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Timing of invasive strategy in NSTE-ACS and Chronic Kidney Disease: could it influence the occurrence of arrhythmic and pump failure events?
Session:
Posters (Sessão 2 - Écran 3) - Doença arterial coronária
Speaker:
Mariana Martinho
Congress:
CPC 2023
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
12. Coronary Artery Disease (Chronic)
Subtheme:
12.8 Coronary Artery Disease - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Mariana Martinho; Rita Calé; João Grade Santos; Bárbara Marques Ferreira; Diogo Santos Cunha; Nazar Ilchyshyn; João Mirinha Luz; Oliveira Baltazar; Ana Rita Pereira; Gonçalo Morgado; Cristina Martins; Ana Catarina Gomes; Hélder Pereira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><u><span style="color:black">Introduction</span></u></strong><span style="color:black">: </span><span style="color:black">Chronic Kidney Disease (CKD) is related to higher rates of ventricular arrhythmias (VA), heart failure (HF) and poor outcomes in Non-ST Segment Elevation Acute Coronary Syndromes (NSTE-ACS). Although early percutaneous coronary intervention (PCI) is recommended by European guidelines in the presence of high-risk features, CKD pts are less often submitted to early PCI (<24h). It is not well established how timing PCI correlates with VA or HF. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><u><span style="color:black">Objectives</span></u></strong><span style="color:black">: To evaluate how time to PCI in different CKD stages affects 2 primary endpoints: in-hospital mortality and VA (VA); in-hospital mortality and HF (HF).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><u><span style="color:black">Methods</span></u></strong><span style="color:black">: Retrospective study of a national registry on ACS. Of 32.334 ACS pts, 6.200pts with NSTE-ACS submitted to PCI were included. CKD was stratified according to estimated glomerular filtration rate (eGFR): (G1) eGFR>60mL/min; (G2) eGFR 30-59 mL/min; (G3) eGFR<29mL/min. Logistic regression analysis was used to determine independent predictors of the primary endpoints and to test the interaction between CKD severity and the effect of time to PCI (early <24h vs late >24h) on outcomes.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><u><span style="color:black">Results</span></u></strong><span style="color:black">: Distribution between CKD groups was 74.7% in G1, 20.0% in G2 and 5.3% in G3. CKD severity was associated with older age and cardiovascular comorbidities. GRACE score was >140 for eGFR<60mL/min: 117±29 in G1, 152±30 in G2 and 169±35 in G3, p<0.001. Despite having similar pt-delay times, G2 and G3 had significantly higher door-to-balloon time (23±51h vs 34±57h vs 54±93h, p<0.001). While 73.5% of G1 pts had early-PCI, this rate decreased significantly for the other groups: 69.4% and 59.1%, respectively (p<0.001). Regarding adverse events, time to PCI was significantly associated with HF (45±57h vs 56±63h, p=0.01), but not with VA (27±55h vs 40±90h, p=0.175). CKD severity was an independent predictor for both endpoints. However, when CKD severity was tested for interaction with time to PCI, there was no effect on outcomes. Results within each CKD group are displayed in figure 1.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="background-color:white"><span style="font-family:Calibri,sans-serif"><strong><u><span style="color:black">Conclusions</span></u></strong><span style="color:black">: Although advanced CKD stages are associated with adverse outcomes (in-hospital mortality, pump failure and malignant arrhythmias) and less early PCI rates, their worst prognosis does not seem to be related with timing to PCI. This suggests that early outcomes are more related to comorbidities and clinical severity of ACS presentation.</span></span></span></span></p>
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