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A multicenter registry of acute left main coronary artery occlusion: diabetes matters?
Session:
Posters (Sessão 2 - Écran 1) - DAC e Cuidados Intensivos 2 - Tronco comum e Idade
Speaker:
Mariana Silva Brandão
Congress:
CPC 2022
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.6 Acute Coronary Syndromes - Clinical
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Mariana s. Brandão; Marta Braga; João Calvão; Andreia Campinas; André Alexandre; Bruno Brochado; João Carlos Silva; Gustavo Pires-Morais; Pedro Braga; Marisa Passos Silva; Ricardo Fontes-Carvalho
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background: </strong>Acute left main coronary artery (LMCA) occlusion is often a catastrophic event. Diabetes may add complexity to this high-risk scenario.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Aim: </strong>To compare outcomes of diabetic (DM) and non-diabetic (NDM) patients presenting with acute LMCA occlusion.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Multicenter retrospective study including all patients presenting with acute unprotected LMCA occlusion (Thrombolysis In Myocardial Infarction [TIMI] ≤ 2) between January 2008 and December 2020. Patients were divided into 2 groups: DM and NDM. MACE comprised reinfarction, reintervention, hospitalization for heart failure, stroke and cardiovascular mortality.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> 128 patients (74.2% male, mean age 63.4 ± 11.4 years) were included, of whom 39 (30.7%) were diabetic. DM patients were older (66.9 <em>vs </em>61.0 years, p=.010), and more often hypertensive (84.6% <em>vs </em>54.5%, p=.002) and dyslipidemic (74.4% <em>vs</em> 50.0%, p=.018). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">ST-elevation myocardial infarction was the main clinical presentation in both groups (68.4% <em>vs </em>68.6%, p=.984). Symptom to coronary angiography time (4.0 <em>vs </em>4.5 hours, p=0.472), occurrence of cardiac arrest (47.4% <em>vs </em>50.0%, p=.939) or cardiogenic shock (66.7% <em>vs </em>56.8%, p=.427) did not differ. Three-vessel disease was more common in DM (38.5% <em>vs </em>17.0%, p=0.017); degree of collateral circulation was comparable between groups. Most patients underwent PCI (94.6% <em>vs </em>86.0%, p=0.289), and procedural characteristics did not differ significantly, except for lower use of glycoprotein IIb/IIIa inhibitors in DM (12.8% <em>vs </em>30.2%, p=.037). CABG was rare in both groups (5.1% <em>vs </em>13.6%, p=.248).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In-hospital (64.1% <em>vs </em>48.9%, p=.163) and 30-day (56.4% <em>vs </em>43.2%, p=.332) mortality were comparable between groups, but 5-year mortality was higher in DM patients (84.6% <em>vs </em>61.6%, p=.016). Among patients surviving the index-event, occurrence of MACE was similar between groups (Log-rank test, p=.130). During a mean follow-up of 1.6 ± 2.8 years, all-cause mortality was higher in DM patients (<em>Log-rank </em>test, p=.005) [Figure].</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>In this cohort of patients presenting with acute LMCA occlusion, clinical presentation and method of revascularization did not differ between diabetic and non-diabetic patients. While in-hospital and short-term outcomes were comparable between groups, long-term outcomes were poorer in diabetic patients: all-cause mortality was higher in the DM group, during follow-up. Larger studies are warranted to clarify if the management of diabetic patients in this setting should be tailored.</span></span></p>
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