Does Selective Abciximab use Influence Clinical Outcome in Patients with Acute STEMI Undergoing Primary PCI?

Abstracts

Results: There were 115 interventional procedures performed on SVG with a mean follow up 27 ± 18 months. The use of DP was strongly associated with a reduction in post-procedure troponin rise (15.9 ± 5.6 versus 47.8 ± 5.0%, p < 0.01). High extent score, use of covered stents and long stent length were all associated with increased troponin levels post procedure. MACE

Event free survival

p-Value

Extent score

55.7%

25.6%

0.02

Diabetes

34.6%

10.0%

<0.01

SVG age

11.5 years

10.0 years

NS

↑ Troponin

47.4%

21.3%

<0.01

S167

months after DES placement, however 36% of surgeons and 11% of anaesthetists would stop aspirin perioperatively. Conclusions: Surgeons and anaesthetists have knowledge deficiencies regarding the optimal management of patients with DES. Education strategies are required to improve awareness and avoid potential adverse outcomes. doi:10.1016/j.hlc.2008.05.398 398 Does Selective Abciximab use Influence Clinical Outcome in Patients with Acute STEMI Undergoing Primary PCI?

On regression analysis high extent score, diabetes and post-PCI troponin level were all independently associated with higher major adverse cardiac event (MACE) rates. Conclusions: High SVG extent score and troponin rise are predictive of poorer long-term outcome following PCI.

Chin Hiew ∗ , Trent Williams, Rohan Bhagwandeen, Suku Thambar, Simon Mylabathula, Bruce Bastian, Greg Bellamy, Nick Collins

doi:10.1016/j.hlc.2008.05.397

Aim: Abciximab is not routinely used during primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) at our institution and is reserved for patients with high-risk clinical and angiographic features. We assessed whether selective use of abciximab in patients undergoing primary PCI influenced clinical outcome. Methods: We reviewed 230 consecutive patients presenting with acute STEMI for primary or rescue angioplasty. All patients received aspirin and clopidogrel before the procedure. Concomitant abciximab was used based on clinical and angiographic factors. Clinical characteristics, PCI results and major adverse events during hospitalization and 30-day follow-up were assessed. Results: Abciximab was used in 29% of patients. Patients treated with abciximab (n = 67) were younger (58.7 ± 12.8 vs. 61.6 ± 12.2). There was no difference in overall inhospital death, rate of recurrent ischaemia or MI and need for target vessel revascularization. Major bleeding requiring blood transfusion (7.5% vs. 1.2%, p = 0.004) and profound thrombocytopenia (6.0% vs. 0.6%, p = 0.04) was higher in abciximab group.

397 Surgeons and Anaesthetists Require Education about the Appropriate Timing of Elective Surgery and the Perioperative Management of Antiplatelet Therapy in Patients with Drug Eluting Stents Anil Ranchord 1,∗ , Patrick Kay 2 , Helen Tanner 1 , Wil Harrison 2 , Manuprabha Ratnayeke 3 , Janice Swampillai 4 , Susan Plunkett 1 , Scott Harding 1 1 Wellington

Hospital, Wellington, New Zealand; Hospital, Auckland, New Zealand; 3 Auckland City Hospital, Auckland, New Zealand; 4 Waikato Hospital, Waikato, New Zealand 2 Middlemore

Objectives: This study assessed the knowledge of New Zealand surgeons and anaesthetists with regard to the appropriate timing of major elective non-cardiac surgery and the perioperative management of antiplatelet therapy in patients with drug eluting stents (DES). Methods: A total of 85 surgeons and 65 anaesthetists were surveyed by telephone using vignettes in which patients were presenting for surgery 3 or 12 months after placement of a DES for stable single vessel coronary artery disease. The vignettes did not include patients having urgent elective or neurosurgical operations. Results: Surgeons (63%) and anaesthetists (32%) frequently reported that they did not have a good understanding of the differences between bare metal stents and DES. Major elective surgery would be performed by 37% of those interviewed 3 months following DES implantation. Of those operating at 3 months, 17% would stop dual antiplatelet therapy and 67% would stop either aspirin or clopidogrel with the remaining 16% continuing dual antiplatelet therapy perioperatively. Those who deferred surgery most often did so because of concerns about increased bleeding whilst on dual antiplatelet therapy (56%) rather than the risk of stent thrombosis (34%) although a minority (10%) were concerned about both. No one deferred surgery in those presenting 12

John Hunter Hospital, New Lambton, New South Wales, Australia

Abciximab with dual antiplatelet therapy

Dual antiplatelet therapy alone

p-Value

Overall in-hospital death

3(4.5%)

7(4.3%)

ns

CV-related in-hospital death

1(1.5%)

3(1.8%)

ns

4(6%)

10(6.1%)

ns

Target vessel revascularization within 30-day

1(1.5%)

2(1.2%)

ns

Major bleeding requiring transfusion

5(7.5%)

2(1.2%)

0.004

Thrombocytopenia (<50 × 103 cells/mm)

4(6.0%)

1(0.6%)

