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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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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
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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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Angiotensin-converting enzyme inhibitors in acute coronary syndrome with mid-range ejection fraction
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:
13.4 Acute Coronary Syndromes – Treatment
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>: Classically included in the group of patients with 'preserved' left ventricular systolic function (LVEF), heart failure (HF) with mid-range ejection fraction (40-49%) is a group of patients with more recent individualization, whom approach and treatment in the context of ischemic heart disease are not yet fully established. The aim of this study was to evaluate the impact of angiotensin-converting enzyme inhibitors (ACEI) on acute coronary syndrome (ACS) with mid-range LVEF (MREF) and its comparison with patients with LVEF ≥50%.</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, who were evaluated for LVEF during the index event. Patients were subdivided into 2 groups - group 1 with MREF and group 2 with LVEF ≥50%. The primary endpoints evaluated were cardiovascular mortality (CV) and MACE (myocardial infarction, coronary revascularization and CV death), at a median follow-up of 42 months (IQR 27-59).</p> <p><u>Results</u>: A total of 394 patients were identified, 28,9% belonging to group 1 and 71,1% to group 2. The prescription of ACEI at discharge was 90,4% in group 1 and 90% in group 2.</p> <p>Cardiovascular mortality was significantly higher in group 1 (11,4% vs. 3,6%, p<0,05). In addition, there was a trend for more MACE in this group (17,5% vs. 11,4%, p=0,104).</p> <p>In a multivariate analysis adjusted for age and ACS type, the use of ACEI in group 1 was associated with lower CV death (HR 0,2, 95% CI 0,1-0,8). There was also less MACE, but this difference did not reach statistical significance (HR 0,5, 95% CI 0,2-1,5). In group 2, no significant differences were found either for CV death (HR 0,9, 95% CI 0,2-4,5) or for MACE (HR 0,8, 95% CI 0,3-2,1), despite a tendency for fewer events.</p> <p><u>Conclusions</u>: In ACS, MREF appears to be associated with worse prognosis when compared with LVEF ≥50%. The prescription of ACEI was associated with a decrease in cardiovascular events in the MREF group, which did not occur significantly in the LVEF ≥50% group.</p>
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