A new rapid ecarin clotting time assay but not activated clotting time strongly correlates with bivalirudin concentration: a percutaneous coronary intervention study

JACC

ABSTRACTS - ACCIS2002

March 6, 2002

Conclusions: trended

In this large

pilot experience,

rates of ischemic

lower with bivalirudin

than with heparin

may be the first antithrcmbctic

agent to uncouple

hemorrhagic

during

and bleeding

contemporary

suppression

events from

Reduction in Percutaneous

Leslie Cho. A. Michael Linccff, John A. Bittl. Eric J. Tcpol, Cleveland

Clinic Foundation,

Background: among

Female

patients

Methods:

Cleveland,

Ohio, Ocala Heart Institufe,

gender

undergoing

is a known

Within a randomized

to unfractionated

heparin

major hemorrhage Results:

(the Bivalirudin

were stratified

rhage - males:

enrolled.

(Table). Considering

bivalirudin

Trial), rates of ischemic

1367 (32.2%)

events and

patients were women.

with a 2.3-fold 144/1367

was associated

However,

a combined

Ipshiva

comparing

increased

(10.4%) (pc0.0001).

with a significant

this effect was most striking safety and efficacy endpoint

When strati-

reduction

among

in bleeding

female

patients

of death, MI, revasculariza-

bivalirudin

in adverse

_ 141/690 (20.4%) vs 69/697 (9.9%) (p~O.OOOl), and a 35%

relative risk reduction Conclusions: ischemic prominent

is associated

women.

may benefit if bivalirudin

(7.6%) (p
with a substantial

in both men and women.

among

with a 50% relative risk reduction

in men - 171/1461 (11.7%) vs Ill/l464

Bivalirudin

events

was associated

Compared

risk of major hemor-

tion. and major hemorrhage. events in wcmen

Such patients

reduction

but the improved with an increased

is used in place of unfractionated Major

Kurctobi,

in bleeding

and

safety profile is especially risk of bleeding

during

PCI

heparin.

Atsushi

Ohtani, Kazuhisa Backgrounds, patients

(4.5%) YS females:

arm, bivalirudin

of gender.

angioplasty

Angioplasty

bleeding

(PCI).

by gender.

was associated

131/2925

fied by treatment regardless

gender

intervention

clinical trial of coronary

of the 4312 patients

to males, female

coronary

Smoking, Thrombus, and Plaque in the Culprit Vessel In Patients With Acute Myocardlal Infarction: Angioscopic Findings

1054-13

Ocala, Florida.

potent risk factor for post-procedural

percutaneous

Habitual

thrombolytic

therapy.

ated in 62 patients ous coronary Furthermore,

divided

and the number

enrolled

patients

we investigated

Bivalirudin

P Value

Women

(I 07/690) 15.5%

(37/697)

5.3%

<0.@301

Men

(92/1461)

(39/1464)

2.7%


of plaque

smokers.

Cleveland, Background: agulation

A. Michael Linccff, Marco Roffi, Teresa Kaldus,

Recently,

direct thrombin

in percutaneous

coronary

inhibitors

clotting time (ACT), used for monitoring

heparin.

new point-of-care

assay has been developed

which specifically

measures

evaluated

the correlation

activity duirng and Pro-DM) patients

receiving

To test the accuracy

the DTI bivalirudin of bivalirudin

and non-titrated Results:

for patients inhibitors.

of available

higher, and the prevalence

lower in smoking

association

of smoking

at The Cleveland concentration

Bivalirudin

concentration

time (ECT),

No prior study has of anti Factor Ila PCI

point of care

correlated

were tested in both

was calculated well

with

between

ECT

by the Spearman sample

bivalirudin

(rxO.76,

concentra-

ACT (r=0.26, p=O.O5) or pro-DM ACT (wO.41, p
alsc poor correlation

between

ECT and Hemcchrcn

Hemwhron

ACT (w0.40.

coagulation

in patients

din concentration.

