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AS-144: Efficacy of Stent Placement at an Ostial Left Anterior Descending Artery Stenosis with a Deep Caudal Projection
Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone) Conclusion: The lumen diameter and area measured with OCT was underestimated compared with IVUS, which must be considered when performing OCT-guided coronary intervention.
AS-141 Diagnostic Accuracy of 256-Computed Tomography Angiography in Patients with Suspected Coronary Artery Disease. Jun-Jack Cheng, Shu-Ping Chao, Kou-Gi Shyu, Jru-Ren Guo. Shin Kong Hospital, Taipei, Taiwan.
EP O S T E R A B S T R A C T S
Background: Noninvasive imaging of the coronary artery by computed tomography angiography (CTA) has been increasingly performed in recent years. The accuracy of 256-row CTA has not yet been studied. The aim of this study was to assess the accuracy of 256-row CTA compared with conventional coronary angiography (CCA) in the diagnosis and assessment of coronary artery disease (CAD). Methods: We prospectively evaluated 159 consecutive individuals who accepted CTA and then underwent CCA. The presence of stenosis of ⱖ50% was considered obstructive. The diagnostic accuracy of CTA for detecting obstructive stenosis was compared with that of CCA. The area under the receiver operating characteristic curve (AUC) was used to evaluate the diagnostic accuracy of CTA relative to CCA. Results: The segment-based analysis of CTA for detecting stenosis of ⱖ50% according to CCA revealed an AUC of 0.997 (95% confidence interval [CI], 0.991–1.002), with a sensitivity of 92.8%, a specificity of 92.1%, a positive predictive value of 68.3%, and a negative predictive value of 98.6%. The vessel-based analysis revealed an AUC of 0.7 (95% CI, 0.616 – 0.783), with a sensitivity of 95.6%, a specificity of 83.5%, a positive predictive value of 78.2%, and a negative predictive value of 96.8%. Conclusion: The presence and severity of CAD is accurately identified by 256-row CTA. Our data indicate that 256-row CTA has a powerful diagnostic ability and correlates well with CCA. The high negative predictive value indicates that 256-row CTA is a powerful test to exclude CAD.
AS-142 Association of Carotid Intima-Media Thickness and the Extent of Angiographically Silent Left Main Disease Detected by Virtual Histology Intravascular Ultrasound. William Hau, Stephen Lee, Shunling Kong, Michael Chan, Kelvin Chan, Jojo Hai, Simon Lam, Heehwa Ho, Raymond Chan. Queen Mary Hospital, Hong Kong, China. Background: Increase in the carotid intima-media thickness (cIMT) has been shown to be associated with an increased risk in cardiovascular events and correlated with traditional coronary artery disease (CAD) risk factors. Thus, cIMT has commonly been used for diagnosing patients at risk for CAD. However, studies comparing cIMT and the angiographic extents of CAD are inconclusive, and the association between cIMT and coronary plaque morphology in vivo has not been investigated. Intravascular ultrasound (IVUS) has been shown to detect angiographically silent left main coronary artery (LMCA) diseases. Virtual histology IVUS (VH-IVUS) extends the ability of IVUS to aid the assessment of 4 plaque types: fibrous, fibrofatty, necrotic core, and calcium. The aim of this study was to investigate whether there is an in vivo correlation among cIMT, the extent of coronary plaque burden, and the plaque composition of angiographically silent LMCA disease assessed by VH-IVUS. Methods: Patients who underwent LAD or LCX interventions and had angiographically normal LMCA were selected for VH-IVUS assessment using a solid-state IVUS catheter with 0.5 mm/s pullback speed. Plaque volume and the volume of the 4 plaque types of the VH-IVUS-detected LMCA diseases were measured. Carotid ultrasound scans were carried by
a sonographer unaware of quantitative coronary angiography and VHIVUS results. The carotid ultrasonic variables used in the statistical analyses were cIMT at the bulb, internal, and common arteries at both sides. Pearson correlation analysis between cIMT and VH-IVUS variables were evaluated, and p values ⱕ.05 were considered significant. Results: Twelve patients (aged 67.4 ⫾ 9.6; 8 men) were enrolled in the study. Percentage plaque burden by VH-IVUS was 51 ⫾ 6.9%. Mean % of the different plaque types were 58.5 ⫾ 10.1% fibrous, 24.0 ⫾ 11.9% fibrofatty, 6.3 ⫾ 6.4% calcium, and 11.2 ⫾ 11.2% necrotic core. Among the carotid ultrasonic variables measured, none were statistical significantly correlated with the plaque volume or the 4 VH-IVUS plaque types. Conclusion: cIMT is not able to predict the presence of angiographically silent LMCA disease revealed by VH-IVUS and is weakly correlated with the 4 atherosclerotic plaque types.
