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Predictors of Mechanical complications after Acute Myocardial Infarction- a large retrospective study
Session:
Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker:
José João Monteiro
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:
José João Monteiro; Sara Borges; Pedro Rocha Carvalho; Helder Ribeiro; Catarina Ribeiro Carvalho; Marta Bernardo; Miguel Moz; Jose Pedro Guimarães; Fernando Fonseca Gonçalves; Ilidio Moreira
Abstract
<p><br /> <strong>Introduction</strong><br /> The development of mechanical complications (MC) after an acute coronary syndrome (ACS) is rare but associated with a reduction of short-term and long-term survival. The common underlying mechanism involves excessive, transmural myocardial necrosis followed by the rupture or extensive scarring of the affected tissue.<br /> </p> <p><strong>Objective </strong></p> <p>To study potential predictors of MC in order to anticipate this potential lethal complications<br /> </p> <p><strong>Methods</strong><br /> Retrospective study based on the Portuguese National Registry of ACS, including patients (pts) hospitalized with this diagnoses<br /> betweenOctober 2010 and January 2019.<br /> Papillary muscle rupture, interventricular communication and septum rupture were considered. Patients with previous acute myocardial infarction (AMI), percutaneous coronary intervention (PCI) and coronary artery bypass<br /> grafting (CABG) were excluded. Logistic regression was used to verify possible predictors of MC.<br /> </p> <p><strong>Results</strong><br /> After exclusion criteria, 13665 pts were analised: 71,5% male, age 65 ±14 years, 50,5% with ST segment elevation AMI (STEMI), 47% non-ST segment elevation AMI(NSTEMI) and 2,5% with undetermined location AMI.<br /> There was a total of 119 (0.9%) patients that developed MC after ACS.<br /> Hypertension (64.3%), dyslipidemia (51.6%), smoking (31.7%) and diabetes (27.0%) were the most frequent comorbidities. Logistic regression showed a positive correlation between post-ACS MC and age >75 (OR 2.92, p<0.001), hypertension (OR: 2.1, p =0.051), left anterior descending artery (LAD) stenosis > 50% (OR 2.22, p= 0.031) and use of GP 2b/3a inhibitors (OR 3.11, p = 0.033).<br /> STEMI vs NSTEMI(OR 3.73, p<0.001), as well as time between symptoms and first medical contact >120 minutes (OR 2, p= 0.002) weren’t independent predictors of MC, in spite of statistic significance in univariate analysis.</p> <p><strong>Conclusion</strong><br /> In this study, positive predictive factors for MC after ACS were identified: Older Age, Hypertension, Significative LAD disease and infarct-related artery with High Thrombotic Burden.</p>
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