- Email: [email protected]
Adverse outcomes in patients with peripheral vascular disease (PVD) following percutaneous coronary intervention (PCI)
Abstract
346 Accuracy of the pre-hospital assessment for primary Angioplasty (PAPA) program in the Illawarra region of NSW G. Femia, T. Fetahovik ∗ , T. Tiberio, W. Mckenzie, T. Nguyendang, D. Owensby, A. Yeung, P. Shetty, A. Lee The Wollongong Hospital, Wollongong, NSW, Australia Background: Pre-hospital assessment for primary angioplasty (PAPA) has been developed to reduce ischaemia times and improve cardiology outcomes. In our region, we use the Glasgow ECG analysis algorithm in the LIFEPAK 15 monitor/defibrillator. In our cohort, all patients with chest pain undergo an ambulance electrocardiogram and all ECGs that satisfy the ST elevation criteria are transmitted to the attending cardiologist. Patients that are deemed appropriate are managed with thrombolysis or direct transfer to catheterisation lab. Methods: Between March 1st 2013 and July 31st 2014, we examined the accuracy of the Glasgow algorithm by retrospectively analysing all ambulance ECGs that satisfied the algorithm for ST elevation. Three separate physicians; one cardiologist and two emergency physicians validated the original diagnosis of the attending cardiologist. Results: 165 pre-hospital ECGs satisfied the Glasgow algorithm for ST elevation but the on call cardiologist only accepted 96. In addition, 14 cases were not referred from the ambulance but had ST elevation in the emergency department. Therefore the sensitivity and PPV of the Glasgow algorithm to detect STEMIs was 92.9% (91/98) and 55.2% (91/165) respectively. We compared the characteristics of the accepted and rejected groups and found the rejected group was significantly older with a higher incidence of ischaemic heart disease, congestive heart failure, atrial arrhythmias, bundle branch block and pacemakers; p value < 0.05. Conclusion: The high false positive and negative rate may be due to the high prevalence of ischaemic and conductive heart disease in our cohort. http://dx.doi.org/10.1016/j.hlc.2015.06.347 347 This abstract has been withdrawn.
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348 Adverse outcomes in patients with peripheral vascular disease (PVD) following percutaneous coronary intervention (PCI) J. Ramzy 1,∗ , N. Andrianopoulos 2 , J. Sajeev 1 , L. Roberts 1 , S. Duffy 3 , D. Clark 4 , A. Teh 1 , A. Ajani 5 , C. Reid 2 , E. Oqueli 6 , G. New 1 , M. Freeman 1 1 Eastern
Health, VIC, Australia University - CCRET, VIC, Australia 3 Alfred Hospital, VIC, Australia 4 Austin Hospital, VIC, Australia 5 Royal Melbourne Hospital, VIC, Australia 6 Ballarat Base Hospital, VIC, Australia 2 Monash
Background: PVD is an independent risk factor for adverse outcomes following PCI. We aimed to evaluate the clinical characteristics and outcomes of patients with PVD undergoing PCI, and whether use of drug-eluting stents (DES) improved outcomes.
Methods: We analysed data from 18,380 patients undergoing PCI from an Australian registry between 2005 and 2013. Clinical and procedural data, 30-day and 12-month outcomes were compared in those with and without PVD. Long-term mortality was compared using National Death Index linkage (follow-up 4.9±2.6 years). Results: Patients with PVD (n=1,251, 6.8%) were older and had more diabetes, hypertension, cerebrovascular disease, heart failure, renal impairment, ostial lesions, left main and multi-vessel disease (all p<0.001). PVD was associated with greater in-hospital bleeding (1.9 vs. 1.1%, p=0.015). Patients with PVD had significantly higher rates of MACE in-hospital (5.7% vs. 4.1%, p<0.008), at 30-days (8.6% vs. 5.8%, p < 0.001) and 12-months (24.6% vs. 13.2%, p<0.001). There was significantly greater long-term mortality in the PVD group (see Kaplan-Meier figure). Forty-five per cent of patients with PVD had DES. This group experienced significantly less MACE than PVD patients treated with bare-metal stents (BMS) at 30 days (4.8 vs. 10.1%, p<0.001) and 12 months (19.4 vs. 26.4%, p<0.005).
