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CLEAR FILTERS
Management of chronic coronary syndromes: developing mathematics to calculate risk in percutaneous revascularization.
Session:
Painel 8 -Doença Coronária 6
Speaker:
Rui Files Flores
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.4 Coronary Artery Disease – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Rui Files Flores; Marco Costa; Rui Campante Teles; Pedro Braga; Helder Pereira; Pedro Canas Da Silva; José Batista; João Costa; Rui Cruz Ferreira; JOAO SILVA; Pedro Pinto Cardoso; Fernando Matias; Filipe Seixo; João Brum Silveira; Pedro Farto e Abreu; Renato Fernandes; Pedro Costa Ferreira; GRAÇA SILVA; Dinis Martins; Luis Bernardes; Francisco Pereira Machado; José Palos; Hugo Vinhas; Jorge Marques
Abstract
<p>INTRODUCTION: Percutaneous or surgical revascularization of chronic coronary syndrome remains an appropriate approach for patients who fail to respond to optimal pharmacological therapy. Selection of patients for this approach is complex and there is a lack of models to estimate the procedural risk. Our objective is to assess potential predictors of successful percutaneous intervention in patients with CCS.</p> <p>MATERIALS AND METHODS: We conducted a multicentered retrospective study that included chronic coronary syndrome patients that were submitted to percutaneous revascularization between January 2012 and December 2018. Successful intervention was defined by TIMI flow improvement with a final result of 3 in patients with previous flow scale inferior to 3. Potential predictors of success were determined by logistic regression. We enrolled a total of 15 877 patients with chronic coronary syndrome that were treated by percutaneous coronary intervention. Mean age was 66.7 ± 10.2. Our sample was mostly composed of men (75.6%, 12 010 patients) with multiple cardiovascular risk factors (hypertension, 78.3%; hypercholesterolemia, 72.9%; diabetes, 35.9%) and with some degree of ventricular dysfunction. About 33% (5230 patients) were previously revascularized by percutaneous procedure. A total of 6383 patients (40.2%) had one-vessel coronary disease, 5263 (33.1%) had two-vessel disease and 3589 (22.6%) three-vessel disease.</p> <p>RESULTS: Previous peripheral arterial disease (OR 1.36; CI 95% 1.10 – 1.65), main left branch (OR 1.30; CI 95% 1.04 – 1.61) or right coronary disease (OR 1.38; CI 95% 1.25 – 1.53), intrastent stenosis (OR 1.30; CI 95% 1.05 – 1.61) and procedure with cutting-balloon (OR 2.45; CI 95% 1.52 – 3.97) were found to predict the unsuccess of percutaneous revascularization by logistic regression. Involvement of anterior descending (OR 0.77; CI 95% 0.69 – 0.85) or circumflex artery (OR 0.86; CI 95% 0.77 – 0.94), radial access (OR 0.79; CI 95% 0.71 – 0.88) and use of aspirin (OR 0.47; CI 95% 0.43 – 0.53) and anticoagulants (OR 0.55; CI 95% 0.49 – 0.63) were found to predict success of revascularization.</p> <p>CONCLUSION: Optimal care of chronic coronary syndromes may require invasive approaches to reduce ischemic events and symptoms. Previous comorbidities, coronary anatomy and procedural complications seem to be central to predict (un)success of percutaneous revascularization. Patients should be selected carefully considering overall prognosis and estimated outcomes.</p>
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