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P-388 Outcomes of Primary Percutaneous Coronary Intervention (PCI) in a Tertiary Care Cardiac Centre
Poster Sessions 14: Interventional Cardiology was female. Balloon angioplasty of aorta was performed with number 15 pulmonary balloons. Patients were followed up for 6 months with echocardiography in order to document residual gradient and possible complications. Results: Balloon angioplasty was performed without any acute vascular complication. After six months patients were evaluated for complications again. We also considered fluctuations in blood pressure levels. Average systolic blood pressure was dropped immediately from 180±20 to 127±8 (mmHg). Average diastolic blood pressure was decreased from 110±10 to 86±7 (mmHg) too. Average of systolic and diastolic blood pressures were 120±10 and 85±3 after six months. Gradient in coarctation region was dropped immediately from 60±15 after balloon inflatation to13±5 (mmHg). Average of gradient was 16±5 (mmHg) after six months. All patients were free of anti-hypertensive drugs at the end of follow up. Conclusion: Balloon angioplasty of aortic coarctation without stents could be performed in adults with acceptable results without significant vascular complications and excellent blood pressure control after six months follow up. P-386 In-Hospital and Mid-Term Outcomes of Following Percutaneous Coronary Intervention in Patients >65 Years Old Comparing to Younger Patients Kayvan Abbasi, Hamidreza Porhoseini, Saeed Sadeghian, Seyed Hesamedin Abbasi, Ahmad Sharafi, Ali Abbasi. Department of Cardiovascular Research, Department of Cardiology, Tehran University of Medical Sciences, Iran (Islamic Republic of) Background: Advanced age has related to adverse outcomes in subjects underwent the percutaneous coronary intervention (PCI). We compared outcomes of PCI in patients >65 years with younger. Methods: From Tehran Heart Centre PCI Registry, a total of 5572 patients, 1318 (23.7%) aged above 65-year (group I) compared with 4254 patients <65 (group II) who underwent PCI (2003 2005). Inhospital Major Adverse Cardiac Events (MACEs) clarified; nonfatal myocardial infarction, cardiac death, emergent coronary artery bypass graft (CABG). Midterm outcomes were considered; cardiac death, nonfatal myocardial infarction, CABG, target vessel revascularization (TVR) and target lesion revascularization (TLR). Results: In-hospital death was similar in both groups. Whilst in mid-term outcomes: Cardiac death (1.7% vs. 0.5%, P = 0.0001), nonfatal MI (2.7% vs. 1.7%, P value = 0.03), CABG (1.8% vs. 2.4%, P = 0.25), TVR (3.1% vs. 4.0%, P = 0.14), TLR (1.4% vs. 1.8%, P = 0.36), MACEs (7.0% vs. 6.6%, P = 0.64) respectively. As a consequence, nonfatal-MI and Cardiac Death were occurred more in the patients aged above 65 years despite there were no significant difference in TVR, TLR, and MACE amongst both groups. Conclusion: In-hospital complications were not significantly different in both groups, but the mid-term followed up, nonfatal-MI and cardiac death, were explicitly significant in advanced age subjects. Consequently, age above 65 years could be considered as a predisposing factor for nonfatal-MI and cardiac death in patients who undergoing to PCI.
