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Mid-range ejection fraction after STEMI: different apples in the same basket
Session:
Sessão de Posters 35 - Enfarte agudo do miocárdio com supra ST
Speaker:
Sofia Esteves
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:
Cartazes
FP Number:
---
Authors:
Sofia Esteves; João Agostinho; Fátima Salazar; Ana Francês; Catarina Simões de Oliveira; Ana Abrantes; Daniel Inácio Cazeiro; Nuno Lousada; Joana Rigueira; Rafael Santos; Doroteia Silva; Fausto J. Pinto
Abstract
<p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">ST segment elevation infarction with mid-range ejection fraction (EF) constitutes a subgroup of population with less evidence in respect to therapeutic indications, prognosis and risk estimation. Several studies showed that troponin levels after STEMI could act as a marker of prognosis, but such conclusions are yet to be drawn in this subgroup. </span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose: </strong>To define whether troponin levels after STEMI in this subgroup of patients (pts) could help establishing long term prognosis.</span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong></span></span></p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#212121">Single center retrospective observational study including patients with STEMI and a resulting mildly reduced ejection fraction (40-49%) between January 2015 and December 2019. Clinical, laboratory, echocardiographic and cath data were obtained through electronic patient records at the time of STEMI and during follow-up.</span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#212121">Frequency tables were created and data analysis was performed with Chi-square test; ROC curve analysis and Kaplan-Meyer curves were obtained to analyze survival. </span></span></span></span></span></span></p> <p> </p> <p><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif">During the study period <span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#212121">we enrolled a total of 219 patients who presented with STEMI and mildly reduced ejection fraction. Mean age was 62,67 </span></span></span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:Symbol"><span style="color:#212121">±</span></span></span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#212121"> 12,9 years and 72,1% were male. Most frequent risk factors were hypertension and dyslipidemia. In most patients anterior descending artery was the culprit vessel (62,8%), followed by right coronary artery (23,3%). </span></span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#212121">Mean left ventricle ejection fraction (LVEF) after the event was 44,9 </span></span></span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:Symbol"><span style="color:#212121">±</span></span></span></span><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#212121"> 2,37% and subsequent echocardiographic evaluation showed that 11,4% of patients had a worsening of LVEF. </span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#212121">ROC curve analysis was performed, and a cut-off of 4300 ng/L was established as having the best sensitivity and specificity (AUC 0,809, 95% CI 0,722-0,895). The Kaplan Meyer curve showed that patients with troponin level>4300 ng/L presented a higher rate of cardio-vascular events (composite endpoint of death, cardiovascular hospital admissions and stroke) – figure 1. Peak troponin levels also showed an inverse correlation with left ventricular ejection fraction at follow-up (p=0,031).</span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#212121">Conclusion:</span></span></span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt"><span style="background-color:white"><span style="font-family:"Segoe UI",sans-serif"><span style="color:#212121">Post STEMI mid-ranged ejection fraction pts are not an homogeneous population, as higher troponin levels identified a subset of patients in whom worsening of LVEF was detected and at higher risk of events during follow-up. Since specific therapeutic recommendations are lacking in this group, close clinical monitoring is warranted in those at higher risk, as starting neurohormonal modifying therapy and referral to an HF center must be considered.</span></span></span></span></span></span></p> <p style="text-align:justify"> </p> <p> </p>
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