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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
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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
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13. Acute Coronary Syndromes
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15. Valvular Heart Disease
16. Infective Endocarditis
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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
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34. Public Health and Health Economics
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Prognostic significance of obesity in STEMI patients: the impact on heart failure
Session:
Posters 5 - Écran 1 - Doença Coronária
Speaker:
Ricardo Costa
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:
Ricardo Costa; Raquel Baggen Santos; Maria Trêpa; Susete Vieira; Mariana Santos; Marta Fontes Oliveira; André Dias De Frias; André Luz; Mário Silva Santos; Severo Torres
Abstract
<p><strong>Introduction: </strong>In general population, a normal range body mass index (BMI) is associated with lower mortality. Paradoxically, in several chronic diseases an increased BMI is related to better prognosis, including in patients post-acute coronary syndrome. We aimed to evaluate if this effect occurs in a cohort of ST-elevation myocardial infarction (STEMI) patients.</p> <p><strong>Methods: </strong>We retrospectively studied consecutive STEMI patients treated with primary percutaneous coronary intervention 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. BMI was categorized as low weight (<18.5kg/m<sup>2</sup>), normal (18.5-24.9kg/m<sup>2</sup>), overweight (25- 29.9kg/m<sup>2</sup>) and obese (>30kg/m<sup>2</sup>). Major adverse cardiovascular and cerebrovascular events (MACCE) were defined as occurrence of cardiovascular death, myocardial infarction, stroke or target lesion revascularization. Heart failure (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.</p> <p><strong>Results: </strong>We included 864 patients (63±13 years, 75% male), 0.6% with low weight, 33.3% with normal weight, 45.1% overweight and 16.1% obese. Obese were younger and exhibited higher prevalence of previous hypertension, diabetes and dyslipidemia. Incidence of MACCE was 20.1%, with a median time to event of 10.1 [1.3-255.1] days and no significant differences between BMI groups. In multivariate analysis, only left ventricular ejection fraction (LVEF; if preserved, HR 0.45, 95 CI 0.23-086) and previous history of hypertension (HR 2.77, 95 CI 1.43-5.39) were independent predictors of MACCE. The overall post-STEMI HF-related events was 18.2% (6.2% <em>de novo</em> HF, 2.7% HF worsening and 9.3% HF hospitalization) with a median time to event of 10.8 [2.4-32.4] months. Independent predictors of HF-related events were age (HR 1.05, 95 CI 1.03-1.08), diabetes (HR 1.94, 95 CI 1.17-3.20), Killip-Kimball class (HR 3.02, 95 CI 1.96-5.25), LVEF (if preserved, HR 0.46, 95 CI 0.27-0.79) and obesity (HR 2.43, 95 CI 1.19-4.96). Obese individuals had a 1.8-fold increased risk of HF-related events (HR 1.80, 95% CI 1.11-2.92).</p> <p><strong>Conclusion: </strong>In a cohort of all-comers STEMI patients, BMI was not associated with MACCE. In contrast, obese patients had an increased risk of developing <em>de novo</em> HF or worsening of preexistent HF. Our data suggests that obesity has a divergent prognostic significance regarding cardiovascular outcomes.</p>
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