P704Apical ballooning syndrome and anterior myocardial infarction - same clinic with different prognosis?


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Abstract

Purpose: Apical Ballooning Syndrome (ABS) is characterized by transient left ventricular (LV) dysfunction, which can mimic acute myocardial infarction (AMI) in the absence of obstructive coronary artery disease. The purpose of this study was to compare the in-hospital outcome and the midterm follow-up of these patients (P), with P admitted for anterior AMI with coronary artery disease.Material and Methods: Of the 956 P (267 female) admitted with anterior AMI in a Cardiology Department between January 2003 and December 2010, 30 P (3,1%) met the criteria for ABS. We analyzed: baseline characteristics (BC), electrocardiogram (ECG), left ventricle ejection fraction (LVEF) on echocardiogram, coronariography, in-hospital and midterm events. This ABS population was compared with a group of 34 consecutive P admitted for anterior AMI.Results:The two populations have similar BC. ABS P were predominantly female (93,3% vs 20,6%, p<0,001), representing 10,5% of all female with anterior AMI.During hospitalization, ABS P presented less Q wave (3,3% vs 73,5%, p<0,001) but more negative T wave (93,3% vs 14,7%, p<0,001). ABS P presented a more depressed LVEF (46,6 ± 8,8% vs 56,6 ± 13,4% p=0,002). There were no significant differences regarding complications and there was no in-hospital mortality in both populations.The mean follow-up was similar in both populations (ABS 24,1 ± 21,5 vs 20,5 ± 8,9 months, p=0,372).In the follow-up, ABS P had more normalization of ECG (80% vs 43,8%, p=0,003), without P presenting Q wave (0% vs 46,9%, p<0,001). ABS P presented a better LVEF (70,7 ± 7,2% vs 50 ± 12%, p<0,001) with all P normalizing they LVEF (100% vs 57,6%, p<0,001). In this ABS group we have no P taking clopidogrel (0% vs 58,8%, p<0,001) and less P taking beta-blockers (37,9% vs 67,6%, p= 0,018). ABS P had less ischemic complications (post-infarction angina and re-infarction) (3,3% vs 23,5%, p= 0,020) and less devices implantation (0% vs 11,8%, p=0,050). There was no statistically significant differences in follow-up mortality (p=0,283).Conclusions: 1- ABS occurs more frequently than previously recognized with a prevalence of 10,5 % in females presenting with anterior AMI. 2- During hospitalization the ABS P presented more depressed LVF, with similar in-hospital complications and mortality than this group of anterior AMI P. 3- In the follow-up, all P with ABS had echocardiographic recovery of left ventricular function, unlike the P with anterior AMI. They also presented less ischemic complications and devices implantation but similar mortality. 4- More research is needed to better understand the treatment and prognosis of ABS.

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