AS-143 Predictors of Contrast-Induced Nephropathy after Use of Nonionic Contrast Media during Percutaneous Coronary Intervention. Soo Hwan Park, Myung Ho Jeong, In Soo Kim, Jeong Hun Kim, Doo Hwan Lee, In Cheol Park, Kyung Soo Oh, Nam Yun Kim, Jin Hee Park, Jae Hun Lee, Young Suk Jeong, Hyun A Park, Hyun Kuk Kim, Sung Soo Kim, Jum Suk Ko, Min Goo Lee, Keun Ho Park, Doo Sun Sim, Nam Sik Yoon, Hyun Ju Yoon, Hyung Wook Park, Young Joon Hong, Ju Han Kim, Young Keun Ahn, Jeong Gwan Cho, Jong Chun Park, Jung Chae Kang. Chonnam National University Hospital, Gwangju, Republic of Korea. Background: Contrast-induced nephropathy (CIN), defined as the elevation of serum creatinine by more than 0.5 mg/dL or 25% of the baseline level after percutaneous coronary intervention (PCI), has recently been increasing. However, the preventive strategy for CIN remains unclear. The aim of this study was to assess the incidence and predictors of CIN when nonionic contrast media (Visipaque) is used. Methods: This study included 510 patients (aged 68.9 ⫾ 9.1 years, 384 men) who underwent diagnostic coronary angiography (CAG) or PCI using of nonionic contrast media between January 2006 and June 2009 and whose baseline serum creatinine level was ⱖ1.3 mg/dL. The patients were divided into 2 groups according to the rate of increase in the serum creatinine: group I (ⱖ20%) and group II (⬍20%). Results: Patients with CIN after CAG or PCI had lower left ventricular ejection fraction (LVEF; 50.9% ⫾ 14.0% vs 58.0% ⫾ 13.6%, p ⬍0.001), body mass index (22.8 ⫾ 2.9 vs 24.0 ⫾ 3.3 kg/m2, p ⬍0.001), and baseline hematocrit level (33.5% ⫾ 5.5% vs 36.6% ⫾ 5.5%, p ⬍0.001); more diabetes (55% vs 42.2%, p ⫽ 0.021), higher baseline creatine level (1.6 ⫾ 0.4 vs 1.5 ⫾ 0.3 mg/dL, p ⫽ 0.001), and higher in-hospital mortality (6% vs 3%, p ⬍0.001); and longer hospital stay (14.7 ⫾ 11.9 vs 8.5 ⫾ 8.2, p ⫽ 0.014). Independent risk factors for CIN were LVEF ⬍55% (hazard ratio [HR] ⫽ 2.852; 95% confidence interval [CI], 1.806 – 4.504, p ⬍0.001), baseline hematocrit ⬍37% (HR ⫽ 1.955; 95% CI, 1.189 –3.216, p ⫽ 0.008), and baseline creatinine ⬎1.5 mg/dL (HR ⫽ 1.737; 95% CI, 1.079 –2.797, p ⫽ 0.023). The incidence of CIN increased significantly when the amount of CM exceeded 135 mL by ROC curve. Conclusion: Predictors of CIN after use of nonionic contrast media during PCI were LVEF ⬍55%, baseline hematocrit 37%, and baseline creatinine 1.5 mg/dL.