Additionally

patients. These findings tion during

p=O.O02). Conclusion:

receiving

PCI with DTI.

ACT (r&27.

There was poor correlation bivalirudin,

pro-DM

ECT is a reliable measurement

while ACT has poor correlation

there is poor correlation

have important

p=O.O4) and ECT with

between

implications

between

for guiding

Tani, lkuyoshi

Matsumcto,

Takeo Anazawa,

Watanabe,

ACT and

Investigators

dence of acute coronary circulating

(50% vs. 35, p
This is first evidence

was

to assess the

in culprit lesion directly, and

Takeshi Fujii, Kazutoshi

Takashi Miyamoto,

paradox.

syndrome(ACS)

formation MDA-LDL

.Therefcre between

were collected

of left coronary analyses

Surugadai

Hospital,

with diffuse

LDL(MDA-LDL)

we investigated

the differences

of vascspasm

of spasm lesions were evaluated

was reponed

sinus

just at the lesion with focal vascspasm disease,

existed

diffusely

Plasma

MDA-LDL

along

circulation

% plaque volume

the mechanism

arteries.

levels associated

vated in the coronary increased

the coronary

in diffuse

thrombosis

in focal vascspasm.

intimal

of

thickness

in TableConclusions: were

significantly

Under this condition,

during focal vascccnstriction

of thrcmbogenicity

and volumetric More abundant

even in the absence

vascspasm,

Data is presented

with triggering

and Blood

before provocation

IVUS system.

soft plaque was localized

whereas

and Results:

IVUS study was performed

with Netra-3D

Recently to activate

in plaque appearance

significant

angiographic

has a high inci-

vascspasm.

.Methcds

and coronary

After relief of spasm,

Tokyo, Japan.

focal vascspasm

oxidized

two patterns

Michiaki

Tokyo, Japan, 2nd

School of Medicine,

compared

from aortic rcct(Ao)

spasm

Ishikawa,

Ken Nagao, Katsuo Kanmatsuse,

have that demonstrated

malondialdehyde-modified

thrombus samples

risk factors,

(136 vs. 114 mg/dl. ~~0.05)

Possible Mechanism of Coronary Thrombosis Caused by Vasospasm In Angiographically Nearly Normal Coronary Artery: Evaluation by Plaque Appearance and Malondlaldehyde-Modified Oxidized LDL

&&masa

plasma

in culprit lesion (2.7kO.9

of the smoker’s

Background:

DTI. A

with non-smok-

status. As ccronaly

of thrcmbus

receiving

64 consecutive

in body. Samples

coefficient

status and the amount

may provide the explanation

of Internal Medicine, Nihon University

tion and Hemcchrcn

ACT (r=O.52, p
compared

in IRA (3.012.0 vs. 3.3~1.6)

of hypertension

of Cardiobgy, Nihon University

Clinic. We compared

p
pro-DM

related artery was higher in

patients,

Conclusion.

Department

anti Factor Ila activity levels, Anti Factor Ila activity is

blood. Correlation

patients.

65% of the

(45% VS. 17%. p=O.O9). The

of plaque

by smoking

Department

ACT assays (Hemcchrcn

we enrolled

affected

for antico-

based on the ecarin clotting

and the rapid ECT assay (Pharmanetics),

a direct measurement test.

is uncertain

of ECT and ACT to the direct measurement

ACT and ECT to central laboratory titrated

(PCI). The accuracy

the activity of direct thrombin

PCI. Methods:

patients

in smoking

Results,

TIMI grade was not signifi-

vessels to infarcted

of the activated

(DTI) have been approved

interventions

baseline

with non- smoking

significantly

Kandice

Inc, Chapel Hi//, Ohio.

percutane-

after PCI were

lesion (4 grades from white to

artery (IRA).

