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http://www.aievolution.com/tct0801 ACS (Abstracts Nos 121-131) TCT-121 Administration Of Intracoronary Bone Marrow Mononuclear Cells On Chronic Myocar...

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http://www.aievolution.com/tct0801 ACS (Abstracts Nos 121-131) TCT-121 Administration Of Intracoronary Bone Marrow Mononuclear Cells On Chronic Myocardial Infarction Improves Diastolic Function Kang Yao, Rongchong Huang, Juying Qian, Jie Cui, Lei Ge, Yanlin Li, Feng Zhang, Aijun Sun, Yunzeng Zou, Junbo Ge Zhongshan Hospital, Fudan University, Shanghai, China Background: The effects of intracoronary cell infusion in chronic MI patients DUHVWLOOXQNQRZQ7KHSXUSRVHRIWKHSUHVHQWVWXG\ZDVWRLQYHVWLJDWHZKHWKHU intracoronary infusion of BMC into the infarct-related artery in patients with KHDOHG0,FRXOGOHDGWRLPSURYHPHQWLQOHIWYHQWULFXODU /9 IXQFWLRQ Methods: Among 47 patients with stable ischemic heart disease due to a SUHYLRXV0, “PRQWKVSUHYLRXVO\ ZHUHUDQGRPL]HGWRLQWUDFRURQDU\ infusion of BMC (BMC group) and 23 to a saline infusion (CON group) into the target vessel after successful PCI within 12 hours after chest pain occurred. /9 V\VWROLF DQG GLDVWROLF IXQFWLRQ LQIDUFW VL]H DQG P\RFDUGLDO SHUIXVLRQ defect were assessed with the use of echocardiography, magnetic resonance imaging (MRI), or 201Tl single-photon-emission computed tomography (SPECT) at baseline and repeated at the 6 month follow-up examination. Results:%0&WUHDWPHQWGLGQRWUHVXOWLQDVLJQL¿FDQWLQFUHDVHLQ/9HMHFWLRQ fraction in any of the groups by any of the methods used, and the apparent tendency of an improvement was not statistically different between the two JURXSV7KHWZRJURXSVDOVRGLGQRWGLIIHUVLJQL¿FDQWO\LQFKDQJHVRI/9HQG diastolic and systolic volume, infarct size, or myocardial perfusion. However, there was an overall effect of BMC transfer compared with the control group ZLWKUHVSHFWWR($ 3 (D$DUDWLR 3  DQG,957 3   after 6 months, as evaluated by tissue Doppler echocardiography . We noted no complications associated with BMS transfer. Conclusion: Intracoronary transfer of autologous BMC in patients with KHDOHG0,GLGQRWOHDGWRVLJQL¿FDQWLPSURYHPHQWRIFDUGLDFV\VWROLFIXQFWLRQ infarct size, and myocardial perfusion, but did lead to improvement in diastolic function.

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TCT-122 Prevalence, Detection and Management of the Metabolic Syndrome in Patients with Acute Myocardial Infarction Sandhir Prasad, Farzan Fahrtash, Yuvaraj Malaiapan, James Cameron, Ian T Meredith Monash Heart, Melbourne, Australia Background: The Metabolic Syndrome (MS) is a powerful predictor of coronary artery disease. There is limited data on the prevalence of MS XWLOL]LQJFRQWHPSRUDU\GH¿QLWLRQVLQSDWLHQWVZLWKDFXWHP\RFDUGLDOLQIDUFWLRQ (AMI). We sought to determine the true prevalence, as well as rates of clinical detection and management of MS in patients with AMI undergoing primary percutaneous coronary intervention (PCI). Methods: We prospectively evaluated 107 consecutive patients with acute ST-elevation myocardial infarction undergoing primary PCI at a tertiary referral center between May and November 2007 for MS. The presence of 06ZDVGHWHUPLQHGDFFRUGLQJWRWKHWZRPRVWFRQWHPSRUDU\GH¿QLWLRQVWKH ,QWHUQDWLRQDO 'LDEHWHV )HGHUDWLRQ ,')  GH¿QLWLRQ   DQG WKH 1DWLRQDO &KROHVWHURO(GXFDWLRQ3URJUDP 1&(3 GH¿QLWLRQ  )DVWLQJOLSLGVZHUH obtained within 24 hours of admission. Fasting glucose was obtained on day of discharge. Anthropometric measurements were obtained at bedside review on day of discharge. A post-discharge folder audit was performed to ascertain rates of discharge diagnosis coding of MS. Results: Baseline patient characteristics included a mean age of 59+13 years, 80% males, 19% with pre-existing diabetes, 48% with hypertension and 40%

