- Email: [email protected]
Intra-Coronary Thrombectomy with the Possis AngioJet Rheolytic Catheter in ST Elevation Myocardial Infarction-a Single Centre Experience
Abstracts
Methods: We compared baseline clinical characteristics and early mortality (in-hospital and 30 day) of 4359 consecutive patients undergoing PCI (MIG registry) and 3841 primary CABG (ASCTS registry) from 1.4.2004 to 30.6.2006. Results: PCI, n = 4359
CABG, n = 3841
P-value
Age, years (mean ± S.D.)
64.8 ± 12.1
66.0 ± 10.2
<0.001
Female, n (%)
1174 (26.9%)
873 (22.7%)
<0.001
Diabetes
998 (22.9%)
1258 (32.8%)
<0.001
Peripheral vascular disease
279 (6.4%)
520 (13.5%)
<0.001
Prior CABG
409 (9.4%)
107 (2.8%)
<0.001
S139
Year
PCI
% Stent
% DES
2000
2026
78
0
2001
2151
87
0
2002
2395
89
26
2003
2682
90
74
2004
2976
94
89
2005
3195
94
90
In-hospital/30 day mortality was 1.4%/2.0% in the PCI registry, and 1.8%/1.7% in the CABG registry (P = NS). Conclusion: Although the risk profile of patients undergoing CABG or PCI differs, both cohorts have low early mortality. Long-term outcomes are awaited.
Results: Preliminary analysis shows that over 15,000 PCI procedures were performed in public (58%) and private hospitals in WA between January 2000 and December 2005. Drug eluting stents were introduced in mid 2002 with rapid uptake (see Table). By 2005, DES were used in 90% of PCI procedures, with similar proportions in the public (90%) and private (89%) sectors. Conclusions: These population-based data on all PCI procedures in WA cover the period of introduction and rapid uptake of DES and provide a unique opportunity to assess the safety and effectiveness of this dramatic change in coronary revascularization therapy. Long-term trends in rates of death, myocardial infarction and repeat revascularization over this period will be presented.
doi:10.1016/j.hlc.2007.06.348
doi:10.1016/j.hlc.2007.06.349
344 Safety and Effectiveness of Drug Eluting Stents in Western Australia
345 Intra-Coronary Thrombectomy with the Possis AngioJet Rheolytic Catheter in ST Elevation Myocardial Infarctiona Single Centre Experience
Myocardial infarct: <7 days
1724 (39.6%)
590 (15.4%)
<0.001
<24 h
877 (20.1%)
100 (2.6%)
<0.001
Presentation with CHF
183 (3.6%)
773 (20.1%)
<0.001
Cardiogenic shock
91 (2.1%)
85 (2.2%)
Multi-vessel disease
1058 (57.8%)
3679 (96%)
0.712 <0.001
J. Rankin 1,8 , F. Sanfilippo 2 , P. Berg 2 , M. Hands 3,7 , R. Hendriks 4,6 , B. Hockings 5 , A. Whelan 6,4 , E. Whitford 7,3 , M. Hobbs 2 , G. Cope 8,1,∗ 1 Royal
Perth Hospital, Perth, Western Australia, Australia; of Population Health, University of WA, Perth, Western Australia, Australia; 3 St. John of God Hospital, Subiaco, Perth, Western Australia, Australia; 4 St. John of God Hospital, Murdoch, Perth, Western Australia, Australia; 5 Mount Hospital, Perth, Western Australia, Australia; 6 Fremantle Hospital, Perth, Western Australia, Australia; 7 Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; 8 Hollywood Private Hospital, Perth, Western Australia, Australia
M. Erickson ∗ , E. Simillion, G. Clugston, S. Shetty, J. Rankin
Cope, G.
Mews, R.
Royal Perth Hospital, Wellington St, WA, Australia
2 School
Background: Randomised trials have demonstrated the efficacy of drug eluting stents (DES) in reducing restenosis and repeat revascularization after percutaneous coronary intervention (PCI) in selected patients. The safety and effectiveness of drug eluting stents in real world populations remains unclear. Methods: Using data from the Western Australian Data Linkage System, supplemented with chart review, we have sought to acquire baseline, procedural and clinical followup data for all patients undergoing PCI in WA between January 2000 and December 2005.
