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Outcomes of diabetic patients with acute coronary syndromes treated with aspirin in primary prevention
Session:
Posters (Sessão 4 - Écran 8) - Síndromes coronárias agudas em populações especiais
Speaker:
Hugo Costa
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:
Hugo Alex Costa; Miguel Espirito Santo; Raquel Fernandes; Daniela Carvalho; João Bispo; João Guedes; Pedro Azevedo; Rui Candeias; Hugo Vinhas; Jorge Mimoso; Ilidio Jesus; 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>The use of aspirin in primary prevention (PP) remains a matter of international debate. In type 2 diabetes mellitus (DM2) patients with high/very high cardiovascular (CV) risk, low dose aspirin may be considered for PP (class IIb, evidence level A) in european guidelines in the absence of hemorrhagic contraindication. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>Objectives: </strong><span style="color:black">Our aim was to analyze in-hospital and one year follow-up (FU) outcomes of acute coronary syndrome (ACS) DM2 patients without previous atherosclerotic CV disease (ASCVD) treated with vs without aspirin in primary prevention. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>Methods:</strong> <span style="color:black">A retrospective analysis was carried out of DM2 patients without established ASCVD admitted with ACS included in the Portuguese Registry of ACS between 2010-2021. Patients were divided in two groups regarding the use of aspirin in primary prevention (with-AG and without-NAG). Composite primary outcome (re-infarction, heart failure, shock, death – in-hospital) and secondary outcomes (one-year all-cause mortality and mortality/rehospitalization) were compared in both groups. Independent predictors of primary outcome were assessed by multivariate logistic regression. Survival analysis </span>and cox regression were used to compare and identify predictors of secondary outcomes. P value < 0.05 indicates statistical significance.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>Results:</strong> A total of 4517 patients were analyzed, mean age 68±12 years, 64.8% male. AG showed higher rates of hypertension (89.9%, p<0.001), dyslipidemia (74.1%, p<0.001), history of heart failure (9.2%, p<0.001), valvular disease (3.9%, p=0.002) and chronic renal disease (12.3%, p<0.001). STEMI presentation was more frequent in NAG (48%, p<0.001). Multivessel disease (mainly three vessels disease) was more frequent in AG (32.7%, p<0.001), but anterior descendent (AD) as culprit artery was more common in NAG (40.3%, p=0.013). Both groups had no difference in major hemorrhage occurrence. Primary outcome was more frequent in AG (18.6%, p=0.034). One-year all-cause mortality and mortality/rehospitalization were higher in AG (9.90%, p=0.004 and 32.9%, p=0.017, survival analysis). Independent predictors of primary outcome were aspirin in primary prevention (OR 1.38, p=0.026), age (OR 1.59, p<0.001), valvular disease (OR 4.46, p<0.001), STEMI at presentation (OR 2.20, p<0.001), LVEF <40% (OR 4.40, p<0.001) and Killip-Kimball class > I (OR 12.9, p<0.001). Aspirin in primary prevention (HR 1.84, p=0.004), chronic lung disease (HR 5.68, p<0.001), and Killip-Kimball class > I (HR 3.27, p<0.001) were predictors of one-year all-cause mortality. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:"Calibri",sans-serif"><strong>Conclusion: </strong>DM2 patients with ACS treated with aspirin in primary prevention had worst in-hospital and one-year FU outcomes. Although with higher rates of three vessels disease, PP with aspirin showed less AD disease and STEMI presentation, with similar major clinical hemorrhage.</span></span></p>
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