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AN EARLY INVASIVE STRATEGY IN ELDERLY PATIENTS WITH ACUTE CORONARY SYNDROMES (ACS)—ARE WE MAKING A DIFFERENCE?
S20
Heart, Lung and Circulation 2008;17S:S1–S34
Abstracts
ABSTRACTS
Method: From March 2004 to September 2007, 49 patients with ABS were identified in the Auckland region and data prospectively collected. Results: 96% were female of mean age 65 years. They included 73% European and 12% Maori patients. Chest pain was described in 82% and dyspnoea in 39%. A triggering emotional or physical stressor was identified in 37% patients. ST-segment elevation on electrocardiogram was noted in 22 patients (45%) of whom 4 received thrombolytic therapy. All patients had raised cardiac troponin level. All had apical and mid-distal LV wall motion abnormality with most (78%) having at least moderate LV systolic impairment acutely. 14% had concomitant right ventricular involvement. Four patients had systolic anterior motion of mitral valve and moderate to severe mitral regurgitation. 8 (16%) had radiological pulmonary oedema. 2 (4%) had VF, 3 (6%) VT and 4 (8%) had AF. Two patients died, one with cardiogenic shock and another with intractable arrhythmias. Conclusion: The demographics and clinical presentation in Auckland are similar to that described in other countries. In the acute phase ABS is not a benign condition, a significant minority of patients having major hemodynamic or arrhythmic complications. doi:10.1016/j.hlc.2008.03.043 43 LONG-TERM FOLLOW-UP OF THE MOSAIC AORTIC BIOPROSTHESIS—A THIRD-GENERATION PORCINE VALVE THE GREEN LANE EXPERIENCE 1995–2007 ME Legget ∗ , S Simpson-Plauman, PJ Raudkivi Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand Background: The Mosaic bioprosthesis is a thirdgeneration porcine stented valve utilising root pressure fixation, with zero-pressure leaflet fixation, a low profile stent, and alpha amino oleic acid (AOA) antimineralisation treatment. Methods: Between 1995 and 1998, 98 patients underwent aortic valve replacement (AVR) using this prosthesis. Seventy (71%) were males with a mean age of 69.2 years (range 34.2–83.6). Fifty-nine (60%) patients underwent concomitant procedures. Results: Early (<30 days) complications included 1 (1.0%) death, 3 (3.1%) re-operations, greater than mild regurgitation (paravalvular) in 1 (1.0%) patient and thromboembolism in 4 (4.1%). Long-term clinical follow-up was for a mean of 7.6 years (range 17 days to 12.2 years), 744 patient-years (Pt-Yr). Late complications included 38 deaths (5.2%/Pt-Yr), of which 12 were cardiac and 3 valve related (0.4%/Pt-Yr). There were 6 re-operations—2 for endocarditis, 1 for non-structural valve dysfunction, and 3 for structural valve deterioration. Overall survival at 5 and 10 years was 87% and 69%, and freedom from re-operation was 97% and 91%, respectively.
Late follow-up echocardiography in 67 patients at a mean of 8.7 years (range 6–12 years, 580 Pt-Yr). Valvular regurgitation was present in 9 patients (8 trivial/mild, 1 moderate). Echo parameters at 6+ years postoperative Valve size
Peak velocity
Mean gradient
Effective orifice area
Small
2.7 ± 0.5 m/s
14.0 ± 6.9 mmHg
1.5 ± 0.4 cm2
Large
2.4 ± 0.6 m/s
11.5 ± 6.6 mmHg
1.9 ± 0.6 m2
(Valve size: small = 21, 23 mm; large = 25, 27, 29 mm). Conclusion: The mosaic aortic bioprosthesis demonstrates acceptable medium term results in terms of structural integrity and haemodynamic performance. doi:10.1016/j.hlc.2008.03.044 44 AN EARLY INVASIVE STRATEGY IN ELDERLY PATIENTS WITH ACUTE CORONARY SYNDROMES (ACS)—ARE WE MAKING A DIFFERENCE? AN AUDIT OF CCU ADMISSIONS 2001 AND 2006 AT AUCKLAND AND GREEN LANE HOSPITAL G Raj ∗ , ME Legget, RAH Stewart, HD White, PN Ruygrok Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand Background: More aggressive use of early revascularisation therapy for acute coronary syndromes in the elderly has improved outcomes. The aim of this audit was to compare coronary angiography and intervention rates, and 1-year mortality in patients aged ≥80 years admitted with an acute coronary syndrome in the years 2001 and 2006. Methods: All patients ≥80 years admitted to Auckland and Green Lane CCUs in 2001 and 2006 were identified. The catheter lab database was used to identify those who went on to catheterisation or percutaneous intervention (PCI). One-Year mortality was determined from NZHIS (New Zealand Health Information Systems). Results: Year 2001
P-Value 2006
Number of patients
297
Age (mean, range in years)
83.9 (80–95)
230 84 (80–98)
Coronary angiography
26 (10%)
84 (36%)
<0.0001
<0.0001
PCI
13 (4%)
45 (20%)
<0.01
0.75
NS
%PCI after angiography
50%
54%
NS
CABG
5 (1.7%)
6 (2.6%)
NS
%CABG after angiography
19%
8%
NS
1-Year mortality
72 (24%)
64 (28%)
NS
0.35
1-Year mortality invasive group
4 (15%)
17 (20%)
NS
0.6
Conclusion: Between 2001 and 2006 early angiography and PCI increased in elderly patients presenting with an acute coronary syndrome. However one-year mortality remains high and did not decrease. doi:10.1016/j.hlc.2008.03.045