S161 P-387 3-Year Experience of Primary Percutaneous Coronary Intervention in a Hospital Without On-Site Cardiac Surgery Sea Hing Ong1 , Victor Yt Lim2 , Boon Cheng Chang1 , Jayaram Lingamanaicker1 , Chong Hiok Tan1 , Yew Seong Goh1 , Kok Soon Tan1 . 1 Department of Cardiology, Changi General Hospital, Singapore, 2 Department of Cardiology, National Heart Centre, Singapore Background and Objective: Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in hospitals without on-site cardiac surgery capability had been shown to have satisfactory outcomes, despite previously receiving only a class IIb recommendation in the ACC/AHA practice guidelines. We reviewed the first 3 years of our experience. Method: This is a retrospective cohort review of all patients receiving primary PCI for STEMI from 2003 till 2005. Demographic, procedural and outcome data were analyzed. Results: There were 259 patients who underwent primary PCI. The mean age was 55.3+12.3 years. Median door-toballoon time was 97.5 minutes. 44.8% and 53.3% had anterior and inferior STEMI respectively. The majority of patients presented with Killip class I (87.5%); however 5.8% were in Killip class IV. The infarct related vessels were mainly the left anterior descending artery (45.1%) and the right coronary artery (44.3%). 47.4% had only single vessel disease. Angiographic PCI success (defined as residual stenosis <50% with TIMI 3 flow) was achieved in 89.9%. Usage of stents, distal protection device (Guardwire) and aspiration catheters were 97.2%, 28.1% and 33.2% respectively. 8.2% required intra-aortic balloon pump insertion. No patients required transfer for emergency coronary bypass surgery as a result of PCI complications. Post-PCI ST resolution >50% was achieved in 82.5%. The mean post infarct left ventricular ejection fraction was 44%. In-hospital, 30-day, 6-month and 1-year mortality rates were 2%, 2.8%, 4.1% and 4.3% respectively. Clinical target lesion revascularization rate was 3.4% at 1 year. Conclusion: Our results are comparable to those from centers with on-site cardiac surgery. This supports the feasibility and safety of primary PCI in centers without onsite cardiac surgery. P-388 Outcomes of Primary Percutaneous Coronary Intervention (PCI) in a Tertiary Care Cardiac Centre Ayaz Hussain Shaikh, Faiza Malik, Bashir Hanif, Shamim Siddiqui. Department of Cardiology, Tabba Heart Intitute, Pakistan Objective: To determine the outcomes of primary percutaneous coronary intervention (PCI) in a tertiary care cardiac centre. Methods: We retrospectively reviewed medical records of 104 consecutive patients presented in our hospital between January 2006 to December 2007 with acute ST elevation myocardial infarction (STEMI) and treated with primary PCI as a mode of reperfusion. The primary end point was in hospital mortality and secondary end points were 30 day mortality, myocardial infarction, recurrent angina and congestive cardiac failure, from discharge to one month follow up. Results: The procedural success was 97%. Six (5.8%) patients died during hospital stay including one on table death. Out of six patients who died, five (83.3%) had cardiogenic shock. No mortality was observed in 30 day follow up from discharge while other complications like myocardial
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infarction, recurrent angina and congestive cardiac failure were 1%, 1% and 5% respectively. Conclusion: Our findings suggest that favorable outcomes, matching the international data can be achieved in our patients with primary PCI in the management of life threatening illness like STEMI despite all the limitations. Primary PCI as a preferred method of reperfusion strategy needs to be practiced more often in our part of world. P-389 Improving Door-to-Balloon Time: Emergency Physician Activation of Percutaneous Coronary Intervention for STEMI at the ED Kim Poh Chan1 , Marcus Eng Hock Ong1 , Arul Earnest2 , Aaron Sung Lung Wong3 , Anantharaman Venkataraman1 , Terrance Siang Jin Chua3 , Swee Han Lim1 . 1 Department of Emergency Medicine, Singapore General Hospital, Singapore, 2 Principal Medical Statistician, Tan Tock Seng Hospital, Singapore, 3 Department of Cardiology, National Heart Centre, Singapore Introduction: Primary percutaneous coronary intervention (PCI) is usually offered as first line treatment for patients with acute STEMI at the Singapore General Hospital (SGH). Shorter door-to-balloon times (D2B) have been shown to minimize infarct size, improve left ventricular function and improve long-term survival. Objective: To reduce D2B in primary PCI for patients presenting to the ED with acute STEMI, by the adoption of ED Physician activated PCI. Previously, PCI could only be activated by the cardiologist. Method: The study was a prospective, observational study of patients who presented at the ED with STEMI and required PCI. All consecutive cases from 24 Jul 2007 were eligible based on inclusion and exclusion criteria. Cases with exclusion criteria were referred to the Cardiologist according to previous procedure. PCI would be activated by direct calling to the cardiovascular laboratory (CVL) during office hours or via the hospital operator during non-office hours. D2B time was tabulated for both ED and CVM activation. Two-sample Wilcoxon rank-sum (Mann Whitney) analysis of the median DTB timing was performed. Results: We recruited a total of 101 patients from 24 Jul to 4 Dec 2007. The median D2B time for ED and CVM activation was 80.5 mins and 106 mins respectively. 