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ZLWK G\VOLSLGHPLD 7KH SUHYDOHQFH RI 06 ZDV  E\ WKH ,') GH¿QLWLRQ  E\ WKH 1&(3 GH¿QLWLRQ DQG  E\ HLWKHU GH¿QLWLRQ 06 ZDV WKXV PRUHSUHYDOHQWLQWKLVSRSXODWLRQWKDQDQ\LQGLYLGXDOULVNIDFWRU$JUHHPHQW EHWZHHQGH¿QLWLRQVIRU06GLDJQRVLVZDVPRGHUDWHO\KLJK&RKHQ¶V.DSSD =0.664, p<0.001. While all individual components of MS were more prevalent in patients with MS, the following factors were predictive of MS by both GH¿QLWLRQV DIWHU PXOWLYDULDWH DQDO\VLV K\SHUWHQVLRQ IDVWLQJ JOXFRVH ZDLVW circumference and serum high density lipoprotein (all p<0.05). Despite the high prevalence, the diagnosis of MS was recognized on the discharge summary in only 1 patient (1%), and referral for exercise or weight loss SURJUDPVZDVXQGHUWDNHQLQRQO\SDWLHQWV   Conclusion: 8WLOL]LQJFRQWHPSRUDU\GH¿QLWLRQVWKHUHLVDKLJKSUHYDOHQFH of MS in AMI patients: 54% by IDF criteria and 49% by NCEP criteria. +RZHYHUGHVSLWHWKHPDUNHGO\KLJKSUHYDOHQFH06ZDVXQGHUUHFRJQL]HG DQGXQGHUWUHDWHGLQWKLVKLJKULVNSRSXODWLRQ7KHFOLQLFDOXWLOLW\RI06LQ SDWLHQWVZLWK$0,QHHGVIXUWKHUFODUL¿FDWLRQ TCT-123 Relation Between High-Sensitivity C-Reactive Protein and Coronary Plaque Components in Patients with Acute Coronary Syndrome: Virtual Histology-Intravascular Ultrasound Analysis Young Joon Hong, Myung Ho Jeong, Yun Ha Choi, Jum Suk Ko, Min Goo Lee, Won Yu Kang, Shin Eun Lee, Soo Hyun Kim, Doo Sun Sim, Keun-Ho Park, Nam Sik Yoon, Hyun Ju Youn, Kye Hun Kim, Hyung Wook Park, Ju Han Kim, Youngkeun Ahn, Jeong Gwan Cho, Jong Chun Park, Jung Chaee Kang Chonnam National University Hospital, Gwangju, Republic of Korea Background: An elevated high-sensitivity C-reactive protein (hs-CRP) level