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Cardiac arrest in patients with acute left main stem occlusion: a real-world multicenter registry
Session:
Comunicações Orais (Sessão 14) - Doença Coronária e Cuidados Intensivos 3 - Foco na Oclusão do Tronco Comum
Speaker:
André Filipe Macedo Alexandre
Congress:
CPC 2022
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:
Comunicações Orais
FP Number:
---
Authors:
André Alexandre; Marta Braga; Andreia Campinas; Ricardo Costa; Dias de Frias; João Calvão; Mariana Brandão; Marisa Passos Silva; Gustavo Pires de Morais; João Carlos Silva; Raquel Santos; Bruno Brochado; André Luz; João Silveira; Severo Torres
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-family:"Times New Roman",serif">Introduction and objective</span></u><span style="font-family:"Times New Roman",serif">: Patients presenting with acute coronary syndrome (ACS) with unprotected left main coronary artery (LMCA) occlusion are at higher risk for mortality. Most studies have shown an association between LMCA occlusion and cardiac arrest at admission. We aimed to evaluate clinical determinants and prognostic factors of cardiac arrest presentation in patients with ACS from unprotected LMCA occlusion.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-family:"Times New Roman",serif">Methods</span></u><span style="font-family:"Times New Roman",serif">: We conducted a retrospective multicenter registry of patients with ACS with unprotected LMCA occlusion admitted in three central hospitals from Portugal between 2008 and 2020. Patients were divided according to cardiac arrest presentation.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-family:"Times New Roman",serif">Results</span></u><span style="font-family:"Times New Roman",serif">: Of 128 patients with ACS from unprotected LMCA occlusion, 26% presented with cardiac arrest and they were younger (58 vs 65 years; p=0.001). Comorbidities such as hypertension, diabetes, dyslipidemia, previous ACS, left ventricular dysfunction, peripheral artery disease, or chronic kidney disease were not clinical determinants for cardiac arrest. There was no significant association between the site of LMCA lesion and cardiac arrest (p=0.935). Similarly, there was no association with the number of other epicardial vessels with significant disease. Regarding interventional procedures, cardiac arrest at admission was associated with a shorter symptom-to-balloon time (150 vs 195 minutes; p=0.042). In terms of outcomes, there was a significant association with cardiogenic shock (88% vs 51%; p<0.001) and with the need for aminergic support (91% vs 64%; p=0.004), but not with mechanical circulatory support (MCS) (58% vs 53%; p=0.624). Furthermore, cardiac arrest patients had significantly higher in-hospital (79% vs 45%; p=0.001) and 5-year (97% vs 73%; p=0.008) mortality, as anticipated by Kaplan-Meier survival curves (p=0.002; log-rank test).</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><u><span style="font-family:"Times New Roman",serif">Conclusion</span></u><span style="font-family:"Times New Roman",serif">: In our real-world population, more than one quarter of patients with ACS with LMCA occlusion present with cardiac arrest, which correlates with higher probability of cardiogenic shock and dictates higher short- and long-term mortality. Despite cardiac care improvements, technological evolution and better patient/system-delay times, this is still a subpopulation with poor prognosis. Further studies (namely with early use of MCS) are needed to find </span></span><span style="font-family:"Times New Roman",serif">innovative </span><span style="font-family:Calibri,sans-serif"><span style="font-family:"Times New Roman",serif">strategies that can make a difference in this subgroup of patients.</span></span></span></p>
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