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Prevalence of Coronary Slow Flow in Patients Undergoing Coronary Angiogram in a Large Teaching Hospital
271 PRE-EVENT CARDIOVASCULAR RISK IN CORONARY CARE UNIT PATIENTS Janarthanan Sathananthan 2 , Andrew J. Kerr 1,2 , Susan Wells 2 , Mildred Lee 2 , Andrew McLachlan 1 , Sue 2 2 Furness , Roger Marshall , Rod Jackson 2 1 Department
of Cardiology, Middlemore Hospital, Auckland, New Zealand 2 Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand Aim: To assess pre-event cardiovascular (CVD) risk in patients admitted to coronary care with CVD, and to determine the proportion who would have met New Zealand Guidelines Group (NZGG) criteria for screening and for intensive CVD risk management. Methods: Pre-event CVD risk was estimated in 970 patients presenting to Middlemore Hospital coronary care unit between 1 July 2004 and 30 June 2006. Patients without prior CVD were risk assessed using the NZGG adjusted Framingham CVD equation. Patients with prior CVD events were classified clinically as being at high risk. Results: 641/970 patients (66.1%) had no prior CVD. Nearly all (98%) met the NZGG age/gender/ethnicity criteria for a formal CVD risk assessment. The majority (59.6%) would have been recommended for intensive risk management pre-event [i.e. they either had prior CVD (n = 329) or a CVD risk ≥15% (n = 249)]. A further 17.3% were at moderate risk (10–15%), meeting criteria for individualised non-pharmacological risk management. However, 23.1 % were classified as being at low risk (<10%). Conclusion: Population-wide CVD risk screening and management following New Zealand Guidelines would identify and recommend individualised lifestyle intervention or intensive CVD risk management in about three quarters of patients who subsequently present to coronary care units.
Abstracts
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vessels (TIMI-2 flow) in the absence of significant epicardial coronary stenosis. There are varying opinions regarding the prevalence and importance of this phenomenon. The only Australian experience reported the finding in 1% of the total diagnostic angiograms based upon reports from the cardiologist performing the procedure. Methods: We reviewed angiograms reported as showing no significant coronary disease over a 6-month period from January to June 2008 in a major teaching hospital. For the purpose of this study CSF was defined as requiring 3 or more beats to fill the distal coronary vessels on multiple views in at least one vessel. Clinical data were collected retrospectively from medical records and compared with previously published data from The Queen Elizabeth Hospital in Adelaide (QEH). Results: 50 of the total 1638 angiograms during this period (3%) were identified as having CSF. The clinical features and distribution were relatively similar to previously reported findings. Prevalence
Age (years) Men
Current 50/1638 (3%) 55 ± 11 QEH 65/6000 (1%) 52 ± 10 p 0.15
58% 70% 0.24
CSF in LAD
CSF in LCX
CSF in RCA
74% 85% 0.17
10% 37% 0.001
72% 63% 0.33
CSF in >1 vessel 60% 48% 0.26
LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery. Conclusion: The prevalence of CSF in our hospital is similar to that previously reported. CSF appears to be a consistent finding across centres and this finding justifies some interest in its investigation as a marker of coronary microvascular dysfunction. doi:10.1016/j.hlc.2009.05.275
doi:10.1016/j.hlc.2009.05.273
274 PROGNOSTIC VALUE OF LEAD V1 ST ELEVATION DURING ACUTE INFERIOR MYOCARDIAL INFARCTION
272 WITHDRAWN
Cheuk-Kit Wong 1 , Harvey D. White 2 , HERO-2 investigators 1 Dunedin School of Medicine, Otago University, New Zealand
doi:10.1016/j.hlc.2009.05.274 273 PREVALENCE OF CORONARY SLOW FLOW IN PATIENTS UNDERGOING CORONARY ANGIOGRAM IN A LARGE TEACHING HOSPITAL Lalith S.B. Jesuthasan 1,2 , John F. Beltrame 2,3 , Thomas H. Marwick 1 1 UQ
Department of Medicine, Princess Alexandra Hospital, Brisbane, Australia 2 The University of Adelaide, Adelaide, Australia 3 The Queen Elizabeth Hospital, Australia Background: Coronary Slow Flow (CSF) is an angiographic observation of delayed opacification of distal
2 Green
Lane Cardiovascular service, Auckland Hospital, New
Zealand Background: Lead V1 faces directly the right ventricle and during an inferior wall acute myocardial infarction (AMI) may exhibit ST elevation with concomitant right ventricular infarction. Leads V1 and V3 face indirectly the posterolateral left ventricle and ST depression (“mirror image” ST elevation) may reflect concomitant posterolateral infarction. Methods: This study evaluates the relationship between V1 ST level and 30-day mortality, and the confounding effect from V3 ST depression in 7967 patients with inferior AMI of the HERO-2 trial. Results: Lead V1 ST elevation at baseline, analyzed as a continuous variable in patients with V1 ST level ≥0 mm,
