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Optimal timing of invasive strategy in patients with diabetes and NSTE-ACS
Session:
Painel 7 - Doença Coronária 11
Speaker:
Ana Neto
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:
Ana Leal Neto; Cláudio Espada-Guerreiro; Daniel Candeias Faria; Daniel Nascimento Matos; Rui Baptista; Cristina Gavina; Sílvia Monteiro; em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p><strong>Background:</strong> An immediate invasive strategy is warranted for all very high-risk non-ST-elevation acute coronary syndrome (NSTE-ACS) patients (pts). For all other pts, an invasive strategy within 24–72 hours is recommended depending on their risk stratification. Although being considered a high-risk subgroup of pts, diabetes is not included in the GRACE risk score nor is it a criterion for early (<24 hours) coronary angiography. The aim of this study was to assess if a routine early invasive strategy should be preferred in NSTE-ACS pts with diabetes.</p> <p><strong>Methods:</strong> We performed a retrospective analysis of diabetic pts admitted with NSTE-ACS included in a nationwide registry of ACS between 2010 and 2019, whom were in Killip ≤ III and had a GRACE score ≤ 140 on admission. A 1-year (1y) follow-up was made through registry consultation and phone call by a Cardiologist. Patients were compared according to the timing of angiography: first 24h (G1) vs 48-72h (G2). The primary endpoint was a composite of all-cause mortality and hospital admissions from any cause. Secondary endpoints were all-cause mortality, cardiovascular mortality and hospital admissions.</p> <p><strong>Results: </strong>A total of 995 pts were included (26.9% female, mean age 63±10 years), 522 (52.5%) of whom were submitted to early angiography (G1). G1 pts had lower prevalence of previous PCI (19.2% vs G2 24.8%, p=0.033), chronic heart failure (1.5% vs G2 4.2%, p=0.011), peripheral artery disease (5.2% vs G2 8.9%, p=0.023) and chronic kidney disease (2.9% vs G2 8.9%, p=0.026). Chest pain was the predominant presenting symptom in both groups (98.1 vs G2 94.5%, p=0.003). There were no differences between groups regarding hemodynamic status or Killip class at presentation. Concerning in-hospital treatment, G1 had more femoral approach for angiography (21.5 vs G2 25.9%, p=0.027). G1 pts had fewer heart failure sings during hospitalization (2.7 vs G2 5.7%, p=0.017). There were no differences in medication options during in-hospital course. G1 pts had fewer 1y FUP primary outcome (14.7 vs G2 23.0%, p=0.034), particularly because of a lower incidence of hospital admissions during FUP (14.0 vs G2 21.4%, p=0.053).</p> <p><strong>Conclusions: </strong>In a diabetic population with NSTE-ACS without high-risk features (GRACE ≤ 140 and Killip ≤ III), an early invasive strategy appears to be associated with a lower rate of all-cause death and hospital admissions, mostly attributable to a lower rate of all-cause hospital admissions.</p>
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