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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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Previous neoplasia in patients with STEMI: characterization of population and impact on prognosis.
Session:
Posters 4 - Écran 5 - Doença Coronária
Speaker:
João Pais
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:
Antonio; Bruno Cordeiro Piçarra; Mafalda Carrington; Ana Rita Santos; Rui Azevedo Guerreiro; Kisa Hyde Congo; Diogo Brás; João Carvalho; David Neves; José Eduardo Aguiar; Em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p><strong>Introduction:</strong> Therapeutic Advances in Oncology have allowed a significant increase in the survival of these patients (P). However options for medical and interventional cardiologic therapies are limited and prognosis of this population is different from general population. </p> <p><strong>Objective</strong>: To evaluate the impact of the presence of previous neoplasia on the therapeutic approach, complications and in-hospital mortality in P with STEMI</p> <p><strong>Population and Methods</strong>: A total of 7176 P with STEMI were evaluated. We considered 2 groups: P with STEMI and previous history of neoplasia and P with STEMI without history of neoplasia. We compared age, personal history, clinical presentation, location and severity of coronary disease, therapeutic approach and ejection fraction (EF). In-hospital mortality (HM) and the following complications were evaluated: heart failure (HF), cardiogenic shock (CC), reinfarction, major haemorrhage (MH), high-grade AV block. Multivariate analysis was performed, adjusting for the variables with a statistically significant difference in the groups' characterization in order to assess the relationship between previous neoplasia and HM and any of the complications considered.</p> <p><strong>Results</strong>: Previous neoplasia was present in 4.5% (324P) with STEMI. These P were older (71 ± 11 vs 63 ± 14, p <0.001) and had a higher prevalence of arterial hypertension (69.4% vs 60.6%; p=0.002), previous HF (4.4% vs 1.9%, p=0.002), peripheral arterial disease (6.3% vs. 2.9%, p <0.001), chronic renal failure (6.6% vs 3.1%, p <0.001) and previous haemorrhage (3.2% vs 1.3%, p <0.012). The P with STEMI and neoplasia presented more frequently with Killip-Kimbal class = 4 (5.9% vs 3.4%, p <0.016), however they were submitted to less coronariography (85.8% vs. 93.1%, p <0.001) and angioplasty (80.2% vs. 87.1%, p <0.001). They presented higher HM (9,0% vs 4.9%, p <0.001) and developed more in-hospital complications: HF (26.5% vs. 17.9%, p < 0.001, CC (10.2% vs 6.1% p <0.003), reinfarction (2.2% vs 0.8% p <0.021), MH (4.6% vs 1.9%, p <0.001), high-grade AV block (8.6% vs 5.4%, p <0.011). After multivariate analysis, the presence of previous neoplasia in P with STEMI was an independent predictor of HM (OR 2.12, p <0.033), reinfarction (OR 2.96; P=0,027), MH (OR 2.62; P=0,005).</p> <p><strong>Conclusion</strong>: The presence of previous neoplasia seems to influence the therapeutic approach of P with STEMI and is associated with increased in-hospital mortality and complications.</p>
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