La enfermedad cardiovascular persiste como primera causa mundial de muerte en los adultos. La población de adultos jóvenes ha cursado con cambios en el estilo de vida con el paso de las décadas, favoreciendo la aparición de ateroesclerosis en etapas más tempranas y como consecuencia la aparición de eventos cardiovasculares de manera más prematura. Se ha identificado que dentro de los factores de riesgo más comunes, la mayoría de ellos son potencialmente modificables. En comparación con adultos mayores, se ha identificado con mayor prevalencia la presencia de etiologías no ateroescleróticas de infarto de miocardio, como la disección coronaria espontánea, alteraciones anatómicas, embolia y espasmo coronarios. Los hallazgos angiográficos y desenlaces son diferentes de acuerdo con el grupo de edad y el sexo. Por dicho motivo realizamos una búsqueda en PubMed de los estudios y registros publicados para el estudio del infarto agudo de miocardio en paciente jóvenes. Con dicha información realizamos la presente revisión con el objetivo de una mejor comprensión de los hallazgos comunes en este grupo y realizar su comparación con grupos de mayor edad.
Funding Acknowledgements Type of funding sources: None. OnBehalf PHASE-MX Background Coronary artery ectasia (CAE), defined as "a dilatation greater than 1.5 times the diameter of the adjacent normal coronary arteries", is an uncommon finding in patients with acute coronary syndrome with a reported prevalence from 0.3 to 4.9% in different series. Because its low frequency, at present time there is lack of evidence and consensus of treatment strategies in those patients. Purpose To identify differences in risk factors, treatment strategies and cardiovascular outcomes among population with and without CAE presented with STEMI. Methods A retrospective, observational, comparative study was conducted in a tertiary-level cardiovascular center. We included hospitalized patients between 2018 and 2020 diagnosed with STEMI who had received reperfusion treatment within 12 hours of symptom onset. Coronary angiography was performed in the setting of primary PCI or pharmacoinvasive strategy. The primary composite endpoint was the time to first occurrence of either cardiovascular death, cardiogenic shock, recurrent MI or congestive heart failure at 30 days of follow-up according to the presence or absence of coronary artery ectasia. Results We identified 539 patients with a STEMI diagnosis, of those 56 (10.3%) were diagnosed with CAE and 483 without CAE (89.7%). The median age of population was 57.9 (±10.9 SD) with no differences between groups and most of them were male (94.6% vs 85.7%, p 0.08). Among risk factors we identified a lower prevalence of type 2 diabetes mellitus in patients with CAE (14.2% vs 36.4%, p 0.001), no difference was observed in prevalence of hypertension (44.6% vs. 43.4%, p 0.86), obesity (26.7% vs 23.4%, p 0.57), dyslipidemia (26.7% vs 18.8%, p 0.35) or smoking (35.7% vs 45.1%, p 0.17). In angiographic findings of patients diagnosed with CAE the infarction culprit artery had ectasia in 83.9% (n = 47) of the patients. According to the Markis classification, type 1 was the most common type, with the right coronary artery presenting the greatest involvement (72.7%, n= 40), followed by the anterior descending artery (67.2%, n= 37) and finally by circumflex artery (54.5%, n= 30). There were no differences in reperfusion strategies performed between both groups, pharmacoinvasive strategy (43.6% vs 50.6%, p 0.32) or PCI (56.4% VS 49.4%, P 0.12). There was no difference in the primary composite endpoint of MACE over a period of 30 days of follow up (8.93% vs 10.3%, p 0.73) Figure 1. There was also no difference in major or minor bleeding between groups (5.4% vs 3.6%, p 0.78; and 3.5% vs 1.6%, p 0.37). Conclusion CAE is a disease with a higher prevalence in México than reported in other countries. There are no identifiable risk factors in our study that predicts the presence of CAE in patients diagnosed with STEMI. Both reperfusion strategies used (Pharmacoinvasive strategy and primary PCI) could be safe with no differences in cardiovascular outcomes or bleeding at 1 month of follow-up. Abstract Figure.
