SPC365

Emergent coronary angiography in a 90-plus population – outcomes at 5-years follow-up

Session: Posters (Sessão 2 - Écran 1) - DAC e Cuidados Intensivos 2 - Tronco comum e Idade
Speaker: Ricardo Alves Pinto

Congress: CPC 2022
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.4 Acute Coronary Syndromes – Treatment
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Ricardo Alves Pinto; Tânia Proença; Miguel Martins Carvalho; Ana Filipa Amador; Catarina Costa; João Calvão; André Cabrita; Catarina Marques; Ana Pinho; Luis Santos; Cátia Priscila; Paula Dias; Filipe Macedo

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Introduction:</span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif"> Elderly people represents a vulnerable and increasing population presenting with acute coronary syndrome (ACS). Several data suggest the benefit of an early revascularization in ST-elevation (STE)-ACS or non-STE-ACS with positive troponin. However questions persist considering the unavoidable adverse prognosis, patient&rsquo;s functional and cognitive status, comorbidities and preferences. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Purpose: </span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">To evaluate a group of very old patients who underwent emergent coronary angiography (CA). </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Methods: </span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">We retrospectively analyzed a group of very old patients (&ge; 90 year-old) who underwent emergent CA from January 2008 to September 2020. Clinical features were collected; survival and MACE were compared with an aged-matched control population with ACS not submitted to emergent CA. MACE was defined as a composite of all-cause death, ischemic stroke, ACS and hospitalization for acute heart failure.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Results: </span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">A total of 34 patients were enrolled: 56% female, with mean age 92 </span><span style="font-family:Symbol">&plusmn;</span><span style="font-family:&quot;Calibri Light&quot;,sans-serif"> 2 year-old. As for the cardiovascular risk factors, 88% had hypertension, 49% dyslipidaemia, 12% diabetes and 15% were previous smokers. Concerning other comorbidities, 27% had atrial fibrillation, 21% chronic kidney disease, 12% had cerebrovascular disease and median modified Rankin scale for neurologic disability was 2. Almost all patients had STE-ACS, 68% anterior and 29% inferior, inferolateral or inferoposterior infarction; 3% had infarction of indeterminate location. In CA, 65% had multivessel disease, 14% of them involving left main coronary artery; coronary intervention was performed in 71% of patients (mostly stent implantation), the remaining 29% had no invasive treatment. Concerning to clinical status, median troponin was 131&nbsp;517 ng/L and median BNP 496 pg/mL; 36% of patients evolved in Killip class III or IV and only 32% of patients had normal left ventricular systolic function. Regarding mortality, 38% of patients died in the index-event versus 25% in the </span><span style="font-family:&quot;Calibri Light&quot;,sans-serif">aged-matched </span><span style="font-family:&quot;Calibri Light&quot;,sans-serif">control group (p=0.319). During five years of follow-up, there was no significant difference in mortality between the two groups (Log Rank, p=0.403) and more than 50% of patients died in two years. Comparing MACE occurrence, both groups were similar (Log Rank, p=0,662), with more than 80% having at least one event in five years.&nbsp; </span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Conclusions: </span></strong><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Very old patients submitted to emergent CA had a high percentage of multivessel disease, left ventricular dysfunction and mortality during hospitalization. Compared to an </span><span style="font-family:&quot;Calibri Light&quot;,sans-serif">aged-matched control group, they showed no survival or MACE benefit of emergent CA strategy during a five-years follow-up. </span><span style="font-family:&quot;Calibri Light&quot;,sans-serif">Although this is a small study, these findings highlight the efforts that should be made to optimize care in this vulnerable population, under-represented in the clinical trials. Special caution should be given to avoid possible unnecessary discomfort in this setting. </span></span></span></p>