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A. Basics
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01. History of Cardiology
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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
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24. Stroke
25. Interventional Cardiology
26. Cardiovascular Surgery
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28. Risk Factors and Prevention
29. Rehabilitation and Sports Cardiology
30. Cardiovascular Disease in Special Populations
31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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34. Public Health and Health Economics
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Friend or foe: acute coronary syndrome without standard modifiable cardiovascular risk factors
Session:
Painel 6 - Doença Coronária 13
Speaker:
Diana De Campos
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:
Diana Decampos; Rogerio Teixeira; Carolina Saleiro; Ana Rita M. Gomes; João Lopes; Joana M. Ribeiro; Luís Puga; José Pedro Sousa; Ana Botelho; Lino Gonçalves
Abstract
<p>Background: Acute coronary syndromes (ACS) in patients without the standard modifiable cardiovascular risk factors (SMCRF; hypertension, diabetes, dislipidemia, smoking) is uncommon and their prognosis is unknown. </p> <p>Methods: We reviewed ACS patients admitted in our coronary unit between 2009 and 2016. We examined the proportion of patients without SMCFR and their outcomes. The primary outcome was all-cause death. Secondary-endpoints were rates of short-term (6 months) all-cause death, long-term re-infarction and hospitalization for heart failure. Logistic regression analyses were performed to estimate the unadjusted and adjusted hazard ratio (HR) for the binary outcomes. Kaplan-Meier methodology was used for the analysis.</p> <p>Results: Of the 1544 patients (67.9±13.3 years old, 70.1% male), 5.1% had no SMCRF. The proportion of patients with no SMCRF was equal between men and women. There were minor non significant differences in the mean age (no SMCRF 69.8±15.3yo, with SMCRF 67.8±13.1yo). No relationship was found between type of ACS and SMCRF status. Mean systolic blood pressure was lower in no SMCRF patients (121.1±28 vs 134.4±27.5 mmHg, <em>P</em>=0.000). Killip-Kimbal class (KK) and left ventricular ejection fraction (LVEF) were comparable. The unadjusted mortality rate during the follow-up (median 47 months) was similar between the two groups (HR=1.12 95% CI 0.82-1.79). No clinically significant difference in the unadjusted rates of all-cause death 6 months post-discharge was observed. Trends for hospitalization for heart failure were similar between the two groups. However, the rates of re-infarction (6.3% versus 16.5%, X<sup>2</sup>=4.75, <em>P</em>=0.034) were lower in patients with no SMCRF, with an approximately 30% less chance (HR=0.28, 95%CI 0.10-0.75, <em>P</em>=0.011). In a multivariable analysis (adjusted for age, sex, type of ACS, atrial fibrillation, chronic kidney disease, KK and LVEF), SMCRF status was not a predictor of long-term death.</p> <p>Conclusions: This under-appreciated group of patients has a comparable rate of mortality to patients with standard modifiable cardiovascular risk factors. This uncovers and highlights the importance of diagnosis coronary artery disease not predicted by the SMCRF.</p>
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