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Complete myocardial revascularization improves short-term clinical outcomes in STEMI patients with severe left ventricular dysfunction.

Session Poster session 2 Sunday 08:30 - 18:00

Speaker Oscar Gonzalez Fernandez

Event : Heart Failure 2015

  • Topic : heart failure
  • Sub-topic : Chronic Heart Failure – Epidemiology, Prognosis, Outcome
  • Session type : Poster Session

Authors : O Gonzalez Fernandez (Madrid,ES), N Montoro Lopez (Madrid,ES), R Dalmau (Madrid,ES), C Alvarez Ortega (Madrid,ES), R Mori Junco (Madrid,ES), I Ponz De Antonio (Madrid,ES), S Rosillo Rodriguez (Madrid,ES), JL Lopez-Sendon (Madrid,ES)

Authors:
O Gonzalez Fernandez1 , N Montoro Lopez1 , R Dalmau1 , C Alvarez Ortega1 , R Mori Junco1 , I Ponz De Antonio1 , S Rosillo Rodriguez1 , JL Lopez-Sendon1 , 1University Hospital La Paz, Cardiology - Madrid - Spain ,

Citation:
European Journal of Heart Failure Abstracts Supplement ( 2015 ) 17 ( Supplement 1 ), 227

Introduction: Primary angioplasty has led to a drastic reduction in mortality in patients with ST elevation myocardial infarction (STEMI). Preventive PCI in noninfarct coronary arteries with major stenosis seems to reduce mortality and reinfarction. However, it is unknown whether this strategy could be beneficial in the subgroup of patients with severe left ventricular dysfunction (LVSD) after STEMI.

Methods: From 2006 and 2014, all patients with severe LVSD after STEMI admitted to an 8 weeks cardiac rehabilitation program in our institution were included. Preventive PCI strategy was defined when PCI was undergone in all noninfarct coronary arteries with major stenosis before discharge. Before and after the rehabilitation program, we assessed heart failure symptoms (according the NYHA scale) and exercise capacity besides a treadmill stress test using Bruce protocol (reported in terms of estimated metabolic equivalents of task or METs and time of exercise). In addition, left ventricular ejection fraction (LVEF) was assessed before and after the rehabilitation program using transthoracic echocardiography.

Results: A total of 156 patients were included, mean age 56.19 ± 12,22 years, 90.4% male. Preventive PCI was underwent in 66.2% of patients. Baseline clinical status was 46.5% class I, 43.7% class II and 9.9% class III. Baseline LVEF was 29.93 ± 5,14% and mean initial exercise capacity was 5.9 ± 2.69 minutes, 6.46 ± 2.98 METs. After 8 weeks, mean LVEF was 42.32 ± 10.52%, exercise time 8.65 ± 2.69%, and METs 10.04 ± 2.98%. Preventive PCI strategy was significantly associated with better functional class compared to those patients with partial revascularization (figure 1). In addition, although non-significantly, there was a trend to higher improvement in LV function (10.7% vs. 12.8% LVEF) and exercise capacity (3.3 vs. 3.5 METS) in those patients with preventive PCI strategy compared with partial revascularization.

Conclusions: A complete revascularization strategy after STEMI in patients with severe LVSD improves short-term clinical outcomes.

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