SPC365

Is Symptoms-Balloon-Time a Better Prognostic Predictor?

Session: Posters (Sessão 4 - Écran 6) - Doença Coronária e Cuidados Intensivos 5 - EAMcST
Speaker: Rita Rocha

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: Rita Caldeira da Rocha; Francisco Dias Cláudio; Miguel Carias; Kisa Congo; Ana Rita Santos; Bruno Piçarra; em Nome Dos Investigadores do Proacs

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><strong>Introduction:</strong><span style="background-color:white"><span style="color:black">There is a strong association between prompt primary PCI as measured by the door to balloon time and improved patients(pts)outcomes.However</span></span> ischemia starts even before symptoms. In <span style="color:#212121">ST elevation acute myocardial infarction(</span>STEMI),time is crucial,and earlier treatment offers a better prognosis.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><strong><span style="color:#212121">Purpose:</span></strong><span style="color:#212121">Evaluate if symptom-to-balloon-time (SBT)is a better outcome predictor than door-to-balloon-time(DBT)in pts with STEMI.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><strong><span style="color:#212121">Methods:</span></strong><span style="color:#212121">From a national multicenter registry,we evaluated pts with STEMI who performed emergent coronariography accordingly with DBT &gt;or </span><span style="color:#212121">&le;120min</span><span style="color:#212121"> and SBT&gt; or </span><span style="color:#212121">&le;</span><span style="color:#212121">240min.We then evaluated pts who had in-hospital mechanical complications, defined as ventricular wall or interventricular septum rupture, or severe acute mitral regurgitation, due to papillary muscles involvement.We analyzed clinical characteristics,coronary anatomy and intervention.We performed multivariate analysis to assess the impact of DBT and SBT in in-hospital mechanical complications,and </span><span style="color:#212121">their discrimination&nbsp;power in predicting in-hospital mechanical complications,using the area under&nbsp;the ROC&nbsp;curve(AUC)method.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;"><strong><span style="color:#212121">Results:</span></strong><span style="color:#212121">From the 6461 pts who performed emergent coronariography due to STEMI,DBT was </span><span style="color:#212121">&gt;</span><span style="color:#212121">120min in 2279 and SBT was &gt;240min in 3406. Both DBT&gt;120 and SBT &gt;240min were associated with higher IMC(0.5%vs1.5%,p&lt;0.001 and 0.3%vs1.2%,p&lt;0.001). Mechanical complications occurred in 50 pts(77% male,63</span><span style="color:#212121">&plusmn;</span><span style="color:#212121">13years old).Those with IMC were older (63</span><span style="color:#212121">&plusmn;</span><span style="color:#212121">13years old vs 71</span><span style="color:#212121">&plusmn;13years old,p&lt;0.001)</span><span style="color:#212121"> and more often female(23%vs45%,p&lt;0.001). No difference was found in comorbidities, STEMI localization nor coronary anatomy.Higher creatinine (0.9(0.8; 1.1)mg/dL vs 1.1(0.8;1.5)mg/dL, p&lt;0.001) and glicemia (134mg/dL (111;175)vs 154mg/dL (123;209), p=0.005) values at admission were present in those who had in-hospital mechanical complications. Left ventricular ejection fraction was lower in pts who had IMC (50</span><span style="color:#212121">&plusmn;12%vs44&plusmn;9,p=0.012</span><span style="color:#212121">).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;">After multivariate analysis, we found that SBT&gt;240min and PBT&gt;120min are IMC independent predictors(respectively,OR 2.980; 95%CI [1.370-6.485],p=0.006, and OR 2.025; 95%CI[1.093-3.753],p=0.025).For the cutt-off value of 240min for SBT(sensitivity of 82%and specificity of 52%),and 120min for DBT(sensitivity of 62% and specificity of 65%),to predict &nbsp;<span style="color:#212121">in-hospital mechanical complications</span>,we found that SBT is a better predictor of in-hospital mechanical complications than DBT (AUC 0.646;CI95%[0.578-0.714], p&lt;0.001, and AUC 0.636;CI95%[0.558-0.714],p=0.001)-fig.1.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,&quot;sans-serif&quot;">Conclusion: Patients who had in-hospital mechanical complications were older and were more often of female gender. These also presented with higher creatinine and glicemia values and lower left ventricular ejection fraction. We found that symptom-to-balloon-time is a better in-hospital mechanical complication predictor than door-to-balloon-time.</span></span></p>