Abstract
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Conclusions: PVD is associated with significantly worse outcomes in patients undergoing PCI. PVD patients receiving DES have improved outcomes compared with those receiving BMS. http://dx.doi.org/10.1016/j.hlc.2015.06.349 349 Age is no barrier to transcather aortic-valve replacement E. Shaw 1,2,∗ , V. Subban 1 , D. Murdoch 1,3 , M. Savage 1 , J. Crowhurst 1,3 , C. Raffel 1,3 , K. Poon 1,3 , A. Incani 1,3 , D. Walters 1,3 1 The
Prince Charles Hospital, QLD, Australia 2 The University of Sydney, NSW, Australia 3 The University of Queensland, QLD, Australia Background and Aim: Transcatheter aortic-valve replacement (TAVR) has emerged as an alternative for high-risk patients with severe aortic stenosis. With increasing life expectancies, there are a greater number of elderly patients requiring TAVR. We examined this cohort of patients and compared outcomes between nonagenarians (≥90 years old) patients and their younger (<90 years old) counterparts. Methods: Data in 209 patients undergoing TAVR at a single centre between August 2008 and July 2013 were examined. Statistical analysis was performed using SPSS version 22. Results: There were 29 nonagenarians and 180 patients <90 years old. Baseline characteristics of the 2 groups were similar. Mean age and STS score of younger patients and nonagenarians were 81.8 ± 6yrs vs 91.5 ± 1.7yrs and 5.77±3.42% vs 6.92±3.06% (p=0.09) respectively. There was no significant difference between younger patients and nonagenarians in their procedural complications of death (0% vs 3.4%, p > 0.1), myocardial infarction (MI) (1.7% vs 0%, p >0.6), cerebral vascular accident (CVA) (3.9% vs 3.4%, p >0.6) or major bleeding (9.4% vs 10%, p>0.3). At 1 year, there was no significant difference between younger patients and nonagenarians in mortality (10.6% and 17.2%, p >0.2), MI (3.3% vs 3.4%), CVA (1.1% vs 6.9%, p >0.09) or symptomatic relief with 15% of younger patients vs 3.5% of nonagenarians having NYHA >2 (p>0.13). Conclusion: Among high-risk patients, TAVR outcomes in selected nonagenarians are comparable to those obtained in younger patients. Age alone should not be a limiting factor when considering candidates for TAVR. http://dx.doi.org/10.1016/j.hlc.2015.06.350
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350 An article on coronary stent deployment by oversizing versus high pressure dilatation: a randomised intravascular ultrasound controlled study E. Zhou 1,∗ , S. Lo 2 , C. Mussap 2 , S. Burgess 2 , C. Juergens 2 1 University of New South Wales, NSW, Australia 2 Department of Cardiology, Liverpool Hospital, NSW, Australia
Background: Optimal stent deployment (OSD) typically requires high pressure post-dilatation (≥14 atm). This may cause intimal barotrauma injury, contributing to restenosis. This randomised controlled trial sought to determine the efficacy and safety of intravascular ultrasound (IVUS)-guided, lower pressure (≤10 atm) ‘oversized’ stent deployment versus conventional high pressure deployment. Methods: A total of 27 patients undergoing percutaneous coronary intervention were randomised to stent oversizing (n=14) or high pressure deployment (n=13). IVUS was used to measure the vessel and luminal diameters and areas at baseline. IVUS also measured the minimal stent area (MSA), minimal luminal diameter (MLD), average per cent stent expansion (APSE) and stent symmetry index (SSI) following initial stent deployment and after post-dilatation, if required. The primary endpoint was attainment of OSD criteria after initial stent deployment. Results: There were no overall differences in OSD between the stent oversize and high pressure groups (57.1% vs. 61.2% respectively, p = 1.00); nor between the final MSA (8.32 ± 2.28mm2 vs. 7.23 ± 2.10mm2 respectively, p = 0.23) and final MLD (3.00 ± 0.62mm vs. 3.00 ± 0.80mm respectively, p = 0.95). The stent oversize group had comparatively larger APSE (106.78 ± 22.01% vs. 91.00 ± 20.23%, p = 0.047) and greater SSI (0.90 ± 0.07 vs. 0.84 ± 0.08, p = 0.039). No adverse cardiac events occurred in either group at 30-day follow-up. Conclusions: This pilot study shows that IVUS-guided stent oversizing, without routine high pressure postdilatation, is both safe and achieves OSD through improved APSE and stent SSI measures. http://dx.doi.org/10.1016/j.hlc.2015.06.351
