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AS-147 Characteristics, In-Hospital and Long-Term Clinical Outcomes of Nonagenarian AMI Patients Compared with Octogenarian AMI patients
April 24 –27, 2012
Angina Treatment Complex PCI V Thursday, April 26, 2012 8:30 AM ⬃ 9:30 AM (Abstract nos. AS-142, AS-147) Complex PCI VI Thursday, April 26, 2012 4:00 AM ⬃ 5:00 AM (Abstract no. AS-143) AS-142 Successful DES Deployment for GEA Graft Stenosis. Akihiko Matsumura, Masakazu Ohno. Kameda Medical Center, Kamogawa, Japan. Background: An 84 year-old female with history of CABG (LITALAD, free RITA-OM, GEA-RCA) was admitted to our hospital. Methods: She felt chest discomfort and nausea when waking-up and electrocardiogram disclosed ST segment depression of chest leads, which suggested angina. Emergent coronary angiography was performed and 90% stenosis of the mid gastroepiploic artery (GEA) graft, which was patent in 2002. Results: Six French JR4 guiding catheter was cannulated to the celiac artery and pre-dilatation was performed with 2.0mm balloon. Subsequent intravascular ultrasound (IVUS) examination disclosed focal atheroscrelotic change at the stenotic site. After IVUS examination, 3.0x15mm xience V stent was implanted successfully. The patient is free from angina and coronary CT 9 month after the procedure revealed good patency of the stent site. Conclusion: We report a rare case of DES implantation to stenotic GEA graft.
AS-143 The Long-Term Cardiac Mortality and the Rate of Percutaneous Coronary Intervention in Korean Vasospastic Angina Patients. Dong Il Shin, Ki Bae Seung, Seok Min Seo, Yoon Seok Ko, Hoon Joon Park, Pum Joon Kim, Ki Yook Chang, Wook Sung Chung. The Catholic University of Korea, Seoul, Korea (Republic of). Background: There have been few reports about long-term prognosis of vasospastic angina (VA) in the East. We estimated long-term mortality and rate of percutaneous coronary intervention (PCI) due to de novo atherosclerotic change in known Korean VA using data-sets of VA-CMC (Vasospastic Angina in Catholic Medical Center) registry.
Methods: Total 952 patients of 8 centers in CMC were enrolled to VA-CMC registry from March 2008 to October 2010. The patients were diagnosed as VA by acetylcholine or ergonovine provocation test using the same criteria; “total or near total occlusion with ischemic electrocardiographic change or ischemic symptom or both”. Patients who had significant atherosclerotic stenosis (⬎50% of luminal diameter narrowing) on their baseline angiography were excluded. We also excluded the patients with significant heart failure or renal failure, cancer, inflammatory disease, and catheter-induced spasm on angiography. All patients in the registry received conventional vasodilator therapy including calcium-channel blockers or nitrates during follow up period. Out of these patients, 442 patients were included as study subjects in this retrospective analysis. The mean follow-up duration was 39⫾11 months. We evaluated the rate of cardiac or non-cardiac deaths and the rate of PCI. Results: During follow up period, the rate of mortality was 2.71% (12 patients). Nine patients died from cardiac cause (2.04%). Baseline and angiographic characteristics were similar between patients who died and survivors, however, patients who died demonstrated a higher frequency of diffuse type of vasospasm on initial vasospasm provocation test and a higher rate of drug cessation during follow up period than survivors (p⬍0.05, respectively). In multivariate analysis, drug cessation was an independent risk factor for cardiac mortality (odds ratio 1.47, p⬍0.05). The rate of PCI due to development of de novo atherosclerosis was 2.26% (10 patients). Out of 10 patients, only 3 patients (0.68%) demonstrated the development of significant atherosclerosis on the segment of vasospasm documented on previous provocation test. In other 7 patients, PCI was done for de novo atherosclerosis on non-vasospastic segment. PCI group had higher numbers of male, current smoker, and higher level of initial hsCRP than non-PCI group (p⬍0.05, respectively). In multivariate analysis, current smoking (odds ratio 2.31, p⬍0.05) and high level of initial hsCRP (odds ratio 1.57, p⬍0.05) were independent risk factors for PCI. Conclusion: In Korean VA patients, the rates of cardiac mortality (2.04%) and development of de novo atherosclerosis (2.26%) were very low. During follow up, atherosclerotic change developed more frequently on non-vasospastic segment than on the segment of vasospasm. Current smoking, increased hsCRP and drug cessation were independent risk factors for unfavorable outcomes in Korean VA patients.
