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TCTAP A-025 Predictors of Mortality in Acute Myocardial Infarction Patients with Unprotected Left Main Coronary Artery Disease
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
METHODS We performed a retrospective registry data review in our Invasive Cardiac Laboratory, Hospital Tengku Ampuan Afzan Kuantan from January 2014 until December 2015. Consecutive cases of emergency Percutaneous Coronary Intervention (PCI) or intended intervention performed on patients with a diagnosis of Cardiogenic Shock Acute Myocardial Infarction (CS-AMI) or pre-procedure survived Cardiac Arrest - Acute Myocardial Infarction (CA-AMI) were collected, tabulated and analysed. Cases with incomplete data documentations were excluded. RESULTS A total of 75 cases were included of which 68/75 (90.6%) were males and mean age at 59.7 8.5 years old. There was 9/75 (12.0%) mortality within 24 hours of the procedure, in which 4/9 (44.4%) had PCI-stenting done; 2 left the main stem, 1 left anterior descending artery and 1 right coronary artery respectively with 5 other cases did not have stenting performed. Within this cohort as well, a total of 7/75 (9.3%) had left main stem stenting and 5/75 (6.7%) had dual vessel stenting performed. The remaining 58/75 (77.3%) of cases had only a single culprit vessel stenting performed. The use of Intraaortic balloon pump (IABP) was only in 4/75 (5.3%) of cases. CONCLUSION The experience from our center highlighted that in those small samples of a very high-risk group of patient with CS-AMI or CA-AMI, PCI and stenting is a relatively valuable, practical and safe treatment strategy. A larger and more comprehensive real world PCI registry data analysis may contribute to a better understanding of the significant prognostic pattern following the invasive procedures in these groups of patient.
BACKGROUND Unprotected left main coronary artery (ULMCA) in the setting of acute myocardial infarction (AMI) is rare but devastating with high mortality rate. However, there were limited data regarding incidence and prognosis of AMI with ULMCA disease treated with percutaneous coronary intervention (PCI). The aim of the study was to investigate the predicting factors for mortality following PCI of ULMCA disease in the setting of AMI. METHODS Among a total 12,431 AMI patients (pts) enrolled in nationwide Korean AMI registry (KAMIR) from Nov 2011 to May 2015, 253 pts (2%) had a culprit lesion in ULMCA. Among those pts, 199 (78.7%) pts survived for 12 months and 54 (21.3%) pts experienced mortality. Multivariate logistic regression analysis was performed to evaluate the independent predictors of mortality. RESULTS Most of mortality occurred during index admission. Pts with mortality were older (66.0 12.4 vs 70.5 12.3, p¼0.018), presented with STEMI (29.6% vs 61.1%, p<0.001, OR¼3.729) and cardiogenic shock (9.0% vs 74.1%, p<0.001, OR¼28.73). In multivariate logistic regression analysis, concomitant LAD disease (HR¼13.098, p¼0.008) and cardiogenic shock (HR¼16.734, p¼0.005) were independent predictors of mortality (Table 2). CONCLUSION In AMI of ULMCA, overall mortality at 12 months was about 20%. Concomitant LAD disease and cardiogenic shock were independent predictors of mortality.
