SPC365

Evolution trends in the management and prognosis of cardiogenic shock in Portugal

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Bruno Piçarra

Congress: CPC 2021
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 14. Acute Cardiac Care
Subtheme: 14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type: Posters
FP Number: ---
Authors: Bruno Cordeiro Piçarra; Ana Rita Santos; João Pais; Mafalda Carrington; Francisco Cláudio; Rita Rocha; Diogo Brás; em Nome Dos Investigadores do RNSCA

<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:ArialRegular"><span style="color:#000000">Introduction: Mortality associated with cardiogenic shock (CS) in patients (pts) with ST-elevation acute myocardial infarction (STEMI) remains high, despite the therapeutic evolution observed in the treatment of STEMI.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:ArialRegular"><span style="color:#000000"><span style="font-size:10.5pt"><span style="font-family:ArialRegular"><span style="color:#000000">Objective: To evaluate the evolution in clinical profile, therapeutic management and mortality of pts with CS after STEMI in Portugal from a period between 2010 to 2018.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:ArialRegular"><span style="color:#000000">&nbsp;<span style="font-size:10.5pt"><span style="font-family:ArialRegular"><span style="color:#000000">Methods: We studied all pts with CS after STEMI included in a national database. We registered age, gender, cardiovascular and non-cardiovascular history, electrocardiographic presentation, rate of reperfusion, coronary anatomy and angioplasty strategy. We also evaluated the presence of the following complications: Re-Infarction, mechanical complications, high-grade atrial ventricular block (AVB), sustained ventricular tachycardia (VT), atrial fibrillation (AF), stroke, major bleeding and in-hospital mortality.</span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:ArialRegular"><span style="color:#000000"><span style="font-size:10.5pt"><span style="font-family:ArialRegular"><span style="color:#000000">Results: During this period 815 pts were included with CS after STEMI. Most of the pts were male (nearly 63,5%) and almost half had more than 75 years-old, however no temporal trend was seen in age and gender. Simultaneously, there were no differences <span style="font-size:10.5pt"><span style="font-family:ArialRegular"><span style="color:#000000">observed between cardiovascular risks factors or other non-cardiac comorbidities. Therapeutics changes were observed, with areduction in the use of clopidogrel (p&lt;0,001), glycoprotein IIb/IIIa inhibitors (p=0,01) and an increase use of ticagrelor (p&lt;0,001) with no differences regarding other therapeutics. Inotropes were used in 63,3% of pts with CS and among these only 4,7% with levosimendan. The rate of coronariography and angioplasty were stable during this period (78,5% and 72,1%, respectively), with no differences in the type of vessels with disease. There was an increase in the utilization of drug-eluting stents (p&lt;0,001) and a decrease in bare-metal stents (p&lt;0,001). During CS management, mechanical ventilation was used only in 23,2% and there was a decrease in the utilization of Swan-Ganz catheter (p=0,004), and a decrease in the use of intra-aortic balloon pump (p&lt;0,001). Otherwise the expansion of left ventricular assist devices (LVAD) in Europe, its utilization in Portugal is very low (approximately 0,2%) with no tendency to increase. Mortality of CS after STEMI remains high (44,9%), but with a small tendency to a decrease (p=0,049) over the years. We also observed a reduction in the rate of major bledding (p=0,017) and high-grade atrial ventricular block (p&lt;0,001).</span></span></span></span></span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:10.5pt"><span style="font-family:ArialRegular"><span style="color:#000000"><span style="font-size:10.5pt"><span style="font-family:ArialRegular"><span style="color:#000000">Conclusions: Mortality for cardiogenic shock after STEMI remains high in Portugal, but present a slight tendency to a reduction. This temporal trends reflect guidelines recommendations in STEMI with an increase in utilization of ticagrelor, a decrease in the utilization of glycoprotein IIb/IIIa inhibitors and IABP. Inotropes remain the cornerstone in the management of CS, but we still have a poor use of LVAD in Portugal.</span></span></span></span></span></span></p>