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Complete revascularization on patients presenting with cardiogenic shock: real life data.

Session Poster Session 3

Speaker Hugo Miranda

Event : Heart Failure 2019

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

Authors : I Almeida (Barreiro,PT), H Miranda (Barreiro,PT), H Santos (Barreiro,PT), J Chin (Barreiro,PT), C Sousa (Barreiro,PT), S Almeida (Barreiro,PT), J Tavares (Barreiro,PT)

Authors:
I Almeida1 , H Miranda1 , H Santos1 , J Chin1 , C Sousa1 , S Almeida1 , J Tavares1 , 1Hospital N.S. Rosario - Barreiro - Portugal ,

On behalf: Portuguese Registry of Acute Coronary Syndrome - ProACS

Citation:

Introduction: The CULPRIT-SHOCK trial showed that immediate multivessel percutaneous coronary intervention (PCI) increased the risk of death or severe renal failure at 30 days on patients (P) presenting with cardiogenic shock (CS).

Objective: Evaluation of prognostic impact of complete revascularization (CR) on P admitted with ST segment elevation myocardial infarction (STEMI) in CS and multivessel disease (MVD).

Material and methods: Retrospective analysis of P data admitted due to STEMI and CS and MVD at multicentric registry between 2000-2018. Compared demographic and clinical characteristics of P who were submitted to CR (group 1 – G1) versus who did not (group 2 – G2) and evaluated its prognostic impact.

Results: Admitted 7919 P with STEMI, which 295 (3.7%) on CS. 46.8% of the P on CS had MVD, 69.6% were submitted to CR. G1 P were younger (61±11 vs 73±12 years, p<0.001). The STEMI location was predominantly anterior (80%) in G1 and inferior in G2 (50%). The stablished timings symptoms start - reperfusion therapy and first medical contact - reperfusion were not statistically different between groups. 20% of G1 P did more than one coronarography during hospitalization. The anterior descendent was the artery more frequently involved in both groups (80 vs 89.8%) being the culprit lesion in 47.4% of G1 P and in 27.7% of G2 P, where the most frequently was the right coronary (43.4%, p <0.001). The majority of G1 P (95%) had 2-vessel disease; in G2 53.4% had 2-vessel disease and 46.6% 3-vessel disease (p<0.001).  All the G1 P did PCI; in G2, 96.6% did PCI and 3.4% had a hybrid technique (in 2.3% coronary artery bypass grafting planned after hospital discharge). Other interventions during hospitalization were needed, namely non-invasive ventilation (35 vs 21.6%), invasive ventilation (30 vs 34.1%), intra-aortic pump (20 vs 17%) and temporary pacemaker (5 vs 25%), not statistically significant. The stablished endpoints were reinfarction rate (5% between G1 P vs 0%), AHF (70 vs 83%), stroke (5.3 vs 0%) and in hospital death (35 vs 37.5%), not statistically significant.

Conclusion: Although the evaluated endpoints are different and measured at different timings, our results do not appear to follow the trends presented in CULPRIT-SHOCK trial probably as a result of the small sample size and the shorter follow up time.

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