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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
H. Interventional Cardiology and Cardiovascular Surgery
I. Hypertension
J. Preventive Cardiology
K. Cardiovascular Disease In Special Populations
L. Cardiovascular Pharmacology
M. Cardiovascular Nursing
N. E-Cardiology / Digital Health, Public Health, Health Economics, Research Methodology
O. Basic Science
P. Other
0 Themes
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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Will my patient with acute coronary syndrome develop heart failure?
Session:
Posters 5 - Écran 1 - Doença Coronária
Speaker:
Raquel Menezes Fernandes
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:
Raquel Menezes Fernandes; Teresa Faria Da Mota; João De Sousa Bispo; Pedro Oliveira De Azevedo; João Pedro Moura Guedes; Daniela Carvalho; Dina Bento; Nuno Marques; Walter Santos; Jorge Mimoso; Ilidio Paulos De Jesus
Abstract
<p><strong>Introduction:</strong> Acute coronary syndrome (ACS) is one of the main precipitating factors of heart failure (HF), worsening the patient’s prognosis. This study pretends to determine a predictive score of HF in patients with ACS.</p> <p><strong>Methods:</strong> We conducted a retrospective, descriptive and correlational study including patients admitted with ACS in a Cardiology service from 1<sup>st </sup>October 2010 to 1<sup>st</sup> October 2018. Demographic factors, risk factors, antecedents and clinical characteristics were analyzed. The correlation between the categorical variables was performed by the Chi-square test, while the T-Student test was applied to the continuous variables, with a significance level of 95%. Independent predictors of HF were identified through a binary logistic regression analysis, considering p=0,05. A discriminatory function was applied using the Wilks lambda test to determine the discriminant score of the analized groups. SPSS 24.0 was used for statistical analysis.</p> <p><strong>Results:</strong> 4458 patients were admitted with ACS and 522 (11,7%) developed HF. Of these, 70,9% were over 65 years, 65,1% were male and 45,9% had diabetes mellitus (DM). In addition, 51,7% had acute myocardial infarction with ST-segment elevation, 31,9% had left ventricular ejection fraction (LVEF) <50% and 10,5% developed cardiogenic shock. The in-hospital mortality rate was 19,2%. Age>65 (p=0,04), DM (p=0,025), cardiogenic shock (p<0,001), absence of sinus rhythm at admission (p=0,029), BNP>100 pg/ml (p=0,008) ), LVEF<30% (p=0,003), LVEF<50% (p<0,001) and no previous medication with oral antidiabetic agents (OAA) (p=0,033) were independent predictors of HF development. We determined a predictive score of HF in patients with ACS, using the formula: 0,49 + 0,383x(Age>65) + 0,577x(DM) + 3,638x(cardiogenic shock) – 0,265x(sinus rhythm at admission) + 0,487x(BNP>100) + 1,475x(LVEF<30%) – 1,357x(LVEF>50%) – 0,310x(previous medication with OAA). A cutoff of 0,49 was obtained with 68% sensitivity, 78,4% specificity and 77% discriminative power.</p> <p><strong>Conclusion</strong>: HF is a frequent complication of ACS. We produced a predictive score of HF with a good discriminative power, including age over 65 years, DM, history of medication with OAA, rhythm on admission’s electrocardiogram, LVEF<30%/50%, BNP>100 pg/ml and cardiogenic shock. By considering clinical variables, it can be used at an early stage of the hospitalization, allowing stratification of the risk of developing HF. It still needs validation to be applied in clinical practice.</p>
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