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The Portuguese approach to cardiogenic shock in acute coronary syndrome
Session:
Comunicações Orais - Sessão 04 - Choque cardiogénico
Speaker:
Margarida G. Figueiredo
Congress:
CPC 2023
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Margarida G. Figueiredo; Sofia B. Paula; Mariana Santos; Hélder Santos; Mariana Coelho; Samuel Almeida; Lurdes Almeida
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction: Acute myocardial infarction (ACS) with myocardial dysfunction is the most frequent cause of cardiogenic shock (CS), which results in end-organ damage tissue, with high mortality rates. Early use of mechanical circulatory support (MCS) allows a reduction in need for inotropes and may prevent the downward spiral of shock.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Objectives: To compare patients with CS due to ACS that received with those that didn’t receive MCS, regarding intrahospital complications, intrahospital mortality, and one-year follow-up in terms of mortality, readmissions (R) for cardiovascular (CV) causes and R for other causes.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: Multicenter retrospective study, based on the Portuguese Registry of ACS, from 1/10/2010-24/10/2022. Patients were divided into two groups: A – without MCS - and B – patients that needed MCS. Kaplan-Meier test was performed to establish the survival rates, CV readmissions and readmissions for other causes, at one year.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: A total of 1168 patients were analyzed, 1074 in group A (92.0%) and 94 in group B (8.0%). Mean age was 72.5±12.6 years and 62.5% of the patients were male in group A, while in group B mean age was 68.0±11.4 and 64.9% were men. Group A had more patients with previous acute myocardial infarction (MI) (21.2% vs 11.1% p=0.024). On admission, group B presented more ST-elevation myocardial infarction (STEMI) (81.9% vs 21.2%, p=0.020), anterior MI (63.6% vs 49.9%, p=0.022) and Killip-Kimball classification of IV (48.9% vs 37.2%, p=0.025). Group B underwent more prehospital thrombolysis (66.7% vs 6.5%, p<0.001), had a higher Door-to-Balloon time (134.5 (62.0-234.0)min vs 95.0 (39.5-185.0)min, p=0.020), and left main artery was the culprit artery in more cases in this group (15.6% vs 6.0%, p=0.003). Group B had more mechanical complications (13.8% vs 5.8%, p=0.002) and cardiac arrest (29.8% vs 17.5%, p=0.003). There were no differences between the two groups in terms of intrahospital mortality (group A 48% vs group B 46.8%, p=0.826) or in mortality rates, R for CV causes and R for other causes at one-year follow-up, with a Kaplan-Meier test of p=0.235 (Figure 1A), p=0.601 (Figure 1B) and p=0.257 (Figure 1C), respectively.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusions: Even though patients in need of MCS had a more severe clinical presentation, intrahospital mortality, survival rates, CV hospitalizations and R for other causes at one year did not show significant differences from patients without MCS.</span></span></p>
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