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Impact of previous neoplasia in patients with Acute Myocardial Infarction
Session:
Painel 8 - Doença Coronária 3
Speaker:
João Pais
Congress:
CPC 2020
Topic:
K. Cardiovascular Disease In Special Populations
Theme:
30. Cardiovascular Disease in Special Populations
Subtheme:
30.6 Cardio-Oncology
Session Type:
Posters
FP Number:
---
Authors:
Antonio; Bruno Cordeiro Piçarra; Mafalda Carrington; Ana Rita Santos; Rui Azevedo Guerreiro; Diogo Brás; Rita Caldeira Da Rocha; Kisa Hyde Congo; José Eduardo Aguiar; Em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p><strong>Introduction:</strong> Therapeutic Advances in Medical Oncology have allowed a significant increase in the survival of these patients (P). Coronary artery disease is equally prevalent in this population. However options for medical and interventional therapies are limited and prognosis of this population is different from general population. </p> <p><strong>Objective</strong>: To characterize P with Acute Myocardial Infarction (AMI) and previous neoplasia and to evaluate the impact of the presence of neoplasia on the therapeutic approach, complications and in-hospital mortality.</p> <p><strong>Population and Methods</strong>: A total of 16328 P with AMI were evaluated. We considered 2 groups: P with AMI and previous history of neoplasia and P with AMI without history of neoplasia. We compared age, personal history, clinical presentation, location and severity of coronary disease, therapeutic approach and ejection fraction (EF). In-hospital mortality (HM) and the following complications were evaluated: heart failure (HF), cardiogenic shock (CC), reinfarction, major haemorrhage, high-grade AV block. Multivariate analysis was performed, adjusting for the variables with a statistically significant difference in the groups' characterization in order to assess the relationship between previous neoplasia and HM and any of the complications considered.</p> <p><strong>Results</strong>: Patients with AMI and previous neoplasia constituted 4,9% (799P) of the study population. These patients were older (72 ± 11 vs 66 ± 13, p <0.001) and had a higher prevalence of arterial hypertension (74.8% vs 68.5%; p=0.001), previous heart failure (9.6% vs 5.5%, p=0.001), valvular disease (6.0% vs. 3.1%, p <0.001), chronic renal failure (10.5% vs 5.6%, p <0.001) and previous haemorrhage (4.4% vs 1.7%, p <0.001). The P with AMI and previous neoplasia presented more frequently with Killip-Kimbal class >1 (21,6% vs 15,9%, p <0.001), however they were submitted to less coronariography (78.0% vs. 88.1%, p <0.001) and angioplasty (58.0% vs. 67.9%, p <0.001). The P with AMI and previous neoplasia presented higher HM (5,9% vs 3,5%, p <0.001) and developed more complications during hospitalization: HF (24.1% vs. 16.4%, p < 0.001, CC (5,8% vs 3,6% p <0.005), major haemorrhage (3,3% vs 1.6%, p <0.001), high-grade AV block (4,9% vs 3,2%, p <0.008). After multivariate analysis, the presence of previous neoplasia in P with STEMI was an independent predictor of major haemorrhage (OR 2.11; p=0,006) and heart failure (OR 1,36; p=0,02)</p> <p><strong>Conclusion</strong>: The presence of previous neoplasia seems to influence the therapeutic approach of P with AMI and is associated with increased major haemorrhage and heart failure in this population of P.</p>
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