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Prognosis of patients with left circumflex artery-related myocardial infarction based on the results of a large national registry
Session:
Posters (Sessão 2 - Écran 6) - Enfarte Agudo do Miocárdio 1
Speaker:
Pedro Rocha 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:
Pedro Rocha Carvalho; Isabel Moreira; Catarina Carvalho; Marta Catarina Bernardo; Fernando Gonçalves; Pedro Mateus; José Paulo Fontes; Ilídio Moreira; Em Nome Dos Investigadores do Registo Nacional de Síndromes Coronárias Agudas
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: Patients presenting with ST-elevation myocardial infarction (STEMI) have worse short-term outcomes in comparison to those with non-ST elevation myocardial infarction (NSTEMI). However, <span style="font-size:11.5pt">little is known about clinical differences and outcomes in patients with left circumflex artery (Cx) occlusion presenting with non-ST elevation myocardial infarction (NSTEMI)</span>.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong>: To evaluate the difference in clinical outcomes between patients with Cx-related STEMI <em>versus</em> Cx-related NSTEMI with and without artery occlusion.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: ACS patients included in a national registry between October 2010 and January 2022 with culprit lesion on LCx were selected. Patients with previous history of coronary artery bypass graft were excluded. Patients were then divided into three groups based on the admission diagnosis and coronary angiography findings: Cx-related <strong>STEMI</strong>, NSTEMI with Cx occlusion (<strong>NSTE</strong><span style="font-size:16px"><sub><strong>CxO</strong></sub></span>), and NSTEMI without Cx occlusion (<strong>NSTE</strong><span style="font-size:16px"><strong><sub>N</sub></strong></span>). <span style="background-color:white"><span style="color:black">The primary outcome was a composite of </span></span>in-hospital death, reinfarction, cardiac arrest, and heart failure.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: <span style="color:#212529">During the study period, a total of </span>2211<span style="color:#212529"> patients with Cx-related MI were treated,</span> and most (50.3%) presented with NSTEMI <strong>without</strong> Cx occlusion, 21.2% with NSTEMI <strong>with</strong> Cx occlusion and 28.5% with STEMI. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients in the <strong>NSTE</strong><span style="font-size:16px"><strong><sub>CxO</sub></strong></span> and STEMI group were younger than NSTE<strong><span style="font-size:16px"><sub>N</sub></span></strong> (62±12 vs 62±13 vs 65±12, p<0.001). Frequency of admission Killip class IV was 0.2% in NSTE<strong><span style="font-size:16px"><sub>N</sub></span></strong>, 0.6% in NSTE<sub><span style="font-size:14.0pt"><span style="font-size:14px"><strong>CxO</strong></span>,</span></sub> and 3.1% in the STEMI group (p<0.001). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients of NSTE<strong><span style="font-size:16px"><sub>CxO</sub></span></strong> group were less frequently submitted to coronary angioplasty (70.4% vs 86.7% in NSTE<span style="font-size:16px"><sub>N</sub></span> vs 95.5% in STEMI, p<0.001), possibly because of longer delay from onset of pain to coronary angiography (median 454 vs 330 minutes NSTE<strong><span style="font-size:16px"><sub>N</sub></span></strong> and 184 minutes in STEMI, p<0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During hospitalization, 285 patients (14.4%) experienced the composite endpoint. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients in NSTE<span style="font-size:16px"><strong><sub>CxO</sub></strong> </span>group had an incidence of adverse events higher than NSTE<strong><span style="font-size:16px"><sub>N</sub></span></strong> (in-hospital death 2.2% vs. 0.6%, p=0.009, heart failure 13.4% vs 10.9%, p=0.264, cardiac arrest 1.9% vs 1.1%, p=0.195 and reinfarction 0.6% vs 0.6%, p=0.391) and lower than STEMI patients (in-hospital death 2.2% vs. 3,3%, p=0.268, heart failure 13.4% vs 19.7%, p=0.079, cardiac arrest 1.9% vs 7.1%, p<0.001 and reinfarction 0.6% vs 0.2%, p=0.391). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In a multivariate regression analysis, after adjusting for possible confounders, risk of composite endpoint was higher in STEMI group (HR 2.08, 95% CI: 1.51-2.87, p<0,001) than in NSTE<strong><span style="font-size:16px"><sub>N</sub></span></strong>, but risk of composite endpoint in NSTE<strong><span style="font-size:16px"><sub>CxO</sub></span></strong> was only marginally increased (HR 1.31, 95% CI: 0.90-1.90, p=0.151). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">No statistically significant difference was noted in mortality at one year between NSTEMI and STEMI patients.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions</strong>: The STEMI group undoubtedly diverged from the NSTEMI group. NSTEMI <strong>with</strong> Cx occlusion seems to be an intermediate condition between NSTEMI without Cx occlusion and STEMI.</span></span></p>
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