(205 vs. 160 mg/dl, ~~0.05) and triglycelide

1054-14

The Cleveland Clinic Foundation,

Patrick D. Mize, David J. Moliterno.

Ohio, Pharrnanetics

Although

was higher prevalence

were significantly

A New Rapid Ecarin Clotting Time Assay but Not Activated Clotting Time Strongly Correlates With Blvallrudln Concentration: A Percutaneous Coronary Intervention Study Joel Reginelli,

an culprit

in infarct related

of collateral

compared

also these findings

Kottke-Marchant,

were underwent of thrombus

of

evalu-

1x33 or little: n=29) by angioscopy.

(massive:

the color of plaque

(65% vs. 22%, p
Total cholesterol

status is

The prevalence

arteries were successfully

max plaque score (2.7eO.9 vs. 2.7kO.9) and the color of plaque

Heparin

mCho,

that smoking

into 2 groups

prevalence

massive thrcmbus

in

successful

amount

vs. 2.6*1 .I) were not significantly

1053-5

the hypothesis

culprit lesion. Methods,

in the major coronary

prognosis

in the higher

(PCI), and the residual

were current

patients,

Tcmohito

with good

and results

(male: 55, mean age: 60.2). All patients

yellow),

Shimizu,

associated

(AMI),

of thrcmbus

of thrombus

we analyzed

cantly changed,

Ueda, Masahiko

is paradoxically infarction

Therefore,

intervention

semi-quantatively

smoking

smoking

with amount

and amount

Yasunori

Osaka Police Haspita/, Osaka, Japan.

myccardial

closely associated plaques

Hirayama,

Kodama,

with acute

ing patients

Hemorrhage

6.3%

SESSION

Sunday, March 17, 2002, 3:00 p.m.-5:OO p.m. Georgia World Congress Center, Hall G Presentation Hour: 3:00 p.m.-4:OO p.m.

Coronary Intervention-

Related Bleeding With Bivalirudin Is Particularly Striking in Women &s&&&v&,

17A

Cardiology)

Vulnerable Plaque: Acute lschemic Syndromes

1054

risk.

1053-4

& Interventional

POSTER

events

PCI. Bivalirudin

of ischemic

(Angiography

ele-

dramatically

might play an important

role in

leading to ACS

of antiDiffuse n=20

Focal n=l5

p value

-6.9+/-9.0

12+/-14.9

to.05

Vessel volume(mm3)

127.7+/-39.1

134.4+/s44.0

ns

Lumen volume(mm3)

91.3+/-11.2

79.5+/-10.6

ns

Plaque vclume(mm3)

30.6+/-10.2

55.2+/-10.3

<0.05

23.9+/-9.2

40.2+/-9.6

co.05

with bivaliru-

ACT and ECT in such

Cs-AC difference

of MDA-LDL

(U/L)

the extent of anticoagula-

% plaque volume(plaque

1054-I

volume)

Insulin Resistance as an Independent Predictor of Acute Coronary Syndrome: An Intravascular Ultrasound Study With Clinical Correlations

5

Takashi Yoshitama. Suguru

volume/vessel

Masato Nakamura.

Yajima, Masamichi

Hitoshi Anzai. Takahirc

Tan, Tsunoda,

Wada. Raisuke

Ycko Kitagawa,

lijima, Rintam

Nishida, Tetsu Yamaguchi,

Nakajima.

Ohashi Hospital,

Masanori

Shiba,

Takurc Takagi.

Jcho University,

Tokyo, Japan. Background:

Insulin

resistance

coronary

atherosclerosis.

coronary

syndrome

Methods: ultrasound

elastic membrane

asscciations

as an important

between

insulin

initiating

resistance

factor in and acute

(ACS) remain unclear.

Before intervention, (IVUS)

has been implicated

However,

examination

75 patients with 65 culprit lesions underwent by which cross-sectional

(EEM), lumen CSA, and plaque

intravascular

area (CSA) within the external

CSA were evaluated.

Positive remod-