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Are the results of the COMPLETE trial applicable to all acute coronary syndromes?
Session:
Posters (Sessão 2 - Écran 6) - Enfarte Agudo do Miocárdio 1
Speaker:
Diana Vale Carvalho
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:
Diana Vale Carvalho; Adriana Rei Pacheco; Raquel Ferreira; Ana Briosa; Em Nome Dos Investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Background</strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The COMPLETE trial demonstrated that coronary artery bypass grafting in patients admitted for acute coronary syndrome with ST-segment elevation (STEMI) was superior to culprit-lesion-only percutaneous coronary intervention (PCI) in reducing the risk of major adverse cardiovascular events.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The aim of the study was to verify if the results of the COMPLETE trial apply to patients admitted with acute coronary syndrome with or without ST-segment elevation (STEMI and NSTEMI). </span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Retrospective study conducted through the analysis of data provided by the National Center for Data Collection in Cardiology. Patients admitted for STEMI and NSTEMI from 1 January/2015 to 31 December/21 and who underwent PCI were included. Patients were divided into two groups: complete (CR) and incomplete (IR) revascularization. Death or hospital admission due to cardiovascular causes was considered the adverse event.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">2222 patients were included, 1532 with CR (68,9%) and 690 with IR (31,1%). The male gender was the most prevalent in both groups (76.2% in CR and 77.2% in IR). Mean age was significantly higher in the IR group (67.1 ± 11.9 vs 62.5 ± 12.5, p<0.001). STEMI was the admission diagnosis in 60% of patients with CR and 54.8% of those with IR [OR 0,81 (IC 0.67-0.97, p=0,021)]. NSTEMI was the admission diagnosis in 40% of patients with CR and 45,2% of those with IR [OR 1,24 (IC 1.03-1.48, p=0,021)]. Patients with IR more frequently presented Killip class>I (7.7% vs 14.3%, p<0.001). Most risk factors and cardiovascular comorbidities were more prevalent in the IR group, except for smoking history which was more frequent in CR (38.0% vs 26.1%, p<0.001), and obesity (23,6%vs26,3%, p=0,227). Multivessel disease was documented in 22.3% of patients in the CR group. 0.1% of patients in the CR group and 2.2% of patients in the IR group underwent bypass surgery in addition to PCI. Left ventricular ejection fraction was higher in the CR group (55±11% vs 51±12%, p<0.001). Considering the outcomes at 1 year, it was found that the CR group had fewer readmissions and deaths from cardiovascular causes at follow-up (10.5% vs 21.0%, p<0.001). In the event-free survival curve analysis, CR was associated with better survival (LogRank test p-value <0.001).</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions</strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Complete revascularization is associated with a better prognosis in patients admitted for Acute Coronary Syndrome with or without ST-segment elevation, thus confirming the results of the COMPLETE study. In the Portuguese population, there is a tendency to attempt complete revascularization.</span></span></p>
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