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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
G. Aortic Disease, Peripheral Vascular Disease, Stroke
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
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0 Themes
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
37. Miscellanea
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Chronic obstructive pulmonary disease in acute coronary syndrome – a vicious circle
Session:
Posters 4 - Écran 3 - Doença Coronária
Speaker:
Fernando Gonçalves
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:
Fernando Fonseca Gonçalves; José P. Guimarães; Sara Borges; José João Monteiro; Pedro Sousa Mateus; Ilidio Moreira
Abstract
<p><u>Introduction</u>: Chronic obstructive pulmonary disease (COPD) and acute coronary syndrome (ACS) are two prevalent diseases and impose a considerable degree of difficulty in the diagnostic and therapeutic approach when present simultaneously. The aim of this study was to evaluate the prognostic impact of COPD in patients hospitalized for ACS.</p> <p><u>Methods</u>: This was a retrospective study of patients with nonfatal ACS, periodically included in our center registry between October/2010 and November/2017. At a median follow-up of 42 months (IQR 25-59), the endpoints evaluated were acute myocardial infarction (MI), hospitalization due to decompensated heart failure (DHF) and mortality.</p> <p><u>Results</u>: In a total of 574 patients, in which 74,7% were men and the mean age was 66,2 ± 13,0 years, 5,4% had past history of COPD. In this group, patients were older (74,1±8,1 vs. 65,7±13,1 years, p<0,001), 19,4% had ST-segment elevation MI (STEMI) and 67,7% non-ST-segment elevation MI (NSTEMI), whereas 43,8% of patients without COPD had STEMI and 47,9% NSTEMI. We found that patients with past history of COPD were less medicated with beta-blockers (BB) at discharge (58,1% vs. 82,1%, p<0,05). The prescription of BB in this group was associated with a significant reduction in DHF events (HR 0,3, 95% CI 0,1-0,8), but not mortality (HR 0,4, 95% CI 0,2-1,3), nor cardiovascular (HR 0,3, IC 95% 0,1-1,1) nor non-cardiovascular (HR 1,1, IC 95% 0,2-6,3), and MI (HR 1,2, 95% CI 0,1-21,0).</p> <p>In a multivariate analysis adjusted for age, ACS type, left ventricular ejection fraction and BB prescription at discharge, patients with past history of COPD had a significant increase in DHF events (HR 2,0, 95% CI 1,0-3,7) and mortality (HR 2,8, 95% CI 1,5-5,1), either cardiovascular (HR 2,4, 95% CI 1,1-5,4) or non-cardiovascular (HR 3,2, 95% CI 1,2-8,8). The same did not happen for MI (HR 0,7, 95% CI 0,2-3,1).</p> <p><u>Conclusions</u>: In this study, patients with ACS diagnosed previously with COPD had an independent greater number of DHF events and death, both cardiovascular and non-cardiovascular. In this group, patients who were not prescribed BB, possibly due to the severity of the pulmonary disease, had a significant increase in DHF events.</p>
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