AS-144 Efficacy of Stent Placement at an Ostial Left Anterior Descending Artery Stenosis with a Deep Caudal Projection. Kenji Sadamatsu, Yuka Tsutsumi, Nobuhiro Honda, Yuya Yoshidomi,
60B The American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster
Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone) Yasuaki Koga, Kaori Oba, Tomotake Tokunou, Haruki Tanaka, Keiki Yoshida. Saga Prefectural Hospital Koseikan, Saga, Japan. Background: Percutaneous coronary intervention in ostial lesions of the left anterior descending artery (LAD) remains challenging, even in the era of drug-eluting stents. We have investigated the optimization of the projection angle to clearly show the ostium of the LAD with 3-dimensional reconstruction of coronary angiography, and then the superiority of the deeper caudal projection to the standard right or left anterior oblique-caudal view was demonstrated. The aim of this study was to determine whether the deep caudal view is useful for the ostial stenting. Methods: Consecutive 30 patients who underwent stent placement to ostial lesions of the LAD with the deep caudal projection were
analyzed. We measured the distance from the bifurcation between the LAD and the circumflex artery to the proximal edge of the stent with intravascular ultrasound (IVUS). Results: Forty-degree projection of the right anterior oblique– caudal was used in 26 patients and 40° of the left anterior oblique– caudal in 4 patients. All procedures were successful. IVUS examination showed complete stent coverage of the ostium in 29 patients, and the stent edge protruded in the left main trunk within 1 mm in 20 patients and more than 1 mm in 9 patients. In only 1 case did the stent not cover the ostium, and the distance from the left main bifurcation to the stent proximal edge was 1.6 mm. The mean distance from the bifurcation to the stent was 0.66 ⫾ 0.85 mm. Conclusion: Stent placement using deep caudal projection may be an easy and appropriate method to treat the ostium of LAD lesions.
EP O S T E R A B S T R A C T S The American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster 61B
AS-141 Diagnostic Accuracy of 256-Computed Tomography Angiography in Patients with Suspected Coronary Artery Disease. Jun-Jack Cheng, Shu-Ping Chao, Kou-Gi Shyu, Jru-Ren Guo. Shin Kong Hospital, Taipei, Taiwan.
EP O S T E R A B S T R A C T S
Background: Noninvasive imaging of the coronary artery by computed tomography angiography (CTA) has been increasingly performed in recent years. The accuracy of 256-row CTA has not yet been studied. The aim of this study was to assess the accuracy of 256-row CTA compared with conventional coronary angiography (CCA) in the diagnosis and assessment of coronary artery disease (CAD). Methods: We prospectively evaluated 159 consecutive individuals who accepted CTA and then underwent CCA. The presence of stenosis of ⱖ50% was considered obstructive. The diagnostic accuracy of CTA for detecting obstructive stenosis was compared with that of CCA. The area under the receiver operating characteristic curve (AUC) was used to evaluate the diagnostic accuracy of CTA relative to CCA. Results: The segment-based analysis of CTA for detecting stenosis of ⱖ50% according to CCA revealed an AUC of 0.997 (95% confidence interval [CI], 0.991–1.002), with a sensitivity of 92.8%, a specificity of 92.1%, a positive predictive value of 68.3%, and a negative predictive value of 98.6%. The vessel-based analysis revealed an AUC of 0.7 (95% CI, 0.616 – 0.783), with a sensitivity of 95.6%, a specificity of 83.5%, a positive predictive value of 78.2%, and a negative predictive value of 96.8%. Conclusion: The presence and severity of CAD is accurately identified by 256-row CTA. Our data indicate that 256-row CTA has a powerful diagnostic ability and correlates well with CCA. The high negative predictive value indicates that 256-row CTA is a powerful test to exclude CAD.
