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Acute Myocardial Infarction in patients with acute occlusion of the left main coronary artery – does age matter?
Session:
Posters (Sessão 2 - Écran 1) - DAC e Cuidados Intensivos 2 - Tronco comum e Idade
Speaker:
João Calvão
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:
Pósters Electrónicos
FP Number:
---
Authors:
João Calvão; Marta Braga; Mariana Brandão; Andreia Campinas; André Alexandre; Ana Filipa Amador; Catarina Martins da Costa; Catarina Amaral Marques; André Cabrita; Ana Isabel Pinho; João Carlos Silva; Bruno Brochado; Gustavo Pires-Morais; Marisa Passos Silva; Filipe Macedo
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong>: Acute myocardial infarction (AMI) due to acute occlusion of the <span style="color:black">left main coronary artery (LMCA)</span> is an uncommon event associated with a dismal prognosis. There is limited data regarding management and outcomes in this population. Moreover, elderly patients may be at a particularly high risk of poor outcome. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>To characterize elderly patients presenting with acute LMCA occlusion and assess their short- and long-term outcomes.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: In this retrospective multicentric study, we identified 11 036 patients <span style="color:black">with ST-segment elevation myocardial infarction (STEMI) or high-risk non-ST segment elevation myocardial infarction who underwent emergent coronary angiography between January 2008 and December 2020. Among this cohort, we analyzed </span>128 <span style="color:black">patients who presented with unprotected LMCA occlusion (Thrombolysis In Myocardial Infarction – TIMI ≤2) and divided them in 2 groups according to their age at presentation: G1 (patients ≥70 years old) and G2 (<70 years old).</span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Results</span></strong><span style="color:black">: Of 128 patients with AMI due to LMCA occlusion, 41 patients had ≥70 years and 87 patients had <70 years. The mean age was 76.2±5.5 years in G1 and 57.5±8.0 years in G2. Most patients in both groups were male. At presentation, the proportion of patients with STEMI (63.4 vs 70.2%, p= 0.44), cardiogenic shock (53.7 vs 64.0%, p=0.27) and cardiorespiratory arrest (17.1 vs 29.9%, p=0.12) were similar between groups. Most patients were submitted to primary percutaneous coronary intervention, which was considered successful in 76.3% of G1 patients and 68.0% of G2 patients (p=0.36). The use of intra-aortic balloon pump was similar in both groups </span><span style="color:black">(51.2 vs 51.7%, p=0.96)</span><span style="color:black">. VA-ECMO was used in 21.8% of G2 patients. None of the patients from G1 received VA-ECMO support. </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Overall, in-hospital mortality was high, with no statistically significant differences between groups (46.3 vs 54.0%, p=0.42). Among patients surviving the index-event, there was however a lower long-term survival among G1 patients (p=0.002), who had a 5-year all-cause mortality of 76.5% compared to 29.3% in G2 patients (p=0.002). </span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Conclusion</span></strong><span style="color:black">: A substantial proportion of AMI due to LMCA occlusion occurs in elderly patients. This subgroup has similar in-hospital mortality compared to younger patients, but outcomes among survivors are significantly worse. There is a need of further studies in order to improve the initial and subsequent medical treatment in an attempt to improve the prognosis of these patients.</span></span></span></p>
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