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CPC 2019
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
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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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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
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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
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Predictors of cardiac events occurrence after a non-positive exercise echocardiography in patients previously submitted to percutaneous coronary angioplasty
Session:
Posters 5 - Écran 7 - Imagiologia Cardiovascular
Speaker:
Ana Marques
Congress:
CPC 2019
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters
FP Number:
---
Authors:
Ana I. Marques; Inês Cruz; Sofia Alegria; Ana Rita F. Pereira; Alexandra Briosa; Daniel Sebaiti; Ana Almeida; Paula Fazendas; Isabel João; Helder Pereira
Abstract
<p>Introduction: Stress testing following percutaneous coronary intervention (PCI) can identify myocardial ischemia resulting from in-stent restenosis, progression of coronary lesions in arteries that were not revascularized, or de novo lesions.</p> <p>Objectives: To determine prognostic value and predictors of cardiac events occurrence after a non-positive exercise echocardiography (EE) in pts previously submitted to PCI.</p> <p>Methods: Retrospective single-center study that included pts previously submitted to PCI that performed EE between 2008-2017 that was not positive for myocardial ischemia. A cardiac event was assumed when coronary revascularization during follow-up (FUP) was performed. Statistical analysis applying Kaplan Meier and Cox regression was performed.</p> <p>Results: Were selected 389 pts (84% male, mean age 62±9 years). Almost 78% of these had 1 or 2 vessels with coronary artery disease (CAD) and 60% of the pts had been submitted to complete percutaneous revascularization.</p> <p>EE was negative in 63% and inconclusive in 37%. The main indication for EE performance was chest pain (34%). At the time of EE performance, 115 pts did not stop antianginal therapy with beta blocker therapy. Most pts (91%) had preserved left ventricular ejection fraction (LVEF). The mean exercise time achieved was 7.6±6.2 minutes and the mean METS achieved were 8.5±2.5. Although it was the main indication for the test performance, only 4.1% referred chest pain during treadmill exercise. A positive ischemic response during electrocardiography monitoring was observed in 3.3% of the cases.</p> <p>During a mean FUP of 50±33 months, cardiac events occurred in 68 (17.5%) pts, conferring a negative predictive value of 82.5%. PCI was performed in 65 (16.7%) pts and surgical myocardial revascularization in 3 (0.8%) pts, mainly due to stable CAD (65%). An acute coronary syndrome occurred in 23 (6%) pts.</p> <p>In unadjusted Cox regression, systemic hypertension, chronic renal disease, the number of vessels with CAD, LVEF, wall motion score index and an inconclusive test were positively and significantly associated with events occurrence. </p> <p>After covariate adjustment, systemic hypertension (HR 2.07, CI 1.10-3.91, p=0.025), the number of vessels with CAD (2 vessels: HR 1.37, CI 0.75-2.30, p=0.304; 3 vessels: HR 2.59, CI 1.38-4.87, p=0.003) and an inconclusive test (HR 1.67, 1.03-2.70, p=0.039) remained significantly associated with cardiac events occurrence.</p> <p>Cardiac event-free survival rates at 1, 2, 3, 4 and 5 years were 96.5±0.9%, 93.5±1.4%, 88.3±1.9%, 83.0±2.3% and 79.5±2.6%, respectively.</p> <p>Conclusion: The prognostic value of non-positive treadmill EE in pts previously submitted to PCI was excellent, with high levels of event-free survival rates. The factors associated with cardiac events occurrence in these population were the extent of vessels with CAD, systemic hypertension and an inconclusive result.</p>
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