AS-142 Association of Carotid Intima-Media Thickness and the Extent of Angiographically Silent Left Main Disease Detected by Virtual Histology Intravascular Ultrasound. William Hau, Stephen Lee, Shunling Kong, Michael Chan, Kelvin Chan, Jojo Hai, Simon Lam, Heehwa Ho, Raymond Chan. Queen Mary Hospital, Hong Kong, China. Background: Increase in the carotid intima-media thickness (cIMT) has been shown to be associated with an increased risk in cardiovascular events and correlated with traditional coronary artery disease (CAD) risk factors. Thus, cIMT has commonly been used for diagnosing patients at risk for CAD. However, studies comparing cIMT and the angiographic extents of CAD are inconclusive, and the association between cIMT and coronary plaque morphology in vivo has not been investigated. Intravascular ultrasound (IVUS) has been shown to detect angiographically silent left main coronary artery (LMCA) diseases. Virtual histology IVUS (VH-IVUS) extends the ability of IVUS to aid the assessment of 4 plaque types: fibrous, fibrofatty, necrotic core, and calcium. The aim of this study was to investigate whether there is an in vivo correlation among cIMT, the extent of coronary plaque burden, and the plaque composition of angiographically silent LMCA disease assessed by VH-IVUS. Methods: Patients who underwent LAD or LCX interventions and had angiographically normal LMCA were selected for VH-IVUS assessment using a solid-state IVUS catheter with 0.5 mm/s pullback speed. Plaque volume and the volume of the 4 plaque types of the VH-IVUS-detected LMCA diseases were measured. Carotid ultrasound scans were carried by
a sonographer unaware of quantitative coronary angiography and VHIVUS results. The carotid ultrasonic variables used in the statistical analyses were cIMT at the bulb, internal, and common arteries at both sides. Pearson correlation analysis between cIMT and VH-IVUS variables were evaluated, and p values ⱕ.05 were considered significant. Results: Twelve patients (aged 67.4 ⫾ 9.6; 8 men) were enrolled in the study. Percentage plaque burden by VH-IVUS was 51 ⫾ 6.9%. Mean % of the different plaque types were 58.5 ⫾ 10.1% fibrous, 24.0 ⫾ 11.9% fibrofatty, 6.3 ⫾ 6.4% calcium, and 11.2 ⫾ 11.2% necrotic core. Among the carotid ultrasonic variables measured, none were statistical significantly correlated with the plaque volume or the 4 VH-IVUS plaque types. Conclusion: cIMT is not able to predict the presence of angiographically silent LMCA disease revealed by VH-IVUS and is weakly correlated with the 4 atherosclerotic plaque types.
AS-143 Predictors of Contrast-Induced Nephropathy after Use of Nonionic Contrast Media during Percutaneous Coronary Intervention. Soo Hwan Park, Myung Ho Jeong, In Soo Kim, Jeong Hun Kim, Doo Hwan Lee, In Cheol Park, Kyung Soo Oh, Nam Yun Kim, Jin Hee Park, Jae Hun Lee, Young Suk Jeong, Hyun A Park, Hyun Kuk Kim, Sung Soo Kim, Jum Suk Ko, Min Goo Lee, Keun Ho Park, Doo Sun Sim, Nam Sik Yoon, Hyun Ju Yoon, Hyung Wook Park, Young Joon Hong, Ju Han Kim, Young Keun Ahn, Jeong Gwan Cho, Jong Chun Park, Jung Chae Kang. Chonnam National University Hospital, Gwangju, Republic of Korea. Background: Contrast-induced nephropathy (CIN), defined as the elevation of serum creatinine by more than 0.5 mg/dL or 25% of the baseline level after percutaneous coronary intervention (PCI), has recently been increasing. However, the preventive strategy for CIN remains unclear. The aim of this study was to assess the incidence and predictors of CIN when nonionic contrast media (Visipaque) is