346 Accuracy of the pre-hospital assessment for primary Angioplasty (PAPA) program in the Illawarra region of NSW G. Femia, T. Fetahovik ∗ , T. Tiberio, W. Mckenzie, T. Nguyendang, D. Owensby, A. Yeung, P. Shetty, A. Lee The Wollongong Hospital, Wollongong, NSW, Australia Background: Pre-hospital assessment for primary angioplasty (PAPA) has been developed to reduce ischaemia times and improve cardiology outcomes. In our region, we use the Glasgow ECG analysis algorithm in the LIFEPAK 15 monitor/defibrillator. In our cohort, all patients with chest pain undergo an ambulance electrocardiogram and all ECGs that satisfy the ST elevation criteria are transmitted to the attending cardiologist. Patients that are deemed appropriate are managed with thrombolysis or direct transfer to catheterisation lab. Methods: Between March 1st 2013 and July 31st 2014, we examined the accuracy of the Glasgow algorithm by retrospectively analysing all ambulance ECGs that satisfied the algorithm for ST elevation. Three separate physicians; one cardiologist and two emergency physicians validated the original diagnosis of the attending cardiologist. Results: 165 pre-hospital ECGs satisfied the Glasgow algorithm for ST elevation but the on call cardiologist only accepted 96. In addition, 14 cases were not referred from the ambulance but had ST elevation in the emergency department. Therefore the sensitivity and PPV of the Glasgow algorithm to detect STEMIs was 92.9% (91/98) and 55.2% (91/165) respectively. We compared the characteristics of the accepted and rejected groups and found the rejected group was significantly older with a higher incidence of ischaemic heart disease, congestive heart failure, atrial arrhythmias, bundle branch block and pacemakers; p value < 0.05. Conclusion: The high false positive and negative rate may be due to the high prevalence of ischaemic and conductive heart disease in our cohort. http://dx.doi.org/10.1016/j.hlc.2015.06.347 347 This abstract has been withdrawn.
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348 Adverse outcomes in patients with peripheral vascular disease (PVD) following percutaneous coronary intervention (PCI) J. Ramzy 1,∗ , N. Andrianopoulos 2 , J. Sajeev 1 , L. Roberts 1 , S. Duffy 3 , D. Clark 4 , A. Teh 1 , A. Ajani 5 , C. Reid 2 , E. Oqueli 6 , G. New 1 , M. Freeman 1 1 Eastern
Health, VIC, Australia University - CCRET, VIC, Australia 3 Alfred Hospital, VIC, Australia 4 Austin Hospital, VIC, Australia 5 Royal Melbourne Hospital, VIC, Australia 6 Ballarat Base Hospital, VIC, Australia 2 Monash
Background: PVD is an independent risk factor for adverse outcomes following PCI. We aimed to evaluate the clinical characteristics and outcomes of patients with PVD undergoing PCI, and whether use of drug-eluting stents (DES) improved outcomes.
Methods: We analysed data from 18,380 patients undergoing PCI from an Australian registry between 2005 and 2013. Clinical and procedural data, 30-day and 12-month outcomes were compared in those with and without PVD. Long-term mortality was compared using National Death Index linkage (follow-up 4.9±2.6 years). Results: Patients with PVD (n=1,251, 6.8%) were older and had more diabetes, hypertension, cerebrovascular disease, heart failure, renal impairment, ostial lesions, left main and multi-vessel disease (all p<0.001). PVD was associated with greater in-hospital bleeding (1.9 vs. 1.1%, p=0.015). Patients with PVD had significantly higher rates of MACE in-hospital (5.7% vs. 4.1%, p<0.008), at 30-days (8.6% vs. 5.8%, p < 0.001) and 12-months (24.6% vs. 13.2%, p<0.001). There was significantly greater long-term mortality in the PVD group (see Kaplan-Meier figure). Forty-five per cent of patients with PVD had DES. This group experienced significantly less MACE than PVD patients treated with bare-metal stents (BMS) at 30 days (4.8 vs. 10.1%, p<0.001) and 12 months (19.4 vs. 26.4%, p<0.005).
