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AS-129 Percutaneous Coronary Interventions without On-Site Cardiac Surgery Support (CINWOS) Study
Wednesday, April 27 - Friday April 29, 2011 (Poster Abstract Zone)
AS-130
Miscellaneous Wednesday, April 27, 2011 2:00 PM ⬃ 6:00 PM (Abstract nos. AS-129, AS-130, AS-132, AS-133, AS-134, AS-252–AS-258)
AS-129 Percutaneous Coronary Interventions without On-Site Cardiac Surgery Support (CINWOS) Study. Afzalur Rahman, Jahurul Haque, Shahinur Rahman, Habid Chaudhury, Anisur Khan, Khondoker Asaduzzaman, Sania Hoque. Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh. Background: There is still controversy regarding performing elective percutaneous coronary interventions (PCI) in a centre without on site cardiac surgery. As on site cardiac surgery may not be possible to provide in all the places, greater attention is being given to this topic. We sought to determine the safety of PCI without cardiac surgical support on-site and specifically the safety of complex elective procedures. Methods: Between March 2009 and Dec 2009 a total of 123 elective PCI procedures performed at our outreach university medical centre were prospectively analyzed. The incidence of major cardiac events (MACE) were recorded. Staged procedure was followed especially in high risk multi vessel PCI. Adequate anticoagulant and anti-platelet therapy were followed as per strict protocol. High pressure stent deployment and post dilatation were our standard strategy Results: Out of 123 patient Male 82% and 18.7% Female; the mean(⫾ SD) age 53 (⫾ 8). Multi-vessel PCI 44.71 %, bifurcation PCI 8%, chronic total occlusions 4.87 %, Osteal lesion 2.43 % saphenous vein graft interventions 2% and left main stenting 1.8%. 30.9% patients were diabetic. Among the patient 17.1% was chronic stable angina, unstable angina was 8.1%, post-MI angina was 74.8%. DES 16.3% and BMS 83.7%. 84.6% of the lesions treated were type B or C lesions. The device success rate 99.18% and procedural success rate 99%. The mean (⫾SD) lesion length was 17.42 (⫾6.88) mm and that of reference vessel diameter was 2.43 (⫾0.43) mm. The incidence major cardiac events (MACE) were: Cardiac Death 0(0%), non-cardiac death 1(0.8%), Intraprocedural thrombosis- 1(0.81%), acute ST- 0(0%), Subacute ST- 0(0%), Non-ST MI- 0(0%), ST MI- 0(0%). Conclusion: Among the subjects there was no major cardiac event. Our result supports that elective PCI performed under thorough medicinal management, can be safely performed even in high risk multivessel lesion without on-site cardiac surgery by experience operators followed the staged procedure and high pressure stent deployment.
Cardiac Syndrome X - Clinical and Angiographic Characteristics. Ezhumalai Babu, Ananthakrishna Pillai Ajith, Palamalai Arunprasath, Koonamavu Geofi George, Balakrishnan Karthikeyan, Packirisamy Gobu, Satheesh Santhosh, Raja Selvaraj, Jayaraman Balachander. Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India. Background: Cardiac syndrome X includes a heterogeneous group of patients with angina but normal coronaries by angiography. We aimed to study the clinical and angiographic characteristics of patients with cardiac syndrome X. Methods: A retrospective analysis of the data of patients who underwent coronary angiography over a period of one year from July 2009 to June 2010 was done. Those satisfying the following criteria were included in the study: Clinical features of typical angina OR At least one objective evidence of ischemia which may be: a. ST – T changes in electrocardiogram b. Regional wall motion abnormality in echocardiography c. Positive treadmill test WITH Normal or non-obstructive coronaries in angiography(less than 50% stenosis in epicardial coronaries) Results: A total of 1203 patients had undergone coronary angiography during the study period. Out of these, 105 (8.73 %) patients fulfilled the inclusion criteria. There were 52 (49.52 %) males and 53 (50.48 %) females including 31 (29.52 %) postmenopausal women. The average age was 52.85 ⫾ 8.91 years. There were 56 (53.33 %) patients with hypertension, 31 (29.52 %) with type 2 diabetes, 17 (16.19 %) with BMI more than 25, 32 (30.48 %) with documented dyslipidemia and 19 (18.09%) with smoking habit. Analysis of symptoms revealed effort induced angina in 63 (60 %) patients and angina at rest in 40 (38.09 %) patients. Two (1.9 %) patients though had no complaints of angina, demonstrated objective evidence of ischemia. Resting electrocardiogram showed ST - T changes in 49 (46.67 %) patients, Q waves in 5 (4.76 %) patients and bundle branch blocks in 5 (4.76 %) patients. Echocardiography revealed regional wall motion abnormality with mild left ventricular systolic dysfunction in 4 (3.81 %) patients while the remaining 101 (96.19 %) patients had normal study. Treadmill test based on modified Bruce Protocol was positive for inducible ischemia in 32 (30.48 %) patients, strongly positive in 3(2.86%) patients, and inconclusive in 10 (9.52 %) patients. Angiography showed normal epicardial coronaries in 85 (80.95 %) patients, minor luminal irregularities in 11 (10.48 %) patients, ectasia of coronaries in 4 (3.81 %) patients and slow flow phenomenon in 6 (5.71 %) patients. One of these patients had both coronary ectasia and slow flow phenomenon. All patients demonstrated right coronary dominance. Anomalous origin of left circumflex from right coronary was seen in one patient. Conclusion: Cardiac syndrome X constitutes a significant subset of patients undergoing coronary angiography. It is essential to identify and treat them specifically for microvascular angina. Many of these patients have atherosclerotic risk factors underscoring the same pathophysiology in microvascular angina. Their presentation is different and prognosis is excellent compared to those with obstructive coronaries.
