Antiplatelet and Anticoagulation Therapy Post-Transcatheter Aortic Valve Implantation in Patients With and Without Atrial Fibrillation

Antiplatelet and Anticoagulation Therapy Post-Transcatheter Aortic Valve Implantation in Patients With and Without Atrial Fibrillation

Abstracts Data were analysed by age group. While the highest rate of crossover was in those under 40 years of age (2/14, 14.3%), patient numbers were...

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Abstracts

Data were analysed by age group. While the highest rate of crossover was in those under 40 years of age (2/14, 14.3%), patient numbers were small. Otherwise, rates appear to increase with age, with the next highest rate of crossover in the 80 – 89-year-old age group (11/133, 8.3%). In females, crossover was most common in 80 – 89-year-olds (7/61, 11.5%). In males, the highest rate was in patients under 40 years of age (2/12, 16.67%). Reasons for crossover were failed arterial puncture (21/42, 50%), arterial tortuosity (9/42, 21.4%), arterial spasm (6/42, 14.3%), necessity for larger guide (3/42, 7.1%), arteria lusoria (1/42, 2.4%) and unspecified (1/42, 2.4%). Conclusion: Our data suggest radial to femoral crossover is highest among elderly females. It will serve as a pilot study for a larger, prospective study that will include data on vascular risk factors and comorbidities, sedation, procedure details and outcomes. http://dx.doi.org/10.1016/j.hlc.2016.06.386 385 An Unusual Cause for Coronary Bypass Graft Stenosis V. Appadurai 1,2,∗ , A. Lakshmanan 3 , Z. Zhang 3,4 1 Nambour

General Hospital, Sunshine Coast Hospital and Health Service, Queensland Health, Nambour, Australia 2 The School of Medicine, The University of Queensland, Brisbane, Australia 3 Department of Cardiology, Mackay Hospital and Health Service, Queensland Health, Mackay, Australia 4 James Cook University, Townsville, Australia We report a case of a 61-year-old male who presented for diagnostic angiography for further investigation of poorly controlled angina. This patient had a significant cardiovascular disease history including coronary artery bypass grafting of the LIMA to LAD, SVG to OM1, SVG to D2 and SVG to PDA 21 years prior. Over the subsequent years he required percutaneous coronary intervention (PCI) to the SVG-OM twice and once to the SVG-PDA. The last angiogram in 2011 resulted in PCI to the LIMA-LAD. His remaining past medical history comprised hypertension, hyperlipidaemia and a significant smoking habit. The native vessel study, via the femoral approach, was unchanged from the prior angiogram with diffuse disease requiring no intervention. The graft study demonstrated a 75% proximal in-stent re-stenosis in the SVG-OM that was successfully managed with balloon angioplasty. On engaging the SVGD2, a 70% proximal short stenosis (figure 1a) was present that resolved after wiring and injection of 150mcg of glyceryl trinitrate (figure 1b). This lesion represented a vein graft spasm. The procedure was completed without further complications and the patient was discharged on dual antiplatelet therapy for 12 months with aggressive risk factor modification. This case highlighted the potential for vein graft spasm during coronary angiography of grafts. The usual management

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of these events involves the use of nitrates with relative success. Vein graft spasm is very unusual as there is no muscular layer of vein graft. The key learning point is that the vein graft spasm does occur and recognise it.

http://dx.doi.org/10.1016/j.hlc.2016.06.387 386 Antiplatelet and Anticoagulation Therapy Post-Transcatheter Aortic Valve Implantation in Patients With and Without Atrial Fibrillation S. Hui 1,∗ , S. Zaman 2 , R. Gooley 2 , L. McCormick 2 , I. Meredith 2 1 Monash

Health, Melbourne, Australia Melbourne, Australia

2 MonashHEART,

Objectives: To compare antiplatelet and anticoagulation use following transcatheter aortic valve replacement (TAVR) in patients with and without Atrial Fibrillation (AF) and the impact on clinical outcome. Background: Presently there are no guidelines for antiplatelet or anticoagulation therapy in AF patients undergoing TAVR. Methods: Consecutive patients (n=104) undergoing TAVR with the Lotus Valve were prospectively recruited. Demographics, discharge medication and 30-day outcomes (defined according to VARC-2) were obtained. Patients with pre-existing AF or new AF during the index admission were compared to patients without AF. Results: 35% of patients had a history of AF. Baseline CHADS-VASC was 3.9 and 3.8 in the AF versus nonAF groups respectively (p=0.7). The AF group were more likely to be discharged on anticoagulation (70% versus 4% in the non-AF group; p=<0.01). In the AF group, 5.5%, 25%, 11%, 53% and 5.5% were on single antiplatelet therapy (SAPT), dual antiplatelet therapy (DAPT), anticoagulation, SAPT+anticoagulation and DAPT+anticoagulation, respectively. In the non-AF group, 1.5%, 14.5%, 81%, 0%, 1.5%, 1.5% were on no medication, SAPT, DAPT, anticoagulation, SAPT+anticoagulation and DAPT+anticoagulation respectively. Overall 30-day incidence of life threatening or disabling stroke was 2% with no difference between groups (p=0.8). There was no difference in major or life-threatening bleeds in AF versus non-AF patients (17% versus 21%; p=0.63), nor in patients on anticoagulation versus no anticoagulation (18% versus 20%; p=0.83). Conclusion: AF occurred in over a third of our TAVR cohort with 70% receiving anticoagulation therapy. Patients