3 of the 34 cases activated by CVM showed only minor coronary artery diseases (false positives). Conclusion: ED activation of PCI resulted in a significant reduction in D2B and should be adopted as “standard of care” for all STEMI cases who meet the criteria for PCI. P-390 Neointimal Coverage on the Stent Struts Crossing a Side Branch in Different Type Stents: An Optical Coherence Tomography Study Yong Liu, Masato Mizukoshi, Atsushi Tanaka, Shigeho Takarada, Hironori Kitabata, Takashi Tanimoto, Akio Kuroi, Yu Arida, Hideyuki Ikejima, Hiroto Tsujioka, Kenichi Komukai, Kouhei Ishibashi, Keishi Okochi, Hideaki Kataiwa, Hiroki Matsumoto, Yuichi Ozaki, Akio Shimokado, Nobuo Nakamura, Kumiko Hirada, Toshio Imanishi, Takashi Akasaka. Department of Cardiology, Wakayama Medical University, Japan Background: Late thrombosis (LST) has mostly been concerned as the major clinic and potentially catastrophic complications after the drug-eluting stent (DES) implantation. Although the causes of LST haven’t been revealed exactly, bifurcation might be a high risk one due to the delayed endothelialization over the struts crossing the side
branch. We observed the neointima-coverage on the struts crossing the side branch in different types of stents including bare-metal stent (BMS), sirolimus-eluting stent (SES), and paclitaxel-eluting stent (PES), by using optical coherence tomography (OCT). Method and Result: 65 stents of 40 cases have been observed and 118 struts crossing a side branch were found totally, including 34 struts in BMS, 59 struts in SES, and 25 struts in PES, at a 9-month follow-up study. Among these, neotissue coverage around the struts were demonstrated in 20 (37.0%) in SES and 10 (40.0%) in PES, which was less than that in BMS (24 struts, 70.6%) (p < 0.05, respectively). The neotissue thickness (NTT) on the struts was significantly less in SES and PES compared with that of BMS (72±16 mm, 84±14 mm vs 122±32 mm, p < 0.01 respectively), although on significant difference between SES and PES (72±16 mm vs 84±14 mm, p = 0.0617). Conclusion: OCT allow us to visualize the struts crossing a side branch precisely and to measure the neointimal coverage thickness on them quantitatively. Delayed endothelialization in SES and PES obviously in comparison with BMS might be related to one of the causes of late thrombosis in the bifurcation. P-391 Single-Bolus Eptifibatide is as Effective as Conventional Eptifibatide in Elective Percutaneous Coronary Intervention Syed Ali Ahsan, KMHS Sirajul Haque, Md. Abu Siddique, Mohammad Salman, Md. Mukhlesur Rahman. Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh Objectives: To evaluate the effectiveness of single fixed dose bolus of Eptifibatide in elective percutaneous coronary intervention. Methods: The outcomes of 85 consecutive patients who underwent elective coronary stenting from January 2007 to December 2007 were assessed prospectively. 44 subjects received Eptifibatide (15 mg single bolus) after crossing the lesion and 41 subjects did not received Eptifibatide. All the subjects were treated with aspirin and clopidogrel before and after the procedure and all received single bolus of clopidogrel (300 mg) before the procedure. All of them received weight adjusted doses of Heparin before and after the procedure. Major adverse cardiac events were assessed during hospital stay and one month after the procedure. CK-MB was measured in all post procedure symtomatic patients. Results: Mean age of the subjects was 51.1±8.9 years, 78 (91.8%) were male, 29 (31.1%) were diabetic and 45 (52.9%) were hypertensive. 40 (47.1%) were presented with myocardial infarction, 40 (47.1%) with stable angina and 5 (5.9%) with unstable angina. 80 (94.1%) received bare metal stents and 5 (5.9%) received drug eluting stents. 5 (5.9%) developed in hospital myocardial infarction and 3 (3.5%) in hospital NQMI in the group who did not received Eptifibatide (p = 0.017). 1 (1.2%) had major bleeding in Eptifibatide group (p = 0.33). Conclusion: Single bolus of Eptifibatide is a safe and highly cost-effective alternative to conventional regimens.