AS-147 Characteristics, In-Hospital and Long-Term Clinical Outcomes of Nonagenarian AMI Patients Compared with Octogenarian AMI patients. Ki Hong Lee1, Youngkeun Ahn1, Myung Ho Jeong1, Donghan Kim1, Shung Chull Chae2, Young Jo Kim3, Jei Keon Chae4, Myeong Chan Cho5, Chong Jin Kim6. 1Chonnam National University Hospital, Gwang-ju, Korea (Republic of); 2 Kyungpook National University Hospital, Deagu, Korea (Republic of); 3Yeungnam University Hospital, Deagu, Korea (Republic of); 4 Chonbuk National University Hospital, Jeonju, Korea (Republic of); 5 Chungbuk National University Hospital, Chungju, Korea (Republic of); 6Kyunghee University Hospital, Seoul, Korea (Republic of). Background: Despite increasing prevalence and burden of disease in the elderly, little is known about the management and outcomes of acute coronary syndromes in this group. Furthermore, unique features of nonagenarian acute myocardial infarction (AMI) patients have not been well known, because of the paucity of the nonagenarian population. Methods: We compared clinical characteristics, management, inhospital and 1-year clinical outcomes of nonagenarian AMI patients (n⫽270, 92.3⫾2.3 years old) with octogenarian AMI patients (n⫽ 2,145, 83.5⫾2.7 years old) enrolled in Korean AMI Registry (KAMIR). In-hospital outcome was defined as in-hospital mortality and complica-
The American Journal of Cardiology姞 APRIL 24 –27, 2012 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
11S
O R A L A B S T R A C T S
April 24 –27, 2012
O R A L A B S T R A C T S
tions. One-year clinical outcome was compared between nonagenarian and octogenarian AMI patients who were survived at hospital discharge, and defined as the composite of 1-year major adverse cardiac events (MACE) including death, recurrent MI, repeated percutaneous coronary intervention (PCI), and coronary artery bypass grafting. Results: Nonagenarians were less likely to have hypertension (46.7% vs. 57.5%, p⫽0.001), diabetes (15.6% vs. 27.9%, p⬍0.001) compared with octogenarians. PCI (57.2% vs. 71.6%, p⬍0.001) was preferred and glycoprotein IIb/IIIa inhibitors (5.2% vs. 10.9%, p⫽0.004) were more likely to be used in octogenarians than nonagenarians. However, the success rate of PCI between the two groups was comparable (96.8% vs. 96.7%, p⫽0.984). Also, angiographic findings were comparable between the two groups. Beta-blocker (60.0% vs. 69.3%, p⫽0.002) and statin (65.6% vs. 71.7%, p⫽0.036) were less
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prescribed in nonagenarians compared with octogenarians. In-hospital mortality was higher in nonagenarians compared with octogenarians (15.7% vs. 11.4%, p⫽0.040). However, in-hospital complications were comparable between the two groups including acute renal failure, multi-organ failure, fatal arrhythmia, new onset heart failure, cardiogenic shock, and major bleeding. One-year MACE rate in patients who survived at hospital discharge were comparable between the two groups (25.4% vs. 22.7%, p⫽0.501), although cardiac death was more commonly occurred in nonagenarians than octogenarians (13.6% vs. 8.1%, p⫽0.044). Conclusion: Although PCI was less preferred in nonagenarian AMI patients, it might be performed as safe as octogenarian AMI patients without increment of re-PCI rate. Also, attention to secondary prevention in nonagenarian AMI patients should be uplifted cautiously.
