Funding Acknowledgements Type of funding sources: None. Introduction and objectives Cardiac rehabilitation programmes (CRP) are a fundamental pillar in the education, optimization of treatment and assessment of the functional class in cardiovascular pathology. The aim of this study is to analyse the levels of LDL cholesterol at discharge and after 6 months of follow-up after the CRP carried out in our centre. Material and methods Analysis of a prospective cohort of 268 patients, included in the CRP between November 2015 and October 2018 after an acute coronary event and with a minimum follow-up of 6 months. The CRP consists of a medical and nursing consultation both for inclusion and prior to discharge. It lasts 1 month and includes 3 weekly sessions of individualised and monitored exercise which are carried out together with talks on cardiovascular risk factors, diet, treatments... In the pre-discharge consultation, an analysis is carried out to adjust the treatment, and a new control is performed after 6 months. Results Average age 56.2 years (SD: 8.9), 90% men, 46% hypertense, 24% diabetics, 68% dyslipemics, 70% smokers/ex-smokers and 57% sedentary. 60% of the patients had presented a STEMI, with 80% being revascularized percutaneously. 48% had 1-vessel disease. LVEF was conserved in 74% of the patients. The mean LDL cholesterol after the event is 105.3 mg/dl (SD: 37.7) and at the discharge of the program, 61 mg/dl (SD: 21.3) being the difference statistically significant (p < 0.005). The mean LDL at 6 months was 62 mg/dl (SD: 19.9) with no statistically significant difference with respect to the previous one (p = 0.53) (table 1). At the beginning of the CRP 91% of the patients presented an LDL >55 mg/dl, after the same 55 % and at 6 months 57% (graph 1). After 6 months, 4% maintained levels >100 mg/dl. 98% of patients were receiving high-potency statins and 12% ezetimibe. At discharge, treatment with ezetimibe was started in 28 patients (13%). No treatment with iPCSK9 was initiated. This study was carried out while the 2016 European guidelines were still in effect, with an LDL target in secondary prevention of less than 70 mg/dl. Conclusions CRPs are effective in improving control of LDL cholesterol, due to a closer monitoring and a better health education that allows greater therapeutic adherence. However, after the programme it is necessary to continue with regular monitoring to maintain and, in some cases, reach the target figures. In our case there is a small percentage of patients who could still benefit from starting treatment with iPSCK9. Abstract Figure. Graph 1
Introduction Percutaneous coronary intervention (PCI) in patients with left main (LM) coronary artery disease is acquiring an important role in the last years as an alternative to coronary artery bypass grafting (CABG) in selected patients. The objective of the study was to evaluate predictors of mortality in patients with LM coronary artery disease treated with PCI. Methods Prospective and observational study of consecutive patients referred to our centre for coronary angiography, with LM coronary artery disease, whom PCI was decided in a “Heart team” as a strategy for revascularization between July 2015 and December 2017. Baseline clinical, analytical and coronary angiography data were collected. Follow-up was conducted in person or by telephone for a minimum of one year. We analysed the predictive variables of mortality by means of an uni and multivariate logistic regression model. In addition, a survival analysis was performed. Results A total of 191 patients were recruited. The average age was 72 years (±11.4), 79% males. 42% had previous documented coronary artery disease. PCI was performed in the context of acute coronary syndrome in 81% of them. The mean follow-up period was 17.9 months (± 8.3). After multivariate analysis, the following variables remained as independent predictors of mortality: the hemodynamic situation of the patient, assessed by the Killip-Kimball scale (OR 1.58, 95% CI 1.03–2.43; p=0.04) and the presence of peripheral arterial disease (PAD) (OR 2.61, 95% CI 1.03–6.67; p=0.04) (table 1). The ROC curve of the multivariate model showed an AUC of 0.796 (figure 1A). In the survival analysis, patients with PAD had a significantly lower survival, with a median survival of 6 months, compared to 13.9 months in those without PAD, with p=0.008 (figure 1B). Uni and multivariate analysis Univariate analysis Multivariate analysis OR (95% CI) p OR (95% CI) p Killip-Kimbal scale 1.94 (1.39–2.72) 0 1.58 (1.03–2.43) 0.04 LVEF 0.96 (0.93–0.99) 0.01 0.99 (0.95–1.03) 0.46 Mitral regurgitation 2.54 (1.12–5.63) 0.02 1.60 (0.55–4.56) 0.38 Number of affected vessels 1.96 (1.24–3.29) 0.01 1.78 (1.03–3.37) 0.05 PAD 2.54 (1.16–5.49) 0.02 2.61 (1.03–6.67) 0.,04 Figure 1 Conclusion Although PCI revascularization of LM coronary artery disease is an attractive alternative to CABG in selected patients, a word of caution should be raised in patients with PAD, as in the present study this variable was an important predictor of short-medium term mortality.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.