3.8% and 9%, respectively. After adjusting for covariates in Cox regression analysis, we found no association between any medication at discharge and 1-year outcomes.</p> <p><strong>Conclusion:</strong> Our analysis found no significant 1-year beneficial effect of treatment with statins, ACEi/ARBs, BB, aspirin or DAPT in MINOCA patients. This may be partially explained by the highly heterogenous population and relative short-term follow-up (1-year). In these patients, treatment should be personalized after an exhaustive diagnostic workup to identify the underlying cause (CAD with spontaneous autolysis of an intracoronary thrombus, myocarditis or takotsubo syndrome, for instance).</p>
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