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Curso de Atualização em Medicina Cardiovascular 2019
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Therapeutic decisions for myocardial infarction with non-obstructive coronary artery disease: how gender influences choices
Session:
Posters 4 - Écran 5 - Doença Coronária
Speaker:
Fernando Montenegro Sá
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 Montenegro Sá; Rita Ribeiro Carvalho; Luís Graça Santos; Catarina Ruivo; Alexandre Antunes; Joao Morais; “Em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p><strong>Introduction: </strong>In patients with myocardial infarction (MI) and non-obstructive coronary artery disease (MINOCA), clear recommendations regarding specific therapy are lacking. Women are more frequently affected by this entity. However, their prognosis seems to be worst, and published registries refer that specific medication seems to be less prescribed to women. According to current guidelines, therapy for post-MI patients includes dual antiplatelet therapy (DAPT), beta-blocker (BB), angiotensin converting enzyme-inhibitors (ACE)/angiotensin receptor blockers (ARB) and statins, regardless of gender.</p> <p><strong>Aim:</strong> This study aims to identify whether MINOCA therapeutic decisions are influenced by gender.</p> <p><strong>Methods:</strong> The authors analysed a multicentre national prospective registry enrolling patients with a first MI between 2010 and 2017, who underwent a coronary angiography evidencing absence of any lesion causing ≥ 50% of luminal reduction. Univariate comparison between genders was performed. In order to search for MINOCA therapy predictors, a multivariate analysis with logistic regression was applied for each specific therapeutic group. All analysis included demographic, clinical and laboratorial data, past medical history, coronary angiography findings and MI type.</p> <p><br /> <strong>Results:</strong> From a total of 16 237 patients analysed, 709 (4.4%) were included as MINOCA. Mean age was 64±13 years, 46.3% (n=409) were females and ST-segment elevation MI (STEMI) was identified in 20.2% (n=145). The presence of trivial coronary lesions (< 50% of luminal reduction) was identified in 36.1% (n=256). Regarding univariate comparison, there were no differences between male vs. female patients regarding BB (69.5% vs. 60.3%, p=0.98); ACE/ARB (80.7% vs. 80.2%, p=0.88) and statin therapy (91.1% vs. 89.7%, p=0.51). DAPT was used in a total of 390 (55%) patients, being more frequent in males (62.2% vs. 46.6%, p<0.01) than in females. After multivariate analysis (table), male gender remained an independent DAPT predictor: OR=1.67 [1.05-2.38], p=0.027.</p> <p><br /> <strong>Conclusion:</strong> Despite the lack of clear recommendations for the use of antithrombotics in patients with MINOCA, in a large nationwide registry DAPT was prescribed at discharge in 55% of patients. The explanation for this surprising high rate of DAPT in patients with non-obstructive coronary artery disease is not clear. How gender influences DAPT decision, and how to handle antithrombotics in MINOCA patients in general is an open topic for discussion.</p>
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