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PREDICTORS OF ADVERSE IN-HOSPITAL PROGNOSIS IN NSTEMI WITH RBBB
Session:
Painel 6-Doença Coronária 1
Speaker:
Mariana Saraiva
Congress:
CPC 2020
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:
Mariana Saraiva; Ana Rita Moura; Nuno Craveiro; M. João Vieira; Kevin Domingues; Maria Da Luz Pitta; Vitor Paulo Martins; Em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p>Introduction: Recent recommendations regarding myocardial infarction (MI) underline the adverse prognosis associated with right bundle branch block (RBBB). However, it is unclear if this is due to a more difficult and late diagnosis or to the clinical severity inherent to the patients (pts) with this electrocardiographic pattern.</p> <p>Aim: to characterize a population with non-ST segment elevation MI (NSTEMI) and RBBB and find predictors of worse in-hospital prognosis.</p> <p>Methods: retrospective analysis of pts with NSTEMI included in a multicentric registry of Acute Coronary Syndromes, comparing pts with RBBB (group A) and pts without RBBB (group B), regarding clinical and demographic variables, diagnostic and therapeutic approaches. The primary endpoint was in-hospital heart failure, electrical or mechanical complications or mortality.</p> <p>Results: we included 9375 pts, 686 pts in group A and 8689 pts in group B. Pts in group A were more likely to be male (Odds Ratio -OR- 1.58, p<0.001) and over 75 years old (OR 2.77, p<0.001). Also, they were more prone to have cardiovascular risk factors (hypertension - OR 1.8, p<0.001, diabetes – OR 1.32, p<0.001), history of coronary artery disease (stable angina - OR 1.26, p=0.007, previous MI - OR 1.31, p=0.002 and revascularization, either percutaneous – OR 1.27, p=0.016 or surgical – OR 1.99, p<0.001), stroke (OR 1.53, p<0.001), chronic kidney disease (OR 1.69, p<0.001) and cancer (OR 1.42, p=0.025). There were no differences between time from onset of symptoms and first medical contact or hospital admission between groups. Upon admission, pts in group A presented more frequently with hypotension (OR 1.73, p=0.026), Killip class≥II (OR 1.71, p<0.001) and atrial fibrillation (p<0.001). The use of inotropes (p<0.001), non-invasive (p=0.008) and invasive ventilation (p=0.018) and temporary pacing (p=0.001) was significantly more frequent in group A.</p> <p>Pts with RBBB were less likely to undergo coronary angiography (CA) (OR 0.68, p<0.001). However, among those who did, there were no differences in CA timing (p=0.091). Multivessel disease (OR 1.21, p=0.044) and the decision of no revascularization (OR 1.33, p=0.012) were both more frequent in group A.</p> <p>The primary endpoint was met in 16.66% of all pts, which was significantly more common in group A (11% of pts), comparing to group B (6.6% of pts) - p<0.001. In a multivariate regression analysis, including variables such as gender, age, cardiovascular risk factors, previous evidence of cardiovascular disease, and clinical and coronary anatomy data, RBBB was an independent predictor of the primary endpoint (OR 1.3, p=0.032) - area under the curve of 0.833.</p> <p>Conclusion: In this population, pts with NSTEMI and RBBB had poorer in-hospital prognosis, partly due to a greater clinical complexity (older age, comorbidities and complex coronary anatomy), with RBBB itself being an independent predictor of adverse in-hospital outcome.</p>
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