Background: Extensive intra-coronary thrombus is risk factor for adverse outcome after emergency percutaneous coronary intervention (PCI) for ST elevation Myocardial Infarction (STEMI). However, randomised clinical trials do not support routine use of thrombectomy or distal protection devices during native coronary PCI. The benefits of thrombectomy in high-risk cases may have been diluted by the broad inclusion criteria of such trials. We report our single centre experience with the Possis AngioJet thrombectomy catheter used in selected STEMI patients with extensive thrombus referred for emergency PCI. Methods and Results: Between January 2000 and December 2005, the AngioJet catheter was used in 55 (6.4%) of the 853 STEMI patients, at the operators’ discretion. 79% of these high-risk patients had Thrombolysis in Myocardial Infarction flow grade (TIMI) of 0 at baseline. Post-procedure TIMI-3 flow was achieved in 80% of cases, TIMI-2 or 3 in 95%. TIMI flow improved from 0.57(95%CI ± 0.32) to 2.75(95%CI ± 0.17). Abciximab was used in 95% and an intra-Aortic balloon pump in 20% of cases. 95% received a stent after thrombectomy. Peri-
ABSTRACTS
Heart, Lung and Circulation 2007;16:S1–S201
S140
Abstracts
ABSTRACTS
procedural device related complications were rare, with five patients experiencing ventricular fibrillation and no procedural deaths.Conclusion: At our institution, the AngioJet thrombectomy catheter has been used safely in selected, STEMI patients with a large thrombus burden. Thrombus extraction was effective with TIMI-3 flow achieved in 80% of these high-risk cases. Further multi-centre randomised controlled trials are required to establish the efficacy of this and other thrombectomy strategies in STEMI patients with extensive thrombus. doi:10.1016/j.hlc.2007.06.350
Heart, Lung and Circulation 2007;16:S1–S201
Conclusion: PCI for OL is associated with similar 30-day clinical outcomes, but worse 12-month outcomes than for NO lesions. OL continue to present significant challenges. doi:10.1016/j.hlc.2007.06.351 347 Assessment of Anatomical Risk Factors for Carotid Artery Stenting: Comparison of Spiral Computed Tomographic Angiography with Digital Subtraction Angiography T. Gattorna ∗ , C. Chawantanpipat, M. Stephen, C. Anderson, S. McCormack, G.H. White, M.K.C. Ng
346 Procedural and Clinical Outcomes of Percutaneous Coronary Intervention (PCI) for Ostial Lesions (OL) in Proximal Coronary Arteries
Departments of Cardiology, Radiology, Vascular Surgery and Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
M. Freeman 1,∗ , D. Clark 1 , H. Lim 1 , S.J. Duffy 2 , N. Andrianopoulos 4 , A. Brennan 4 , K. Charter 1 , J. Shaw 2 , M. Sebastian 5 , A.E. Ajani 3 , C. Reid 4 , M. Horrigan 1 , O. Farouque 1
Background: Carotid artery stenting (CAS) is becoming an increasingly attractive treatment alternative to carotid endarterectomy (CEA) in patients with anatomic and/or clinical risk factors that increase the risk of surgery. However, certain anatomic risk factors (e.g. aortic arch elongation and vascular tortuosity/calcification) significantly increase the risk of CAS, making anatomic risk stratification a critical factor in determining the optimal revascularisation modality. We sought to compare the accuracy of computed tomographic angiography (CTA) with digital subtraction angiography (DSA) in the assessment of anatomic risk factors for CAS. Method: Consecutive patients (n = 6) undergoing assessment for CAS underwent spiral CTA together with digital subtraction aortography and carotid angiography. Anatomical characteristics, including aortic arch elongation, aortic arch calcification, aortic arch atheroma, aortic arch vessel stenosis and common carotid artery tortuosity were measured by independent observers, blinded to clinical information or other diagnostic tests. A 3-point scale based on anatomic and procedural complexity was used to grade each characteristic, corresponding to mild, moderate, and severe categories. Results: CTA closely correlated with the DSA findings for all anatomical characteristics with 83% agreement within one grade of each category. When there was a divergence of results within each category, CTA scored a higher grade 91% (10/11) of the time compared to DSA. There was a 17% (1/6) disparity of 2 grades in each category. Conclusion: In this small series, CTA provides a satisfactory non-invasive imaging alternative to DSA for anatomic risk stratification prior to carotid revascularisation.
