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Curso de Atualização em Medicina Cardiovascular 2019
Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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0 Topics
A. Basics
B. Imaging
C. Arrhythmias and Device Therapy
D. Heart Failure
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
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01. History of Cardiology
02. Clinical Skills
03. Imaging
04. Arrhythmias, General
05. Atrial Fibrillation
06. Supraventricular Tachycardia (non-AF)
07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
09. Device Therapy
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20. Congenital Heart Disease and Pediatric Cardiology
21. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure
22. Aortic Disease
23. Peripheral Vascular and Cerebrovascular Disease
24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
27. Hypertension
28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
33. e-Cardiology / Digital Health
34. Public Health and Health Economics
35. Research Methodology
36. Basic Science
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Prognostic value of the CHA2DS2VASc score in acute coronary syndrome without atrial fibrillation
Session:
Painel 7 - Doença Coronária 8
Speaker:
Fernando Gonçalves
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:
Fernando Fonseca Gonçalves; Sara Borges; José J. Monteiro; Pedro Rocha Carvalho; Pedro S. Mateus; Ilidio Moreira
Abstract
<p><u>Introduction</u>: The CHA<sub>2</sub>DS<sub>2</sub>VASc score has been widely used as a predictor of stroke in patients with atrial fibrillation (AF). This study aimed to evaluate the long-term cardiovascular prognostic impact of this score in patients with an acute coronary syndrome (ACS) and without AF.</p> <p><u>Methods</u>: This was a retrospective study of patients hospitalized at one center for nonfatal ACS, who were periodically included in a national registry between October 2010 and November 2017. Patients with past history of AF or <em>de novo</em> AF were excluded. The events evaluated during a median follow-up of 42 (24; 59) months were a composite endpoint of acute myocardial infarction (MI)/stroke/death (MACE), MI, stroke, death and major bleeding according to the ISTH criteria. After ROC curve analysis, patients with a score ≥ 4 were considered high risk and <4 low risk.</p> <p><u>Results</u>: Out of a total of 449 patients, 14% had a CHA<sub>2</sub>DS<sub>2</sub>VASc score of 1, 19,4% a score of 2, 19,8% a score of 3, 21,6% a score of 4, 14,3% a score of 5, 8,5% a score of 6 and 2,4% a score of 7. High-risk patients had less history of smoking (6,7% <em>vs</em> 37,2%, <em>p</em><0,001), but more history of cancer (6,7% <em>vs</em> 2,5%, <em>p</em>=0,032) and major bleeding (4,3% <em>vs</em> 0%, <em>p</em>=0,001). These patients were most often admitted for a non-ST elevation ACS (51% <em>vs</em> 44,4%, <em>p</em><0,001), were associated with a higher presence of multivessel coronary disease or involving the left main artery (68,6% <em>vs</em> 56,9%, <em>p</em>=0,011) and were less likely to have an angioplasty performed (71,9% <em>vs</em> 83,7%, <em>p</em>=0,003). Both during hospitalization and at discharge, they were more frequently medicated with diuretics, aldosterone antagonists, ivabradine and nitrates.</p> <p>In the ROC curve analysis, the CHA<sub>2</sub>DS<sub>2</sub>VASc score showed an AUC for MACE of 0,70 (95% Confidence Interval (CI) 0,63-0,76), for MI of 0,66 (CI 0,56-0,76), for stroke of 0,65 (CI 0,56-0,73), for death of 0,75 (CI 0,68-0,81) and for major bleeding of 0,71 (CI 0,63-0,78).</p> <p>In a multivariate analysis, the presence of a score ≥4 was associated with a significant increase in MACE (HR 2,51 (CI 1,10-5,76)), in MI (HR 2,83 (CI 1,1-7,2)), in stroke (HR 2,74 (CI 1,09-6,90)), in death (HR 2,73 (CI 1,28-5,85)) and major bleeding (HR 2,62 (CI 1,05-6,58)).</p> <p><u>Conclusions</u>: In this study, higher CHA<sub>2</sub>DS<sub>2</sub>VASc scores were associated with more complex coronary disease and therefore fewer angioplasties. In any case, the score was able to independently and significantly predict long-term cardiovascular events.</p>
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