- Email: [email protected]
AS-66: Comparison of Long-Term Clinical Outcomes Between Drug-Eluting Stents and Bare-Metal Stents in Patients with Acute Myocardial Infarction: 3-Year Follow-Up
Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone)
2010 ANGIOPLASTY SUMMIT TRANSCATHETER CARDIOVASCULAR THERAPEUTICS ASIA PACIFIC E-Poster Abstract Presentations All 276 accepted abstracts will be available for viewing and downloading in electronic format at the E-poster abstract zone Acute Myocardial Infarction (Abstract nos. AS-64 –AS-108)
AS-64 Clinical Effects of Non–High-Density Lipoprotein Cholesterol and Apolipoprotein B on Patients with Metabolic Syndrome Underlying Post Percutaneous Coronary Intervention. Mi Sook Oh, Myung Ho Jeong, Chung Kim, Ha Mi Kim, Jum Suk Ko, Min Goo Lee, Doo Sun Sim, Keun-Ho Park, 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 Chaee Kang. Chonnam National University Hospital, Gwangju, Republic of Korea. Background: It is a well-known fact that increasing levels of non– high-density lipoprotein (non-HDL) cholesterol and apolipoprotein B (apoB) are significant markers of coronary artery disease risk. This study examines the clinical effects of non-HDL cholesterol and apoB on patients with metabolic syndrome underlying post percutaneous coronary intervention (PCI) for 1 year. Methods: From December 2005 to January 2008, 420 patients with metabolic syndrome were selected from 830 patients with myocardial infarction (MI) underlying post PCI for 1 year. Patients were classified into 4 groups by levels of apoB (ⱕ82.5 mg/dL, 82.6 –99.9 mg/dL, 100 –118 mg/dL, ⬎118 mg/dL) (for apoB, 1 mg/dL ⫽ 0.01 g/L) and non-HDL cholesterol (ⱕ110 mg/dL, 111–135 mg/dL, 136 –161 mg/dL, ⬎161 mg/dL) (for cholesterol, 1 mg/dL ⫽ 0.02586 mmol/L). Linearby-linear association was used for the relation with major adverse cardiac event (MACE) rates in a year. Results: Average age was 62.9 ⫾ 10.5 years and there were 271 (64.5%) men. Average apoB and non-HDL cholesterol levels were 82.6 ⫾ 1.0 mg/dL and 144.9 ⫾ 38.7 mg/dL, respectively. The relation between non-HDL cholesterol and MACE in 1 year was that the
MACE rate decreased as the level of non-HDL cholesterol increased, although it was not significantly related (19% vs 12% vs 13% vs 11%; linear p ⫽ 0.133). The relation between apoB and the MACE rate in 1 year was that the MACE rate was decreased as apoB increased. Conclusion: Patients with metabolic syndrome, in particular among those with acute MI, need further assessment to prevent MACE with apoB and non-HDL cholesterol.
AS-65 Coronary Plaque Characteristics According to Renal Function in Patients with Acute Myocardial Infarction: An Intravascular Ultrasound Analysis. Young Joon Hong1, Gary S. Mintz2, Myung Ho Jeong1, Jum Suk Ko1, Min Goo Lee1, Keun Ho Park1, Doo Sun Sim1, Ju Han Kim1, Youngkeun Ahn1, Neil J. Weissman3, Jung Chaee Kang1. 1Chonnam National University Hospital, Gwangju, Republic of Korea; 2Cardiovascular Research Foundation, New York, New York, USA; 3Washington Hospital Center, Washington, DC, USA. Background: We used intravascular ultrasound (IVUS) to assess plaque characteristics in patients with acute myocardial infarction (AMI) with varying degrees of renal dysfunction. Methods: We assessed plaque morphology and morphometry using IVUS in 310 patients with AMI (125 ST-segment elevation and 185 non–ST-segment elevation MI) with varying degrees of renal dysfunction according to creatinine clearance (CrCl): group I with CrCl ⬎70 mL/min (n ⫽ 153), group II with CrCl 30 – 69 mL/min (1 mL/min ⫽ 0.0167 mL/sec) (n ⫽ 103), and group III with CrCl ⬍30 mL/min (n ⫽ 54, including 20 dialysis patients). Results: Reference segment and lesion site plaque burden were greatest (30.1 ⫾ 12.3% vs 36.9 ⫾ 11.4% vs 41.2 ⫾ 10.8%, p ⫽ 0.003; and 77.4 ⫾ 11.0% vs 79.8 ⫾ 12.5% vs 82.0 ⫾ 10.3%, p ⫽ 0.031; respectively), and lesions were longest (20.9 ⫾ 9.1 mm vs 23.1 ⫾ 9.5 mm vs 26.3 ⫾ 9.6 mm, p ⫽ 0.038) in the lowest CrCl group. Infarctrelated artery plaque rupture (31.4% vs 34.0% vs 53.7%, p ⫽ 0.011), multiple plaque ruptures (11.1% vs 12.6% vs 33.3%, p ⬍0.001), and IVUS-detected thrombus (22.9% vs 23.3% vs 40.7%, p ⫽ 0.027) were most common in the lowest CrCl group. During 1-year follow-up, the incidences of nonfatal MI (2.6% vs 4.9% vs 11.1%, p ⫽ 0.044) and cardiac death (3.9% vs 6.8% vs 14.8%, p ⫽ 0.024) were observed most frequently, and there was a strong trend toward the highest incidence of stent thrombosis (2.0% vs 3.9% vs 9.3%, p ⫽ 0.057) in the lowest CrCl group. Conclusion: A significant decrease in renal function was associated with more diffuse atherosclerosis, more unstable plaque morphology, and poor clinical outcome in patients with AMI.
AS-66 Comparison of Long-Term Clinical Outcomes Between DrugEluting Stents and Bare-Metal Stents in Patients with Acute Myocardial Infarction: 3-Year Follow-Up. Ki Hong Lee, Youngkeun Ahn, Myung Ho Jeong, Jeong Gwan Cho, Jong Chun Park, Jung Chaee Kang. Chonnam National University Hospital, Gwangju, Republic of Korea. Background: Drug-eluting stents (DES) limit in-stent restenosis and target vessel revascularization (TLR), but the comparison of long-term safety and efficacy with bare-metal stents (BMS) in patients with acute myocardial infarction (AMI) is still controversial. Methods: We compared long-term clinical outcomes between BMS (n ⫽ 807) and DES (n ⫽ 1,449) in patients with AMI (n ⫽ 2,256; age, 66.8 ⫾ 11.6 years; 1,672 men) who visited our hospital between January 2004 and July 2006. Follow-up was conducted for ⱖ3 years (mean duration, 32.5 ⫾ 20.1 months). The primary end point was mortality and
The American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster 29B
EP O S T E R A B S T R A C T S
Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone) the composite of major adverse cardiac events (MACE), including allcause mortality, MI, TLR, and coronary artery bypass graft. Results: Clinical characteristics of both groups were not different. Angiographically, the DES group involved more left anterior descending coronary arteries (31.8% vs 57.5%, p ⬍0.001) and left main arteries (1.4% vs 2.7%, p ⫽ 0.040). The stent diameter (3.3 ⫾ 0.5 mm vs 3.2 ⫾ 0.3 mm, p ⬍0.001) was larger in the BMS group, but stent length (22.3 ⫾ 6.0 mm vs 26.4 ⫾ 5.7 mm, p ⬍0.001) was larger in the DES group. Other angiographic findings were not different between groups. The in-hospital mortality rate was higher in the BMS group (5.5% vs 1.7%, p ⬍0.001). At 3-year follow-up, the mortality rate was higher in the BMS group (9.5% vs 4.1%, p ⬍0.001), as was the TLR rate (16.7% vs 7.6%, p ⬍0.001) and the composite of MACE (25.4% vs 11.7%, p ⬍0.001). Implantation of BMS was the independent predictor of 3-year MACE (odds ratio, 1.47; 95% confidence interval, 1.19 –1.81; p ⬍0.001) and 3-year TLR (odds ratio, 2.64; 95% confidence interval, 1.98 –3.51; p ⬍0.001). Conclusion: DES is superior in reducing the 3-year TLR rate and improving 3-year clinical outcomes in patients with AMI.
