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Early and late onset sustained ventricular tachycardia in Acute Coronary Syndrome
Session:
Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker:
Mariana da Silva Santos
Congress:
CPC 2021
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:
Mariana Da Silva Santos; Helder Santos; Ines Almeida; Hugo Miranda; Catarina sa; Joana Chin; Samuel Almeida; Catarina Sousa; João Tavares; Luis Santos; Maria Lurdes Almeida
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Introduction</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">: S</span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">ustained ventricular tachycardia (SVT) complicates up to 20% of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Objective</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">: To evaluate predictors of early onset (<48h) and late onset (≥48h) SVT.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Methods</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">: Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. </span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Patients (pts) were divided in two groups (G): A – pts that presented early onset SVT (ESVT), and B – pts that presented late onset SVT (LSVT). </span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Pts without data on previous cardiovascular history or uncompleted clinical data were excluded. </span></span><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Logistic regression was performed to assess predictors of SVT in ACS. Survival analysis was evaluated through Kaplan Meier curve.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Results</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">: Population – 29851 pts with ACS. 364 (1.2%) presented SVT. ESVT – 251 pts (69%); LSVT – 91 pts (25%). LSVT G was older (74±13 vs 68±14, p=0.003), was admitted directly to cat lab less frequently (10.1% vs 24.8%, p=0.003), had longer times from first symptoms to admission (440min vs 261 min, p<0.001) and had higher rates of previous stroke (14.4% vs 6.8%, p=0.028). LSVT G had higher rates of non-ST-elevation myocardial infarction (MI) (35.2% vs 23.1%, p=0.025) and lower rates of ST-elevation MI (53.8% vs 71.7%, p=0.002), although both G were similar regarding MI location (anterior – p=0.135, inferior – p=0.097). LSVT G had higher systolic blood pression (130±33 vs 122±33, p=0.050), presented more frequently in Killip-Kimball class ≥2 (52.5% vs 35.5%, p=0.005) and with atrial fibrillation (21.2% vs 12.4%, p=0.045), and had higher brain-natriuretic peptide (1075 vs 329, p<0.001). During hospitalization, LSVT G used more diuretics (80.0% vs 47.8%, p<0.001), amiodarone (62.2% vs 48.8%, p=0.029), digoxin (8.9% vs 2.4%, p=0.013) and levosimendan (11.1% vs 2.8%, p=0.004). ESVT G had higher rates of performed coronarography (88.4% vs 79.1%, p=0.028) but lower rate of 3 vessels disease (58.5% vs 70.8%, p=0.017). LSVT G had higher rates of severe (<30%) left ventricle dysfunction (32.9% vs 15.4%, p<0.001) and need to non-invasive ventilation (23.1% vs 6.8%, p<0.001), although need to invasive ventilation was similar (17.6% vs 23.2%, p=0.266). ESVT G had higher rates of heart failure (34.7% vs 19.1%, p=0.006), atrioventricular block (15.7% vs 1.1%, p<0.001), atrial fibrillation (20.4% vs 7.7%, p=0.006) and major haemorrhage (5.2% vs 0.0%, p=0.024). LSVT G had higher rates of in-hospital death (44.4% vs 20.9%, p<0.001) and longer in-hospital stay (14 days vs 7 days, p<0.001). The G were similar regarding re-infarction (p=0.216), shock (p=0.179), mechanical complications (p=1.00), cardiac arrest (p=0.097) and stroke (0.348) rates. </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Event-free survival was higher in ESVT than LSVT (84.0% vs 68.8%, p=0.020, OR 2.494). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Conclusion</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">: LSVT pts seem to have a poorer prognosis compared to ESVT pts. </span></span></span></span></p>
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