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Acute myocardial Infarction at = 50 years old- Inadequate coronary risk prediction and risk factors control
Session:
Painel 12- Prevenção / Reabilitação Cardíaca 2
Speaker:
João Presume
Congress:
CPC 2020
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.2 Risk Factors and Prevention – Cardiovascular Risk Assessment
Session Type:
Posters
FP Number:
---
Authors:
João Presume; Francisco Albuquerque; Sérgio Maltês; Gonçalo Lopes Da Cunha; Marisa Trabulo; Carlos Aguiar; António Ferreira; Jorge Santos Ferreira; Miguel Mendes
Abstract
<p><strong>BACKGROUND:</strong></p> <p>The ability to predict the risk of cardiovascular (CV) events is paramount, so that primary prevention efforts can be implemented. However, predicting risk in young patients is challenging. The purpose of this study was to evaluate the performance of the main risk stratification methods available and assess the rates of primary prevention use.</p> <p> </p> <p><strong>METHODS:</strong></p> <p>This was a retrospective cohort of patients with ≤50 years old from several centers admitted consecutively at our hospital for acute myocardial infarction (AMI) with obstructive coronary artery disease in angiography, from 2016 to 2018. CV risk scores were calculated based on data available prior to AMI or at the time of presentation.</p> <p> </p> <p><strong>RESULTS:</strong></p> <p>A total of 151 patients were included - 126 (83%) were men, 111 (74%) smokers, 21 (14%) had diabetes, and 44 (29%) were obese. Overall, 92 (61%) patients had hypertension, 61 of them (66%) had previously been prescribed an antihipertensive drug, but 22 discontinued it. Also, 110 (72,8%) had hypercholesterolemia based on the indication of statin recommendation (class I and IIa), 43 (39%) had previous prescription of a statin, but 30 had discontinued it. At least 1 CV risk factor was present in 148 (98%) of the patients.</p> <p>The median ESC-SCORE risk was 2% (10-year risk of CV death). The median ACC/AHA atherosclerotic cardiovascular disease (ASCVD) risk was 5.85% (10-year risk of ASCVD event).</p> <p>When comparing the distribution across risk categories by both risk stratification guidelines, we found a statistically significant difference between both of them (p<0,001), with ASCVD score classifying 59 (39,1%) patients as high/very high risk, whereas ESC-risk stratification only identified 33 (21,9%) patients as high/very high risk. Score stratification agreement was poor (K-Cohen 0,121).</p> <p> </p> <p><strong>CONCLUSION:</strong></p> <p>ESC-SCORE and ACC/AHA ASCVD risk scores inadequately predict coronary risk in young patients with first AMI and show pronouced differences in terms of stratification of this population. However, ASCVD seems to have better capacity to identify high risk patients.</p> <p>Moreover, primary prevention was not being thoroughly carried out, which may be related to the misperception of low risk.</p>
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