SPC365

Re-infarction during hospitalization for acute myocardial infarction: prevalence, predictors and impact on mortality

Session: Posters (Sessão 2 - Écran 6) - Enfarte Agudo do Miocárdio 1
Speaker: Miguel Carias

Congress: CPC 2023
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.7 Acute Coronary Syndromes - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Miguel Carias De Sousa; Marta Paralta; António Almeida; Francisco Cláudio; Rita Rocha; Bruno Piçarra; Ângela Bento; Manuel Trinca

<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;Arial&quot;,sans-serif">Introduction:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> Reinfarction is defined as recurrence of clinical signs and symptoms of ischemia in patients with previously diagnosed acute myocardial infarction (AMI).</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;Arial&quot;,sans-serif">Purpose:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> To determine the prevalence of Reinfarction (RI) during hospitalization for AMI, identify predictors and evaluate its impact on in-hospital mortality.</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;Arial&quot;,sans-serif">Methods:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> We studied 6900 patients diagnosed with AMI included in a national multicenter registry. We considered 2 groups: patients with RI and patients without RI. We recorded age, gender, cardiovascular history, heart rate (HR) and blood pressure (BP) on admission, electrocardiographic presentation, coronary angiography performed, number of vessels with lesions, number of angioplasties performed, type of stent implanted and therapy during hospitalization. We evaluated left ventricular function (LVF) and the presence of the following complications: heart failure, mechanical complications, late high-grade arrhythmic complications, major bleeding and the need for transfusion support. In-hospital mortality was compared. Multivariate analysis was performed to identify predictors of RI and the impact of RI on in-hospital mortality.</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;Arial&quot;,sans-serif">Results:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> RI was found in 1.4% (99 patients). The patients with RI were older (70&plusmn;12 vs 66&plusmn;14 years; p&lt;0.001), had higher prevalence of hypertension (83.8 vs 68.4%, p=0.001), history of stroke (14.1% vs 8.1%, p=0.028) and peripheral vascular disease (13.4% vs 5.0%, p=0.001). Except for the lower diastolic blood pressure in the patients with RI (76&plusmn;14 vs 80&plusmn;17 mmHg, p=0.01), there were no differences in the remaining vital parameters or in the Killip-Kimball class on admission. The presence of AMI without ST elevation was more prevalent in the patients with RI (67.7% vs 53.7%, p=0.006).The rate of coronary angiographies was similar between the 2 groups, however the patients with RI showed more multivessel disease (71.9% vs 49.8%, p&lt;0.001), left main coronary disease (16.3% vs 7.5%, p=0.002), anterior descending disease (78.9% vs 64.6%, p=0.005) and the right coronary artery (71.1%% vs 55.0%, p=0.002). There were no differences in the number or type of vessels undergoing angioplasty. RI was associated with worse LVF (p&lt;0.001), higher prevalence of HF (40.4% vs 16.1%, p&lt;0.001), major hemorrhage (7.1% vs 1.5%, p=0.001) and need for transfusion (6.1% vs 1.9%, p=0.01). In-hospital mortality was higher in patients with RI (11.1% vs 3.0%, p&lt;0.001). Multivariate analysis, RI was an independent predictor of in-hospital mortality and the following were identified as independent predictors of RI: age, history of peripheral vascular disease and left main coronary disease.</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;Arial&quot;,sans-serif">Conclusion:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> RI is a rare complication, present in 1.4% of patients with AMI and is associated with an increase in in-hospital complications and mortality. Age, history of peripheral vascular disease and left main coronary disease were independent predictors of RI.</span></span></span></span></p>