Funding Acknowledgements Type of funding sources: None. Introduction Patients (P) with acute heart failure (AHF) are a heterogeneous population. Therefore, early risk stratification at admission is essential. The Get With The Guidelines Heart Failure score (GWTG-HF) predicts in-hospital mortality (IHM) of patients admitted with AHF. GRACE score estimates risk of death, including IHM and long-term mortality (M), in non-ST elevation acute coronary syndromes. Objective To validate GRACE score in AHF and to compare GRACE and GWTG-HF scores as predictors of IHM, post discharge early and late M [1-month mortality (1mM) and 1-year M (1yM)], 1-month readmission (1mRA) and 1-year readmission (1yRA), in our center population, using real-life data. Methods Based on a single-center retrospective study, data collected from P admitted in the Cardiology department with AHF between 2010 and 2017. P without data on previous cardiovascular history or uncompleted clinical data were excluded. Statistical analysis used chi-square, non-parametric tests, logistic regression analysis and ROC curve analysis. Results 35.3% were admitted in Killip-Kimball class (KKC) 4. Mean GRACE was 147.9 ± 30.2 and mean GWTG-HF was 41.7 ± 9.6. Inotropes’ usage was necessary in 32.7% of the P, 11.3% of the patients needed non-invasive ventilation, 8% needed invasive ventilation. IHM rate was 5%, 1mM was 8% and 1yM 27%. 6.3% of the patients were readmitted 1 month after discharge and 52.7% had at least one more admission in the year following discharge. Older age (p < 0.001), lower SBP (p = 0,005), higher urea (p = 0,001), lower sodium (p = 0.005), previous history of percutaneous coronary intervention (p = 0,017), lower GFR (p < 0.001) and need of inotropes (0.001) were predictors of 1yM after discharge in our population. As expected, patients presenting in KKC 4 had higher IHM (OR 8.13, p < 0.001), higher 1mM (OR 4.13, p = 0.001) and higher 1yM (OR 1.96, p = 0.011). On the other hand, KKC at admission did not predict readmission (either 1mRA or 1yRA, respectively p = 0.887 and p = 0.695). Logistic regression confirmed that GWTG-HF was a good predictor of IHM (OR 1.12, p < 0.001, CI 1.05-1.19) but also 1mM (OR 1.1, p = 0.001, CI 1.04-1.16) and 1yM (OR 1.08, p < 0.001, CI 1.04-1.11). GRACE also showed the ability to predict IHM (OR 1.06, p < 0.001, CI 1.03-1.10), 1mM (OR 1.04, p < 0.001, CI 1.02-1.06) and 1yM (OR 1.03, p < 0.001, CI 1.01-1.03). ROC curve analysis revealed that GRACE and GWTG-HF were accurate at predicting IHM (AUC 0.866 and 0.774, respectively), 1mM (AUC 0.779 and 0.727, respectively) and 1yM (AUC 0.676 and 0.672, respectively). Both scores failed at predicting 1mRA (GRACE p = 0.463; GWTG-HF p = 0.841) and 1yRA (GRACE p = 0.244; GWTG-HF p = 0.806). Conclusion This study confirms that, in our population, both scores were excellent at predicting IHM, with GRACE performing better. Although both scores were able to predict post-discharge mortality outcomes, their performance was poorer.
Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes (ProACS) Introduction The main treatment for ST elevation myocardial infarction (STEMI) is the reestablishment of coronary flow of infarct related artery. However, 50% of cases present multivessel disease (MVD), negatively affecting mortality. Complete revascularization (CR) is currently advocated since it can reduce major adverse cardiovascular events (MACE). Objective Evaluation of revascularization strategy and its prognostic value in a Portuguese cohort of STEMI patients. Material and methods Retrospective analysis of patients admitted with STEMI included in the Portuguese Registry of Acute Coronary Syndromes (ProACS) between 2010-19. Patients were divided in two groups regarding revascularization status: complete – group 1; incomplete – group 2. Independent predictors of a composite of all-cause mortality and rehospitalization for cardiovascular causes were assessed by multivariate logistic regression. Results 3500 patients were included, mean age 65 ± 13 years, 77.7% male. A CR strategy was performed in 21.8%. G1 patients were younger (63 ± 12 vs 66 ± 13, p < 0.001), with less classic cardiovascular risk factors except for smoker status and family history of premature cardiovascular disease, and less previous cardiovascular and kidney disease. They were more hemodynamically stable (Systolic blood pressure 138 ± 30 vs 135 ± 31mmHg, p = 0.019) and have less kidney dysfunction (maximum creatinine 1 ± 0.5 vs 1.2 ± 0.9 mg/dl, p < 0.001) and anemia (hemoglobin 14.3 ± 1.8 vs 13.9 ± 1.9 g/dl, p < 0.001). Inferior STEMI was the most frequent location for both groups, however G1 patients presented lower Killip-Kimball (KK) class (KK class >I 12.7 vs 17.7%, p = 0.001) and BNP value (298 ± 550 vs 453 ± 819pg/ml, p < 0.001) and higher mean left ventricle ejection fraction (LVEF) (52 ± 13 vs 48 ± 12%, p < 0.001). Left anterior descendent (LAD) and right coronary were similarly the most prevalent culprit vessels: the first one in G1 and the second one in G2. 2-vessel disease was more prevalent in G1, having all patients being submitted to percutaneous intervention during hospitalization; and 3-vessel disease in G2 with 0.3% patients being submitted to surgical intervention. G1 patients needed less frequently advanced therapeutic devices and ventilatory support. In-hospital complications were, generally, more frequent in G2 especially HF (21.8% vs 13.9%, p < 0.001) and cardiogenic shock (8.7% vs 6.0%, p 0.005); and mortality was almost twice (3.3% vs. 5.8%, p < 0.001). Global 1-year mortality rate was 6.1% and rehospitalization for cardiovascular causes 13.6%, being CR associated with lower rates (p < 0.001). Predictor factors for this endpoint, evaluated through Cox multivariate regression were IR, tachycardia at admission, KK class > I, involvement of LAD, LVEF < 40%, in-hospital mechanical complication, at discharge medication with digoxin, nitrates and diuretics. Conclusion CR was a powerful prognostic biomarker for in-hospital and 1-year all-cause mortality and MACE.
