Funding Acknowledgements Type of funding sources: None. OnBehalf on behalf of the Investigators of " Portuguese Registry of ACS " Introduction Sustained ventricular tachycardia (SVT) complicates up to 20% of acute coronary syndromes (ACS) and it is, therefore, important to access its impact on prognosis and identify patients with higher risk of SVT. Objective To evaluate predictors of early onset (<48h) and late onset (≥48h) SVT. Methods Based on a multicenter retrospective study, data collected from admissions between 1/10/2010 and 4/09/2019. Patients (pts) were divided in two groups (G): A – pts that presented early onset SVT (ESVT), and B – pts that presented late onset SVT (LSVT). Pts without data on previous cardiovascular history or uncompleted clinical data were excluded. Logistic regression was performed to assess predictors of SVT in ACS. Results Between 29851 pts with ACS, 364 (1.2%) presented SVT. ESVT – 251 pts (69%); LSVT – 91 pts (25%). LSVT G was older (74 ± 13 vs 68 ± 14, p = 0.003), was admitted directly to cat lab less frequently (10.1% vs 24.8%, p = 0.003), had longer times from first symptoms to admission (440min vs 261 min, p < 0.001) and had higher rates of previous stroke (14.4% vs 6.8%, p = 0.028). LSVT G had higher rates of non-ST-elevation myocardial infarction (MI) (35.2% vs 23.1%, p = 0.025) and lower rates of ST-elevation MI (53.8% vs 71.7%, p = 0.002), although both G were similar regarding MI location (anterior – p = 0.135, inferior – p = 0.097). LSVT G had higher systolic blood pression (130 ± 33 vs 122 ± 33, p = 0.050), presented more frequently in Killip-Kimball class ≥2 (52.5% vs 35.5%, p = 0.005) and with atrial fibrillation (21.2% vs 12.4%, p = 0.045), and had higher brain-natriuretic peptide (1075 vs 329, p < 0.001). LSVT G was treated more frequently with diuretics (80.0% vs 47.8%, p < 0.001), amiodarone (62.2% vs 48.8%, p = 0.029), digoxin (8.9% vs 2.4%, p = 0.013) and levosimendan (11.1% vs 2.8%, p = 0.004). ESVT G had higher rates of performed coronarography (88.4% vs 79.1%, p = 0.028) but lower rate of 3 vessels disease (58.5% vs 70.8%, p = 0.017). LSVT G had higher rates of severe (<30%) left ventricle dysfunction (32.9% vs 15.4%, p < 0.001) and need to non-invasive ventilation (23.1% vs 6.8%, p < 0.001). Regarding in-hospital complications, ESVT G had higher rates of heart failure (34.7% vs 19.1%, p = 0.006), atrioventricular block (15.7% vs 1.1%, p < 0.001), atrial fibrillation (20.4% vs 7.7%, p = 0.006) and major haemorrhage (5.2% vs 0.0%, p = 0.024). LSVT G had higher rates of in-hospital death (44.4% vs 20.9%, p < 0.001) and in-hospital stay (14 days vs 7 days, p < 0.001). The G were similar regarding re-infarction (p = 0.216), shock (p = 0.179), mechanical complications (p = 1.00), cardiac arrest (p = 0.097) and stroke (0.348) rates. Logistic regression confirmed ESVT was predictive in-hospital heart failure (p = 0.010, OR 2.67) and de novo AF (p = 0.001, OR 5.56), whether LSVT was predictive of in-hospital death (p = 0.002, OR 2.70). Conclusion LSVT was associated with higher rates of in-hospital complications, but ESVT was associated with higher in-hospital mortality.
Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes Background Acute coronary syndrome (ACS) and atrial fibrillation (AF) are common diseases in developed countries and in some cases, the first episode of AF can occur during the ACS. A stressful event like an ACS can be a trigger for AF, being important to realize its impact and prognosis in the short and long term. Objective Evaluate the impact and prognosis of new-onset AF in ACS. Methods Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. Patients were divided into two groups: A – patients without new-onset AF, and B – patients that presented new onset of AF. Were excluded patients without a previous cardiovascular history or clinical data during the admission and the follow-up period. Logistic regression was performed to assess if new-onset AF in ACS was a predictor of major adverse cardiac events and mortality. Kaplan-Meier test was performed to establish the survival rates and re-admission for one year of follow up. Results 9687 patients suffered ACS and had follow-up at 1 year, 9264 in group A (95.6%) and 423 in group B (4.4%). Both groups were similar regarding dyslipidemia, diabetes mellitus, previous coronary artery disease, multivessel disease after the cardiac catheterization. Group A had more smokers (28.2 vs 17.8%, p < 0.001) and left ventricular ejection fraction (LVEF) >50% (69.2 vs 45.1%, p < 0.001). On the other hand, group B was elderly (67 ± 14 vs 75 ± 12, p < 0.001), female (26.9 vs 34.0%, p < 0.001), arterial hypertension (70.5 vs 77.5%, p = 0.005), was more admitted directly to the cat lab (12.5 vs 17.7%, p = 0.002), ST-segment elevation myocardial infarction (40.2 vs 49.9%, p < 0.001), Killip-Kimball classification > I (12.8 vs 34.8%, p < 0.001) and hybrid revascularization (0.7 vs 2.4%, p = 0.002). Logistic regression revealed that new-onset of AF in ACS patients was a predictor of congestive heart failure (odds ratio (OR) 1.75, p < 0.001, confidence interval (CI) 1.47-2.09), cardiogenic shock (OR 3.08, p < 0.001, CI 2.37-4.01), sustained ventricular tachycardia (OR 2.29, p < 0.001, CI 1.61-3.25) and intrahospital mortality (OR 1.99, p < 0.001, CI 1.51-2.63). Nevertheless, new-onset of AF was not associated with re-infarction (p = 0.361), mechanical complications (p = 0.319), atrioventricular block (p = 0.574), stroke (p = 0.131) and cardiac arrest (p = 0.060) during the hospitalization for ACS. Mortality rates at one year of follow-up showed significant differences, p < 0.001, between the two groups (Figure 1). Similar results were found concerning re-admission for all causes, p = 0.021 (Figure 2), on the other causes, re-admission for cardiovascular causes do not reveal to be significant, p = 0.515. Conclusions New-onset of AF in ACS was a predictor of congestive heart failure, cardiogenic shock, sustained ventricular tachycardia and intrahospital mortality. AF was associated with higher mortality rates and re-admission for all causes at one year follow up.
Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes Background Acute coronary syndromes (ACS) are common and several scores were proposed to identify high-risk patients that presented worse prognosis in short and long-term follow up. CHA2DS2-VASc score is the score used to decide the initiation of anticoagulation therapy in atrial fibrillation (AF) patients. It is an easy and convenient score, used by physicians in clinical practice, which is helpful to apply in ACS predicting the high-risk patients. Objective CHA2DS2-VASc score as a prognosis method in ACS. Methods Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-4/09/2019. CHA2DS2-VASc test as a predictor of AF with a receiver operating characteristic curve. Logistic regression to access if the score was a predictor of AF. According with a punctuation of CHA2DS2-VASc as 0, 1 and ≥2, was performed a Kaplan-Meier test to establish the survival rates and cardiovascular admission at one year of follow-up. Results 25271 patients had ACS, 1023 patients (4.2%) presented de novo AF. CHA2DS2-VASc score was a median predictor of de novo AF (Area Under Curve: 0.642, confidence interval (CI) 0.625-0.659), with a 66.7% sensibility and 55.1% specificity. Logistic regression revealed that the CHA2DS2-VASc score was a predictor of de novo AF in ACS (odds ratio (OR) 2.07, p < 0.001, CI 1.74-2.47). Mortality rates at one year of follow-up, even showing higher mortality rates associated with higher CHA2DS2-VASc punctuation, do not revealed to be significant, p = 0.099. On the other hand, the score exhibited a significant value, p = 0.050, for re-admission for all causes, according to the classification as 0, 1 or ≥2. Regarding re-admission for cardiovascular causes at one year of follow-up was associated with the score classification, with a Kaplan-Meier test of p = 0.011. Conclusions CHA2DS2-VASc score was a predictor of de novo AF in ACS and can be used as a prognostic method for all causes of re-admission and, in special, for cardiovascular cause of re-admission.
Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes Background The atrioventricular block (AVB) occurrence in acute coronary syndrome (ACS) is a potentially life-threatening complication, that demand a rapid and efficient response regarding reperfusion time and rhythm stabilization. Objective Evaluate the impact and prognosis of AVB in ACS patients, as well as predictors of AVB. Methods Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-3/05/2020. Patients were divided into two groups: A – patients without AVB, and B – patients that presented AVB. Were excluded patients without a previous cardiovascular history or clinical data regarding AVB occurrence. Logistic regression was performed to assess predictors of AVB in ACS patients. Results From 32157 patients, 23774 was included, 23148 in group A (97.4%) and 626 in group B (2.6%). Both groups were similar regarding initial symptons until first medical contact (p = 0.410), smoker status (p = 0.222), arterial hypertension (p = 0.776), diabetes mellitus (p = 0.508), peripheral artery disease (p = 0.479), chronic kidney disease (p = 0.467) and re-infarction during the hospitalization for ACS (p = 0.145). Group A had higher body mass index (27.4 ± 4.4 vs 26.9 ± 4.6, p = 0.005), dislipidaemia (59.6 vs 51.4%, p < 0.001), coronary artery disease (18.9 vs 13.0, p < 0.001), heart rate (78 ± 19 vs 65 ± 25, p < 0.001), systolic blood pressure (139 ± 29 vs 119 ± 32, p < 0.001) and left ventricular ejection fraction (LVEF) >50% (60.1 vs 51.7%, p < 0.001). On the other hand, group B was elderly (66 ± 13 vs 71 ± 13, p < 0.001), female (27.4 vs 32.4%, p < 0.001), previous stroke (6.9 vs 10.9%, p < 0.001), neoplasia (4.9 vs 6.8%, p = 0.031), ST-segment elevation myocardial infarction (46.2 vs 75.4%, p < 0.001), syncope as major symptom (1.3 vs 10.0%, p < 0.001), Killip-Kimball class > I (15.4 vs 31.6%, p < 0.001), multivessel diasease (52.1 vs 61.4%, p < 0.001), heart failure complication (15.5 vs 40.6%, p < 0.001), cardiogenic shock complication (3.8 vs 24.6%, p < 0.001), new-onset of atrial fibrillation (4.2 vs 14.1%, p < 0.001), ACS mechanical complication (0.6 vs 3.2%, p < 0.001), sustained ventricular tachycardia during ACS hospitalization (1.3 vs 10.0%, p < 0.001), cardiac arrest (2.7 vs 13.3%, p < 0.001), stroke complication (0.6 vs 1.9%, p < 0.001) and hospitalization death (3.5 vs 19.0%, p < 0.001). Logistic regression revealed that female gender (odds ratio (OR) 1.422, p = 0.015, confidence interval (CI) 1.072-1.885), age ≥75 years old (OR 1.560, p = 0.002, CI 1.174-2.073), heart rate <60 (OR 6.692, p < 0.001, CI 5.180-8.644) and Killip-Kimball class > I (OR 3.264, p < 0.001, CI 2.446-5.356) were predictors of AVB in ACS patients. Conclusions Female gender, age ≥75 years old, heart rate <60 and Killip-Kimball class > I were predictors of AVB in ACS patients.
Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes Background Atrioventricular block (AVB) can be a consequence of ischemia in acute coronary syndrome (ACS). Then, its expected, that AVB occurrence is associated with higher rates of major adverse cardiac events (MACE). Objective Evaluate if sustained AVB was a predictor of MACE in ACS hospitalized patients. Methods Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-3/05/2020. Patients were divided into two groups: A – patients without AVB, and B – patients that presented AVB. Were excluded patients without a previous cardiovascular history or clinical data regarding AVB occurrence. MACE was defined as re-infarction, congestive heart failure, cardiogenic shock, a mechanical complication of myocardial infarction, completed atrioventricular block, sustained ventricular tachycardia, cardiac arrest, stroke, major hemorrhage, transfusion and hospitalization death. Univariate logistic regression was performed to assess if AVB in ACS patients was a predictor of MACE. Results A total of 32157 patients was analyze and 23774 had information regarding AVB. From the group of patients that presented AVB, 214 (0.9%) had re-infarction, 3847 (16.2%) had congestive heart failure, 1018 (4.3%) had cardiogenic shock, 1069 (4.5%) had atrial fibrillation, 152 (0.6%) had a mechanical complication of myocardial infarction, 354 (1.5%) had sustained ventricular tachycardia, 706 (3.0%) had cardiac arrest, 152 (0.6%) had stroke, 364 (1.5%) had major hemorrhage, 353 (1.5%) had blood transfusion and 928 (3.0%) died. AVB did not predict re-infarction (p = 0.145), congestive heart failure (p = 0.334), atrial fibrillation (p = 0.171), mechanical complication of myocardial infarction (p = 0.465) and cardiac arrest (p = 0.142). Logistic regression revealed that AVB in ACS patients was a predictor of cardiogenic shock (odds ratio (OR) 2.350, p = 0.012, confidence interval (CI) 1.207-4.572), sustained ventricular tachycardia (OR 2.269, p = 0.013, CI 1.187-4.340), stroke (OR 2.231, p < 0.001, CI 1.779-5.852), major hemorrhage (OR 3.863, p < 0.001, CI 2.667-5.558), blood transfusion (OR 4.291, p < 0.001, CI 3.002-6.137) and hospitalization death (OR 2.699, p < 0.001, CI 1.725-4.222). Conclusions AVB in ACS patients predict MACE, namely cardiogenic shock, sustained ventricular tachycardia, stroke, major hemorrhage, blood transfusion and hospitalization death.
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