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Abstract
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Prognosis of revascularazion on a previous myocardial infraction (MI), in patients who present with a new acute coronary syndrome (ACS).
Session:
Painel 6 - Doença Coronária 13
Speaker:
José Lopes De Almeida
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:
José Lopes De Almeida; Sílvia Monteiro; João André Ferreira; Rui Baptista; Lino Gonçalves; em nome dos investigadores do Registo Nacional de Síndromes Coronárias Agudas (SCA)
Abstract
<p><strong>Introduction: </strong></p> <p>In current clinical practice, only a small percentage of patients with myocardial infraction are treated conservatively, receiving neither coronary angiography nor fibrinolysis. Most of these patients are excluded from invasive management strategy due to accompanying comorbidities. The aim of the present study was to assess the effect of revascularazion on a previous myocardial infraction (MI), in patients who present with a new acute coronary syndrome (ACS).</p> <p><strong>Methods:</strong></p> <p>Data were retrospectively collected and included patients admitted for ACS between 2010 and 2019 with a previous diagnosis of MI (n=5085). Patients were divided into one of two groups: those who were revascularized by either CABG or PCI (n=3696) on previous MI and those who were treated medically (n=1389).</p> <p>The primary outcome of interest for this study was all-cause in-hospital mortality. Secondary outcomes of interest included incidence of in-hospital cardiogenic shock during hospital stay and mortality and re-admissions for cardiovascular events at 1 year. Multivariable logistic regression was utilized to evaluate the influence of previous revascularization on the outcomes of interest, while controlling for demographic characteristics, medical history, and procedural characteristics.</p> <p><strong>Results:</strong></p> <p>Patients managed medically on previous MI were older, more often female and had higher rate of other comorbidities including heart failure, previous stroke, kidney failure, chronic obstructive pulmonary disease, dementia and previous hemorrhage. They had more frequently multivessel disease on angiography than their previously revascularized counterparts (69.3% vs 61.7%, p<0.001). They were less likely to receive PCI (40.5% vs 55.5%, p<0.001) but more likely to receive CABG (10.2% vs 4.2%, p<0.001).</p> <p>Hospital mortality was higher for patients treated conservatively on previous MI (5.5% vs 3.0%, HR 1.9, 95% CI 1.41-2.56, p<0.001) as was cardiogenic shock during hospital stay (5.0% vs 3.2%, HR 1.6, 95% CI 1.18-2.17). However, in out adjusted model, there was no difference between groups (HR=1,13, 95% CI 0,74-1,72, p=0,584; HR=0,88, 95% CI 0,57-1,36, p=0,554, respectively).</p> <p>Regarding 1 year follow-up, survival after discharge was higher in patients with conservative management in previous MI (log rank p<0.001) but not in the adjusted model (log rank p<0.085) (Figure 1). Re-admissions for cardiovascular events (log rank p<0.5) were not different between groups.</p> <p><strong>Conclusions:</strong></p> <p>Patients that were not revascularized after an MI have a worse prognosis after a new ACS comparing to those who were submitted to PCI or CABG. This appears to be mainly derived from the higher age and comorbidities associated with these patients.</p>
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