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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
36. Basic Science
37. Miscellanea
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Long-term clinical outcomes of coronary slow-flow phenomenon: not as benign as thought?
Session:
Posters 4 - Écran 8 - Cardiologia de Intervenção
Speaker:
Rita Marinheiro
Congress:
CPC 2019
Topic:
P. Other
Theme:
37. Miscellanea
Subtheme:
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Session Type:
Posters
FP Number:
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Authors:
Rita Marinheiro; Ricardo Santos; Filipe Seixo; Nuno J. Fonseca; Carina Isabel Pereira Ramalho; José Maria Farinha; Marta Ferreira Fonseca; Ana Fátima Esteves; Antonio Pinheiro Cumena Candjondjo; Nuno Gomes; Andreia Cristina Serrano Fernandes; Cristina Carradas; Jose Venancio; Bruno Santos; Rui Caria
Abstract
<p><strong><u>Introduction:</u></strong> Coronary slow flow phenomenon (CSFP) describes a slow progression of contrast medium in filling the coronary arteries during coronary angiography, in the absence of other abnormalities. The pathogenic mechanisms are incompletely understood, but probably include coronary microvascular disease. Although reported as having a benign outcome, relapses and ventricular arrhythmias have been reported. Furthermore, studies incorporating assessment of endothelial function indicated a higher risk of serious cardiovascular events, suggesting CSFP patients can have a similar risk.</p> <p><strong><u>Aim</u></strong>: to study patients (pts) with CSFP regarding basal characteristics and presentation at the time of coronary angiography and analyze long-term clinical outcomes (recurrent angina, acute coronary syndrome (ACS), cardiovascular (CV) death and overall death). </p> <p><strong><u>Methods:</u></strong> We evaluated pts who had performed coronary angiography between 2008 and 2015 in a single center. We identified those in whom CSF was detected. CSF was defined as the presence of angiographically normal coronary arteries and Thrombolysis In Myocardial Infarction (TIMI)-2 flow (i.e., requiring ≥3 beats to opacify prespecified branch points in the distal vasculature of at least one of the three major epicardial coronary vessels). Pts are excluded if they have other conditions that would confound impaired coronary flow. An age- and gender-matched population with normal coronary angiography was evaluated as a control group. </p> <p><strong><u>Results:</u></strong> The selection of pts for analysis is shown in the study flow diagram (figure 1A). Primary CSFP was detected in 72 pts (median age 63 years (IQR 53-71), 68% male). Comparing to control group, CSFP pts were more frequently current smokers (25% versus 11%, p=0.03) and presently more commonly with ACS (50% versus 30%, p=0.02) (figure 1B). Recurrent angina occurred in 17 CSFP pts (25%) comparing with 3 (4) control pts (Odds ratio 7.1, confidence interval (CI) 1.9-25.5, p=0.03), leading to additional invasive and non-invasive exams (7 electrocardiogram exercise testing, 3 myocardial perfusion scintigraphy and 2 invasive coronary angiography in CSFP pts and 2 coronary computed tomography angiography in controls). ACS did not occurred in any pt. During the follow-up (73 ± 23 months), CV death occurred in 6 CSFP pts (8%) comparing to 1 pt in control group (1%) (adjusted hazard ratio (HR) 11.8, CI 0.9-16.3, p=0.06) and overall death occurred in 7 CSFP pts (10%) comparing to 5 pts in control group (7%) (adjusted HR 1.6 CI 0.5-5.5, p=0.45) (figure 1C).</p> <p><strong><u>Conclusions:</u></strong> In our study, CSFP was associated with current smoking and with ACS presentation. There was a trend for a higher risk of CV death in patients with CSFP, raising the hypothesis that microvascular disease may contribute to a worse long-term outcome.</p>
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