1 Department of Cardiology, Austin, Melbourne, Vic., Australia; 2 Department of Cardiology, Alfred, Melbourne, Vic., Australia; 3 Department
of Cardiology, Royal Melbourne Hospitals, Melbourne, Vic., Australia; 4 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia; 5 Department of Cardiology, Geelong Hospital, Melbourne, Vic., Australia Background: OL are a difficult subset associated with suboptimal outcomes after PCI. However, data from contemporary practice is limited. Methods: There were 1714 consecutive patients who underwent PCI for proximal lesions of the left anterior descending, left circumflex and right coronary arteries, who were prospectively enrolled in the Melbourne Interventional Group Registry (February 2004–December 2006). We compared clinical and procedural data in 109 patients undergoing PCI for OL with 1605 patients with proximal non-ostial (NO) lesions. Left main and bifurcation lesions were excluded. Results: The mean age (69 ± 11 versus 65 ± 12 years; p = 0.001) and proportion of women (39% versus 28%; p = 0.021) were greater in the OL group. Other baseline characteristics were similar. Stents were more frequently deployed in the NO group (95% versus 87%; p = 0.005). Drug-eluting stents were deployed more often in the OL group (66% versus 48%; p < 0.0001). There was no significant difference in frequency of procedural success, in-hospital death, bleeding or urgent unplanned reintervention. Unplanned coronary artery bypass grafting was more frequent in the OL group (4.8% versus 1.0%; p = 0.007). There was no difference in 30-day major adverse cardiac events (MACE, 8.7% OL versus 7.0% NO, p = 0.548), and target lesion revascularization (2.9% versus 4.9%, p = 0.233), however, 12-month MACE was higher in the OL group (29% versus 16%; p = 0.036), largely driven by target vessel revascularisation.
doi:10.1016/j.hlc.2007.06.352
Methods: We compared baseline clinical characteristics and early mortality (in-hospital and 30 day) of 4359 consecutive patients undergoing PCI (MIG registry) and 3841 primary CABG (ASCTS registry) from 1.4.2004 to 30.6.2006. Results: PCI, n = 4359
CABG, n = 3841
P-value
Age, years (mean ± S.D.)
64.8 ± 12.1
66.0 ± 10.2
<0.001
Female, n (%)
1174 (26.9%)
873 (22.7%)
<0.001
Diabetes
998 (22.9%)
1258 (32.8%)
<0.001
Peripheral vascular disease
279 (6.4%)
520 (13.5%)
<0.001
Prior CABG
409 (9.4%)
107 (2.8%)
<0.001
S139
Year
PCI
% Stent
% DES
2000
2026
78
0
2001
2151
87
0
2002
2395
89
26
2003
2682
90
74
2004
2976
94
89
2005
3195
94
90
In-hospital/30 day mortality was 1.4%/2.0% in the PCI registry, and 1.8%/1.7% in the CABG registry (P = NS). Conclusion: Although the risk profile of patients undergoing CABG or PCI differs, both cohorts have low early mortality. Long-term outcomes are awaited.
Results: Preliminary analysis shows that over 15,000 PCI procedures were performed in public (58%) and private hospitals in WA between January 2000 and December 2005. Drug eluting stents were introduced in mid 2002 with rapid uptake (see Table). By 2005, DES were used in 90% of PCI procedures, with similar proportions in the public (90%) and private (89%) sectors. Conclusions: These population-based data on all PCI procedures in WA cover the period of introduction and rapid uptake of DES and provide a unique opportunity to assess the safety and effectiveness of this dramatic change in coronary revascularization therapy. Long-term trends in rates of death, myocardial infarction and repeat revascularization over this period will be presented.