AS-67
EP O S T E R A B S T R A C T S
Impact of Metabolic Syndrome on the Clinical Outcomes of Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Min Goo Lee1, Youngkeun Ahn1, Myung Ho Jeong1, Jong Hyun Kim2, Shung Chull Chae3, Young Jo Kim4, Seung Ho Hur5, In Whan Seong6, Taek Jong Hong7, Dong Hoon Choi8, Myeong Chan Cho9, Chong Jin Kim10, Ki Bae Seung11, Wook Sung Chung12, Yang Soo Jang8, Seung Woon Rha13, Jang Ho Bae14, Jeong Gwan Cho1, Seung Jung Park15. 1Chonnam National University Hospital, Gwangju, Republic of Korea; 2Busan Hanseo Hospital, Busan, Republic of Korea; 3Kyungpook National University Hospital, Daegu, Republic of Korea; 4Yeungnam University Hospital, Daegu, Republic of Korea; 5Keimyung University Dongsan Medical Center, Daegu, Republic of Korea; 6 Chungnam National University Hospital, Daejon, Republic of Korea; 7Busan National University Hospital, Busan, Republic of Korea; 8Yonsei University Severans Hospital, Seoul, Republic of Korea; 9Chungbuk National University Hospital, Cheongju, Republic of Korea; 10Kyunghee University Hospital, Seoul, Republic of Korea; 11Catholic University Hospital, Seoul, Republic of Korea; 12 Catholic University Hospital, Seoul, Republic of Korea; 13Korea University Hospital, Seoul, Republic of Korea; 14Konyang University Hospital, Daejon, Republic of Korea; 15Asan Medical Center, Seoul, Republic of Korea Background: Metabolic syndrome (MS) is highly prevalent among patients with acute myocardial infarction (MI) and is associated with increased risk for cardiovascular diseases and related mortalities. The aim of this study was to investigate the effects of MS on clinical outcomes after primary percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI). Methods: In data from the Korea Acute Myocardial Infarction Registry (KAMIR; from November 2005 to December 2007), 3,736 patients with acute STEMI who underwent primary PCI were categorized according to the National Cholesterol Education Plan Adult Treatment Panel III (NCEP ATP III) criteria of MS. Primary study outcomes included major adverse cardiac events (MACE; cardiac death, noncardiac death, re-MI, re-PCI, and coronary artery bypass surgery) during 1 year of follow-up. Results: Group I with MS (n ⫽ 2,292; 1,574 men; age, 60.9 ⫾ 12.7 years) and group II without MS (n ⫽ 1,444; 1,235 men; age, 61.7 ⫾ 12.7 years) were categorized. There were no differences between the 2 groups in the coronary angiographic findings except for the multivessel involvement (p ⬍0.001). The incidence of in-hospital death was significantly higher in the MS group compared with the non-MS group (p ⬍0.001), but
during the follow-up period, no significant differences were observed in the rates of composite MACE at 1, 6, and 12 months between the 2 groups. Multivariate analysis showed that old age (ⱖ65 years), MS, low highdensity cholesterol levels (men, ⬍40 mg/dL, women, ⬍50 mg/dL) and multivessel involvement were the independent predictors of in-hospital mortality. Conclusion: Although MS did not influence the long-term clinical outcomes after primary PCI in patients with acute STEMI, it was associated with higher rates of multivessel involvement and in-hospital death.