TCTAP A-024 High Neutrophil-to-lymphocyte Ratio May Predict Insufficient Coronary Reperfusion in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention Qiang Fu,1 Buxing Chen1 Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, China
1
BACKGROUND It is well known that inflammation plays a crucial role in acute coronary syndrome. However, the usefulness of inflammatory cells pattern such as neutrophil-to-lymphocyte ratio (NLR) in predicting coronary reperfusion in patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) has not been inadequately evaluated. Thus, the aim of the present study was to investigate the association between NLR and coronary reperfusion in STEMI patients undergoing primary PCI. METHODS A total of 135 consecutive patients with a diagnosis of STEMI who underwent primary PCI were included in this prospective study between January 2014 and May 2015. The coronary reperfusion of infarct-related artery was evaluated using the recorded PCI procedures by corrected TIMI frame counts (cTFC) values. A value of >40 for the cTFC was considered as an index of insufficient coronary reperfusion, and the patients were divided into two groups: sufficient coronary reperfusion group (cTFC&40, n¼94) and insufficient coronary reperfusion group (cTFC>40, n¼41). The white blood cell subtypes and counts were determined in the blood samples obtained before primary PCI. The correlation between NLR and coronary reperfusion of infarct-related artery was analyzed. RESULTS There was no significant difference in the baseline characteristics between the two groups. The NLR was significantly greater in insufficient coronary reperfusion group than that in sufficient coronary reperfusion group (9.6 7.2 versus 7.1 4.7, p¼0.04). In multivariate analyses, a high NLR was found to be an independent predictor of insufficient coronary reperfusion (odds ratio 1.08, 95% confidence interval 1.01-1.15; p¼0.019). CONCLUSION The pre-procedural high NLR may be independently associated with insufficient coronary reperfusion in STEMI patients undergoing primary PCI. TCTAP A-025 Predictors of Mortality in Acute Myocardial Infarction Patients with Unprotected Left Main Coronary Artery Disease 1
1
1
Sung Hun Park, Seung-Woon Rha, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun,1 Min Shim,1 Jun Hyuk Kang,1 Woo Hyeun Kim,1 Eun Jin Park,1 Jah Yeon Choi,1 Sunki Lee,1 Li Hu,1 Jin Oh Na,1 Cheolung Choi,1 Hong Euy Lim,1 Jin Won Kim,1 Eung Ju Kim,1 Chang Gyu Park,1 Hong Seog Seo,1 Dong Joo Oh1 1 Korea University Guro Hospital, Korea (Republic of)
1
TCTAP A-026 Circadian Rhythm in Southeast Asian Patients with ST-elevation Myocardial Infarction and the Differences in Clinical Characteristics and Outcomes Kah Hua Peck,1 Violet Hoon,1 Wee Kiat Ang,1 Jason Kwok Kong Loh,1 Fahim Haider Jafary,1 David Foo,1 Timothy James Watson,1 Paul JL Ong,1 Hee Hwa Ho1 1 Tan Tock Seng Hospital, Singapore BACKGROUND Several studies have evaluated the circadian pattern of ST elevation myocardial infarction (STEMI) with differences observed in different regions.
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
METHODS We performed a retrospective registry data review in our Invasive Cardiac Laboratory, Hospital Tengku Ampuan Afzan Kuantan from January 2014 until December 2015. Consecutive cases of emergency Percutaneous Coronary Intervention (PCI) or intended intervention performed on patients with a diagnosis of Cardiogenic Shock Acute Myocardial Infarction (CS-AMI) or pre-procedure survived Cardiac Arrest - Acute Myocardial Infarction (CA-AMI) were collected, tabulated and analysed. Cases with incomplete data documentations were excluded. RESULTS A total of 75 cases were included of which 68/75 (90.6%) were males and mean age at 59.7 8.5 years old. There was 9/75 (12.0%) mortality within 24 hours of the procedure, in which 4/9 (44.4%) had PCI-stenting done; 2 left the main stem, 1 left anterior descending artery and 1 right coronary artery respectively with 5 other cases did not have stenting performed. Within this cohort as well, a total of 7/75 (9.3%) had left main stem stenting and 5/75 (6.7%) had dual vessel stenting performed. The remaining 58/75 (77.3%) of cases had only a single culprit vessel stenting performed. The use of Intraaortic balloon pump (IABP) was only in 4/75 (5.3%) of cases. CONCLUSION The experience from our center highlighted that in those small samples of a very high-risk group of patient with CS-AMI or CA-AMI, PCI and stenting is a relatively valuable, practical and safe treatment strategy. A larger and more comprehensive real world PCI registry data analysis may contribute to a better understanding of the significant prognostic pattern following the invasive procedures in these groups of patient.
