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07. Syncope and Bradycardia
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32. Cardiovascular Nursing
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Prognostic impact of chronic kidney disease in acute coronary syndromes
Session:
Posters (Sessão 4 - Écran 8) - Síndromes coronárias agudas em populações especiais
Speaker:
Catarina Ribeiro 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:
Catarina Ribeiro Carvalho; Pedro Rocha Carvalho; Marta Catarina Bernardo; Isabel Martins Moreira; Fernando Fonseca Gonçalves; Pedro Mateus; Ana Baptista; 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> coronary artery disease is a prevalent comorbidity in patients with chronic kidney disease (CKD). Considering the higher risk of contrast-induced nephropathy, acute coronary syndrome (ACS) patients with CKD may be less likely to have an invasive diagnostic and therapeutic strategy, which may further aggravate their prognosis.</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 prognostic impact of CKD in the Portuguese population with ACS.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> patients hospitalized for non-ST elevation acute myocardial infarction (NSTEMI) included in a national multicentre retrospective study between 2010 and 2022 were divided according to eGFR. The impact of eGFR on the probability of invasive angiography and revascularization, complications, in-hospital and one year mortality rates was evaluated.</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 12348 patients was included: 73.8% had eGFR >60, 19.1% between 30 and 60, 4.3% between 15 and 30 and 2.8% had eGFR <15 ml/min/1.73m<sup>2</sup>. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Compared with patients with eGFR >60, those who had lower eGFR were less likely to receive an invasive diagnostic and therapeutic strategy, with only 66.9% of patients with eGFR <15 ml/min/1.73m<sup>2</sup> being submitted to coronary angiography (vs. 87.6%, <em>p</em><0.001) and 43.4% receiving percutaneous coronary intervention (vs. 56.6%, <em>p</em><0.001). Despite having more frequent multivessel disease (63.1% vs. 51.6%, <em>p</em><0.001), orientation for coronary artery bypass was also less frequent in lower eGFR patients (5.6% vs. 10.4%, <em>p</em><0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Patients with lower eGFR had worse systolic function (mean left ventricle ejection fraction of 48±13% vs. 54±12%, <em>p</em><0.001) and more in-hospital complications - the group with eGFR 15-30 ml/min/1.73m<sup>2</sup> presented the higher rates of acute heart failure (33.6% vs. 8.5% in the eGFR>60, <em>p</em><0.001), shock (21.4% vs. 10.5%, <em>p</em><0.001), atrial fibrillation: 7.1% vs. 2.5%, <em>p</em><0.001 and atrioventricular block: 2.4% vs. 1.0%, <em>p</em>=0.002). Also, this group presented the highest in-hospital mortality rate (10.1% vs. 1.1%, <em>p</em><0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">CKD was also associated with an increased one year mortality rate, with the worst outcome in the 15-30 ml/min/1.73m<sup>2 </sup>group (30.6%). Mortality rate of the patients with eGFR <15 was not significantly different of those with 30-60 ml/min/1.73m<sup>2</sup> (17 vs. 15%, <em>p</em>=0.71).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>CKD was associated with worse prognosis in NSTEMI. In line with the described in literature, patients with lower eGFR were less likely to receive an invasive diagnosis and treatment strategy and presented worse left ventricular systolic function. However, patients with eGFR between 15 and 30 ml/min/1.73m<sup>2</sup> had the worst outcomes, with the highest rate of in-hospital complications, as well as in-hospital and one year mortality rates.</span></span></p>
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