The American Journal of Cardiology姞 APRIL 24 –27, 2012 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
Angina Treatment Complex PCI V Thursday, April 26, 2012 8:30 AM ⬃ 9:30 AM (Abstract nos. AS-142, AS-147) Complex PCI VI Thursday, April 26, 2012 4:00 AM ⬃ 5:00 AM (Abstract no. AS-143) AS-142 Successful DES Deployment for GEA Graft Stenosis. Akihiko Matsumura, Masakazu Ohno. Kameda Medical Center, Kamogawa, Japan. Background: An 84 year-old female with history of CABG (LITALAD, free RITA-OM, GEA-RCA) was admitted to our hospital. Methods: She felt chest discomfort and nausea when waking-up and electrocardiogram disclosed ST segment depression of chest leads, which suggested angina. Emergent coronary angiography was performed and 90% stenosis of the mid gastroepiploic artery (GEA) graft, which was patent in 2002. Results: Six French JR4 guiding catheter was cannulated to the celiac artery and pre-dilatation was performed with 2.0mm balloon. Subsequent intravascular ultrasound (IVUS) examination disclosed focal atheroscrelotic change at the stenotic site. After IVUS examination, 3.0x15mm xience V stent was implanted successfully. The patient is free from angina and coronary CT 9 month after the procedure revealed good patency of the stent site. Conclusion: We report a rare case of DES implantation to stenotic GEA graft.
AS-143 The Long-Term Cardiac Mortality and the Rate of Percutaneous Coronary Intervention in Korean Vasospastic Angina Patients. Dong Il Shin, Ki Bae Seung, Seok Min Seo, Yoon Seok Ko, Hoon Joon Park, Pum Joon Kim, Ki Yook Chang, Wook Sung Chung. The Catholic University of Korea, Seoul, Korea (Republic of). Background: There have been few reports about long-term prognosis of vasospastic angina (VA) in the East. We estimated long-term mortality and rate of percutaneous coronary intervention (PCI) due to de novo atherosclerotic change in known Korean VA using data-sets of VA-CMC (Vasospastic Angina in Catholic Medical Center) registry.
Methods: Total 952 patients of 8 centers in CMC were enrolled to VA-CMC registry from March 2008 to October 2010. The patients were diagnosed as VA by acetylcholine or ergonovine provocation test using the same criteria; “total or near total occlusion with ischemic electrocardiographic change or ischemic symptom or both”. Patients who had significant atherosclerotic stenosis (⬎50% of luminal diameter narrowing) on their baseline angiography were excluded. We also excluded the patients with significant heart failure or renal failure, cancer, inflammatory disease, and catheter-induced spasm on angiography. All patients in the registry received conventional vasodilator therapy including calcium-channel blockers or nitrates during follow up period. Out of these patients, 442 patients were included as study subjects in this retrospective analysis. The mean follow-up duration was 39⫾11 months. We evaluated the rate of cardiac or non-cardiac deaths and the rate of PCI. Results: During follow up period, the rate of mortality was 2.71% (12 patients). Nine patients died from cardiac cause (2.04%). Baseline and angiographic characteristics were similar between patients who died and survivors, however, patients who died demonstrated a higher frequency of diffuse type of vasospasm on initial vasospasm provocation test and a higher rate of drug cessation during follow up period than survivors (p⬍0.05, respectively). In multivariate analysis, drug cessation was an independent risk factor for cardiac mortality (odds ratio 1.47, p⬍0.05). The rate of PCI due to development of de novo atherosclerosis was 2.26% (10 patients). Out of 10 patients, only 3 patients (0.68%) demonstrated the development of significant atherosclerosis on the segment of vasospasm documented on previous provocation test. In other 7 patients, PCI was done for de novo atherosclerosis on non-vasospastic segment. PCI group had higher numbers of male, current smoker, and higher level of initial hsCRP than non-PCI group (p⬍0.05, respectively). In multivariate analysis, current smoking (odds ratio 2.31, p⬍0.05) and high level of initial hsCRP (odds ratio 1.57, p⬍0.05) were independent risk factors for PCI. Conclusion: In Korean VA patients, the rates of cardiac mortality (2.04%) and development of de novo atherosclerosis (2.26%) were very low. During follow up, atherosclerotic change developed more frequently on non-vasospastic segment than on the segment of vasospasm. Current smoking, increased hsCRP and drug cessation were independent risk factors for unfavorable outcomes in Korean VA patients.
