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Acute coronary syndrome following prior PCI or CABG - are all patients the same?
Session:
Painel 6 - Doença Coronária 10
Speaker:
James Milner
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:
James Milner; João André Ferreira; José Paulo Almeida; André Azul Freitas; Sofia S. Martinho; Cátia Santos Ferreira; Sílvia Monteiro; Pedro Monteiro; Francisco Gonçalves; Natália António; Lino Gonçalves
Abstract
<p>Background: Both prior PCI and prior CABG represent subsets of patients with increased risk of future cardiovascular events, and readmission for new acute coronary syndromes (ACS) is not uncommon. However, it is unclear whether both groups are at similar risk, and secondary prevention following CABG is not as well established. Further clarification is of utmost importance to adequately stratify risk and implement appropriate risk modification strategies.</p> <p>Objectives: to evaluate in-hospital outcomes and long-term risk of readmission for ACS in patients with prior PCI or CABG.</p> <p>Methods and population: Retrospective, observational study of 1.154 patients with a previous history of either PCI or CABG, admitted to a tertiary center coronary ICU due to acute coronary syndrome between 2004 and 2017. Patients were divided into 2 groups: Group A, with prior PCI (N=883) and B, with prior CABG (N=271). Baseline clinical and demographic characteristics were compared, as well as ACS-related variables. Primary outcomes were in-hospital mortality and re-admission due to acute coronary syndrome during long term follow-up.</p> <p>Results: Mean follow-up was 7.0±3.6 years. Patients with prior CABG were more frequently male (86 vs 75%, p<0.001) and were older than their counterparts (69±10 vs 66±12, p<0.001). Prevalence of other cardiovascular risk factors were similar in both groups, but patients with a history of PCI were more often medicated with P2Y12 inhibitors, ACE inhibitors or ARBs, beta blockers and statins. Those with prior PCI presented with STEMI in 16% of cases, which happened only in 9% of CABG patients (p=0.02), and CABG patients had higher GRACE scores at presentation (130±32 vs 121±36, p=0.001). Following this index event, readmission due to new ACS during follow-up was similar in both groups (21%, p=0.853), and both yielded similar Kaplan-Meier curves. However, in-hospital mortality during this index episode was higher in the CABG group (4.4 vs 2.5%, p=0.049).</p> <p>Conclusion: Following surgical revascularization, patients with acute coronary syndromes tend to present more often with non ST elevation-ACS than their PCI counterparts. Patients with prior PCI have implemented pharmacological strategies for risk reduction more often, which results in lower in-hospital mortality in future events. </p>
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