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Predictors of need of non-invasive ventilation in acute coronary syndrome
Session:
Painel 7 -Doença Coronária 5
Speaker:
Sara Cristina da Silva Borges
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.3 Acute Cardiac Care – CCU, Intensive, and Critical Cardiovascular Care
Session Type:
Posters
FP Number:
---
Authors:
Sara Borges; Fernando Fonseca Gonçalves; José João Monteiro; José P. Guimarães; Pedro Rocha Carvalho; Joaquim Manuel Chemba; Pedro Mateus; Catarina Ferreira; Ilidio Moreira
Abstract
<p>Background: Non-invasive mechanical ventilation (NIMV) plays an important role in the management of patients with cardiogenic pulmonary oedema, cardiogenic shock, or cardiac arrest. Despite that, data addressing the use of respiratory support in acute coronary syndromes are lacking. Our aim is to identify predictors of need of non-invasive mechanical ventilation among patients admitted for acute coronary syndrome (ACS).</p> <p>Methods: Retrospective study of patients (pts) with ACS periodically included in one center registry between March/2013 and December/2018. The primary endpoint was necessity of NIMV during hospitalization for index event;</p> <p>Results: From a cohort of 518 pts, 1 in each 20 patients with ACS will require respiratory support with either invasive mechanical ventilation or non-invasive ventilation.</p> <p>Those treated with NIMV presented more frequently with ST elevation myocardial infarction (STEMI), with higher Killip Kimbal (KK) class, higher NT proBNP levels and lower ejection fraction (all p value<0.005). Shock index at admission (heart heart/systolic blood pressure) was significantly higher in this group of pts (p<0.001)</p> <p>Multivariate analysis identified STEMI (OR 12, 95%IC 2-58, p=0.002), Killip Kimbal classe > 2 (OR 11.8, 95%IC 3.6-38, p= 0.001), shock index > 0.6 (OR 3.6, 95%IC 1.1-11.3, p=0.033) and NT proBNP > 1400 (OR 3, 95%IC 1-9.5, p=0.045) as predictors of need of non-invasive mechanical ventilation during hospitalization;</p> <p>A score with this 4 variables displayed excellent predictive performance of need of NIVM after ACS (AUC: 0.91, IC 0.862 – 0.953, p<0.001)</p> <p>Conclusion: Prediction of the need of NIVM can be made with simple and readily available variables at admission. Early identification of patients at risk of respiratory failure can avoid delay in proper treatment.</p>
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