TCT-228 Prasugrel or Clopidogrel in Patients With Acute Coronary Syndromes With Multivessel Disease: Results From the PROMETHEUS Study

Abstract Funding Acknowledgements Type of funding sources: None. OnBehalf Portuguese Registry of Acute Coronary Syndromes (ProACS) Introduction Brain natriuretic peptide (BNP) is a highly sensitive and specific biomarker on the extension of myocardial infarction, strongly related to short and long-term prognosis in patients with ST elevation myocardial infarction (STEMI). Objective To evaluate diagnostic and prognostic value of BNP levels 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 between 2010-19. Patients were divided in three groups regarding BNP: Group 1 if BNP <100 pg/ml; Group 2 100 ≤ BNP < 400 pg/ml and Group 3 ≥400 pg/ml. Independent predictors of a composite of all-cause mortality and rehospitalization for cardiovascular causes were assessed by multivariate logistic regression. Results 1650 patients were included, mean age 64 ± 13 years, 75.4% male. 39.0% (n = 643) integrated group 1, 39.5% (n = 652) group 2 and 21.5% (n = 355) group 3. Group 3 patients were significantly older (58 ± 11 vs 66 ± 13 vs 72 ± 12 years, p < 0.001), had more classic cardiovascular risk factors, except for smoker status, and more previous history of cardiovascular disease, chronic kidney disease, chronic obstructive pulmonary disease and cancer. Anterior STEMI was the most frequent location (51.1%), however group 3 patients presented with lower systolic blood pressure (136 ± 30 vs 140 ± 31 vs 131 ± 28 mmHg, p < 0.001) and higher heart rate (76 ± 17 vs 77 ± 19 vs 84 ± 26 bpm, p < 0.001) and KK class (KK class > I 5.6 vs 9.5 vs 28.5%, p < 0.001). They also presented higher levels of creatinine (1 ± 0.5 vs 1.2 ± 0.9 vs 1.5 ± 1 mg/dl, p < 0.001) and the lowest levels of hemoglobin (13.5 ± 1.6 vs 12.6 ± 1.9 vs 11.7 ± 2.1 g/dl, p < 0.001). Mean ejection fraction (EF) was lower in group 3 (58 ± 11 vs 53 ± 12 vs 44 ± 13%, p < 0.001). Multivessel disease was more common in group 3 (34.8 vs 44.8 vs 51.3%, p < 0.001), where a higher percentage was proposed to medical therapy (2.8 vs 3.5 vs 8.5%, p < 0.001). In the patients proposed to revascularization, although not statistically significant, there was a trend towards surgical revascularization or hybrid approach. In-hospital complications were more frequent in group 3, especially heart failure (HF) (18.9% mean vs 45.4%, p < 0.001), and mortality was seven times superior in group 3 versus group 1 (1.2% vs. 8.5%, p < 0.001). The composite endpoint of 1-year mortality and cardiovascular rehospitalization occurred in 12%. After propensity score application, the 1-year endpoint total mortality rate and cardiovascular readmission was 20.3%, and higher BNP was associated with higher rates (p < 0.001). Predictor factors for the composite endpoint, evaluated through Cox multivariate regression were previous HF, multivessel disease, EF < 30% and the use of nitrates and aldosterone antagonists. The use of aspirin was a protector factor. Conclusion BNP levels during index hospitalization were a powerful prognostic biomarker for all-cause mortality MACE in patients admitted with STEMI.

Download Full-text

Revascularization strategies in STEMI and multivessel disease

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.114 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

I Almeida ◽

H Santos ◽

H Miranda ◽

M Santos ◽

J Chin ◽

...

Keyword(s):

Acute Coronary Syndromes ◽

Ventilatory Support ◽

Multivessel Disease ◽

Major Adverse Cardiovascular Events ◽

Complete Revascularization ◽

Mechanical Complication ◽

Vessel Disease ◽

Premature Cardiovascular Disease ◽

All Cause Mortality ◽

Coronary Syndromes

Abstract 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.

Download Full-text