LV DVVRFLDWHG ZLWK D VLJQL¿FDQWO\ LQFUHDVHG ULVN RI IXWXUH IDWDO RU QRQIDWDO LVFKHPLFFRPSOLFDWLRQVLQDFXWHFRURQDU\V\QGURPH $&6 SDWLHQWV9LUWXDO KLVWRORJ\LQWUDYDVFXODU XOWUDVRXQG 9+,986  FDQ SURYLGH TXDQWLWDWLYH information on plaque components. Methods::HXVHG9+,986WRHYDOXDWHWKHUHODWLRQEHWZHHQKV&53OHYHOVDQG SODTXHFRPSRQHQWVLQ$&6SDWLHQWV9+,986FODVVL¿HGWKHFRORUFRGHGWLVVXH LQWRIRXUPDMRUFRPSRQHQWV¿EURWLF¿EURIDWW\GHQVHFDOFLXPDQGQHFURWLFFRUH 1& :HGLYLGHGWKHSDWLHQWVLQWRWZRJURXSVDFFRUGLQJWRWKHKV&53OHYHOV>• PJGO Q  YVPJGO Q  @7KLQFDS¿EURDWKHURPD 7&)$ ZDV GH¿QHGDVIRFDO1&ULFK •RIWKHFURVVVHFWLRQDODUHD SODTXHVEHLQJLQ FRQWDFWZLWKWKHOXPHQLQDSODTXHEXUGHQ• Results: Elevated hs-CRP group was more diabetics (36% vs. 16%, p<0.001), DQGKDGORZHUHMHFWLRQIUDFWLRQ “YV“S  KLJKHUZKLWH EORRG FHOO FRXQWV “PP3 YV “PP3, p<0.001), higher JOXFRVH “PJGOYV“PJGOS  KLJKHU¿EULQRJHQ “ PJGO YV “ PJGO S   DQG KLJKHU 1WHUPLQDO SUR%W\SH QDWULXUHWLFSHSWLGH “SJPOYV“SJPOS 7KHDEVROXWH DQGSHUFHQWDUHDVRI1&ZHUHVLJQL¿FDQWO\JUHDWHULQHOHYDWHGKV&53JURXS DW WKH PLQLPXP OXPHQ VLWHV “ PP2 YV “ PP2, p=0.008, DQG “ YV “ S  UHVSHFWLYHO\  DQG DW WKH ODUJHVW 1&VLWHV “PP2YV“PP2S DQG“YV “S UHVSHFWLYHO\ $EVROXWHDQGSHUFHQW1&YROXPHVZHUH VLJQL¿FDQWO\JUHDWHULQHOHYDWHGKV&53JURXS “PP2YV“ mm2S DQG“YV“S UHVSHFWLYHO\ 7KH presence of at least one TCFA (62% vs. 35%, p=0.006) and multiple TCFAs (26% vs. 11%, p=0.016) within culprit lesions were observed more frequently in elevated hs-CRP group. Conclusion: 9+-,986 DQDO\VLV GHPRQVWUDWHV WKDW $&6 SDWLHQWV ZLWK elevated hs-CRP had more vulnerable plaque component (NC-rich plaques and higher frequency of culprit lesion TCFAs) compared with ACS patients with normal hs-CRP.

