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Evolution of hospital discharge medication and 6 months outcomes of ST-Segment Elevation Myocardial Infarction patients in Portugal over the years
Session:
Painel 7 - Doença Coronária 11
Speaker:
João Pedro de Sousa Bispo
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Posters
FP Number:
---
Authors:
João De Sousa Bispo; Teresa Faria Da Mota; Raquel Menezes Fernandes; Pedro Oliveira De Azevedo; João Pedro Moura Guedes; Daniela Carvalho; Dina Bento; Nuno Marques; Jorge Mimoso; Ilidio Paulos De Jesus
Abstract
<p><strong>Objectives: </strong>To assess the evolution of hospital discharge management, 6 months hospitalization and mortality over the years of all patients admitted with ST segment elevation myocardial infarction (STEMI) in Portugal.</p> <p> </p> <p><strong>Methods: </strong>A nationwide electronic prospective registry that included all patients admitted to Portuguese hospitals with a diagnosis of Acute Coronary Syndrome since 2002 until 2018 was used to collect all data relative to patients admitted with a STEMI diagnosis during that time frame. Data on demographic data, clinical status, revascularization strategy, discharge medication and 6 months hospitalization and mortality were obtained. We compared the data and its evolution over the years to assess for trends. For statistical analysis, Qui-square tests were used to assess trends in categorical variables, and Kruskal-Wallis tests were used to assess trends in numerical variables. A p-value <0,05 was considered statistically significant.</p> <p> </p> <p><strong>Results: </strong>A total of 23807 patients were admitted for STEMI in Portuguese hospitals, 74,3% were male and average age of 63,9±13,6 years.</p> <p>We report a progressive and significant increase the use of primary angioplasty versus fibrinolysis (24,3% to 98,4% - p <0,001), in coronary angioplasties (36,4% to 73,2% - p <0,001), in the use of drug-eluting stents (0% to 70,1% - p <0,001), and a decrease in the patients that underwent surgery (6,8% to 1,3%, p <0,001) and intra-aortic balloon pump (1,8% to 0% - p=0,009), resulting in a decrease in in-hospital mortality from 9,9% to 6,1% (p <0,001).</p> <p>At discharge, we note a progressive increase in the prescription of P2Y12 inhibitors (21,1% to 95,2% - p <0,001), beta-blockers (68,8% to 83,8% - p <0,001), RAAS inhibitors (69,5% to 86,7% - p <0,001) and statins (79,6% to 94,9% - p <0,001), while the prescription of aspirin (94,1% para 94,8% - p=0,428), calcium channel blockers (5,3% to 5,6% - p <0,684) stayed stable, and there was a decrease in the prescription of nitrates (52,9% to 5,8% - p <0,001). Hospital admissions at 6 months consistently and progressively reduced over time (18,6% to 8,5% - p <0,001) as well as mortality (6,7% to 4,3% - p <0,001).</p> <p> </p> <p><strong>Conclusion: </strong>Post discharge treatment of STEMI patients in Portuguese hospitals has evolved according to guidelines, with higher prescription of medication proven to reduce outcomes, resulting in lower hospitalization rates and mortality.</p>
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