AS-68 The Effect of High-Dose Statin Loading Before Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction. Sang Yup Lim. Korea University Ansan Hospital, Ansan, Republic of Korea. Background: We studied whether single high-dose statin loading is beneficial on the outcome of patients with acute myocardial infarction (AMI) by reduction of myocardial damage and oxidative stress. Methods: A total of 65 consecutive patients with AMI who underwent primary PCI were randomly assigned to 3 groups: group I (n ⫽ 21) with no statin treatment before PCI, group II (n ⫽ 22) with 10 mg rosuvastatin loading before PCI, and group III (n ⫽ 22) with 40 mg rosuvastatin loading before PCI. Periprocedural myocardial injury was assessed by the peak level of creatinine kinase–MB (CK-MB). Baseline and follow-up inflammatory markers, lipid levels, and thioredoxin levels were also measured. Major adverse cardiac events (MACE; death, MI, target lesion revascularization) were evaluated. Results: There were no significant differences in clinical characteristics between the groups. Mean preprocedural CK-MB and highsensitivity C-reactive protein (hs-CRP) showed no significant differences between the groups. After PCI, peak CK-MB levels (388.7 ⫾ 264.3 IU/L vs 403.7 ⫾ 225.7 IU/L vs 193.7 ⫾ 143.2 IU/L, respectively; p ⫽ 0.04) and hs-CRP level (24.3 ⫾ 22.2 vs 19.3 ⫾ 25.6 IU/L vs 3.2 ⫾ 6.9 mg/dL, respectively; p ⫽ 0.01) were significantly lower in group III. There were no significant differences in MACE between the groups during the 6-month follow-up. The oxidized low-density lipoprotein and thioredoxin levels showed no significant difference between the groups. Conclusion: A high dose of statin before PCI reduces periprocedural myocardial injury and inflammation in patients with AMI.
AS-69 Routine Transradial Primary Coronary Intervention for Acute ST-Elevation Myocardial Infarction. Wei-Hsian Yin, Hsu-Lung Jen, Wen-Pin Huang, Mason Shing Young. Cheng-Hsin General Hospital, Taipei, Taiwan. Background: Transradial percutaneous coronary intervention (TRI) reduces access site bleedings while preserving procedural success and clinical outcome compared with transfemoral intervention (TFI). The aim of this study was to investigate the feasibility, efficacy, and safety of primary TRI in patients with acute ST-elevation myocardial infarction (STEMI) performed on a routine basis. Methods: From 2005 to 2009, all consecutive patients who presented with acute STEMI, including those with cardiogenic shock, were considered eligible for primary TRI if the radial artery pulse could be felt. TFI was used only in certain circumstances: poor or absent radial pulse, failed Allen test, failed radial approach, vascular access time ⬎5 minutes, and in patients on chronic hemodialysis or who were considered to be a future candidate for hemodialysis. The efficacy and safety end points and major adverse cardiovascular events (MACE) regarding mortality, recurrent nonfatal MI, and revascularization were recorded.
30B The American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster
2010 ANGIOPLASTY SUMMIT TRANSCATHETER CARDIOVASCULAR THERAPEUTICS ASIA PACIFIC E-Poster Abstract Presentations All 276 accepted abstracts will be available for viewing and downloading in electronic format at the E-poster abstract zone Acute Myocardial Infarction (Abstract nos. AS-64 –AS-108)
AS-64 Clinical Effects of Non–High-Density Lipoprotein Cholesterol and Apolipoprotein B on Patients with Metabolic Syndrome Underlying Post Percutaneous Coronary Intervention. Mi Sook Oh, Myung Ho Jeong, Chung Kim, Ha Mi Kim, Jum Suk Ko, Min Goo Lee, Doo Sun Sim, Keun-Ho Park, 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 Chaee Kang. Chonnam National University Hospital, Gwangju, Republic of Korea. Background: It is a well-known fact that increasing levels of non– high-density lipoprotein (non-HDL) cholesterol and apolipoprotein B (apoB) are significant markers of coronary artery disease risk. This study examines the clinical effects of non-HDL cholesterol and apoB on patients with metabolic syndrome underlying post percutaneous coronary intervention (PCI) for 1 year. Methods: From December 2005 to January 2008, 420 patients with metabolic syndrome were selected from 830 patients with myocardial infarction (MI) underlying post PCI for 1 year. Patients were classified into 4 groups by levels of apoB (ⱕ82.5 mg/dL, 82.6 –99.9 mg/dL, 100 –118 mg/dL, ⬎118 mg/dL) (for apoB, 1 mg/dL ⫽ 0.01 g/L) and non-HDL cholesterol (ⱕ110 mg/dL, 111–135 mg/dL, 136 –161 mg/dL, ⬎161 mg/dL) (for cholesterol, 1 mg/dL ⫽ 0.02586 mmol/L). Linearby-linear association was used for the relation with major adverse cardiac event (MACE) rates in a year. Results: Average age was 62.9 ⫾ 10.5 years and there were 271 (64.5%) men. Average apoB and non-HDL cholesterol levels were 82.6 ⫾ 1.0 mg/dL and 144.9 ⫾ 38.7 mg/dL, respectively. The relation between non-HDL cholesterol and MACE in 1 year was that the
MACE rate decreased as the level of non-HDL cholesterol increased, although it was not significantly related (19% vs 12% vs 13% vs 11%; linear p ⫽ 0.133). The relation between apoB and the MACE rate in 1 year was that the MACE rate was decreased as apoB increased. Conclusion: Patients with metabolic syndrome, in particular among those with acute MI, need further assessment to prevent MACE with apoB and non-HDL cholesterol.
