SPC365

MACE in myocardial infarction with non-obstructive coronary arteries: predictors and prognosis

Session: Posters (Sessão 5 - Écran 1) - DAC e Cuidados Intensivos 6 - MINOCA, género e idade
Speaker: Mariana da Silva Santos

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: Mariana da Silva Santos; Sofia b Paula; Helder Santos; Inês Almeida; Samuel Almeida; João Tavares; Luís Santos; Lurdes Almeida

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Up to </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">15% of patients admitted with suspected acute myocardial infarction (AMI) have no significant lesions on coronary angiography (&gt;50%) (MINOCA). MINOCA is not a benign disease. </span></span><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">We aimed to evaluate predictors and prognosis of major adverse cardiac events (MACE) in the setting of MINOCA.</span></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-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Based on a multicenter retrospective study, data collected from admissions between 2013 and 2020. Patients (P) were divided in 2 groups (G): GA &ndash; P without MACE; GB - P with MACE. MACE included in-hospital death, stroke, heart failure and re-infarction.</span></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-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: MACE occurred in 90 (7.6%) out of 1098 P with MINOCA. There were no differences between G regarding gender (p=0.851). GB pts were older (72&plusmn;10 vs 65&plusmn;13, p&lt;0.001), had higher rates of arterial hypertension (86.0% vs 68.2%, p&lt;0.001), diabetes (47.0% vs 26.6%, p=0.003), previous heart failure history (16.4% vs 5.9%, p=0.002), kidney dysfunction (18.8% vs 4.5%, p&lt;0.001), dementia (8.2% vs 0.5%, p&lt;0.001) and past bleeding events (8.2% vs 0.7%, p&lt;0.001). GA had higher rates of smoking habits (22.7% vs 4.8%, p&lt;0.001). GB had higher heart rate at admission (91&plusmn;24 vs 75&plusmn;17, p&lt;0.001), higher rates of hypotension (systolic arterial pressure &lt;90mmHg) (4.4% vs 0.8%, p=.0.26), and higher rates of KK&gt;1 (64.3% vs 5.9%, p&lt;0.001), atrial fibrillation (22.0% vs 8.0%, p&lt;0.001) and left branch bundle block (LBBB) (7.3% vs 1.4%, p=0.014). GB presented higher rates of kidney dysfunction (creatinine&gt;2.0mg/dL) (19.4% vs 4.5%, p&lt;0.001), lower haemoglobin levels (12.9&plusmn;2 vs 13.7&plusmn;1.8, p&lt;0.001), higher BNP levels (BNP&gt;400pg/ml) (100% vs 17.4%, p&lt;0.001), and higher rates of left ventricle systolic dysfunction (LVEF&lt;50%) (51.0% vs 17.4%, p&lt;0.001). GB patients were treated with diuretics during hospital stay more often (74.5% vs 14.3%, p&lt;0.001). GB had longer hospital stay (10 vs 5, p&lt;0,001). &nbsp;</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">KK&gt;1 (p&lt;0.001, OR 16.3, CI 5.5-48.5), past bleeding events (p=0.024, OR 13.90, CI 1.4 &ndash; 122.2), hypotension (p=0.045, OR 22.1, CI 1.06-458.9) and diuretics usage (p0.001, OR 16.3, CI 5.5-48.5) were independently associated with MACE. Survival analysis confirmed GA had better prognosis regarding 1 year mortality compared to GB (p&lt;0.001), however there were no differences regarding readmissions for cardiovascular cause (p=0.318). </span></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-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: MACE in the setting of MINOCA are associated with poorer prognosis. Several features may help predict the MACE occurrence during hospitalizations, allowing an earlier treatment. </span></span></span></span></p>