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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
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01. History of Cardiology
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05. Atrial Fibrillation
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
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Is Low Density Lipoprotein cholesterol under control in patients with previous myocardial infarction re-admitted for acute coronary syndrome? – The challenges of secondary prevention in ACS.
Session:
Posters 4 - Écran 5 - Doença Coronária
Speaker:
Teresa Mota
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.5 Acute Coronary Syndromes – Prevention
Session Type:
Posters
FP Number:
---
Authors:
Teresa Faria Da Mota; Raquel Menezes Fernandes; João De Sousa Bispo; Pedro Oliveira De Azevedo; João Pedro Moura Guedes; Daniela Carvalho; Dina Bento; Walter Santos; Nuno Marques; Jorge Mimoso; Ilidio Paulos De Jesus
Abstract
<p><strong>Introduction:</strong> In survivors of Myocardial Infarction (MI), lipid lowering therapies are a key point in secondary prevention strategies, and European guidelines define its goals as a Low Density Lipoprotein cholesterol (LDLc) concentration<70mg/dL or a reduction in its value of at least 50% (if values between 70-135 mg/dL).</p> <p><strong>Methods:</strong> The authors present a retrospective, descriptive and correlational study with all patients with a previous diagnosis of MI admitted for Acute Coronary Syndrome in a Cardiology department between the 1st of October 2010 and the 1st of October 2018. The baseline values of total cholesterol (Tc), LDLc, High Density Lipoprotein cholesterol (HDLc) and tryglicerids (Tg) of these patients were described. Demographic and clinical characteristics as well as hospitalization data of patients with LDLc>70 mg/dL were analyzed. A 1-year (1y) follow up was made through registry consultation and phone call by a Cardiologist. The authors performed a multivariate analysis of in-hospital complications (including mortality), as well as 1y outcomes (mortality and hospitalization rates), using SPSS 24,0 for statistical purposes.</p> <p><strong>Results:</strong> A total of 1069 patients were included, 856 (80,1%) of which were male, with a mean age of 67,63±12,68 years. The mean serum concentrations of Tc, LDLc, HDLc and Tg were respectively 178,8±49 mg/dL, 110,7±42,8 mg/dL, 39±11,1 mg/dL, 135,5±78,2 mg/dL. A serum concentration of LDLc >70mg/dL was present in 574 (81,4%) patients. The authors found significant positive associations of higher LDLc values with a younger age, smoking and family history of coronary artery disease, and negative associations with hypertension, previous angina, and previous stroke. Patients with LDLc >70mg/dL were less frequently medicated with statins (p< 0,001). Higher LDLc values were also significantly more common in patients presenting with ST Elevation Myocardial Infarction (STEMI) (p=0,002) and normal QRS duration (p=0,009). The group with LDLc >70mg/dL showed higer rate of LVEF >30% ( p=0,009). Concerning in-hospital complications, the authors identified a lower incidence of re-infarction in patients with higher LDLc (p= 0,032), but no relation with other intercurrences such as atrial fibrillation, heart failure or in-hospital mortality. Regarding 1y outcomes, there were no diferences in re-admission rates, but 1y mortality was significantely lower (p =0,005). On a multivariate statistical analysis, a LDLc >70mg/dL didn’t prove to be an independent predictor of re-infarction, in-hospital mortality and 1y mortality. </p> <p><strong>Conclusion:</strong> In the present study, a serum concentration of LDLc >70mg/dL was present in 574 patients. Eventhough these patients had an interestingly lower incidence of in-hospital re-infarction and 1y mortality, the established LDLc cutoff didn’t behave as an independent predictor of Re-infarction, in-hospital mortality and 1y mortality.</p>
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