AS-65 Coronary Plaque Characteristics According to Renal Function in Patients with Acute Myocardial Infarction: An Intravascular Ultrasound Analysis. Young Joon Hong1, Gary S. Mintz2, Myung Ho Jeong1, Jum Suk Ko1, Min Goo Lee1, Keun Ho Park1, Doo Sun Sim1, Ju Han Kim1, Youngkeun Ahn1, Neil J. Weissman3, Jung Chaee Kang1. 1Chonnam National University Hospital, Gwangju, Republic of Korea; 2Cardiovascular Research Foundation, New York, New York, USA; 3Washington Hospital Center, Washington, DC, USA. Background: We used intravascular ultrasound (IVUS) to assess plaque characteristics in patients with acute myocardial infarction (AMI) with varying degrees of renal dysfunction. Methods: We assessed plaque morphology and morphometry using IVUS in 310 patients with AMI (125 ST-segment elevation and 185 non–ST-segment elevation MI) with varying degrees of renal dysfunction according to creatinine clearance (CrCl): group I with CrCl ⬎70 mL/min (n ⫽ 153), group II with CrCl 30 – 69 mL/min (1 mL/min ⫽ 0.0167 mL/sec) (n ⫽ 103), and group III with CrCl ⬍30 mL/min (n ⫽ 54, including 20 dialysis patients). Results: Reference segment and lesion site plaque burden were greatest (30.1 ⫾ 12.3% vs 36.9 ⫾ 11.4% vs 41.2 ⫾ 10.8%, p ⫽ 0.003; and 77.4 ⫾ 11.0% vs 79.8 ⫾ 12.5% vs 82.0 ⫾ 10.3%, p ⫽ 0.031; respectively), and lesions were longest (20.9 ⫾ 9.1 mm vs 23.1 ⫾ 9.5 mm vs 26.3 ⫾ 9.6 mm, p ⫽ 0.038) in the lowest CrCl group. Infarctrelated artery plaque rupture (31.4% vs 34.0% vs 53.7%, p ⫽ 0.011), multiple plaque ruptures (11.1% vs 12.6% vs 33.3%, p ⬍0.001), and IVUS-detected thrombus (22.9% vs 23.3% vs 40.7%, p ⫽ 0.027) were most common in the lowest CrCl group. During 1-year follow-up, the incidences of nonfatal MI (2.6% vs 4.9% vs 11.1%, p ⫽ 0.044) and cardiac death (3.9% vs 6.8% vs 14.8%, p ⫽ 0.024) were observed most frequently, and there was a strong trend toward the highest incidence of stent thrombosis (2.0% vs 3.9% vs 9.3%, p ⫽ 0.057) in the lowest CrCl group. Conclusion: A significant decrease in renal function was associated with more diffuse atherosclerosis, more unstable plaque morphology, and poor clinical outcome in patients with AMI.
