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Moderate to severe chronic kidney disease and acute coronary syndromes – approach and outcomes
Session:
Sessão de Posters 20 - Doença coronária - marcadores de prognóstico
Speaker:
Adriana Rei Pacheco
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Cartazes
FP Number:
---
Authors:
Adriana Rei Pacheco; Simão Carvalho; Carlos Costa; Tiago Aguiar; Raquel Ferreira; Mesquita Bastos
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong>Chronic kidney disease (CKD) is present in more than 30% of patients with acute myocardial infarction (AMI). Patients with AMI and concomitant CKD have a worse prognosis than patients with normal renal function.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Objectives: </strong>To evaluate the differences between patients with and without CKD during hospitalization for AMI, in terms of presentation, approach, in-hospital complications, and long-term events.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>Retrospective study including patients admitted for AMI in a district hospital, over a period of 12 months between 2019 and 2020.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: 179 patients were included (76% men, mean age 67.3±12.5 years). Average length of stay was 5.9±3.8 days. 65.9% AMI without ST segment elevation and 34.1% AMI with ST segment elevation. The most frequent risk factors were dyslipidemia (60.3%) and hypertension (72.1%). 30.7% patients had CKD (GFR <60 mL/min/1.73m2) and 10.6% had a history of atrial fibrillation (AF).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Patients without CKD had a mean age of 64.3±12.6 years and BNP of 219±26.3, and patients with CKD had a mean age of 73.9±9.4 and a BNP of 580.9 ±841.3.</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">Individuals with CKD were less likely to undergo invasive management (96.8 vs 87.3%, p<0.001) or were referred to catheterization later in the hospitalization - more than 72 hours after the admission - (16.4% vs 4.0%, p<0.001), and had lower odds of complete revascularization (67.0% vs 47.2%, p<0.039).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The presence of CKD correlated with the development of complications during hospitalization (χ2 14.81, p<0.001), namely new onset AF (χ2 7.37, p=0.007), acute hemorrhage (χ2 12.68, p< 0.001) and heart failure (χ2 9.89, p=0.002). </span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">In a Kaplan-Meier survival analysis, CKD also correlated with events at 3 years (Log Rank 24.8, p<0.001).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">The creatinine value at admission was an independent predictor of long-term events (HR 3.16; CI 1.70-5.89, p<0.001), even after adjusting for confounders (age, sex, history of chronic coronary syndrome, smoking, dyslipidemia, hypertension, diabetes and previous AF).</span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion</strong>: This study highlights the significant impact of CKD on AMI outcomes, both during hospitalization and after discharge. CKD patients, comprising 30.7% of the cohort, faced distinct challenges, including less frequent invasive management and delayed catheterization. Elevated creatinine at admission emerged as a strong predictor of long-term outcomes, underscoring the need for tailored strategies in managing AMI patients with CKD.</span></span></p>
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