Abstract
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Conclusions: PVD is associated with significantly worse outcomes in patients undergoing PCI. PVD patients receiving DES have improved outcomes compared with those receiving BMS. http://dx.doi.org/10.1016/j.hlc.2015.06.349 349 Age is no barrier to transcather aortic-valve replacement E. Shaw 1,2,∗ , V. Subban 1 , D. Murdoch 1,3 , M. Savage 1 , J. Crowhurst 1,3 , C. Raffel 1,3 , K. Poon 1,3 , A. Incani 1,3 , D. Walters 1,3 1 The
Prince Charles Hospital, QLD, Australia 2 The University of Sydney, NSW, Australia 3 The University of Queensland, QLD, Australia Background and Aim: Transcatheter aortic-valve replacement (TAVR) has emerged as an alternative for high-risk patients with severe aortic stenosis. With increasing life expectancies, there are a greater number of elderly patients requiring TAVR. We examined this cohort of patients and compared outcomes between nonagenarians (≥90 years old) patients and their younger (<90 years old) counterparts. Methods: Data in 209 patients undergoing TAVR at a single centre between August 2008 and July 2013 were examined. Statistical analysis was performed using SPSS version 22. Results: There were 29 nonagenarians and 180 patients <90 years old. Baseline characteristics of the 2 groups were similar. Mean age and STS score of younger patients and nonagenarians were 81.8 ± 6yrs vs 91.5 ± 1.7yrs and 5.77±3.42% vs 6.92±3.06% (p=0.09) respectively. There was no significant difference between younger patients and nonagenarians in their procedural complications of death (0% vs 3.4%, p > 0.1), myocardial infarction (MI) (1.7% vs 0%, p >0.6), cerebral vascular accident (CVA) (3.9% vs 3.4%, p >0.6) or major bleeding (9.4% vs 10%, p>0.3). At 1 year, there was no significant difference between younger patients and nonagenarians in mortality (10.6% and 17.2%, p >0.2), MI (3.3% vs 3.4%), CVA (1.1% vs 6.9%, p >0.09) or symptomatic relief with 15% of younger patients vs 3.5% of nonagenarians having NYHA >2 (p>0.13). Conclusion: Among high-risk patients, TAVR outcomes in selected nonagenarians are comparable to those obtained in younger patients. Age alone should not be a limiting factor when considering candidates for TAVR. http://dx.doi.org/10.1016/j.hlc.2015.06.350
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350 An article on coronary stent deployment by oversizing versus high pressure dilatation: a randomised intravascular ultrasound controlled study E. Zhou 1,∗ , S. Lo 2 , C. Mussap 2 , S. Burgess 2 , C. Juergens 2 1 University of New South Wales, NSW, Australia 2 Department of Cardiology, Liverpool Hospital, NSW, Australia
Background: Optimal stent deployment (OSD) typically requires high pressure post-dilatation (≥14 atm). This may cause intimal barotrauma injury, contributing to restenosis. This randomised controlled trial sought to determine the efficacy and safety of intravascular ultrasound (IVUS)-guided, lower pressure (≤10 atm) ‘oversized’ stent deployment versus conventional high pressure deployment. Methods: A total of 27 patients undergoing percutaneous coronary intervention were randomised to stent oversizing (n=14) or high pressure deployment (n=13). IVUS was used to measure the vessel and luminal diameters and areas at baseline. IVUS also measured the minimal stent area (MSA), minimal luminal diameter (MLD), average per cent stent expansion (APSE) and stent symmetry index (SSI) following initial stent deployment and after post-dilatation, if required. The primary endpoint was attainment of OSD criteria after initial stent deployment. Results: There were no overall differences in OSD between the stent oversize and high pressure groups (57.1% vs. 61.2% respectively, p = 1.00); nor between the final MSA (8.32 ± 2.28mm2 vs. 7.23 ± 2.10mm2 respectively, p = 0.23) and final MLD (3.00 ± 0.62mm vs. 3.00 ± 0.80mm respectively, p = 0.95). The stent oversize group had comparatively larger APSE (106.78 ± 22.01% vs. 91.00 ± 20.23%, p = 0.047) and greater SSI (0.90 ± 0.07 vs. 0.84 ± 0.08, p = 0.039). No adverse cardiac events occurred in either group at 30-day follow-up. Conclusions: This pilot study shows that IVUS-guided stent oversizing, without routine high pressure postdilatation, is both safe and achieves OSD through improved APSE and stent SSI measures. http://dx.doi.org/10.1016/j.hlc.2015.06.351