AS-66 Comparison of Long-Term Clinical Outcomes Between DrugEluting Stents and Bare-Metal Stents in Patients with Acute Myocardial Infarction: 3-Year Follow-Up. Ki Hong Lee, Youngkeun Ahn, Myung Ho Jeong, Jeong Gwan Cho, Jong Chun Park, Jung Chaee Kang. Chonnam National University Hospital, Gwangju, Republic of Korea. Background: Drug-eluting stents (DES) limit in-stent restenosis and target vessel revascularization (TLR), but the comparison of long-term safety and efficacy with bare-metal stents (BMS) in patients with acute myocardial infarction (AMI) is still controversial. Methods: We compared long-term clinical outcomes between BMS (n ⫽ 807) and DES (n ⫽ 1,449) in patients with AMI (n ⫽ 2,256; age, 66.8 ⫾ 11.6 years; 1,672 men) who visited our hospital between January 2004 and July 2006. Follow-up was conducted for ⱖ3 years (mean duration, 32.5 ⫾ 20.1 months). The primary end point was mortality and
The American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster 29B
EP O S T E R A B S T R A C T S
Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone) the composite of major adverse cardiac events (MACE), including allcause mortality, MI, TLR, and coronary artery bypass graft. Results: Clinical characteristics of both groups were not different. Angiographically, the DES group involved more left anterior descending coronary arteries (31.8% vs 57.5%, p ⬍0.001) and left main arteries (1.4% vs 2.7%, p ⫽ 0.040). The stent diameter (3.3 ⫾ 0.5 mm vs 3.2 ⫾ 0.3 mm, p ⬍0.001) was larger in the BMS group, but stent length (22.3 ⫾ 6.0 mm vs 26.4 ⫾ 5.7 mm, p ⬍0.001) was larger in the DES group. Other angiographic findings were not different between groups. The in-hospital mortality rate was higher in the BMS group (5.5% vs 1.7%, p ⬍0.001). At 3-year follow-up, the mortality rate was higher in the BMS group (9.5% vs 4.1%, p ⬍0.001), as was the TLR rate (16.7% vs 7.6%, p ⬍0.001) and the composite of MACE (25.4% vs 11.7%, p ⬍0.001). Implantation of BMS was the independent predictor of 3-year MACE (odds ratio, 1.47; 95% confidence interval, 1.19 –1.81; p ⬍0.001) and 3-year TLR (odds ratio, 2.64; 95% confidence interval, 1.98 –3.51; p ⬍0.001). Conclusion: DES is superior in reducing the 3-year TLR rate and improving 3-year clinical outcomes in patients with AMI.
AS-67
EP O S T E R A B S T R A C T S
Impact of Metabolic Syndrome on the Clinical Outcomes of Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Min Goo Lee1, Youngkeun Ahn1, Myung Ho Jeong1, Jong Hyun Kim2, Shung Chull Chae3, Young Jo Kim4, Seung Ho Hur5, In Whan Seong6, Taek Jong Hong7, Dong Hoon Choi8, Myeong Chan Cho9, Chong Jin Kim10, Ki Bae Seung11, Wook Sung Chung12, Yang Soo Jang8, Seung Woon Rha13, Jang Ho Bae14, Jeong Gwan Cho1, Seung Jung Park15. 1Chonnam National University Hospital, Gwangju, Republic of Korea; 2Busan Hanseo Hospital, Busan, Republic of Korea; 3Kyungpook National University Hospital, Daegu, Republic of Korea; 4Yeungnam University Hospital, Daegu, Republic of Korea; 5Keimyung University Dongsan Medical Center, Daegu, Republic of Korea; 6 Chungnam National University Hospital, Daejon, Republic of Korea; 7Busan National University Hospital, Busan, Republic of Korea; 8Yonsei University Severans Hospital, Seoul, Republic of Korea; 9Chungbuk National University Hospital, Cheongju, Republic of Korea; 10Kyunghee University Hospital, Seoul, Republic of Korea; 11Catholic University Hospital, Seoul, Republic of Korea; 12 Catholic University Hospital, Seoul, Republic of Korea; 13Korea University Hospital, Seoul, Republic of Korea; 14Konyang University Hospital, Daejon, Republic of Korea; 15Asan Medical Center, Seoul, Republic of Korea Background: Metabolic syndrome (MS) is highly prevalent among patients with acute myocardial infarction (MI) and is associated with increased risk for cardiovascular diseases and related mortalities. The aim of this study was to investigate the effects of MS on clinical outcomes after primary percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI). Methods: In data from the Korea Acute Myocardial Infarction Registry (KAMIR; from November 2005 to December 2007), 3,736 patients with acute STEMI who underwent primary PCI were categorized according to the National Cholesterol Education Plan Adult Treatment Panel III (NCEP ATP III) criteria of MS. Primary study outcomes included major adverse cardiac events (MACE; cardiac death, noncardiac death, re-MI, re-PCI, and coronary artery bypass surgery) during 1 year of follow-up. Results: Group I with MS (n ⫽ 2,292; 1,574 men; age, 60.9 ⫾ 12.7 years) and group II without MS (n ⫽ 1,444; 1,235 men; age, 61.7 ⫾ 12.7 years) were categorized. There were no differences between the 2 groups in the coronary angiographic findings except for the multivessel involvement (p ⬍0.001). The incidence of in-hospital death was significantly higher in the MS group compared with the non-MS group (p ⬍0.001), but
during the follow-up period, no significant differences were observed in the rates of composite MACE at 1, 6, and 12 months between the 2 groups. Multivariate analysis showed that old age (ⱖ65 years), MS, low highdensity cholesterol levels (men, ⬍40 mg/dL, women, ⬍50 mg/dL) and multivessel involvement were the independent predictors of in-hospital mortality. Conclusion: Although MS did not influence the long-term clinical outcomes after primary PCI in patients with acute STEMI, it was associated with higher rates of multivessel involvement and in-hospital death.
