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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
10. Chronic Heart Failure
11. Acute Heart Failure
12. Coronary Artery Disease (Chronic)
13. Acute Coronary Syndromes
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15. Valvular Heart Disease
16. Infective Endocarditis
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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
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Prevalence, clinical characteristics and prognosis of patients referred for primary PCI without obstructive coronary disease.
Session:
Posters 5 - Écran 2 - Doença Coronária
Speaker:
Rita Carvalheira dos Santos
Congress:
CPC 2019
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.6 Acute Coronary Syndromes - Clinical
Session Type:
Posters
FP Number:
---
Authors:
Rita Carvalheira Dos Santos ; Luís Raposo ; Sérgio Madeira; João Brito; Mariana Gonçalves; Catarina Brízido; NELSON VALE; Sílvio Leal; Pedro Sousa; Pedro de Araújo Gonçalves; Henrique Gabriel; Rui Campante Teles; Manuel Almeida; Miguel Mendes
Abstract
<p>Introduction</p> <p>A proportion of patients with suspected STEMI that are referred for emergent coronary angiography and primary PCI (PPCI) suffer from conditions other than acute coronary obstruction. We aimed to characterize such a population and compare its short-term prognosis with that of confirmed STEMI patients.</p> <p>Methods</p> <p>Retrospective analysis of 2226 pts with suspected STEMI referred for emergent invasive coronary angiography in a single PPCI reference hospital between January 2012 and November 2018. Patients with cardiorespiratory arrest were excluded. Baseline, procedural and 30-day outcome data was prospectively collected in a local dedicated Cath-lab database for patients admitted to the reference centre, while data regarding diagnosis and outcome of patients without confirmed STEMI finally admitted to referral institutions was captured from the national health system clinical registry. Baseline characteristics and 30-day mortality were compared between those with and without a definitive diagnosis of STEMI.</p> <p>Results</p> <p>72 pts (3.2%) referred for PPCI presented with non-obstructed coronary arteries. These patients were younger (55 IQR 42-66 vs 64 IQR 54-73), had a lower prevalence of hypertension (35% vs 58%, p<0.001), diabetes (10% vs 23 %, p=0.006), smoking (36% vs 49%, p=0.041) and of clinical background of coronary artery disease (myocardial infarction or coronary revascularization, p<0.001). The most common EKG finding was ST elevation in inferior leads (31%), while left bundle brunch block was present in 7 patients (10%). Forty-sixt percent of the patients (n=33) had a cardiac condition, 37% without coronary involvement. The most frequent final discharge diagnosis were miopericarditis (n=14;19%), Takotsubo syndrome (n=8;11%), musculoskeletal diseases (n=6;8%), myocardial infarction assumed to be due to coronary artery spasm or with spontaneous revascularization (n=6; 8%), acute heart failure with new onset LBBB (n=5; 7%), gastro-intestinal diseases (n=4; 6%) and drug abuse (n=3; 4%).</p> <p>At 30 days, none of the patients that presented with suspected STEMI died; conversely, patients with confirmed STEMI had an overall 30-day mortality rate of 3.5% (n=76).</p> <p>Conclusions</p> <p>In a contemporary PPCI population, the prevalence of “normal” coronaries (without severe stenosis or complete obstruction) is trivial. A significant proportion of patients (46%) had a cardiac condition mimicking STEMI. The short-term prognosis is good.</p>
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