Funding Acknowledgements Type of funding sources: None. OnBehalf PHASE-MX Background/Introduction: Early routine angiography with subsequent Percutaneous Coronary Intervention (PCI) (if needed) after fibrinolysis reduced the rates of reinfarction and recurrent ischemia compared with a ‘watchful waiting’ strategy. A crucial issue is the optimal time delay between successful lysis and PCI, there is a wide variation in delay in trials from a median of 1.3 h to 17h (CAPITAL AMI, GRACIA-1 and STREAM trials). At present a time window of 2-24h after successful lysis is recommended. Purpose To analyze the incidence of major cardiovascular outcomes in patients with ST-segment elevation myocardial infarction (STEMI) according to the timing of PCI after lysis (pharmacoinvasive strategy, less/more than 24h). Methods A retrospective analysis of the PHASE-MX study (ClinicalTrials.gov Identifier: NCT03974581) including patients with STEMI whom underwent pharmacoinvasive strategy during the first 12h since symptom onset. Patients were further stratified according to the time from the use of fibrinolysis to sheat insertion (<24h or >24h) in the completion of pharmacoinvasive strategy. The primary composite endpoint included the occurrence of cardiovascular death, cardiogenic shock, recurrent myocardial infarction or congestive heart failure at 30 days of follow-up. Results A total of 171 patients were included, of whom 34 underwent PCI after fibrinolysis in less than 24 hours and 137 underwent PCI in more than 24 hours (95% CI 24-120h). Mostly were male (86.4%), mean age was 56.4 ±12.1 years. The primary composite endpoint occurred in 2 patients (5.8%) in PCI < 24 hours and 12 patients (8.6%) in PCI >24 hours (p 0.58). PCI in <24h after lysis was not associated with a reduced risk of the primary endpoint (HR 0.66 95%CI: 0.14-2.97). Conclusion In patients with successful fibrinolysis undergoing to PCI the first 24 h was not associated with a reduced risk of cardiovascular death, cardiogenic shock, recurrent MI or congestive heart failure at 30 days comparing with PCI after 24 h. Abstract Figure. Kaplan-Meier in primary endpoint
Funding Acknowledgements Type of funding sources: None. Background Primary percutaneous coronary intervention (PPCI) is the treatment of choice for ST-elevation myocardial infarction (STEMI). Clinical practice guidelines recommend performing pPCI <120 minutes after the diagnosis of STEMI. Nevertheless, in a real world model this treatment is not always the fastest option. This is mostly due to the transfer delays when patients arrive to non-PCI capable hubs. These delays can decrease the benefits of the PPCI. Regional networks have been created to speed up these times and administer reperfusion therapy as early as possible. The pharmacoinvasive strategy (PIs) consists of the administration of fibrinolytic drugs in the non-pPCI setting followed by the immediate transfer of the patient to a pPCI center. Purpose To compare the efficacy and safety of pharmacoinvasive strategy compared with referral for primary PCI in patients with STEMI presenting to non PCI hubs. Methods A retrospective analysis of the PHASE-MX study (ClinicalTrials.gov Identifier: NCT03974581) including patients with STEMI whom initially presented to non-PCI hospitals and underwent either systemic fibrinolysis followed by pharmaco-invasive strategy or were transfer to perform primary PCIc according to the decision made by the doctor in the non-PCI center, the ease of referring the patient and the proximity of the PCI center. The primary composite endpoint included the occurrence of cardiovascular death, cardiogenic shock, recurrent MI or congestive heart failure at 30 days of follow-up. Results A total of 448 patients were included, of whom 273 (60.9%) underwent PIs and 175 (39.0%) were transfered for pPCI. Mean age was 58+-10 years, and most patients (86.8%) were male. No statistically significant differences in risk factors and other clinically meaningful variables were found. There was a 40% reduction in the risk of the primary composite endpoint (HR 0.60 for PIs: 95% CI:0.36-0.99; p = 0.048) for those undergoing PIs compared with pPCI, (Figure 1). Conclusion The pPCI main limitation is the impossibility to use it in the entire population due to its limited geographic availability and the delays involved in the transfer of patients from non-pPCI centers to reference hospitals. Through the PIs patients who arrive at non-PCI hospitals with STEMI and receive thrombolysis and then are redirect to PCI center there was a 40% reduction in the risk of a major endpoint occurring. Abstract Figure 1
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