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TCT-124

Conclusion: The incidence of PP phenomenon in ACS lesions was higher than that had been reported previously in non ACS lesions. PP was not DVVRFLDWHGZLWKLQFUHDVHGULVNRIUHVWHQRVLV,WZDVVXJJHVWHGWKDWLIVXI¿FLHQW stent expansion is obtained after stenting, additional ballooning to PP lesion is not necessary.

Elderly Acute Coronary Syndrome Patients Have More Dense Calcium and Necrotic Core-Rich Plaque Compared with Younger Acute Coronary Syndrome Patients: Virtual Histology-Intravascular Ultrasound Analysis Young Joon Hong, Myung Ho Jeong, Yun Ha Choi, Jum Suk Ko, Min Goo Lee, Won Yu Kang, Shin Eun Lee, Soo Hyun Kim, Doo Sun Sim, Keun-Ho Park, Nam Sik Yoon, Hyun Ju Youn, Kye Hun Kim, Hyung Wook Park, Ju Han Kim, Youngkeun Ahn, Jeong Gwan Cho, Jong Chun Park, Jung chaee Kang Chonnam National University Hospital, Gwangju, Republic of Korea

TCT-126

Background: The aim of this study was to assess the age-related differences in pre-percutaneous coronary intervention (PCI) virtual histology-intravascular XOWUDVRXQG 9+,986 ¿QGLQJVDWFXOSULWOHVLRQVWUHDWHGZLWK3&,LQSDWLHQWV with acute coronary syndrome (ACS). Methods: $WRWDORIFRQVHFXWLYH$&6SDWLHQWVZKRXQGHUZHQWSUH3&,9+ ,986LPDJLQJZHUHJURXSHGDFFRUGLQJWRDJH*URXS, \HDUV“ \HDUVQ  DQG*URXS,, !\HDUV“\HDUVQ  9+,986FODVVL¿HG WKHFRORUFRGHGWLVVXHLQWRIRXUPDMRUFRPSRQHQWVJUHHQ ¿EURWLF \HOORZJUHHQ ¿EURIDWW\ ZKLWH GHQVHFDOFLXP DQGUHG QHFURWLFFRUH  Results:7KHSHUFHQWDUHDVRIGHQVHFDOFLXPDQGQHFURWLFFRUHZHUHVLJQL¿FDQWO\ JUHDWHULQ*URXS,,WKDQLQ*URXS,DWWKHPLQLPXPOXPHQVLWHV “ YV“S DQG“YV“S UHVSHFWLYHO\  DQGDWWKHODUJHVWQHFURWLFFRUHVLWHV “YV“S DQG “YV“S UHVSHFWLYHO\ 7KHSHUFHQWGHQVHFDOFLXP DQGQHFURWLFFRUHYROXPHVZHUHVLJQL¿FDQWO\JUHDWHULQ*URXS,,WKDQLQ*URXS , “YV“S DQG“YV“S  respectively). The percent area of dense calcium at the minimum lumen site correlated positively with the percent area of necrotic core at the minimum lumen site (r=0.620, p<0.001), and the percent dense calcium volume positively correlated with the percent necrotic core volume (r=0.580, p<0.001). Conclusion: 9+-,986 DQDO\VLV GHPRQVWUDWHV WKDW HOGHUO\ SDWLHQWV KDYH PRUH FDOFL¿FSODTXHZLWKPRUHQHFURWLFFRUHSODTXHFRPSDUHGZLWK\RXQJHUSDWLHQWVDQG QHFURWLFFRUHIRUPDWLRQDFFRPSDQLHVZLWKFDOFL¿FDWLRQLQSDWLHQWVZLWK$&6

Ramin Ebrahimi1, Steven V Manoukian2, Frederick Feit3, A Michael Lincoff4, Cornelius Dyke5, Bernard Gersh6, Roxana Mehran7, Jeffrey W Moses7, Gregg W Stone7 1 University of California Los Angeles and the Greater Los Angeles VA Center, Los Angeles, CA; 2The Sarah Cannon Research Institute and The Centennial Heart Center, Nashville, TN; 3New York University School of Medicines, New York, NY; 4Cleveland Clinic Foundation, Cleveland, OH; 5Gaston Memorial Hospital, Gastonia, NC; 6Mayo Clinic, Rochester, MN; 7Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY

Upstream Bivalirudin Monotherapy Results in Similar One Year Survival as Heparin Plus Glycoprotein IIb/IIIa Inhibitors in Patients With Non-ST-Elevation Acute Coronary Syndromes Undergoing Bypass Graft Surgery: A Report From the ACUITY Trial