BACKGROUND Unprotected left main coronary artery (ULMCA) in the setting of acute myocardial infarction (AMI) is rare but devastating with high mortality rate. However, there were limited data regarding incidence and prognosis of AMI with ULMCA disease treated with percutaneous coronary intervention (PCI). The aim of the study was to investigate the predicting factors for mortality following PCI of ULMCA disease in the setting of AMI. METHODS Among a total 12,431 AMI patients (pts) enrolled in nationwide Korean AMI registry (KAMIR) from Nov 2011 to May 2015, 253 pts (2%) had a culprit lesion in ULMCA. Among those pts, 199 (78.7%) pts survived for 12 months and 54 (21.3%) pts experienced mortality. Multivariate logistic regression analysis was performed to evaluate the independent predictors of mortality. RESULTS Most of mortality occurred during index admission. Pts with mortality were older (66.0 12.4 vs 70.5 12.3, p¼0.018), presented with STEMI (29.6% vs 61.1%, p<0.001, OR¼3.729) and cardiogenic shock (9.0% vs 74.1%, p<0.001, OR¼28.73). In multivariate logistic regression analysis, concomitant LAD disease (HR¼13.098, p¼0.008) and cardiogenic shock (HR¼16.734, p¼0.005) were independent predictors of mortality (Table 2). CONCLUSION In AMI of ULMCA, overall mortality at 12 months was about 20%. Concomitant LAD disease and cardiogenic shock were independent predictors of mortality.
TCTAP A-024 High Neutrophil-to-lymphocyte Ratio May Predict Insufficient Coronary Reperfusion in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention Qiang Fu,1 Buxing Chen1 Department of Cardiology, Beijing Tiantan Hospital, Capital Medical University, China
1
BACKGROUND It is well known that inflammation plays a crucial role in acute coronary syndrome. However, the usefulness of inflammatory cells pattern such as neutrophil-to-lymphocyte ratio (NLR) in predicting coronary reperfusion in patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI) has not been inadequately evaluated. Thus, the aim of the present study was to investigate the association between NLR and coronary reperfusion in STEMI patients undergoing primary PCI. METHODS A total of 135 consecutive patients with a diagnosis of STEMI who underwent primary PCI were included in this prospective study between January 2014 and May 2015. The coronary reperfusion of infarct-related artery was evaluated using the recorded PCI procedures by corrected TIMI frame counts (cTFC) values. A value of >40 for the cTFC was considered as an index of insufficient coronary reperfusion, and the patients were divided into two groups: sufficient coronary reperfusion group (cTFC&40, n¼94) and insufficient coronary reperfusion group (cTFC>40, n¼41). The white blood cell subtypes and counts were determined in the blood samples obtained before primary PCI. The correlation between NLR and coronary reperfusion of infarct-related artery was analyzed. RESULTS There was no significant difference in the baseline characteristics between the two groups. The NLR was significantly greater in insufficient coronary reperfusion group than that in sufficient coronary reperfusion group (9.6 7.2 versus 7.1 4.7, p¼0.04). In multivariate analyses, a high NLR was found to be an independent predictor of insufficient coronary reperfusion (odds ratio 1.08, 95% confidence interval 1.01-1.15; p¼0.019). CONCLUSION The pre-procedural high NLR may be independently associated with insufficient coronary reperfusion in STEMI patients undergoing primary PCI. TCTAP A-025 Predictors of Mortality in Acute Myocardial Infarction Patients with Unprotected Left Main Coronary Artery Disease 1
1
1
Sung Hun Park, Seung-Woon Rha, Byoung Geol Choi, Se Yeon Choi, Jae Kyeong Byun,1 Min Shim,1 Jun Hyuk Kang,1 Woo Hyeun Kim,1 Eun Jin Park,1 Jah Yeon Choi,1 Sunki Lee,1 Li Hu,1 Jin Oh Na,1 Cheolung Choi,1 Hong Euy Lim,1 Jin Won Kim,1 Eung Ju Kim,1 Chang Gyu Park,1 Hong Seog Seo,1 Dong Joo Oh1 1 Korea University Guro Hospital, Korea (Republic of)
1
TCTAP A-026 Circadian Rhythm in Southeast Asian Patients with ST-elevation Myocardial Infarction and the Differences in Clinical Characteristics and Outcomes Kah Hua Peck,1 Violet Hoon,1 Wee Kiat Ang,1 Jason Kwok Kong Loh,1 Fahim Haider Jafary,1 David Foo,1 Timothy James Watson,1 Paul JL Ong,1 Hee Hwa Ho1 1 Tan Tock Seng Hospital, Singapore BACKGROUND Several studies have evaluated the circadian pattern of ST elevation myocardial infarction (STEMI) with differences observed in different regions.