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Left ventricular dysfunction in early primary angioplasty: characterization and predictors
Session:
Painel 8 - Doença Coronária 9
Speaker:
Bruno Piçarra
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:
Bruno Cordeiro Piçarra; Ana Rita Santos; Antonio; Mafalda Carrington; Diogo Brás; Rita Caldeira Da Rocha; Rui Azevedo Guerreiro; DAVID NEVES ; José Eduardo Aguiar; Em nome dos investigadores do RNSCA
Abstract
<p>Introduction: According to ST elevation acute myocardial infarction (STEMI) guidelines the earlier reperfusion the better the prognosis of the patients and this is a quality marker. However, some patients (pts) develop left ventricular dysfunction (LV) even performing primary angioplasty in first two hours (PCI<2h) of STEMI symptoms. </p> <p>Objective: To characterize the population of pts with LV dusfunction (defined as ejection fraction (EF) <40%) submitted to PCI<2h of symptoms and to identified predictors of LV dysfunction.</p> <p>Methods: We evaluated 6484 pts with STEMI submitted to primary angioplasty. From this we studied all submitted to PCI<2h (475 pts). We considered 2 groups: Group 1 – Pts who developed EF< 40% and Group 2 - Pts with EF > 40%. We registered age, gender, cardiovascular and non-cardiovascular co-morbidities, electrocardiographic presentation, hospital admission and coronary anatomy. We also evaluated the following in-hospital complications: Re-Infarction, heart failure (HF), cardiogenic shock (CS), mechanical complications, high-grade atrial ventricular block, sustained ventricular tachycardia (VT) atrial fibrillation (AF) and stroke. We compared the in-hospital mortality. Multivariate analysis was performed to identify predictors of LV dysfunction.</p> <p>Results: Only 7,3% of pts with STEMI are submitted to PCI<2h and the presence of LV dysfunction was registered in 14,5% of these pts. With the exception of previous heart failure more prevalent in group 1 (7,2 vs 0,5%, p<0,001), no differences were observed in age, gender, cardiovascular and non-cardiovascular co-morbidities between the two groups. Group 1 pts had more hospital admissions in the emergency department (47,8 vs 33,9%, p=0,029) and less admissions in cardiac care units (11,9% vs 25,9%, p=0,013) and less admissions performed by the pre-hospital emergency units (INEM) (22,2 vs 42,3%, p=0,004). No differences were observed in the symptoms-reperfusion between the two groups. Group 1 pts had more anterior STEMI (85,5 vs 45,6%, p<0,001), left main disease (6,8 vs 1,6%, p=0,036), left anterior descending disease (89,6 vs 65,6%, p<0,001). Group 1 pts had more in-hospital complications: HF (31,9 vs 5,2%, p<0,001), CS (11,6 vs 1,5%, p<0,001), AF (8,7 vs 3,0%, p=0,034). In-hospital mortality was also higher in Group 1 pts (8,8 vs 0,7%, p<0,001). By multivariate analysis, admission in the emergency department [OR: 2,16 (IC:1,20-3,88), p=0,010] were a predictor LV dysfunction instead inferior STEMI was a protector factor [OR: 0,09 (IC:0,04-0,21), p<0,001] comparing with anterior STEMI.</p> <p>Conclusions: Even when primary angioplasty is performed within two hours of symptoms LV dysfunction is present of 14,5% of pts. These patients are more frequently admitted in the emergency department and not in cardiac care units, had more anterior STEMI and more disease of the left main and left descending artery.</p>
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