TCT-125 Impact of Plaque Prolapse Phenomenon after Coronary Stenting in ACS patients: Intravascular Ultrasound Study Akiyoshi Kurita, Hiroaki Takashima, Tomofumi Mizuno, Kenji Asai, Yasuo Kuroda, Yoshinori Wakita, Takashi Kousaka, Yasushi Kuhara, Kazuyuki Maeda, Yasuhsi Wakida, Takayuki Ito Department of Cardiology, Aichi, Japan Background: Plaque prolapse (PP) phenomenon is not a rare phenomenon DQGKDVEHHQGHWHFWHGIUHTXHQWO\E\LQWUDYDVFXODUXOWUDVRXQG ,986  HVSHFLDOO\ LQ $&6 OHVLRQV %XW WKH LQÀXHQFH RI 33 RQ RXWFRPHV LQ $&6 patients has not been well discussed. Purpose: The aim of this study was to evaluate the PP phenomenon using ,986DIWHUFRURQDU\VWHQWLQJLQSDWLHQWVZLWK$&6 Methods: We evaluated PP phenomenon in 137 consecutive ACS patients, ZKRXQGHUZHQWVXFFHVVIXO,986JXLGHGVWHQWLQJ)ROORZXS,986VWXG\ZDV performed to 120 patients (88%) at average 8.6-month after procedure. Results: At procedure, PP was found in 81 lesions (59%). Of 81 PP lesions, 38 (47%) PP lesions were observed at non culprit lesion (proximal 26 lesions, GLVWDOOHVLRQV ,Q33SRLQWVWHQWFURVVVHFWLRQDODUHD &6$ ZDVVLJQL¿FDQWO\ ODUJHUWKDQWKDWRIFXOSULWOHVLRQ “PP2YV“PP2, p<0.001). 7KHIUHTXHQF\RIVORZÀRZZDVVLJQL¿FDQWO\KLJKHULQ33FDVHVFRPSDUHG with non PP cases (22.2%, 5.4%, p=0.007, respectively). The overall restenosis rate was 27.0% and there was no association between PP and restenosis (PP cases vs non PP cases: 25.9% vs 28.6%, p=0.73). In logistic regression analysis small stent CSA at procedure was only predictor of restenosis (odds ratio 0.67, 95%CI 0.499-0.911, p<0.01).

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Background: In patients with non-ST-elevation acute coronary syndromes (ACS) undergoing coronary artery bypass graft surgery (CABG) in the ACUITY trial, upstream bivalirudin (Biv) monotherapy (mono) resulted in similar protection from ischemic complications and reduced non-CABG major bleeding at 30 days compared to heparin (enoxaparin or unfractionated) + GP IIb/IIIa inhibitors (Hep+GPI).We sought to determine the durability of ischemic results at 1 year. Methods: ,Q$&8,7<PRGHUDWHDQGKLJKULVN$&6SDWLHQWVZHUHUDQGRPO\ assigned to 1 of 3 antithrombotic strategies prior to angiography: Hep+GPI, Biv + GPI, or Biv mono. All patients received heparin for procedural anticoagulation during CABG. We examined composite ischemia (death, myocardial infarction, or revascularization) and mortality at one year by randomized treatment in patients undergoing CABG. Results: CABG was performed in 1539 (11.1%) patients (87% on-pump, 13% RIISXPS 7KHUHZHUHQRVLJQL¿FDQWGLIIHUHQFHVLQEDVHOLQHFKDUDFWHULVWLFV among the 3 antithrombotic strategies. Treatment with Biv mono or Biv + GPI vs Hep + GPI resulted in similar rates of composite ischemia (21.0%, 18.2% vs 20.4% respectively p=NS) and mortality (6.7%, 6.6% vs 6.6%, p=NS) at 1 \HDU ¿JXUH  Conclusion: $PRQJ  SDWLHQWV ZLWK PRGHUDWH DQG KLJK ULVN QRQ67 elevation ACS undergoing CABG in the ACUITY trial, treatment with upstream bivalirudin mono resulted in similar rates of composite ischemia and one-year mortality compared to Hep + GPI.

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TCT-127 The Relationship between Plaque Prolapse Phenomenon and Late Incomplete Stent Apposition after Sirolimus Eluting Stents Implantation in Patients with Acute Coronary Syndrome

at baseline. The groups did not differ by gender, diabetes, and high TIMI ULVN VFRUH   &RPSDUHG WR SWV LQ WHUWLOHV  DQG  WKRVH LQ WHUWLOH  KDG VLJQL¿FDQWO\KLJKHUUDWHVRIDGYHUVHRXWFRPHVDWGD\VDQG\HDU )LJXUH  In a multivariable model, the odds of mortality at 1 year increased by 20% per 10,000 cells/mm3 increase in the WBC count (p=0.006).