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Poster
99A
P O S T E R A B S T R A C T S
AS-130
Miscellaneous Wednesday, April 27, 2011 2:00 PM ⬃ 6:00 PM (Abstract nos. AS-129, AS-130, AS-132, AS-133, AS-134, AS-252–AS-258)
AS-129 Percutaneous Coronary Interventions without On-Site Cardiac Surgery Support (CINWOS) Study. Afzalur Rahman, Jahurul Haque, Shahinur Rahman, Habid Chaudhury, Anisur Khan, Khondoker Asaduzzaman, Sania Hoque. Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh. Background: There is still controversy regarding performing elective percutaneous coronary interventions (PCI) in a centre without on site cardiac surgery. As on site cardiac surgery may not be possible to provide in all the places, greater attention is being given to this topic. We sought to determine the safety of PCI without cardiac surgical support on-site and specifically the safety of complex elective procedures. Methods: Between March 2009 and Dec 2009 a total of 123 elective PCI procedures performed at our outreach university medical centre were prospectively analyzed. The incidence of major cardiac events (MACE) were recorded. Staged procedure was followed especially in high risk multi vessel PCI. Adequate anticoagulant and anti-platelet therapy were followed as per strict protocol. High pressure stent deployment and post dilatation were our standard strategy Results: Out of 123 patient Male 82% and 18.7% Female; the mean(⫾ SD) age 53 (⫾ 8). Multi-vessel PCI 44.71 %, bifurcation PCI 8%, chronic total occlusions 4.87 %, Osteal lesion 2.43 % saphenous vein graft interventions 2% and left main stenting 1.8%. 30.9% patients were diabetic. Among the patient 17.1% was chronic stable angina, unstable angina was 8.1%, post-MI angina was 74.8%. DES 16.3% and BMS 83.7%. 84.6% of the lesions treated were type B or C lesions. The device success rate 99.18% and procedural success rate 99%. The mean (⫾SD) lesion length was 17.42 (⫾6.88) mm and that of reference vessel diameter was 2.43 (⫾0.43) mm. The incidence major cardiac events (MACE) were: Cardiac Death 0(0%), non-cardiac death 1(0.8%), Intraprocedural thrombosis- 1(0.81%), acute ST- 0(0%), Subacute ST- 0(0%), Non-ST MI- 0(0%), ST MI- 0(0%). Conclusion: Among the subjects there was no major cardiac event. Our result supports that elective PCI performed under thorough medicinal management, can be safely performed even in high risk multivessel lesion without on-site cardiac surgery by experience operators followed the staged procedure and high pressure stent deployment.
Cardiac Syndrome X - Clinical and Angiographic Characteristics. Ezhumalai Babu, Ananthakrishna Pillai Ajith, Palamalai Arunprasath, Koonamavu Geofi George, Balakrishnan Karthikeyan, Packirisamy Gobu, Satheesh Santhosh, Raja Selvaraj, Jayaraman Balachander. Department of Cardiology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India. Background: Cardiac syndrome X includes a heterogeneous group of patients with angina but normal coronaries by angiography. We aimed to study the clinical and angiographic characteristics of patients with cardiac syndrome X. Methods: A retrospective analysis of the data of patients who underwent coronary angiography over a period of one year from July 2009 to June 2010 was done. Those satisfying the following criteria were included in the study: Clinical features of typical angina OR At least one objective evidence of ischemia which may be: a. ST – T changes in electrocardiogram b. Regional wall motion abnormality in echocardiography c. Positive treadmill test WITH Normal or non-obstructive coronaries in angiography(less than 50% stenosis in epicardial coronaries) Results: A total of 1203 patients had undergone coronary angiography during the study period. Out of these, 105 (8.73 %) patients fulfilled the inclusion criteria. There were 52 (49.52 %) males and 53 (50.48 %) females including 31 (29.52 %) postmenopausal women. The average age was 52.85 ⫾ 8.91 years. There were 56 (53.33 %) patients with hypertension, 31 (29.52 %) with type 2 diabetes, 17 (16.19 %) with BMI more than 25, 32 (30.48 %) with documented dyslipidemia and 19 (18.09%) with smoking habit. Analysis of symptoms revealed effort induced angina in 63 (60 %) patients and angina at rest in 40 (38.09 %) patients. Two (1.9 %) patients though had no complaints of angina, demonstrated objective evidence of ischemia. Resting electrocardiogram showed ST - T changes in 49 (46.67 %) patients, Q waves in 5 (4.76 %) patients and bundle branch blocks in 5 (4.76 %) patients. Echocardiography revealed regional wall motion abnormality with mild left ventricular systolic dysfunction in 4 (3.81 %) patients while the remaining 101 (96.19 %) patients had normal study. Treadmill test based on modified Bruce Protocol was positive for inducible ischemia in 32 (30.48 %) patients, strongly positive in 3(2.86%) patients, and inconclusive in 10 (9.52 %) patients. Angiography showed normal epicardial coronaries in 85 (80.95 %) patients, minor luminal irregularities in 11 (10.48 %) patients, ectasia of coronaries in 4 (3.81 %) patients and slow flow phenomenon in 6 (5.71 %) patients. One of these patients had both coronary ectasia and slow flow phenomenon. All patients demonstrated right coronary dominance. Anomalous origin of left circumflex from right coronary was seen in one patient. Conclusion: Cardiac syndrome X constitutes a significant subset of patients undergoing coronary angiography. It is essential to identify and treat them specifically for microvascular angina. Many of these patients have atherosclerotic risk factors underscoring the same pathophysiology in microvascular angina. Their presentation is different and prognosis is excellent compared to those with obstructive coronaries.
The American Journal of Cardiology姞 APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Poster
99A
P O S T E R A B S T R A C T S