AS-68 The Effect of High-Dose Statin Loading Before Percutaneous Coronary Intervention in Patients with Acute Myocardial Infarction. Sang Yup Lim. Korea University Ansan Hospital, Ansan, Republic of Korea. Background: We studied whether single high-dose statin loading is beneficial on the outcome of patients with acute myocardial infarction (AMI) by reduction of myocardial damage and oxidative stress. Methods: A total of 65 consecutive patients with AMI who underwent primary PCI were randomly assigned to 3 groups: group I (n ⫽ 21) with no statin treatment before PCI, group II (n ⫽ 22) with 10 mg rosuvastatin loading before PCI, and group III (n ⫽ 22) with 40 mg rosuvastatin loading before PCI. Periprocedural myocardial injury was assessed by the peak level of creatinine kinase–MB (CK-MB). Baseline and follow-up inflammatory markers, lipid levels, and thioredoxin levels were also measured. Major adverse cardiac events (MACE; death, MI, target lesion revascularization) were evaluated. Results: There were no significant differences in clinical characteristics between the groups. Mean preprocedural CK-MB and highsensitivity C-reactive protein (hs-CRP) showed no significant differences between the groups. After PCI, peak CK-MB levels (388.7 ⫾ 264.3 IU/L vs 403.7 ⫾ 225.7 IU/L vs 193.7 ⫾ 143.2 IU/L, respectively; p ⫽ 0.04) and hs-CRP level (24.3 ⫾ 22.2 vs 19.3 ⫾ 25.6 IU/L vs 3.2 ⫾ 6.9 mg/dL, respectively; p ⫽ 0.01) were significantly lower in group III. There were no significant differences in MACE between the groups during the 6-month follow-up. The oxidized low-density lipoprotein and thioredoxin levels showed no significant difference between the groups. Conclusion: A high dose of statin before PCI reduces periprocedural myocardial injury and inflammation in patients with AMI.
AS-69 Routine Transradial Primary Coronary Intervention for Acute ST-Elevation Myocardial Infarction. Wei-Hsian Yin, Hsu-Lung Jen, Wen-Pin Huang, Mason Shing Young. Cheng-Hsin General Hospital, Taipei, Taiwan. Background: Transradial percutaneous coronary intervention (TRI) reduces access site bleedings while preserving procedural success and clinical outcome compared with transfemoral intervention (TFI). The aim of this study was to investigate the feasibility, efficacy, and safety of primary TRI in patients with acute ST-elevation myocardial infarction (STEMI) performed on a routine basis. Methods: From 2005 to 2009, all consecutive patients who presented with acute STEMI, including those with cardiogenic shock, were considered eligible for primary TRI if the radial artery pulse could be felt. TFI was used only in certain circumstances: poor or absent radial pulse, failed Allen test, failed radial approach, vascular access time ⬎5 minutes, and in patients on chronic hemodialysis or who were considered to be a future candidate for hemodialysis. The efficacy and safety end points and major adverse cardiovascular events (MACE) regarding mortality, recurrent nonfatal MI, and revascularization were recorded.
30B The American Journal of Cardiology姞 APRIL 28 –30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster