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Is stable angina a protective factor? Results of a national registry.

Session Poster session 1

Speaker Dina Bento

Event : ESC Congress 2017

  • Topic : coronary artery disease, acute coronary syndromes, acute cardiac care
  • Sub-topic : Coronary Artery Disease (Chronic)
  • Session type : Poster Session

Authors : D Carvalho Silva (Faro,PT), D Bento (Faro,PT), JP Guedes (Faro,PT), J Amado (Faro,PT), N Marques (Faro,PT), W Santos (Faro,PT), J Mimoso (Faro,PT), P Gago (Faro,PT), I De Jesus (Faro,PT), A Belo (Lisbon,PT)

Authors:
D. Carvalho Silva1 , D. Bento1 , J.P. Guedes1 , J. Amado1 , N. Marques2 , W. Santos2 , J. Mimoso1 , P. Gago1 , I. De Jesus1 , A. Belo3 , 1Faro Hospital, Cardiology - Faro - Portugal , 2DCBM, UAlg, Faro Hospital, Cardiology - Faro - Portugal , 3Portuguese Society of Cardiology - Lisbon - Portugal ,

On behalf: Portuguese National Registry of Acute Coronary Syndromes

Citation:
European Heart Journal ( 2017 ) 38 ( Supplement ), 200

Introduction: Slow progression of atherosclerosis may increase the myocardial tolerance to underlying ischemia, either due to conditioning phenomena or the development of collateral circulation. Thus, the presence of stable angina (SA) prior to the first acute coronary syndrome (ACS) may be a protective factor.

Purpose: This study aims to evaluate the factors associated with the occurrence of SA preceding the first ACS and its impact on prognosis.

Methods: A retrospective, descriptive and correlational study was performed with patients (P) enrolled in a national registry of ACS between 1st October 2010 and 19th January 2017. P with a personal history (PH) of ACS, coronary angioplasty, myocardial revascularization surgery (CABG) and previously anticoagulated were excluded. P were divided into 2 groups, whether or not they had a history of SA. It was evaluated the baseline characteristics and evolution during hospitalization. Univariate (UA) and multivariate statistical analysis (MA) of the factors associated with the occurrence of previous SA was performed. It was also evaluated if the history of SA was associated with higher mortality (M), in-hospital complications (C) (mechanical C, resuscitated cardiac arrest, major bleeding, transfusion, re-infarction, temporary pacemaker (PM) need, heart failure (HF) and cardiogenic shock) or to the combined endpoint (CE) of in-hospital M, non-fatal re-infarction and stroke. SPSS 19.0 was used.

Results: In this period, 11,441 P met the criteria described. 4.049 (27.5%) were female and the mean age was 65±14 years. 1696 (14.8%) had a history of SA. In the UA, the factors associate with SA (p<0.05) were female sex; obesity, diabetes; PH of HF, renal failure and chronic obstructive pulmonary disease; higher systolic blood pressure, Killip-Kimbal class >1 and lower haemoglobin value at admission; diagnoses other than ST elevation myocardial infarction; admission to centres without haemodynamic unit and longer periods between the onset of symptoms, 1st medical contact and hospital admission; left ventricular ejection fraction >50%; non-accomplishment of coronary angiography, significant stenosis of any of the epicardial coronary arteries, left main as culprit artery, multivessel disease and indication for CABG. In the MA, independent predictors (IP) of SA were: older age, hypertension, dyslipidaemia, PH of valvular disease (VD), peripheral arterial disease (PAD) and major bleeding, and absence of PH of PM/ICD and stroke. SA was associated with in-hospital HF and major bleeding. There was a negative association with shock, mechanical complication and need for a temporary PM. There were no differences in M or CE.

Conclusions: P with a history of SA had more risk factors and comorbidities. The IP of SA were older age, hypertension, dyslipidaemia, PH of VD, PAD and major bleeding, and absence of a PH of PM/ICD and stroke. SA may be protective against shock, mechanical complication and need for a temporary PM.

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