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Is the cardioprotective effect of Pre-Infarction Angina blunted by age?
Session:
Sessão de Posters 50 - Doença coronária - diferenças demográficas
Speaker:
Mariana Pereira Santos
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:
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>: Pre-infarct angina (PIA) has been demonstrated to reduce infarct size and improve prognosis in ST-elevation myocardial infarction (STEMI). However, the effects of ischemic preconditioning with aging are controversial. </span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong>Aim</strong>: We aimed at evaluating the effect of pre-infarction angina (PIA) on infarct size in two age groups.</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 consecutive STEMI patients treated by primary percutaneous coronary intervention (PCI) from January 2008 to December 2017. PIA was diagnosed if a patient had arm, jaw, or chest pain in the preceding eight days. Peak creatine kinase (CK) concentration (U/L) was used as a surrogate of infarct size. Patients were divided into two groups based on the median age: ≤62 years and >62 years. Multiple linear regression was used to identify independent predictors for infarct size and included total ischemic time and classic cardiovascular risk factors (hypertension, diabetes, dyslipidaemia, and smoking). Interaction between age and PIA was evaluated by a 2-way factorial ANOVA.</span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong>Results: </strong>From the 1131 patients included in the study, 590 (52,2%) had ≤62 years and 541 (47,8%) had >62 years. Older patients were more often women (17.2% vs 8.6%, p<0.001) and had longer total ischemic time [4.6(3.0-9.0) vs 3.5(2.3-6.0) hours, p<0.001]. They also had higher prevalence of hypertension (32.8% vs 22.8%, p<0.001), diabetes (30.7% vs 18.7%, p<0.001) and were less likely to be smokers (26.9% vs 71.4%, p<0.001). The prevalence of PIA was similar across age groups (≤62Y 31.2% vs >62Y 32.0%, p=0.668). </span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt">In older patients, PIA was associated with smaller infarct size [1.29(0.72-2.33) vs. 1.76(0.97-2.91) U/Lx10<sup>3</sup>, P<0.001]. This was not statistically significant for younger patients [1.72 (0.95-3.40) vs. 1.81 (0.94-3.37) U/Lx10<sup>3</sup>, p=0.392]. There was no significant interaction observed between the existence of PIA and age on peak CK (p=0.280 for interaction) (Figure 1).</span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt">In multivariate analysis, overall, PIA was associated with reduced peak CK (β=-0,320, p=0.011). On subgroup group analysis, PIA was a predictor of infarct size only in the older patients (β=-0,459, p=0.005), but not in the younger (β=-0,182, p=0.394). </span></span></p> <p style="text-align:justify"><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:11pt"><strong>Conclusion</strong>: Older patients with PIA had significantly lower infarct size compared to patients in the same age group without PIA. After adjustment for risk factors and total ischemic time, PIA was a predictor of lower infarct size only for the older patients. This cohort’s results suggest that the effect of pre-ischemic conditioning is not blunted by age, indicating that older patients should not be excluded from clinical trials of cardioprotective strategies for STEMI. </span></span></p>
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