Abstracts

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. with AF had comparable rates of stroke and bleeding to ... .. those without AF. .. .. .. .. http://dx.doi.org/10.1016/j.hlc.2016.06.388 .. .. .. 387 .. .. .. Aorta Atheroma Burden Predicts Acute .. Kidney Injury after Transcatheter Aortic .. .. Valve Implantation: Volumetric Computed .. .. Tomography Analysis .. .. .. D. Shishikura 1,∗ , Y. Kataoka 2 , S. Honda 1 , .. K. Takata 1 , J. Andrews 1 , A. Pisaniello 1 , .. .. P. Psaltis 1 , J. Montarello 1 , S. Nicholls 1 , .. 1 S. Worthley ... .. .. 1 South Australian Health & Medical Research .. .. Institute, Adelaide, Australia .. 2 National Cerebral & Cardiovascular Centre, .. .. .. Osaka, Japan .. .. Background: Acute kidney injury (AKI) is a major com- ... . plication of transcatheter aortic valve implantation (TAVI). ... . Atheroembolisation of debris has been considered as a poten- .. . tial factor for AKI. As embolisation of atherosclerotic plaques ... . is thought to occur during procedure, we hypothesised that ... .. more aorta atheroma burden might cause AKI. .. Methods: Preoperative multislice computed tomographic ... (MSCT) images were analysed in 218 patients with symp- ... . tomatic severe aortic valve stenosis who received TAVI. AKI ... was defined as an absolute increase in serum creatinine ≥ 0.3 ... . mg/dl according to Valve Academic Research Consortium ... criteria. Vessel and lumen areas in each 1-mm cross-sectional ... . image within aorta were measured by using a software (3- ... . mensio, Structural Heart ver 5.1, PIE medical imaging BV, .. . Maastricht, The Netherlands). Total atheroma volume above ... . (TAVabove ) and below (TAVbelow ) renal arteries was calculated ... .. by the following formula: TAV=(Vessel area–lumen area). .. Results: AKI was observed in 48 patients (22.0%). Patients ... having AKI were more likely to exhibit lower level of ... . estimated glomerular filtration rate (eGFR: 57.1±19.6 vs. ... 2 74.4±16.8 ml/min/1.73m , p=0.001). On MSCT imaging, ... . patients having AKI exhibited greater TAVabove (9.4±2.9 vs. ... 3 8.0±2.6 mm , p=0.02), whereas TAVbelow was comparable ... . (1.1±0.3 vs. 1.0±0.2 mm3 , p=0.54). Multivariate analysis iden- ... tified eGFR (hazard ratio=1.29, 95%CI, 1.03-1.65, p=0.03) and ... . TAVabove (hazard ratio=1.85, 95%CI, 1.24- 2.63, p=0.01) as an ... ... independent predictor of AKI. . Conclusions: Patients having AKI after TAVI harbored ... . greater aorta atheroma burden. Our finding might underscore ... the evaluation of aorta atherosclerosis on MSCT to identify ... . high risk patients for AKI, who require intensive pre- and ... .. postoperative management. .. .. .. .. http://dx.doi.org/10.1016/j.hlc.2016.06.389 .. .. .. .. .. .. .. .. .. .. .. ..

388 Association Between ‘CRUSADE’ Bleeding Risk Score, DAPT Regimen and In-Hospital Bleeding in STEMI Patients Having PCI: A Single-Centre Observational Study O. Gibbs 1,∗ , L. Hee 2 , A. Hopkins 1 , S. Lo 1 , C. Juergens 1 , J. French 1 , C. Mussap 1 1 Department of Cardiology, Liverpool Hospital, Sydney, Australia 2 SWS Clinical School, Liverpool Hospital, UNSW, Sydney, Australia

Introduction: Dual antiplatelet therapy (DAPT) is mandated in patients with ST-elevation myocardial infarction (STEMI) having percutaneous coronary intervention (PCI). Yet DAPT may predispose to bleeding in high risk patients. Our aim was to investigate the association between the ‘CRUSADE’ bleeding risk score (CBRS), DAPT regimen, and in-hospital bleeding. Methods: We retrospectively analysed 100 consecutive PCI-treated STEMI patients at Liverpool Hospital, Sydney (Jan 2014-Jul 2014). Patients receiving thrombolysis (n=15) were excluded. Demographic, procedural, and bleeding data, were retrieved from hospital records. In-hospital bleeding was defined as any overt, actionable sign of haemorrhage (BARC Type 2-5). Results: Total 85 patients had a mean age 62±12 years, 84% (n=71) were male, and 24% (n=10) had diabetes. Femoral artery access was preferred (87%, n=73) and drug-eluting stents were used in 39% (n=33). Patients were sub-grouped according to DAPT regimen: aspirin with ticagrelor (64%, n=54), and aspirin with clopidogrel (33%, n=28) or prasugrel (4%, n=3). The ticagrelor group was: younger (60±11 vs 68±12 years, p=0.001), had lower serum creatinine (79±16 vs 120±71mmol/L, p<0.0001), and higher haemoglobin (144±13 vs 137±18g/L, p<0.04). There was no difference in bleeding rates between subgroups (41% vs 50%, p=ns). Mean CBRS was lower for the ticagrelor group (20.8±11.8 vs 33.5±18, p<0.0001), and ROC analysis showed a significant association between CBRS and bleeding for the ticagrelor group (AUC 0.73, 95% CI 0.60-0.88, p=0.003). Conclusion: In our cohort of STEMI patients, the ticagrelorbased DAPT regimen was associated with lower CRBS (bleeding risk). The CRBS may better predict bleeding in lower risk patients. http://dx.doi.org/10.1016/j.hlc.2016.06.390 389 Bifurcation Percutaneous Coronary Intervention With Bio-resorbable Scaffold: Pushing the Boundary K. Liou ∗ , S. Ooi, N. Jepson Eastern Heart Clinic, Prince of Wales Hospital, Australia Introduction: The development of bio-resorbable scaffold (BRS) has introduced a new paradigm in the field of