used. Methods: This study included 510 patients (aged 68.9 ⫾ 9.1 years, 384 men) who underwent diagnostic coronary angiography (CAG) or PCI using of nonionic contrast media between January 2006 and June 2009 and whose baseline serum creatinine level was ⱖ1.3 mg/dL. The patients were divided into 2 groups according to the rate of increase in the serum creatinine: group I (ⱖ20%) and group II (⬍20%). Results: Patients with CIN after CAG or PCI had lower left ventricular ejection fraction (LVEF; 50.9% ⫾ 14.0% vs 58.0% ⫾ 13.6%, p ⬍0.001), body mass index (22.8 ⫾ 2.9 vs 24.0 ⫾ 3.3 kg/m2, p ⬍0.001), and baseline hematocrit level (33.5% ⫾ 5.5% vs 36.6% ⫾ 5.5%, p ⬍0.001); more diabetes (55% vs 42.2%, p ⫽ 0.021), higher baseline creatine level (1.6 ⫾ 0.4 vs 1.5 ⫾ 0.3 mg/dL, p ⫽ 0.001), and higher in-hospital mortality (6% vs 3%, p ⬍0.001); and longer hospital stay (14.7 ⫾ 11.9 vs 8.5 ⫾ 8.2, p ⫽ 0.014). Independent risk factors for CIN were LVEF ⬍55% (hazard ratio [HR] ⫽ 2.852; 95% confidence interval [CI], 1.806 – 4.504, p ⬍0.001), baseline hematocrit ⬍37% (HR ⫽ 1.955; 95% CI, 1.189 –3.216, p ⫽ 0.008), and baseline creatinine ⬎1.5 mg/dL (HR ⫽ 1.737; 95% CI, 1.079 –2.797, p ⫽ 0.023). The incidence of CIN increased significantly when the amount of CM exceeded 135 mL by ROC curve. Conclusion: Predictors of CIN after use of nonionic contrast media during PCI were LVEF ⬍55%, baseline hematocrit 37%, and baseline creatinine 1.5 mg/dL.
AS-144 Efficacy of Stent Placement at an Ostial Left Anterior Descending Artery Stenosis with a Deep Caudal Projection. Kenji Sadamatsu, Yuka Tsutsumi, Nobuhiro Honda, Yuya Yoshidomi,
60B The American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster
Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone) Yasuaki Koga, Kaori Oba, Tomotake Tokunou, Haruki Tanaka, Keiki Yoshida. Saga Prefectural Hospital Koseikan, Saga, Japan. Background: Percutaneous coronary intervention in ostial lesions of the left anterior descending artery (LAD) remains challenging, even in the era of drug-eluting stents. We have investigated the optimization of the projection angle to clearly show the ostium of the LAD with 3-dimensional reconstruction of coronary angiography, and then the superiority of the deeper caudal projection to the standard right or left anterior oblique-caudal view was demonstrated. The aim of this study was to determine whether the deep caudal view is useful for the ostial stenting. Methods: Consecutive 30 patients who underwent stent placement to ostial lesions of the LAD with the deep caudal projection were
analyzed. We measured the distance from the bifurcation between the LAD and the circumflex artery to the proximal edge of the stent with intravascular ultrasound (IVUS). Results: Forty-degree projection of the right anterior oblique– caudal was used in 26 patients and 40° of the left anterior oblique– caudal in 4 patients. All procedures were successful. IVUS examination showed complete stent coverage of the ostium in 29 patients, and the stent edge protruded in the left main trunk within 1 mm in 20 patients and more than 1 mm in 9 patients. In only 1 case did the stent not cover the ostium, and the distance from the left main bifurcation to the stent proximal edge was 1.6 mm. The mean distance from the bifurcation to the stent was 0.66 ⫾ 0.85 mm. Conclusion: Stent placement using deep caudal projection may be an easy and appropriate method to treat the ostium of LAD lesions.
EP O S T E R A B S T R A C T S The American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster 61B