0.04

Recurrent ischaemia or MI

ABSTRACTS

Heart, Lung and Circulation 2008;17S:S1–S209

S168

Abstracts

ABSTRACTS

Conclusion: In patients with STEMI, a selective strategy of abciximab use can be safely employed. Dual oral antiplatelet therapy alone is adequate for patients without high-risk clinical and angiographic features. Avoiding routine abciximab use may reduce major bleeding and thrombocytopaenia. doi:10.1016/j.hlc.2008.05.399 399 Same Day Discharge can be Achieved Safely in the Majority of Elderly Patients Undergoing Elective Percutaneous Coronary Intervention Anil Ranchord ∗ , Sandir Prasad, Sujith Seneviratne, Russell Anscombe, Mark Simmonds, Phillip Matsis, Andrew Aitken, Scott Harding Wellington Hospital, Wellington, New Zealand Introduction: We investigated whether day-case percutaneous coronary intervention (PCI) could safely be expanded to include the elderly. Methods: The study included 1385 consecutive patients undergoing elective PCI. The elderly group included 186 patients aged 75 and older (median age 77, range 75–92). The remaining 1199 patients formed the control group (median age 62, range 29–74). Results: The elderly were more likely to be female, hypertensive and to have had previous coronary artery bypass grafting and less likely to be current smokers or to have hyperlipidemia (all P < 0.05). The number of lesions treated and their complexity was similar in both groups. Angiographic success (elderly 95.7%, control 96.9%) procedural success (91.9%, 93.4%), in-hospital MACE (2.2%, 2.1%) and the rates of same day discharge (86.6%, 88.2%) were similar in both groups (all P > 0.05). There were no deaths within 24 h of discharge. Readmission within 24 h of discharge was very infrequent (elderly 0.54%, control 0.58%, P = 1.0) in both groups. In the elderly this was due to 1 access site complication. In the control group this was due to 2 stent thromboses, 4 access site complications and 1 episode of chest pain. The 30-day MACE rate was similar in both the elderly (3.25%) and control groups (3.1%, P = 1.0). Conclusions: Same day discharge is safe and can be achieved in the majority of elderly patients following elective PCI. Suitability for same day discharge should be determined by the occurrence of in-hospital complications rather than age.

Heart, Lung and Circulation 2008;17S:S1–S209

400 Comparison of the Clinical Characteristics and Mortality of Patients with Cardiogenic Shock Undergoing Coronary Artery Bypass Grafting Compared with Percutaneous Coronary Intervention—Insights from Two Multi-centre Registries Michael Wong 1,∗ , Christopher Reid 2 , Nick Adrianopoulos 2 , Siven Seevanayagam 1 , Omar Farouque 1 , Gishel New 3 , Gil Shardey 4 , Martin Sebastian 5 , Han Lim 1 , Julian Smith 6 , Angela Brennan 2 , Diem Dinh 2 , Andrew Ajani 7 , Stephen Duffy 4 , David Clark 1 1 Austin Hospital, Melbourne, Australia; 2 Monash University, Melbourne, Australia; 3 Box Hill Hospital, Melbourne, Australia; 4 Alfred Hospital, Melbourne, Australia; 5 Geelong Hospital, Melbourne, Australia; 6 Monash Medical Centre, Melbourne, Australia; 7 Royal Melbourne Hospital, Melbourne, Australia

Background: The optimal revascularization strategy for patients with cardiogenic shock (CS) and multivessel disease is uncertain. The aim of this study was to compare the clinical characteristics and early mortality of patients with CS undergoing primary coronary artery bypass grafting (CABG) compared with percutaneous coronary intervention (PCI). Methods: Comparison of two large parallel multi-centre Australian registries consisting of PCI (Melbourne Interventional Group, MIG) and CABG (Australasian Society of Cardiac and Thoracic Surgeons, ASCTS) was performed with recruitment between April 2004 to June 2006. CS was present in 2.1% of both registries, PCI n = 97 and CABG n = 86, respectively. Results: PCI, n = 97

CABG, n = 86

Age (mean ± S.D.)

67.4 ± 12.0

68.3 ± 9.8

Male, n (%)

66 (68)

58 (67)

1.00

DM, n (%)

24 (25)

33 (38)

<0.05

HT, n (%)

53 (55)

63 (73)

<0.01

9 (9)

20 (23)

<0.01 <0.01

PVD, n (%)

0.58

Multivessel disease (%)

73

95

LVEF (% ±S.D.)

38.9 ± 16.7

39.3 ± 19.7

Renal failure (Cr > 0.2 mmol/L), n (%)

18 (19)

2 (2)

<0.01

<24 h, n (%)

78 (80)

33 (38)

<0.01

1–7 days, n (%)

15 (16)

27 (31)

<0.01

58 (60)

56 (65)

0.54

0.95

Myocardial infarction

Intra-aortic balloon pump, n (%)

doi:10.1016/j.hlc.2008.05.400

p-Value

The CABG group had at least one internal mammary artery used in 77.9% and there were 3.4 ± 1.2 (mean ± S.D.) grafts. The PCI group used stents in 92.3% of which 69.9% were ACC/AHA type B2/C lesions. Thirty days mortality was higher in the PCI group compared to CABG registry (40.2% vs. 22.1%, respectively) (p < 0.01).

Conclusion: In contemporary practice, patients with CS with acute (<24 h) myocardial infarction and renal failure are much more likely to undergo PCI, while diabetics, and those with multivessel coronary and peripheral vascular