Heart, Lung and Circulation 2008;17S:S1–S34
Abstracts
ABSTRACTS
Method: From March 2004 to September 2007, 49 patients with ABS were identified in the Auckland region and data prospectively collected. Results: 96% were female of mean age 65 years. They included 73% European and 12% Maori patients. Chest pain was described in 82% and dyspnoea in 39%. A triggering emotional or physical stressor was identified in 37% patients. ST-segment elevation on electrocardiogram was noted in 22 patients (45%) of whom 4 received thrombolytic therapy. All patients had raised cardiac troponin level. All had apical and mid-distal LV wall motion abnormality with most (78%) having at least moderate LV systolic impairment acutely. 14% had concomitant right ventricular involvement. Four patients had systolic anterior motion of mitral valve and moderate to severe mitral regurgitation. 8 (16%) had radiological pulmonary oedema. 2 (4%) had VF, 3 (6%) VT and 4 (8%) had AF. Two patients died, one with cardiogenic shock and another with intractable arrhythmias. Conclusion: The demographics and clinical presentation in Auckland are similar to that described in other countries. In the acute phase ABS is not a benign condition, a significant minority of patients having major hemodynamic or arrhythmic complications. doi:10.1016/j.hlc.2008.03.043 43 LONG-TERM FOLLOW-UP OF THE MOSAIC AORTIC BIOPROSTHESIS—A THIRD-GENERATION PORCINE VALVE THE GREEN LANE EXPERIENCE 1995–2007 ME Legget ∗ , S Simpson-Plauman, PJ Raudkivi Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand Background: The Mosaic bioprosthesis is a thirdgeneration porcine stented valve utilising root pressure fixation, with zero-pressure leaflet fixation, a low profile stent, and alpha amino oleic acid (AOA) antimineralisation treatment. Methods: Between 1995 and 1998, 98 patients underwent aortic valve replacement (AVR) using this prosthesis. Seventy (71%) were males with a mean age of 69.2 years (range 34.2–83.6). Fifty-nine (60%) patients underwent concomitant procedures. Results: Early (<30 days) complications included 1 (1.0%) death, 3 (3.1%) re-operations, greater than mild regurgitation (paravalvular) in 1 (1.0%) patient and thromboembolism in 4 (4.1%). Long-term clinical follow-up was for a mean of 7.6 years (range 17 days to 12.2 years), 744 patient-years (Pt-Yr). Late complications included 38 deaths (5.2%/Pt-Yr), of which 12 were cardiac and 3 valve related (0.4%/Pt-Yr). There were 6 re-operations—2 for endocarditis, 1 for non-structural valve dysfunction, and 3 for structural valve deterioration. Overall survival at 5 and 10 years was 87% and 69%, and freedom from re-operation was 97% and 91%, respectively.
Late follow-up echocardiography in 67 patients at a mean of 8.7 years (range 6–12 years, 580 Pt-Yr). Valvular regurgitation was present in 9 patients (8 trivial/mild, 1 moderate). Echo parameters at 6+ years postoperative Valve size
Peak velocity
Mean gradient
Effective orifice area
Small
2.7 ± 0.5 m/s
14.0 ± 6.9 mmHg
1.5 ± 0.4 cm2
Large
2.4 ± 0.6 m/s
11.5 ± 6.6 mmHg
1.9 ± 0.6 m2
(Valve size: small = 21, 23 mm; large = 25, 27, 29 mm). Conclusion: The mosaic aortic bioprosthesis demonstrates acceptable medium term results in terms of structural integrity and haemodynamic performance. doi:10.1016/j.hlc.2008.03.044 44 AN EARLY INVASIVE STRATEGY IN ELDERLY PATIENTS WITH ACUTE CORONARY SYNDROMES (ACS)—ARE WE MAKING A DIFFERENCE? AN AUDIT OF CCU ADMISSIONS 2001 AND 2006 AT AUCKLAND AND GREEN LANE HOSPITAL G Raj ∗ , ME Legget, RAH Stewart, HD White, PN Ruygrok Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand Background: More aggressive use of early revascularisation therapy for acute coronary syndromes in the elderly has improved outcomes. The aim of this audit was to compare coronary angiography and intervention rates, and 1-year mortality in patients aged ≥80 years admitted with an acute coronary syndrome in the years 2001 and 2006. Methods: All patients ≥80 years admitted to Auckland and Green Lane CCUs in 2001 and 2006 were identified. The catheter lab database was used to identify those who went on to catheterisation or percutaneous intervention (PCI). One-Year mortality was determined from NZHIS (New Zealand Health Information Systems). Results: Year 2001
P-Value 2006
Number of patients
297
Age (mean, range in years)
83.9 (80–95)
230 84 (80–98)
Coronary angiography
26 (10%)
84 (36%)
<0.0001
<0.0001
PCI
13 (4%)
45 (20%)
<0.01
0.75
NS
%PCI after angiography
50%
54%
NS
CABG
5 (1.7%)
6 (2.6%)
NS
%CABG after angiography
19%
8%
NS
1-Year mortality
72 (24%)
64 (28%)
NS
0.35
1-Year mortality invasive group
4 (15%)
17 (20%)
NS
0.6
Conclusion: Between 2001 and 2006 early angiography and PCI increased in elderly patients presenting with an acute coronary syndrome. However one-year mortality remains high and did not decrease. doi:10.1016/j.hlc.2008.03.045