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Cardiogenic shock following ST-segment elevation myocardial infarction in women: complications and outcomes.
Session:
Sessão de Posters 04 - Choque cardiogénico
Speaker:
Mariana Pereira Santos
Congress:
CPC 2024
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:
Cartazes
FP Number:
---
Authors:
Mariana Pereira Santos; André Alexandre; Andreia Campinas; David Sá-Couto; Diana Ribeiro; Raquel Baggen Santos; Bruno Brochado; João Silveira; André Luz; Severo Torres
Abstract
<p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong>Background</strong>: Differences in women’s prognosis have been described for both ST-segment elevation myocardial infarction (STEMI) and cardiogenic shock (CS). These might reflect asymmetries in clinical management, but also gender-specific comorbidities and pathologic mechanisms. </span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong>Purpose</strong>: We aimed to evaluate the risk of in-hospital complications and mid-term outcomes of women with CS following STEMI. </span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong>Methods</strong>: We retrospectively studied STEMI patients treated by primary percutaneous coronary intervention (PCI) from 2008 to 2017 in a tertiary care centre, presenting or evolving in Killip class IV (defined as cardiogenic shock or hypotension and organ hypoperfusion). Clinical and demographic characteristics, as well as complications and outcomes, were evaluated for both sexes. Major adverse cardio-cerebrovascular events (MACCE) at 1-year follow-up was a composite of death, cerebrovascular accident, new myocardial infarction in any vessel, or target lesion revascularization.</span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong>Results:</strong> Among 1131 patients presenting with STEMI, our study included 117 (10.3%) patients in CS, of which 40 (34.2%) were women. Women were older [71.8(±13.4) vs 64.6(±11.72) years, p=0.002] and less frequently smokers (25.0% vs 50.7%, p=0.008). Prevalence of classic cardiovascular risk factors, namely diabetes (34,1% vs 39.2%, p=0.860), hypertension (71.5% vs 60.8%, p=0.212), BMI [26.6(±5.2) vs 26.1(±3.4) kg/m<sup>2</sup>, p=0.539] and dyslipidaemia (47.5% vs 70.0%, p=0.799), was the same for both groups. Women had lower haemoglobin [12.4(±1.9) vs 13.8(±1.9) g/dl, p<0.001] and lower creatinine clearance at admission [52.4(±30.6) vs 67.3(±29.4) ml/min, p=0.017]. Door-to-balloon times [80.0(59.0-180.0) vs 67.5(47.5-105.0) min, p=0.302], total ischemic time [210(120-360) vs 203(120-476) min, p=0.302] and prevalence of anterior STEMI (35.0% vs 50.0%, p=0.123) were not significantly different. </span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt">The prevalence of in-hospital complications was generally similar for both sexes (Table 1), except for the risk of advanced atrioventricular (AV) block that was higher in women (32.5% vs 10.7%, p=0.004). Also, haemoglobin nadir was lower in women [10.6(±2.1) vs 11.7(±2.1) g/dl, p=0.023]. In a 1-year follow-up, the occurrence of MACCE was similar for both sexes (60.0% vs 50.7, log-rank P 0.734). </span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong>Conclusion</strong>: Women with CS and STEMI submitted to PCI had a similar prevalence of complications as men. Mid-term outcomes, assessed by MACCE at 1 year, were also similar for both sexes.</span></span></p>
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