Tomofumi Mizuno, Hiroaki Takashima, Kenji Asai, Yasuo Kuroda, Yoshinori Wakita, Takashi Kousaka, Yasushi Kuhara, Akiyoshi Kurita, Kazuyuki Maeda, Yasushi Wakida, Takayuki Ito Department of Cardiology, Aichi, Japan Background:Although both plaque prolapse (PP) phenomenon and late incomplete stent apposition (LISA) is often observed in patients treated with sirolimus eluting VWHQWV 6(6 WKHLQÀXHQFHRI33RQ/,6$KDVQRWEHHQZHOOVWXGLHGHVSHFLDOO\LQ acute coronary syndrome (ACS) patients. The aim of this study was to evaluate the LQÀXHQFHRI33SKHQRPHQRQRQ/,6$LQ$&6SDWLHQWV Methods: This study population consisted of 42 ACS patients (45lesions) ZKRXQGHUZHQWVXFFHVVIXO,986JXLGHG6(6LPSODQWDWLRQVLQFH-XQHWR 0D\DQGSHUIRUPHGIROORZXS,986VWXG\DWPRQWK DYHUDJHIROORZ XSSHULRGZDV“PRQWKV DIWHUSURFHGXUH Results: At procedure, PP was found in 29 lesions (67.4%). Restenosis rate ZDVWHQGHGWREHKLJKHUEXWQRWVLJQL¿FDQWLQ33OHVLRQFRPSDUHGZLWKQRQ33 lesion (25.0%, 6.9%; p=0.09, respectively). LISA was found more frequently in PP cases than in non PP cases (62.1%, 25.0%; p=0.017). Lumen area of 33SRLQWZHUHVLJQL¿FDQWO\LQFUHDVHGUHÀHFWLQJSODTXHGLPLQLVK DWSURFHGXUH “PP2IROORZXS“PP2; p<0.001), whereas lumen area of FXOSULWOHVLRQZHUHQRWFKDQJHGLQERWK33SDWLHQWV DWSURFHGXUH“ mm2IROORZXS“PP2; p=0.52) and non PP patients (at procedure “PP2IROORZXS“PP2; p=0.91) However, Extra elastic membrane (EEM) area was not increased in all points WKHFKDQJHLQ((0RI33SRLQWVFXOSULW33FXOSULWQRQ33“PP2, S  “ PP2 S  “ PP2; p=0.10. respectively). In logistic regression analysis PP and absence of post ballooning was the predictors of LISA (odds ratio 139.19, 95%CI 3.45-5612.79, p=0.009; odds ratio 0.056, 95%CI 0.003-0.929, p=0.04, respectively). Conclusion: ,Q $&6 SDWLHQWV WUHDWHG ZLWK 6(6 33 LQFUHDVHV WKH ULVN RI LISA. It is suggested that, in ACS patients, not enlargement of EEM area but diminish of plaque played an important role in LISA, especially in plaque prolapse point.

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TCT-128 Prognostic Utility of the Baseline White Blood Cell Count in Patients with Acute Coronary Syndromes: The ACUITY Trial Roxana Mehran, Somjot Brar, George Dangas, Damiana Fiscella, Adriano Caixeta, Giora Weisz, LeRoy Rabbani, Konstantinos Sfakianakis, Jena Stent, Jeffrey W Moses, Gregg W Stone Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY Background: ,QÀDPPDWLRQ SOD\V DQ LPSRUWDQW UROH LQ WKH SURJUHVVLRQ RI atherosclerosis. Prior studies have suggested that an elevated white blood cell (WBC) count is associated with increased adverse outcomes in patients with acute coronary syndromes (ACS) managed conservatively. We sought to determine the relationship betweenbaseline WBC count and clinicaloutcomes in patients with ACS undergoing an invasive management strategy in the ACUITY trial. Methods:$&8,7<HQUROOHGSDWLHQWVZLWKPRGHUDWHDQGKLJKULVNDFXWH coronary syndrome (ACS). We compared rates of 30 day composite ischemia (death, MI, ischemic revascularization), non-CABG major bleeding, and net adverse clinical events (NACE = composite ischemia or major bleeding) and \HDUPRUWDOLW\E\WHUWLOHVRI:%&FRXQW WHUWLOH”FHOOVPP3; tertile 2, 7,000 - 9,000 cells/mm3WHUWLOH!FHOOVPP3). Results: Of the 13,628 patients with baseline WBC data, pts in the highest tertile were younger, had less hypertension, hyperlipidemia, prior MI, PCI, DQG &$%* +RZHYHU WKH KLJKHVW WHUWLOH ZDV PRUH OLNHO\ WR EH D FXUUHQW VPRNHUKDYHFDUGLDFELRPDUNHUHOHYDWLRQDQG67VHJPHQWGHYLDWLRQ•PP