AS-147 Characteristics, In-Hospital and Long-Term Clinical Outcomes of Nonagenarian AMI Patients Compared with Octogenarian AMI patients. Ki Hong Lee1, Youngkeun Ahn1, Myung Ho Jeong1, Donghan Kim1, Shung Chull Chae2, Young Jo Kim3, Jei Keon Chae4, Myeong Chan Cho5, Chong Jin Kim6. 1Chonnam National University Hospital, Gwang-ju, Korea (Republic of); 2 Kyungpook National University Hospital, Deagu, Korea (Republic of); 3Yeungnam University Hospital, Deagu, Korea (Republic of); 4 Chonbuk National University Hospital, Jeonju, Korea (Republic of); 5 Chungbuk National University Hospital, Chungju, Korea (Republic of); 6Kyunghee University Hospital, Seoul, Korea (Republic of). Background: Despite increasing prevalence and burden of disease in the elderly, little is known about the management and outcomes of acute coronary syndromes in this group. Furthermore, unique features of nonagenarian acute myocardial infarction (AMI) patients have not been well known, because of the paucity of the nonagenarian population. Methods: We compared clinical characteristics, management, inhospital and 1-year clinical outcomes of nonagenarian AMI patients (n⫽270, 92.3⫾2.3 years old) with octogenarian AMI patients (n⫽ 2,145, 83.5⫾2.7 years old) enrolled in Korean AMI Registry (KAMIR). In-hospital outcome was defined as in-hospital mortality and complica-
The American Journal of Cardiology姞 APRIL 24 –27, 2012 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
11S
O R A L A B S T R A C T S
April 24 –27, 2012
O R A L A B S T R A C T S
tions. One-year clinical outcome was compared between nonagenarian and octogenarian AMI patients who were survived at hospital discharge, and defined as the composite of 1-year major adverse cardiac events (MACE) including death, recurrent MI, repeated percutaneous coronary intervention (PCI), and coronary artery bypass grafting. Results: Nonagenarians were less likely to have hypertension (46.7% vs. 57.5%, p⫽0.001), diabetes (15.6% vs. 27.9%, p⬍0.001) compared with octogenarians. PCI (57.2% vs. 71.6%, p⬍0.001) was preferred and glycoprotein IIb/IIIa inhibitors (5.2% vs. 10.9%, p⫽0.004) were more likely to be used in octogenarians than nonagenarians. However, the success rate of PCI between the two groups was comparable (96.8% vs. 96.7%, p⫽0.984). Also, angiographic findings were comparable between the two groups. Beta-blocker (60.0% vs. 69.3%, p⫽0.002) and statin (65.6% vs. 71.7%, p⫽0.036) were less
12S
prescribed in nonagenarians compared with octogenarians. In-hospital mortality was higher in nonagenarians compared with octogenarians (15.7% vs. 11.4%, p⫽0.040). However, in-hospital complications were comparable between the two groups including acute renal failure, multi-organ failure, fatal arrhythmia, new onset heart failure, cardiogenic shock, and major bleeding. One-year MACE rate in patients who survived at hospital discharge were comparable between the two groups (25.4% vs. 22.7%, p⫽0.501), although cardiac death was more commonly occurred in nonagenarians than octogenarians (13.6% vs. 8.1%, p⫽0.044). Conclusion: Although PCI was less preferred in nonagenarian AMI patients, it might be performed as safe as octogenarian AMI patients without increment of re-PCI rate. Also, attention to secondary prevention in nonagenarian AMI patients should be uplifted cautiously.
The American Journal of Cardiology姞 APRIL 24 –27, 2012 ANGIOPLASTY SUMMIT ABSTRACTS/Oral