Introduction Vascular calcifi cation is a regulated process, which associates with coronary artery disease (CAD) and occurs through an increase in transcription factor expression such as RUNX2, MSX2 and alkaline phosphatase (ALP), then inducing calcium deposition. Bone morphogenetic protein-2 (BMP2) is a potent osteochondrogenic mediator, which is expressed in CAD. Endothelin-1 (ET1) and leptin have a role in regulating infl ammation and CAD. We hypothesized that BMP2, leptin or both increase ROS formation in C57BL/6 vascular smooth muscle cells (SMC), stimulating osteochondrogenic diff erentiation. We also investigated the eff ect of ET1 in SMC osteochondrogenesis. Our objectives were: to investigate ROS production in SMC after BMP2 (50 ng/ml) and/or leptin (10 ng/ml) incubation for 6 hours; and to assess osteochondrogenic gene expression and calcifi cation of SMC stimulated with BMP2, leptin or ET1 (10 nM). Methods We assessed 2-hydroxyethidium, more specifi c for superoxide, and ethidium which refl ects hydrogen peroxide through HPLC analysis in SMC after stimulation. SMC cells were incubated with these stimuli for 48 to 96 hours and RUNX2, MSX2, ALP mRNA and protein expression were assessed using qPCR and western blotting. We quantifi ed SMC calcifi cation after 14 days of stimulation through Alizarin Red staining. Results The results are shown as mean ± SD and were statistically signifi cant when pHydrogen peroxide and superoxide production increased both in BMP2 and in leptin-incubated SMC (3.77 ± 0.32 and 3.26 ± 0.26) versus control (n = 6); pBMP2 and leptin alone increased SMC calcifi cation (1.25 ± 0.08 and 1.28 ± 0.14) versus control after 14 days (n = 6); pET1 alone did not stimulate osteocondrogenic mRNA expression vs. control. Conclusion We showed that BMP2 and leptin increased ROS formation in SMC, which stimulated osteocondrogenic mRNA/protein expression to induce SMC calcifi cation. ET1 alone did not increase osteochondrogenesis in SMC. P2 Eff ects of rapid repetition of a vascular occlusion test on near-infrared spectroscopy-derived variables in healthy subjects and in critically ill patients
Introduction In patients (P) with non-ST segment elevation acute coronary syndromes (NSTE-ACS), an invasive strategy is recommended to reduce adverse outcomes. The optimal timing to perform coronary angiography (CA) remains undetermined, particularly in our era attending to the new European guidelines restricting pre-treatment (PT). Objective To evaluate the prognostic value of an early strategy (ES; <24h) versus a delayed strategy (DS; >24h) when no loading dose of a P2Y12 antagonist was given as PT in NSTE-ACS. Material and methods Retrospective analysis of P data admitted with NSTE-ACS at multicentric national registry between 2015–19. Compared demographic and clinical characteristics of P with an ES versus DS. A multivariate logistic regression was performed to evaluate predictor factors of in-hospital and 1-year endpoints. Survival was evaluated through Kaplan-Meier curve and Cox multivariate regression. Results 691P were included, mean age 64±11 years, 77.4% male. 59.2% performed CA as an ES. P proposed to a DS presented higher KK class, higher levels of creatinine and lower of hemoglobin. They also needed more frequently invasive (1.1 vs 0.7%, p=0.692) or non-invasive ventilation (1.8 vs 0.7%, p=282). A higher proportion of DS patients used the transfemoral access (5.5 vs 9.3%, p=0.058). On CA, 6.2% had normal coronary arteries, 49.2% 1-vessel disease and 45.1% multivessel disease. Revascularization was performed in 88.2%: PCI in 86.2%, CABG in 1.7% and both in 0.3%, with no significant differences. Pending CA, 98.4% were medicated with aspirin, 64.8% ticagrelor and 44% clopidogrel, with no differences. P proposed to an ES were more medicated with glycoprotein inhibitor (36.3 vs 26.4%, p=0.015) and non-fractioned heparin (6.4 vs 2.1%, p=0.01) and less with fondaparinux (56.2 vs 65.2%, p=0.017). A higher percentage of calcium-channel blockers (25.2 vs 11.7%, p<0.001) and nitrates (74.1 vs 53.3%, p<0.001) was observed in the DS. No difference was observed in beta-blockers (p=0.581). Discharge medication followed these tendencies. There was a trend to worse in-hospital outcomes in the DS regarding heart failure, shock, ventricular arrhythmias, cardiac arrest and death, although not significatively different, except for major bleeding (1.8 vs 0.2%, p=0.044). 1-year composite endpoint of mortality and cardiovascular rehospitalization occurred in 9.9%, with no difference between groups (p=0.181). Predictor factors, evaluated through Cox multivariate regression, were ejection fraction <50% (p=0.001), KK class >I (p=0.002) and nitrate prescription at discharge (p=0.001). A DS was not a predictor factor (p=0.812). Conclusion Our results are in accordance with available data. In P with higher-risk NSTE-ACS in the absence of P2Y12 antagonist PT, an ES was not associated with a reduction in the composite of global mortality and rehospitalization for cardiovascular causes. FUNDunding Acknowledgement Type of funding sources: None.
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