SPC365

Can pulmonary artery systolic pressure predict outcomes in patients with acute coronary syndromes?

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Joana Guimarães

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: Joana M. Guimarães; José Pedro Barbosa; Eric Monteiro; Diogo Fernandes; Gonçalo Costa; João Rosa; Gustavo Campos; Ana Sofia Martinho; José Paulo Almeida; André Azul Freitas; Cátia Ferreira; James Milner; João Ferreira; Carolina Lourenço; Graça Castro; Lino Gonçalves

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong>It is known that pulmonary artery systolic pressure (PASP) in acute coronary syndrome (ACS) may increase as a result of cardiac alterations that lead to increased filling pressures. <span style="color:black">Nevertheless the impact of this association with prognosis is poorly defined. The aim of the study was to evaluate the prognosis significance of a higher PASP detected at the time of ACS.</span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="color:#000000"><strong>Methods: </strong><span style="font-family:Calibri,sans-serif">We conducted a retrospective study of patients with ACS admitted to a single coronary intensive care. Echocardiography was performed within 2 days of admission and pulmonary artery systolic pressures estimated. The patients were then divided in 2 groups: group 1 (G1) with PASP &lt; 40 mmHg and group 2 (G2) with PASP </span><span style="font-family:Symbol">&ge;</span></span></span><span style="font-size:medium"><span style="color:#000000"><span style="font-family:Calibri,sans-serif">&nbsp;40 mmHg. Clinical, analytical and echocardiographic characteristics were evaluated in both groups. All-cause mortality was the primary endpoint. Univariate Cox regression analysis were performed to assess the prognostic value of each variable in the two groups. Then, the covariates included in the multivariate Cox regression analysis were those associated with the development of all-cause mortality in the respective univariate analyses. Kaplan-Meier survival curves were used to compare the unadjusted survival curves of the two groups.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="color:#000000"><strong>Results: </strong><span style="font-family:Calibri,sans-serif">A total of 235 patients were enrolled.</span><strong> </strong><span style="font-family:Calibri,sans-serif">Median age was 74 years-old (IQR 64-81), 70.6% were males, 29.4% had PASP </span><span style="font-family:Symbol">&ge;</span><span style="font-family:Calibri,sans-serif">&nbsp;40 mmHg and the median follow-up was 33 (IQR 18-66) months. Only 24.7% of the patients had previous history of heart failure (HF). Patients with PASP </span><span style="font-family:Symbol">&ge;</span><span style="font-family:Calibri,sans-serif">&nbsp;40 mmHg were older and had lower left ventricular ejection fraction (LVEF). In the univariate Cox regression analysis, PASP </span><span style="font-family:Symbol">&ge;</span><span style="font-family:Calibri,sans-serif">&nbsp;40 mmHg predicted death by all causes (HR 3.69; 95% CI 2.42-5.65; P&lt;0.001), along with other variates. Adjusted multivariate analysis (including age, dyslipidemia, hypertension, history of HF, serum creatinine, LVEF and Killip class </span><span style="font-family:Symbol">&ge;</span><span style="font-family:Calibri,sans-serif">2), proved that PASP </span><span style="font-family:Symbol">&ge;</span><span style="font-family:Calibri,sans-serif">&nbsp;40 mmHg was an independent predictor of mortality by all causes (HR 1.95; 95% CI 1.22-3.13: P=0.005) in patients with ACS.</span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="color:#000000"><strong>Conclusion: </strong><span style="font-family:Calibri,sans-serif">In our study we concluded that PASP </span><span style="font-family:Symbol">&ge;</span><span style="font-family:Calibri,sans-serif">&nbsp;40 mmHg detected at the time of ACS was an independent predictor of long term all-cause mortality, as well as age, dyslipidemia, serum creatinine and LVEF. These subsets of patients represent a very high risk group in which close attention should be paid during follow-up with the aim of improving their poor outcomes.</span></span></span></p>