S161 P-387 3-Year Experience of Primary Percutaneous Coronary Intervention in a Hospital Without On-Site Cardiac Surgery Sea Hing Ong1 , Victor Yt Lim2 , Boon Cheng Chang1 , Jayaram Lingamanaicker1 , Chong Hiok Tan1 , Yew Seong Goh1 , Kok Soon Tan1 . 1 Department of Cardiology, Changi General Hospital, Singapore, 2 Department of Cardiology, National Heart Centre, Singapore Background and Objective: Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) in hospitals without on-site cardiac surgery capability had been shown to have satisfactory outcomes, despite previously receiving only a class IIb recommendation in the ACC/AHA practice guidelines. We reviewed the first 3 years of our experience. Method: This is a retrospective cohort review of all patients receiving primary PCI for STEMI from 2003 till 2005. Demographic, procedural and outcome data were analyzed. Results: There were 259 patients who underwent primary PCI. The mean age was 55.3+12.3 years. Median door-toballoon time was 97.5 minutes. 44.8% and 53.3% had anterior and inferior STEMI respectively. The majority of patients presented with Killip class I (87.5%); however 5.8% were in Killip class IV. The infarct related vessels were mainly the left anterior descending artery (45.1%) and the right coronary artery (44.3%). 47.4% had only single vessel disease. Angiographic PCI success (defined as residual stenosis <50% with TIMI 3 flow) was achieved in 89.9%. Usage of stents, distal protection device (Guardwire) and aspiration catheters were 97.2%, 28.1% and 33.2% respectively. 8.2% required intra-aortic balloon pump insertion. No patients required transfer for emergency coronary bypass surgery as a result of PCI complications. Post-PCI ST resolution >50% was achieved in 82.5%. The mean post infarct left ventricular ejection fraction was 44%. In-hospital, 30-day, 6-month and 1-year mortality rates were 2%, 2.8%, 4.1% and 4.3% respectively. Clinical target lesion revascularization rate was 3.4% at 1 year. Conclusion: Our results are comparable to those from centers with on-site cardiac surgery. This supports the feasibility and safety of primary PCI in centers without onsite cardiac surgery. P-388 Outcomes of Primary Percutaneous Coronary Intervention (PCI) in a Tertiary Care Cardiac Centre Ayaz Hussain Shaikh, Faiza Malik, Bashir Hanif, Shamim Siddiqui. Department of Cardiology, Tabba Heart Intitute, Pakistan Objective: To determine the outcomes of primary percutaneous coronary intervention (PCI) in a tertiary care cardiac centre. Methods: We retrospectively reviewed medical records of 104 consecutive patients presented in our hospital between January 2006 to December 2007 with acute ST elevation myocardial infarction (STEMI) and treated with primary PCI as a mode of reperfusion. The primary end point was in hospital mortality and secondary end points were 30 day mortality, myocardial infarction, recurrent angina and congestive cardiac failure, from discharge to one month follow up. Results: The procedural success was 97%. Six (5.8%) patients died during hospital stay including one on table death. Out of six patients who died, five (83.3%) had cardiogenic shock. No mortality was observed in 30 day follow up from discharge while other complications like myocardial
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infarction, recurrent angina and congestive cardiac failure were 1%, 1% and 5% respectively. Conclusion: Our findings suggest that favorable outcomes, matching the international data can be achieved in our patients with primary PCI in the management of life threatening illness like STEMI despite all the limitations. Primary PCI as a preferred method of reperfusion strategy needs to be practiced more often in our part of world. P-389 Improving Door-to-Balloon Time: Emergency Physician Activation of Percutaneous Coronary Intervention for STEMI at the ED Kim Poh Chan1 , Marcus Eng Hock Ong1 , Arul Earnest2 , Aaron Sung Lung Wong3 , Anantharaman Venkataraman1 , Terrance Siang Jin Chua3 , Swee Han Lim1 . 1 Department of Emergency Medicine, Singapore General Hospital, Singapore, 2 Principal Medical Statistician, Tan Tock Seng Hospital, Singapore, 3 Department of Cardiology, National Heart Centre, Singapore Introduction: Primary percutaneous coronary intervention (PCI) is usually offered as first line treatment for patients with acute STEMI at the Singapore General Hospital (SGH). Shorter door-to-balloon times (D2B) have been shown to minimize infarct size, improve left ventricular function and improve long-term survival. Objective: To reduce D2B in primary PCI for patients presenting to the ED with acute STEMI, by the adoption of ED Physician activated PCI. Previously, PCI could only be activated by the cardiologist. Method: The study was a prospective, observational study of patients who presented at the ED with STEMI and required PCI. All consecutive cases from 24 Jul 2007 were eligible based on inclusion and exclusion criteria. Cases with exclusion criteria were referred to the Cardiologist according to previous procedure. PCI would be activated by direct calling to the cardiovascular laboratory (CVL) during office hours or via the hospital operator during non-office hours. D2B time was tabulated for both ED and CVM activation. Two-sample Wilcoxon rank-sum (Mann Whitney) analysis of the median DTB timing was performed. Results: We recruited a total of 101 patients from 24 Jul to 4 Dec 2007. The median D2B time for ED and CVM activation was 80.5 mins and 106 mins respectively. 