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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
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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High dose statin therapy, acute coronary syndrome and heart failure with reduced ejection fraction: the good, the bad and the ugly?
Session:
Posters 4 - Écran 3 - Doença Coronária
Speaker:
Joana Ribeiro
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Joana M. Ribeiro; Rogerio Teixeira; João Lopes; José Pedro Sousa; Diana Decampos; Carolina Saleiro; Luís Puga; Liliana Reis; Alexandrina Siserman; Carolina Lourenço; Lino Gonçalves
Abstract
<p><strong>Background</strong>: The benefit of statins after an acute coronary syndrome (ACS) is well established. Nevertheless the use of statins in patients with heart failure (HF) and reduced ejection fraction has been recently challenged.</p> <p><strong>Aims</strong>: To understand study the effectiveness and safety of a high-dosage statin therapy (HDST) in ACS patients complicated with HF.</p> <p><strong>Methods</strong>: Cohort analysis of all patients admitted to an intensive care unit for an ACS between 2009 and 2016, who had a left ventricular ejection fraction (LVEF)≤40% plus documented coronary artery disease (CAD). The patients were divided In 2 groups based on the statin therapy prescribed at hospital discharge: group A (N=52) – HDST and group B (N=141) – low dosage statin therapy. HDST was defined as atorvastatin≥ 40mg od, rosuvastatin≥ 20 mg od or pitavastatin≥ 2 mg od; when ezetimib was added, dosages of atorvastatin≥ 20 mg and rosuvastatin≥ 10 mg were considered high dosage. The primary endpoint was all-cause mortality. The secondary endpoints consisted of an “ischaemic endpoint” composed of death, myocardial infarction, stroke and repeat revascularization and an “HF endpoint” composed by death and hospital admission for HF. The impact of HDST was accessed by the Kaplan-Meier method. We also elaborated a Cox regression analysis for 5 years of follow-up, adjusted to the variables more strongly associated with each endpoint in the bivariate analysis.</p> <p><strong>Results</strong>: The cohort consisted of 193 patients with a mean age of 68±13 years (76% male). Mean follow-up time was 46±30 months. The Kaplan-Meier curves (figure 1) showed that a HDST was associated with a lower mortality (panel A), a lower incidence of the ischaemic endpoint (panel B) and a trend towards a lower incidence of the HF endpoint (panel C). After adjustment for the confounding variables, a HDST was associated with a non-significant trend towards a reduced mortality (OR 0.81, CI 0.33-2.00, <em>P</em>=0.65) and a lower incidence in the ischaemic endpoint (OR 0.78, CI 0.38-1.62, <em>P</em>=0.51) but had no effect on the HF endpoint (OR 0.97, CI 0.48-1.98, <em>P</em>=0.94).</p> <p><strong>Conclusions</strong>: A HDST after an ACS in patients with a reduced ejection fraction was associated with a non-significant trend for increased survival. Moreover HDST showed no harm regarding an heart failure readmission.</p>
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