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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
G. Aortic Disease, Peripheral Vascular Disease, Stroke
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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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Heart failure following ST-elevation myocardial infarction: incidence and prognostic predictors
Session:
Posters 4 - Écran 9 - Insuficiência Cardíaca
Speaker:
Ricardo Costa
Congress:
CPC 2019
Topic:
D. Heart Failure
Theme:
10. Chronic Heart Failure
Subtheme:
10.2 Chronic Heart Failure – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Ricardo Costa; Raquel Baggen Santos; Maria Trêpa; Mariana Santos; Susete Vieira; Marta Fontes Oliveira; André Dias De Frias; André Luz; Mário Silva Santos; Severo Torres
Abstract
<p><strong>Introduction: </strong>Patients with ST-elevation myocardial infarction (STEMI) are at high risk of developing heart failure (HF). The magnitude of this risk with the advent of primary percutaneous coronary intervention (PPCI) is less characterized. We aimed to examine the incidence, predictors and prognostic significance of HF in STEMI patients that underwent PPCI.</p> <p><strong>Methods: </strong>We retrospectively studied consecutive STEMI patients treated with PPCI at a tertiary hospital between 1<sup>st</sup> January 2010 and 31<sup>st</sup> December 2016. Clinical and outcome data were retrieved by chart review. HF-related events were defined as <em>de novo </em>HF diagnosis, clinical worsening HF (increased dose of diuretics at outpatient clinic) or HF hospitalization. Associations between clinical variables and HF-related events, as well as the association between HF-related events and all-cause mortality were assessed using Cox models.</p> <p><strong>Results: </strong>Of 864 patients (63±13 years, 75% male), 70% had Killip-Kimball class (KK) I, 14% KK II, 3% KK III and 13% KK IV. In-hospital mortality was 9%; 61% of those who survived had a left ventricular ejection fraction (LVEF) lower than 50% at hospital discharge. The overall post-STEMI HF-related events was 18.2% (7.7% <em>de novo </em>HF, 2.7% HF worsening and 7.8% HF hospitalization) with a median time to event of 10.8 [2.4-32.4] months. In the multivariate analysis, only age (HR 1.05, 95% CI 1.03-1.08), diabetes (HR 1.88, 95% CI 1.32-2.68), KK class (HR 1.47, 95% CI 1.26-1.71) and LVEF (if >50%: HR 0.50, 95% CI 0.33-0.77) were independent predictors of incident HF-related events. Patients with an HF-related event had a 2.2-fold increased risk of dying (HR 2.20, 95% CI: 1.08-4.50). Considering only those patients with no previous history of HF and KK I (<em>n</em>=564), the incidence of post-STEMI HF-related diagnosis was 10.1%; median time to event was 14.4 [3.6-37.2] months. In this subset of patients, only age (HR 1.07, 95% CI 1.04-1.10) and diabetic status (HR 1.72 95% CI 1.0-2.96) independently predicted HF.</p> <p><strong>Conclusion: </strong>Contemporary STEMI patients treated by PPCI still have a heightened risk of developing or worsening preexistent HF, which signals an increased mortality risk. The elderly, diabetics and those with reduced LVEF at hospital discharge are at increased risk, and most of them become symptomatic in the first year post-STEMI.</p>
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