3 of the 34 cases activated by CVM showed only minor coronary artery diseases (false positives). Conclusion: ED activation of PCI resulted in a significant reduction in D2B and should be adopted as “standard of care” for all STEMI cases who meet the criteria for PCI. P-390 Neointimal Coverage on the Stent Struts Crossing a Side Branch in Different Type Stents: An Optical Coherence Tomography Study Yong Liu, Masato Mizukoshi, Atsushi Tanaka, Shigeho Takarada, Hironori Kitabata, Takashi Tanimoto, Akio Kuroi, Yu Arida, Hideyuki Ikejima, Hiroto Tsujioka, Kenichi Komukai, Kouhei Ishibashi, Keishi Okochi, Hideaki Kataiwa, Hiroki Matsumoto, Yuichi Ozaki, Akio Shimokado, Nobuo Nakamura, Kumiko Hirada, Toshio Imanishi, Takashi Akasaka. Department of Cardiology, Wakayama Medical University, Japan Background: Late thrombosis (LST) has mostly been concerned as the major clinic and potentially catastrophic complications after the drug-eluting stent (DES) implantation. Although the causes of LST haven’t been revealed exactly, bifurcation might be a high risk one due to the delayed endothelialization over the struts crossing the side
branch. We observed the neointima-coverage on the struts crossing the side branch in different types of stents including bare-metal stent (BMS), sirolimus-eluting stent (SES), and paclitaxel-eluting stent (PES), by using optical coherence tomography (OCT). Method and Result: 65 stents of 40 cases have been observed and 118 struts crossing a side branch were found totally, including 34 struts in BMS, 59 struts in SES, and 25 struts in PES, at a 9-month follow-up study. Among these, neotissue coverage around the struts were demonstrated in 20 (37.0%) in SES and 10 (40.0%) in PES, which was less than that in BMS (24 struts, 70.6%) (p < 0.05, respectively). The neotissue thickness (NTT) on the struts was significantly less in SES and PES compared with that of BMS (72±16 mm, 84±14 mm vs 122±32 mm, p < 0.01 respectively), although on significant difference between SES and PES (72±16 mm vs 84±14 mm, p = 0.0617). Conclusion: OCT allow us to visualize the struts crossing a side branch precisely and to measure the neointimal coverage thickness on them quantitatively. Delayed endothelialization in SES and PES obviously in comparison with BMS might be related to one of the causes of late thrombosis in the bifurcation. P-391 Single-Bolus Eptifibatide is as Effective as Conventional Eptifibatide in Elective Percutaneous Coronary Intervention Syed Ali Ahsan, KMHS Sirajul Haque, Md. Abu Siddique, Mohammad Salman, Md. Mukhlesur Rahman. Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh Objectives: To evaluate the effectiveness of single fixed dose bolus of Eptifibatide in elective percutaneous coronary intervention. Methods: The outcomes of 85 consecutive patients who underwent elective coronary stenting from January 2007 to December 2007 were assessed prospectively. 44 subjects received Eptifibatide (15 mg single bolus) after crossing the lesion and 41 subjects did not received Eptifibatide. All the subjects were treated with aspirin and clopidogrel before and after the procedure and all received single bolus of clopidogrel (300 mg) before the procedure. All of them received weight adjusted doses of Heparin before and after the procedure. Major adverse cardiac events were assessed during hospital stay and one month after the procedure. CK-MB was measured in all post procedure symtomatic patients. Results: Mean age of the subjects was 51.1±8.9 years, 78 (91.8%) were male, 29 (31.1%) were diabetic and 45 (52.9%) were hypertensive. 40 (47.1%) were presented with myocardial infarction, 40 (47.1%) with stable angina and 5 (5.9%) with unstable angina. 80 (94.1%) received bare metal stents and 5 (5.9%) received drug eluting stents. 5 (5.9%) developed in hospital myocardial infarction and 3 (3.5%) in hospital NQMI in the group who did not received Eptifibatide (p = 0.017). 1 (1.2%) had major bleeding in Eptifibatide group (p = 0.33). Conclusion: Single bolus of Eptifibatide is a safe and highly cost-effective alternative to conventional regimens.