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Revascularization strategies in context of acute coronary syndrome presenting with cardiogenic shock
Session:
Painel 2 -Insuficiencia cardiaca 2
Speaker:
Vera Vaz Ferreira
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:
Vera Ferreira; Sílvia Aguiar Rosa; Ana Teresa Timóteo; Maria De Lurdes Ferreira; Duarte Cacela; Luís Almeida Morais; Alexandra Castelo; Pedro Garcia Brás; Tânia Branco Mano; Rui Cruz Ferreira
Abstract
<p><strong>INTRODUCTION: </strong>The use of early revascularization of the culprit artery with percutaneous coronary intervention (PCI) has been shown to improve outcome in patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS). However, most of patients with CS have multivessel disease (MV), remaining under discussion the optimal timing of non-culprit revascularization and the best treatment strategy for patients with CS .</p> <p><strong>PURPOSE:</strong> The aim of this study was to determine the impact of PCI of the culprit lesion only (CLO) or immediate multivessel (IMV) PCI on procedural and clinical outcomes in patients with CS.</p> <p><strong>METHODS: </strong>150 consecutive patients with AMI, MV and CS treated with PCI admitted at a tertiary centre were included. The primary end point was all-cause mortality within 30 days. Safety endpoints included bleeding and stroke. Clinical characteristics, procedural features, antithrombotic therapies and MACE, including all-cause mortality, hospitalization for heart failure, myocardial reinfarction and repeated revascularization were registered in-hospital, 30-days and at 12-month follow-up (FU).</p> <p><strong>RESULTS: </strong>Mean age was 69.0±12.0 years (Y), 108 male (72.0%). 115 P (76.7%) presented with ST-segment elevation myocardial infarction (STEMI) and 37.3% with anterior STEMI. The patient cohorts, 114 P in CLO group and 36 P in IMV group, were comparable in age, sex, and cardiovascular risk factors. At 30 days, the primary endpoint had occurred in 46 P in CLO PCI group and in 22 P in the IMV PCI group, with an absolute 20.7 % reduction in 30-day mortality (40.4% vs 61.1%; p=0.031). Kaplan–Meier analysis showed that survival was significantly worse for P in IMV group (log-rank 0.036). At 12 months FU, all-cause mortality was not statistically different between groups (51.8% vs 66.7%, p=0.120).</p> <p><strong>CONCLUSIONS: </strong>Among P presenting with CS in context of AMI and MV disease, 30-days outcomes were better in those who initially underwent PCI of the CLO comparing with IMV PCI. At 12 months FU, there was no difference in the incidence of ischemic events or death from any cause. These data are in line with recent publications that state culprit-lesion-only PCI with possible staged revascularization should be the preferred revascularization strategy.</p>
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