doi:10.1016/j.hlc.2007.06.348
doi:10.1016/j.hlc.2007.06.349
344 Safety and Effectiveness of Drug Eluting Stents in Western Australia
345 Intra-Coronary Thrombectomy with the Possis AngioJet Rheolytic Catheter in ST Elevation Myocardial Infarctiona Single Centre Experience
Myocardial infarct: <7 days
1724 (39.6%)
590 (15.4%)
<0.001
<24 h
877 (20.1%)
100 (2.6%)
<0.001
Presentation with CHF
183 (3.6%)
773 (20.1%)
<0.001
Cardiogenic shock
91 (2.1%)
85 (2.2%)
Multi-vessel disease
1058 (57.8%)
3679 (96%)
0.712 <0.001
J. Rankin 1,8 , F. Sanfilippo 2 , P. Berg 2 , M. Hands 3,7 , R. Hendriks 4,6 , B. Hockings 5 , A. Whelan 6,4 , E. Whitford 7,3 , M. Hobbs 2 , G. Cope 8,1,∗ 1 Royal
Perth Hospital, Perth, Western Australia, Australia; of Population Health, University of WA, Perth, Western Australia, Australia; 3 St. John of God Hospital, Subiaco, Perth, Western Australia, Australia; 4 St. John of God Hospital, Murdoch, Perth, Western Australia, Australia; 5 Mount Hospital, Perth, Western Australia, Australia; 6 Fremantle Hospital, Perth, Western Australia, Australia; 7 Sir Charles Gairdner Hospital, Perth, Western Australia, Australia; 8 Hollywood Private Hospital, Perth, Western Australia, Australia
M. Erickson ∗ , E. Simillion, G. Clugston, S. Shetty, J. Rankin
Cope, G.
Mews, R.
Royal Perth Hospital, Wellington St, WA, Australia
2 School
Background: Randomised trials have demonstrated the efficacy of drug eluting stents (DES) in reducing restenosis and repeat revascularization after percutaneous coronary intervention (PCI) in selected patients. The safety and effectiveness of drug eluting stents in real world populations remains unclear. Methods: Using data from the Western Australian Data Linkage System, supplemented with chart review, we have sought to acquire baseline, procedural and clinical followup data for all patients undergoing PCI in WA between January 2000 and December 2005.
Background: Extensive intra-coronary thrombus is risk factor for adverse outcome after emergency percutaneous coronary intervention (PCI) for ST elevation Myocardial Infarction (STEMI). However, randomised clinical trials do not support routine use of thrombectomy or distal protection devices during native coronary PCI. The benefits of thrombectomy in high-risk cases may have been diluted by the broad inclusion criteria of such trials. We report our single centre experience with the Possis AngioJet thrombectomy catheter used in selected STEMI patients with extensive thrombus referred for emergency PCI. Methods and Results: Between January 2000 and December 2005, the AngioJet catheter was used in 55 (6.4%) of the 853 STEMI patients, at the operators’ discretion. 79% of these high-risk patients had Thrombolysis in Myocardial Infarction flow grade (TIMI) of 0 at baseline. Post-procedure TIMI-3 flow was achieved in 80% of cases, TIMI-2 or 3 in 95%. TIMI flow improved from 0.57(95%CI ± 0.32) to 2.75(95%CI ± 0.17). Abciximab was used in 95% and an intra-Aortic balloon pump in 20% of cases. 95% received a stent after thrombectomy. Peri-
ABSTRACTS
Heart, Lung and Circulation 2007;16:S1–S201
S140
Abstracts
ABSTRACTS
procedural device related complications were rare, with five patients experiencing ventricular fibrillation and no procedural deaths.Conclusion: At our institution, the AngioJet thrombectomy catheter has been used safely in selected, STEMI patients with a large thrombus burden. Thrombus extraction was effective with TIMI-3 flow achieved in 80% of these high-risk cases. Further multi-centre randomised controlled trials are required to establish the efficacy of this and other thrombectomy strategies in STEMI patients with extensive thrombus. doi:10.1016/j.hlc.2007.06.350
Heart, Lung and Circulation 2007;16:S1–S201
Conclusion: PCI for OL is associated with similar 30-day clinical outcomes, but worse 12-month outcomes than for NO lesions. OL continue to present significant challenges. doi:10.1016/j.hlc.2007.06.351 347 Assessment of Anatomical Risk Factors for Carotid Artery Stenting: Comparison of Spiral Computed Tomographic Angiography with Digital Subtraction Angiography T. Gattorna ∗ , C. Chawantanpipat, M. Stephen, C. Anderson, S. McCormack, G.H. White, M.K.C. Ng
