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Prognosis of Complete vs Incomplete revascularization in diabetic patients after STEMI
Session:
Painel 8 - Doença Coronária 3
Speaker:
Rita Ribeiro Carvalho
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Rita Ribeiro Carvalho; Francisco Soares; Luís Graça Santos; Sara Lopes Fernandes; Fernando Montenegro Sá; Joao Morais
Abstract
<p><strong>Background: </strong>Different trials documented better long-term prognosis with staged Percutaneous Coronary Intervention (PCI) of non-culprit lesions after ST-elevation Myocardial Infarction (MI). However, those trials included less than one fifth of diabetic patients (pts), and it remains unclear if there is such a benefit in a subgroup of pts associated with such high cardiovascular and renal failure risk. Our aim is to assess whether diabetic pts benefit of staged PCI of non-culprit lesions, after ST-elevation MI, in short term and within 12months follow-up.</p> <p><strong>Methods: </strong>A retrospective multicentric study done in a cohort of diabetic pts admitted to PCI, from October 2010 to January 2019, after ST-elevation MI and with documented multivessel coronary artery disease (CAD). Patients with previous CABG and without information about coronary anatomy or treated vessels were excluded. Complete revascularization (CR) was compared to incomplete revascularization (iCR), regarding the composite primary endpoint of in-hospital re-infarction or death and the co-primary endpoint of death and hospital readmissions, both cardiovascular and all-admissions, within one-year follow-up. Paired Student T-test an χ<sup>2</sup> test were used accordingly to assess differences in baseline characteristics, and univariate logistic regression was used to assess primary composite endpoint. For the co-primary endpoint, survival analysis with cox regression was performed. Alpha level for significance of 5%.</p> <p><strong>Results: </strong>550 pts were included, of which 69.8% (n=384) male and with a mean age of 67.2±11years. Demographic characteristics are summarized in table 1. The majority of pts underwent an iCR: 76.9% (n=423) vs 23.1% (n=127). These patients were older and were more frequently bradycardic and hypotensive (17.3% vs 9.4%, <em>p=0.03</em> and 50.1% vs 39.4%, <em>p=0.03</em>, respectively). The majority of patients (43.8%, n=241) presented with anterior ST elevation MI and 1.8% (n=10) with <em>de novo </em>LBBB<em>.</em> Few pts achieved the primary endpoint (n=45, 8.2%), with no difference between groups (table 2). Regarding survival analysis, there were numerically fewer deaths (9[5.8%] vs 26[8.4%], log-rank <em>p</em>=0.304) and fewer cardiovascular admissions (17[11.4%] vs 53[18.1%], log-rank <em>p</em>=0.064) in the CR group, albeit not reaching statistical significance. All-cause re-admissions were lower in the CR group (22[14.7%] vs 82[27.1%], log rank p=0.003, figure 1 A-C). </p> <p><strong>Conclusion: </strong>These data suggest that, in diabetic patients, there is no difference between CR and iCR after ST-elevation MI, in the composite of in-hospital re-infarction or death, possibly signaling that differing complete revascularization may be safe short-term. However, within one year, there were fewer all-cause hospital re-admissions, and a signal for lower mortality.</p>
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