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Cardiogenic shock without severe ventricular dysfunction in STelevation acute myocardial infarction
Session:
Painel 2 -Insuficiencia cardiaca 2
Speaker:
Bruno Piçarra
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type:
Posters
FP Number:
---
Authors:
Bruno Cordeiro Piçarra; Ana Rita Santos; Antonio; Mafalda Carrington; Diogo Brás; Rita Caldeira Da Rocha; Rui Azevedo Guerreiro; Kisa Hyde Congo; José Eduardo Aguiar; Em nome dos investigadores do RNSCA
Abstract
<p>Introduction: The presence of cardiogenic shock (CS) after ST-elevation acute myocardial infarction (STEMI) is associated with a high mortality. Traditionally, severe left ventricular dysfunction is assumed to be the main predictor of CS, however trials and registries show that in average left ventricular function is only moderately depressed in CS.</p> <p>Objective: To characterize the patients (pts) with CS after STEMI but without severe left ventricular dysfunction (defined as ejection fraction > 30%) and assess their impact in mortality.</p> <p>Methods: We evaluated 7181 pts with STEMI and ejection fraction (EF) > 30%, and excluded all pts with STEMI and an EF<30%. We considered 2 groups: Group 1 – Pts who developed CS and Group 2 - Pts who didn´t developed CS. We registered age, gender, cardiovascular and non-cardiovascular co-morbidities, electrocardiographic presentation, reperfusion strategies, reperfusion times and coronary anatomy. We evaluated the following in-hospital complications: Re-Infarction, mechanical complications, high-grade atrial ventricular block (AVB), sustained ventricular tachycardia (VT), atrial fibrillation (AF) and stroke. We compared in-hospital mortality.</p> <p>Results: Presence of CS without severe left ventricular dysfunction was observed in 5,2% pts (n= 376) with STEMI, being CS present at admission in 51,2% of these pts. The mean EF was lower in group 1 pts (44% ± 11 vs 51 ± 11%, p<0,001). Patients in group 1 were older (70 ± 14 vs 63 ± 13 years, p<0,001), more females (39,4% vs 23,3%, p<0,001), had a higher prevalence of heart failure (4,8% vs 1,4%, p<0,001), peripheral artery disease (5,5% vs 2,9%, p=0,004), chronic kidney disease (6,4% vs 2,7%, p<0,001) and chronic pulmonary obstructive disease (8,2% vs 3,1%, p<0,001). At admission, Group 1 pts had more AF (10,4% vs 4,4%, p<0,001) and more right bundle block (9,7% vs 4,4%, p<0,001). Group 1 patients received less reperfusion (77,7% vs 83,0%, p=0,008), without differences in the type of reperfusion performed or times to reperfusion. The presence of multivessel disease (60,0% vs 45,7%, p<0,001), left main disease (6,6% vs 2,4%, p<0,001) and left anterior descending disease (72,8% vs 66,0%, p=0,016) were more prevalent in Group 1 pts. Group 1 pts had more in-hospital complications: Re-Infarction (3,5% vs 0,7%, p<0,001), AF (22,1% vs 5,0%, p<0,001), mechanical complications (9,6% vs 0,5%, p<0,001), AVB (26,7% vs 3,7%, p<0,001), VT (10,6% vs 1,9%, p<0,001), stroke (1,9% vs 0,6%, p=0,01) and major bleeding (10,4% vs 1,5%, p<0,001). In-hospital mortality was also much higher in Group 1 pts (26,6% vs 1,4%, p<0,001).</p> <p>Conclusions: Cardiogenic shock is present in 5,2% of STEMI pts without severe ventricular dysfunction. These pts were older, had higher morbidities and in-hospital complications. Even without severe ventricular dysfunction, CS in these patients was associated with a much higher in-hospital mortality.</p>
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