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Severe ventricular dysfunction after STEMI complicated by cardiogenic shock: predictors, prognosis
Session:
Painel 7 -Doença Coronária 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; DAVID NEVES ; José Eduardo Aguiar; CNCDC
Abstract
<p>Introduction: Left ventricular function is assumed to be the main predictor of prognosis in cardiogenic shock (CS), however trials and registries show that in average left ventricular function is only moderately depressed in CS after acute myocardial infarction. </p> <p>Objective: To characterize the population of patients (Pts) with CS after ST-elevation acute myocardial infarction (STEMI) and with severe left ventricular dysfunction (defined as ejection fraction (EF) < 30%) and to identify possible predictors of severe left ventricular function.</p> <p>Methods: We evaluated 525 Pts with CS after STEMI. We considered 2 groups: Group 1 – Pts with CS and EF < 30% and Group 2 - Pts with CS and EF > 30%. We registered age, gender, cardiovascular and non-cardiovascular co-morbidities, electrocardiographic presentation, vital signs at admission, reperfusion strategies, reperfusion times and coronary anatomy. We also evaluated the following in-hospital complications: Re-Infarction, mechanical complications, high-grade atrial ventricular block, sustained ventricular tachycardia (VT) atrial fibrillation (AF) and stroke. We compared the in-hospital mortality and multivariate analysis was performed to assess the impact of EF in in-hospital mortality and to identify predictors of severe left ventricular function.</p> <p>Results: Severe left ventricular dysfunction was observed in 28,4% of pts with CS after STEMI (n= 149). The mean EF in group 1 was (EF: 23% ± 5 vs 44 ± 11%, p<0,001). Patients of group 1 had higher diabetes (38,9 vs 28,0%, p=0,017), higher prevalence of previous acute myocardial infarction (AMI) (23,1 vs 8,9%, p<0,001) and previous heart failure (11,5% vs 4,8%, p=0,006), with no differences regarding age, gender or other co-morbidities. Group 1 pts had higher anterior STEMI (81,2 vs 46,0%, p<0,001), higher prevalence of left main disease (21,2 vs 6,6%, p<0,001), higher left anterior descending disease (87,2 vs 72,8%, p=0,001), higher times symptom-reperfusion (median 304 vs 245 min, p=0,003). No differences were observed in the rate of coronariography, rate or type of reperfusion and multivessel disease. Group 1 pts had higher VT (17,4 vs 10,6%, p=0,034), stroke (5,4 vs 1,9%, p=0,041) and in-hospital mortality (51,7 vs 26,6%, p<0,001). After multivariate analysis EF is a strong predictor of in-hospital mortality in pts with CS after STEMI [OR: 2,58 (IC:1,38-4,80), p=0,003]. Diabetes [OR: 2,02 (IC:1,17-3,49), p=0,012], previous AMI [OR: 2,80 (IC:1,24-6,31), p=0,013] and left main disease [OR: 3,38 (IC:1,56-7,31), p=0,002] were identified as predictors of severe left ventricular function.</p> <p>Conclusions: In ou population, most of the patients with CS after STEMI had an EF above 30%. Besides this, a lower EF is still a strong predictor of in-hospital mortalityin patients with CS after STEMI. Left main disease, previous AMI and diabetes were identified as predictors of an EF<30%.</p>
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