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Resuscitated cardiac arrest and no ST-elevation - What to expect?
Session:
Painel 7 -Doença Coronária 2
Speaker:
Rita Ribeiro Carvalho
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.7 Acute Coronary Syndromes - Other
Session Type:
Posters
FP Number:
---
Authors:
Rita Ribeiro Carvalho; Luís Graça Santos; Francisco Soares; Sara Lopes Fernandes; Fernando Montenegro Sá; Joao Morais
Abstract
<p><strong>Background: </strong>Urgent coronary angiography after resuscitated cardiac arrest (rCA) is a class I recommendation in the presence of ST-elevation, however the management of those presenting with no ST-elevation and high suspicion for coronary artery disease (CAD) are still matter of debate. In fact, the prevalence of CAD in this group is high and it is reported a 25% of cases with identified culprit lesion, but one recent trial showed no benefit of an immediate strategy vs a delayed one in respect to overall 90-day survival. Our aim is to characterize this group of patients (pts), regarding the burden of CAD, the identification of a culprit lesion and the short-term and one-year prognosis.</p> <p><strong>Methods: </strong>A retrospective multicentric study, including pts admitted to percutaneous coronary intervention (PCI) after out-hospital rCA, from Oct 2010 to Jan 2019. Pts with no ST-elevation at admission were compared to those with ST-elevation, regarding clinical and angiographic characteristics. The primary endpoint was the composite of in-hospital death, cardiogenic shock (CS), myocardial infarction (MI) and stroke and the co-primary endpoint the composite of death or re-hospitalization at 12 months. Paired Student T-test an χ<sup>2</sup> test were used accordingly to assess baseline characteristics. Univariate logistic regression and cox regression analysis were used, to assess the primary and co-primary endopoints, respectively. Alpha level of 5%.</p> <p><strong>Results: </strong>92 pts were included, mainly male (75%,n=69), with mean age of 62±13years. Baseline characteristics are summarized in table 1. The ST-elevation group, of which 60.0% (n=45) with anterior MIs, were more frequently in Killip-Kimbal class IV (38.9% vs 11.8%,p=0.03). This group had more frequently single-vessel CAD (55.9% vs 21.4%,p=0.02), whereas the group with no ST-elevation had more frequently three-vessel CAD (16.9% vs 42.9%,p=0.01). The culprit lesion was identified in the majority of pts (97.6%, n=83) and similarly in both groups (table2). 79 (85.9%) pts were managed with PCI, most of them in the ST-elevation group (92.0% vs 58.8%,p<0.01). The primary endpoint was achieved in 39 pts (52%) of the ST-elevation group, mainly driven by death; and in 3 pts (20.0%) on no ST-elevation group (p=0.23) (table3). Data of 12 months follow-up was only available for 27 (29.3%) pts, and revealed a low event rate (3 deaths and 4 hospital admissions, one of which for cardiovascular causes), so that between-group survival analysis was not feasible.</p> <p><strong>Conclusion: </strong>Pts admitted to PCI after rCA and no ST elevation have a high burden of CAD, nevertheless in the majority of them it was possible to identify a culprit lesion. This group presented less frequently with CS and was significantly less associated with the primary endpoint, driven by fewer deaths. No conclusions could be taken about the co-primary endpoint because of low event rate.</p>
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