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Conclusions: In pts with acute coronary syndromes undergoing an invasive PDQDJHPHQWVWUDWHJ\WKHKLJKHVWWHUWLOHRI:%&FRXQWLGHQWL¿HVDKLJKULVN patient cohort with increased mortality and adverse events. These results IXUWKHUVXSSRUWWKHSLYRWDOUROHRILQÀDPPDWLRQLQ$&6 TCT-129 A Meta-Analysis Of Facilitated And Primary Percutaneous Coronary Intervention For Patients With ST-Segment Elevation Myocardial Infarction Muhammad Amer1, Yasir Nawaz2, Jurga Adomaityte3, Zishan Khalid Siddiqui1, Rehan Qayyum1 1 Johns Hopkins University, Baltimore, MD; 2King Edward Medical College, Lahore, Pakistan3Sinai Hospital of Baltimore, Baltimore, MD Background: Administration of pharmacological agent(s) in the time interval EHWZHHQ WKH LGHQWL¿FDWLRQ RI 67 VHJPHQW HOHYDWLRQ P\RFDUGLDO LQIDUFWLRQ 67(0,  DQG SHUFXWDQHRXV FRURQDU\ LQWHUYHQWLRQ 3&,  DOVR NQRZQ DV facilitated PCI, may result in early reperfusion and better clinical outcomes. We performed a meta-analysis of the clinical trials to compare facilitated PCI with primary PCI. Methods: PubMed, EMBASE, and The Cochrane Collaboration databases were searched up to May 2008. Clinical trials that were published in English language peer-reviewed medical journals, randomized patients with STEMI to facilitated or primary PCI, and reported on relevant outcomes were included. Data were abstracted independently by two investigators. Results were pooled by using random-effects model. Results: 2I WKH  DUWLFOHV LGHQWL¿HG E\ RXU VHDUFK VWUDWHJ\  VWXGLHV enrolling 7845 patients (facilitated PCI=4377, primary PCI=3495; median DJH   \HDUV PDOHV    ZHUH LQFOXGHG %HIRUH 3&, 7,0, ,,, ÀRZ was present in 1283 and 459 patients in facilitated and primary PCI arms UHVSHFWLYHO\ 25 &, WRS $IWHU3&,7,0,,,,ÀRZ was present in 3591 and 2883 patients in the facilitated and primary PCI arms respectively (OR=1.0; 95%CI=0.9 to 1.2; p=0.43). There was no difference between the two PCI strategies in mortality (229 vs. 206; OR=1.1; 95%CI=0.9 WRS  EXWWKHUHZDVLQFUHDVHGULVNRIPDMRUEOHHGLQJZLWKIDFLOLWDWHG PCI (211 vs. 149; OR=1.4; 95%CI = 1.1 to 1.7; p=0.005). Whether facilitated PCI was performed with gpIIb/IIIa inhibitors or with thrombolytics, results ZHUHVLPLODU ¿JXUH 

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Conclusion: Although facilitated PCI is associated with early restoration RI7,0,,,,ÀRZWKDQSULPDU\3&,LQ67(0,SDWLHQWVLWLVDVVRFLDWHGZLWK LQFUHDVHGEOHHGLQJULVNDQGKDVQRPRUWDOLW\EHQH¿W TCT-130 WITHDRAWN TCT-131 WITHDRAWN

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