ABSTRACTS
Heart, Lung and Circulation 2009;18S:S1–S286
of Cardiology, Middlemore Hospital, Auckland, New Zealand 2 Section of Epidemiology and Biostatistics, School of Population Health, University of Auckland, Auckland, New Zealand Aim: To assess pre-event cardiovascular (CVD) risk in patients admitted to coronary care with CVD, and to determine the proportion who would have met New Zealand Guidelines Group (NZGG) criteria for screening and for intensive CVD risk management. Methods: Pre-event CVD risk was estimated in 970 patients presenting to Middlemore Hospital coronary care unit between 1 July 2004 and 30 June 2006. Patients without prior CVD were risk assessed using the NZGG adjusted Framingham CVD equation. Patients with prior CVD events were classified clinically as being at high risk. Results: 641/970 patients (66.1%) had no prior CVD. Nearly all (98%) met the NZGG age/gender/ethnicity criteria for a formal CVD risk assessment. The majority (59.6%) would have been recommended for intensive risk management pre-event [i.e. they either had prior CVD (n = 329) or a CVD risk ≥15% (n = 249)]. A further 17.3% were at moderate risk (10–15%), meeting criteria for individualised non-pharmacological risk management. However, 23.1 % were classified as being at low risk (<10%). Conclusion: Population-wide CVD risk screening and management following New Zealand Guidelines would identify and recommend individualised lifestyle intervention or intensive CVD risk management in about three quarters of patients who subsequently present to coronary care units.
Abstracts
S121
vessels (TIMI-2 flow) in the absence of significant epicardial coronary stenosis. There are varying opinions regarding the prevalence and importance of this phenomenon. The only Australian experience reported the finding in 1% of the total diagnostic angiograms based upon reports from the cardiologist performing the procedure. Methods: We reviewed angiograms reported as showing no significant coronary disease over a 6-month period from January to June 2008 in a major teaching hospital. For the purpose of this study CSF was defined as requiring 3 or more beats to fill the distal coronary vessels on multiple views in at least one vessel. Clinical data were collected retrospectively from medical records and compared with previously published data from The Queen Elizabeth Hospital in Adelaide (QEH). Results: 50 of the total 1638 angiograms during this period (3%) were identified as having CSF. The clinical features and distribution were relatively similar to previously reported findings. Prevalence
Age (years) Men
Current 50/1638 (3%) 55 ± 11 QEH 65/6000 (1%) 52 ± 10 p 0.15
58% 70% 0.24
CSF in LAD
CSF in LCX
CSF in RCA
74% 85% 0.17
10% 37% 0.001
72% 63% 0.33
CSF in >1 vessel 60% 48% 0.26
LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery. Conclusion: The prevalence of CSF in our hospital is similar to that previously reported. CSF appears to be a consistent finding across centres and this finding justifies some interest in its investigation as a marker of coronary microvascular dysfunction. doi:10.1016/j.hlc.2009.05.275
doi:10.1016/j.hlc.2009.05.273
274 PROGNOSTIC VALUE OF LEAD V1 ST ELEVATION DURING ACUTE INFERIOR MYOCARDIAL INFARCTION
272 WITHDRAWN
Cheuk-Kit Wong 1 , Harvey D. White 2 , HERO-2 investigators 1 Dunedin School of Medicine, Otago University, New Zealand
doi:10.1016/j.hlc.2009.05.274 273 PREVALENCE OF CORONARY SLOW FLOW IN PATIENTS UNDERGOING CORONARY ANGIOGRAM IN A LARGE TEACHING HOSPITAL Lalith S.B. Jesuthasan 1,2 , John F. Beltrame 2,3 , Thomas H. Marwick 1 1 UQ
Department of Medicine, Princess Alexandra Hospital, Brisbane, Australia 2 The University of Adelaide, Adelaide, Australia 3 The Queen Elizabeth Hospital, Australia Background: Coronary Slow Flow (CSF) is an angiographic observation of delayed opacification of distal
2 Green
Lane Cardiovascular service, Auckland Hospital, New
Zealand Background: Lead V1 faces directly the right ventricle and during an inferior wall acute myocardial infarction (AMI) may exhibit ST elevation with concomitant right ventricular infarction. Leads V1 and V3 face indirectly the posterolateral left ventricle and ST depression (“mirror image” ST elevation) may reflect concomitant posterolateral infarction. Methods: This study evaluates the relationship between V1 ST level and 30-day mortality, and the confounding effect from V3 ST depression in 7967 patients with inferior AMI of the HERO-2 trial. Results: Lead V1 ST elevation at baseline, analyzed as a continuous variable in patients with V1 ST level ≥0 mm,
ABSTRACTS
Heart, Lung and Circulation 2009;18S:S1–S286