346 Procedural and Clinical Outcomes of Percutaneous Coronary Intervention (PCI) for Ostial Lesions (OL) in Proximal Coronary Arteries
Departments of Cardiology, Radiology, Vascular Surgery and Neurology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
M. Freeman 1,∗ , D. Clark 1 , H. Lim 1 , S.J. Duffy 2 , N. Andrianopoulos 4 , A. Brennan 4 , K. Charter 1 , J. Shaw 2 , M. Sebastian 5 , A.E. Ajani 3 , C. Reid 4 , M. Horrigan 1 , O. Farouque 1
Background: Carotid artery stenting (CAS) is becoming an increasingly attractive treatment alternative to carotid endarterectomy (CEA) in patients with anatomic and/or clinical risk factors that increase the risk of surgery. However, certain anatomic risk factors (e.g. aortic arch elongation and vascular tortuosity/calcification) significantly increase the risk of CAS, making anatomic risk stratification a critical factor in determining the optimal revascularisation modality. We sought to compare the accuracy of computed tomographic angiography (CTA) with digital subtraction angiography (DSA) in the assessment of anatomic risk factors for CAS. Method: Consecutive patients (n = 6) undergoing assessment for CAS underwent spiral CTA together with digital subtraction aortography and carotid angiography. Anatomical characteristics, including aortic arch elongation, aortic arch calcification, aortic arch atheroma, aortic arch vessel stenosis and common carotid artery tortuosity were measured by independent observers, blinded to clinical information or other diagnostic tests. A 3-point scale based on anatomic and procedural complexity was used to grade each characteristic, corresponding to mild, moderate, and severe categories. Results: CTA closely correlated with the DSA findings for all anatomical characteristics with 83% agreement within one grade of each category. When there was a divergence of results within each category, CTA scored a higher grade 91% (10/11) of the time compared to DSA. There was a 17% (1/6) disparity of 2 grades in each category. Conclusion: In this small series, CTA provides a satisfactory non-invasive imaging alternative to DSA for anatomic risk stratification prior to carotid revascularisation.
1 Department of Cardiology, Austin, Melbourne, Vic., Australia; 2 Department of Cardiology, Alfred, Melbourne, Vic., Australia; 3 Department
of Cardiology, Royal Melbourne Hospitals, Melbourne, Vic., Australia; 4 Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic., Australia; 5 Department of Cardiology, Geelong Hospital, Melbourne, Vic., Australia Background: OL are a difficult subset associated with suboptimal outcomes after PCI. However, data from contemporary practice is limited. Methods: There were 1714 consecutive patients who underwent PCI for proximal lesions of the left anterior descending, left circumflex and right coronary arteries, who were prospectively enrolled in the Melbourne Interventional Group Registry (February 2004–December 2006). We compared clinical and procedural data in 109 patients undergoing PCI for OL with 1605 patients with proximal non-ostial (NO) lesions. Left main and bifurcation lesions were excluded. Results: The mean age (69 ± 11 versus 65 ± 12 years; p = 0.001) and proportion of women (39% versus 28%; p = 0.021) were greater in the OL group. Other baseline characteristics were similar. Stents were more frequently deployed in the NO group (95% versus 87%; p = 0.005). Drug-eluting stents were deployed more often in the OL group (66% versus 48%; p < 0.0001). There was no significant difference in frequency of procedural success, in-hospital death, bleeding or urgent unplanned reintervention. Unplanned coronary artery bypass grafting was more frequent in the OL group (4.8% versus 1.0%; p = 0.007). There was no difference in 30-day major adverse cardiac events (MACE, 8.7% OL versus 7.0% NO, p = 0.548), and target lesion revascularization (2.9% versus 4.9%, p = 0.233), however, 12-month MACE was higher in the OL group (29% versus 16%; p = 0.036), largely driven by target vessel revascularisation.
doi:10.1016/j.hlc.2007.06.352