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Coronary artery aneurisms presenting as acute coronary syndrome – anticoagulation therapy or antiplatelet therapy alone?
Session:
Comunicações Orais - Sessão 09 - Síndrome coronária aguda 1
Speaker:
Ana Raquel Carvalho Santos
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ana Raquel Carvalho Santos; André Ferreira; André Grazina; Tiago Mendonça; Inês Rodrigues; Luis Morais; Tiago Pereira da Silva; Ruben Ramos; Lidia Sousa; António Fiarresga; Duarte Cacela; Rui Ferreira
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Optimal treatment for coronary artery aneurisms (CAA) remains debatable. Studies evaluating oral anticoagulation therapy versus antiplatelet therapy (APT) alone have been contradictory, without specific recommendations for the management of these patients (pts). </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Aim: Evaluate differences in outcomes in pts with CAA presenting as acute coronary syndrome (ACS) treated with OAT versus APT alone. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: A retrospective, single centre analysis was made including pts admitted with ACS and CAA in angiography. Data were collected regarding pts evaluation, management and follow-up. Descriptive statistics are presented as absolute frequency (number) and relative frequency (percentage) for categorical variables and as median and interquartile range (IQR) for continuous variables. When testing hypothesis, Chi-squared and Fisher's exact test was performed. A p value of 0.05 was considered statistically significant.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results:</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">From 2004 to 2023, 5020 pts were admitted for primary angioplasty, with 0.66% (n=33) presenting CAA. Of the pts with CAA, 69.7% were male with a median of 66 years old (59-73). Right coronary artery was the main location of CAA (63.7%), followed by anterior descendant artery (30.3%). One vessel disease was present in 45.5% of pts, two vessels in 24.2% and three in 30.3%. The culprit lesion was the aneurismatic vessel in 87.9% of cases. A complete revascularization was possible only in 36.4% of cases, although an adequate revascularization was achieved in 72.7% of cases, with stent implantation in 72.7% of cases. During follow up, 24.2% of pts died in 5 years. A new ACS occurred in 12.2% of pts and 39.4% had at least one hospitalization in 10 years (median 2 years [1-7]). Coronary review was made in 18.2% of pts, 9.1% with a new stent implantation and 3% requiring cardiac surgery. After diagnosis, 30.3% were under OAT with direct anticoagulants. Pts under OAT died less (p=0.03) than pts under APT alone. In our population there was no significant statistical difference between groups for hospitalization or new ACS. </span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusions:</span></span></p> <p><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Knowledge pertaining to the natural history, assessment, and interventional treatment of CAA is essential to achieve optimal results. Due to its low incidence, it is difficult to have evidence-based management strategies to deal with this uncommon but complex condition. In our population of CAA with presentation as ACS, pts treated with OAC versus antiplatelet therapy alone, had less mortality.</span></span></p>
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