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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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When Youth Meets Risk: A Simple Score Predicting Heart Failure after Early-Onset Acute coronary syndrome
Session:
Sessão de Posters 02 - Síndromes coronárias agudas: vias, atrasos e impacto das recomendações
Speaker:
Liliana Brochado
Congress:
CPC 2026
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Liliana Brochado; Diogo Cunha; Oliveira Baltazar; João Mirinha Luz; Nazar Ilchyshyn; Adriana Silva; Mariana Martinho; Ana Rita Pereira; Otilia Simões; Hélder Pereira; Paula Fazendas
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction:</strong> Acute coronary syndrome (ACS) in young adults (≤45 years) carries a substantial long-term risk of heart failure (HF). Existing prediction models, derived from older populations, may not accurately stratify younger patients. A simple, clinically applicable score for early identification of high-risk individuals could enhance preventive care and long-term outcomes.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objective:</strong> To develop and validate a pragmatic risk score for predicting HF in young adults following ACS.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong> We performed a retrospective, single-centre study of patients aged ≤45 years admitted with ACS between January 2013 and October 2023. Median follow-up was 4.5 ± 2.9 years. Demographic, clinical, and angiographic variables were collected. Logistic regression analysis was performed to identify predictors of HF. Six predictors were included in the final score: left ventricular ejection fraction (LVEF) < 50% (3 points), left anterior descending artery (LAD) occlusion (2), and STEMI, multivessel disease, obesity, and smoking (1 each). Discrimination for incident HF was assessed by receiver-operating-characteristic (ROC) analysis.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong> A total of 130 patients were analysed (mean age 41.8 ± 4.2 years; 77.7% male). Almost all (97.9%) had at least one cardiovascular risk factor: smoking 79.2%, overweight/obesity 75.2%, dyslipidaemia 74.6%, hypertension 30.8%, diabetes 20.0%. Family history of premature ACS occurred in 20%. At presentation, 60.8% had STEMI, 30.0% NSTEMI, and 9.2% unstable angina; 3.1% presented with cardiac arrest. LVEF < 50% was observed in 38.5%. Single-vessel disease predominated (74.6%), mainly involving the LAD (61.5%). Atherosclerosis was the leading aetiology (76.9%), followed by in-stent restenosis (8.5%), embolism (5.4%), and spontaneous dissection (2.3%).<br /> During follow-up, 20.8% developed HF; among them, 59.3% had reduced LVEF. </span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The score demonstrated excellent discrimination for HF (AUC 0.866, 95% CI 0.79–0.94; p < 0.001). HF incidence was 0% in the low-risk group, 52,4% in the intermediate (score = 6), and 71,8% in the high-risk group (scores 7–9). </span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000">The positive predictive value for high risk was 69,7%, and the negative predictive value for low risk 100%.</span></span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusion:</strong> A concise six-variable risk score accurately identifies young ACS survivors at high risk of HF. The model uses readily available clinical data and shows excellent discrimination. This simple stratification tool may guide personalised follow-up and early preventive interventions in young adults after ACS. Prospective external validation is warranted.</span></span></span></p>
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