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Assessing Suitability for Early Discharge Following Primary PCI for STEMI
S128
Heart, Lung and Circulation 2013;22:S126–S266
CSANZ 2013 Abstracts
ABSTRACTS
302 Assessing Suitability for Early Discharge Following Primary PCI for STEMI C. Brown 1,2,∗ , A. Antonis 1,2
Hutchison 1,2 , J.
Cameron 1,2 , P.
1 MonashHEART,
Southern Health, Clayton, Victoria, Australia 2 Monash Cardiovascular Research Centre, Clayton, Victoria, Australia Background: Recent literature suggests primary PCI patients can be safely discharged at 72 h, yet there remains a reluctance to do so. Methods: We retrospectively reviewed 47 patients admitted to a coronary care unit after undergoing primary PCI. We examined documented early complication rates (arrhythmias, heart failure, haemodynamic instability, ischaemia and bleeding requiring treatment) and representation to hospital at 30 days and identified those that would have been suitable for early discharge (72 h) using the Zwolle Risk Score (a validated tool to predict early outcomes following STEMI). Results: Fourteen out of 47 patients were discharged between 72 and 96 h following primary PCI, with the remainder discharged >96 h (no patients were discharged at <72 h). Thirty-three patients (70%) were identified as being of low risk (Zwolle score ≤3) and therefore potentially safe for discharge at 72 h. A Zwolle score of ≤3 was identified in 93% of those in the 72–96-h group and 61% in the >96-h group. The overall per-patient complication rate was 62%. All complications except one were identified within 72 h of procedure. The patient with a complication occurring between 72 and 96 h would have been unsuitable for early discharge using the Zwolle score. Three patients (6.3%) re-presented with complications within the first 30 days, all of whom identified as high risk on the Zwolle score. Conclusions: Most complications identified following primary PCI were within 72 h of admission. A validated scoring system appears to identify patients as suitable for early discharge post primary PCI. http://dx.doi.org/10.1016/j.hlc.2013.05.304 303 Atrioventricular Node Recovery in Patients with Pacemakers Implanted Post-Transcatheter Aortic Valve Implantation (TAVI) With the Medtronic CoreValve J. Nathan 1,∗ , S. Duffy 1,2 , J. Mariani 1 , R. Dick 1,2 , A. Walton 1,2
1 The 2 The
Alfred Hospital, Melbourne, Australia Epworth Hospital, Melbourne, Australia
Background: The incidence of complete heart block (CHB) requiring permanent pacemaker (PPM) implantation following CoreValve (Medtronic, Minneapolis, MN, USA) implantation is approximately 30%. This study
aimed to assess whether the atrioventricular node (AVN) in these patients recovers at short-term follow-up, resulting in reduced ventricular pacing (VP) rates. Method: We analysed data from 151 consecutive CoreValve implantations at the Alfred and Epworth Hospitals, Melbourne. All patients had temporary pacing wires placed prior to procedure commencement and were monitored for ≥5 days postoperatively. Those with sustained rhythm disturbances had PPM implantation. PPMs were checked within 24 h and between one and three months. Where possible, managed ventricular pacing algorithms were instituted. Results: Of 151patients (51% male, mean age 83 ± 5.4 years), 45 (30%) received PPM 3.5 ± 2.8 days post-TAVI (range 1–11 days). Two patients died prior to follow-up and 15 had private PPM follow-up. Short-term follow-up data were available for 28 patients (sick sinus syndrome; n = 1, 45% VP); 1◦ AV block and left bundle branch block (n = 1, 17% VP); and 26 for CHB. Of patients with CHB, 6 had atrial fibrillation with 48 ± 27% VP, 12 remained in CHB with average 92 ± 21%VP and the remaining eight (31%) patients had a degree of AVN recovery with minimal (11 ± 18%) ventricular pacing, predominantly in those with residual 1◦ AV block. There were similar postTAVI implant times for patients with AVN recovery (4.4 days, range 1–9) and persisting CHB (3 days, range 1–10), p = 0.33. Conclusion: In our large CoreValve cohort, 31% of patients with CHB post-implant demonstrated significant AVN recovery at short-term follow-up. http://dx.doi.org/10.1016/j.hlc.2013.05.305 304 Calcific Plaque Predicts Stent Malapposition in Acute Coronary Syndrome Patients V. Mutha 1,2,∗ , M. Asrar Ul Haq 1,2 , S. Gocuk 1,2 , S. Al Daher 1,3 , N. Rudd 1,2 , W. Van Gaal 1,2 , P. Barlis 1,2 1 Northern
Hospital, Australia of Melbourne, Australia 3 Monash University, Australia 2 University
Background: Suboptimal stent expansion or malapposition has been linked with thrombus formation as well as stent thrombosis. Aim: To examine lesion factors leading to suboptimal stent expansion. Method: A total of 30 patients who underwent percutaneous intervention for acute coronary syndromes were included in this study. Patients were randomly assigned to either Biolimus-eluting stainless steel stent or everolimuseluting cobalt chromium stent. Results: Average age of cohort was 62 years of age and 50% (n = 15) patients presented with non ST elevation myocardial infarctions. Twenty percent (n = 6) were diabetics. A total of 8316 stent struts were analysed from 36 OCT pullback loops. Patients with greater than 5% strut malapposition (despite stent type) had significantly more calcified plaque
Heart, Lung and Circulation 2013;22:S126–S266
CSANZ 2013 Abstracts
ABSTRACTS
302 Assessing Suitability for Early Discharge Following Primary PCI for STEMI C. Brown 1,2,∗ , A. Antonis 1,2
Hutchison 1,2 , J.
Cameron 1,2 , P.
1 MonashHEART,
Southern Health, Clayton, Victoria, Australia 2 Monash Cardiovascular Research Centre, Clayton, Victoria, Australia Background: Recent literature suggests primary PCI patients can be safely discharged at 72 h, yet there remains a reluctance to do so. Methods: We retrospectively reviewed 47 patients admitted to a coronary care unit after undergoing primary PCI. We examined documented early complication rates (arrhythmias, heart failure, haemodynamic instability, ischaemia and bleeding requiring treatment) and representation to hospital at 30 days and identified those that would have been suitable for early discharge (72 h) using the Zwolle Risk Score (a validated tool to predict early outcomes following STEMI). Results: Fourteen out of 47 patients were discharged between 72 and 96 h following primary PCI, with the remainder discharged >96 h (no patients were discharged at <72 h). Thirty-three patients (70%) were identified as being of low risk (Zwolle score ≤3) and therefore potentially safe for discharge at 72 h. A Zwolle score of ≤3 was identified in 93% of those in the 72–96-h group and 61% in the >96-h group. The overall per-patient complication rate was 62%. All complications except one were identified within 72 h of procedure. The patient with a complication occurring between 72 and 96 h would have been unsuitable for early discharge using the Zwolle score. Three patients (6.3%) re-presented with complications within the first 30 days, all of whom identified as high risk on the Zwolle score. Conclusions: Most complications identified following primary PCI were within 72 h of admission. A validated scoring system appears to identify patients as suitable for early discharge post primary PCI. http://dx.doi.org/10.1016/j.hlc.2013.05.304 303 Atrioventricular Node Recovery in Patients with Pacemakers Implanted Post-Transcatheter Aortic Valve Implantation (TAVI) With the Medtronic CoreValve J. Nathan 1,∗ , S. Duffy 1,2 , J. Mariani 1 , R. Dick 1,2 , A. Walton 1,2
1 The 2 The
Alfred Hospital, Melbourne, Australia Epworth Hospital, Melbourne, Australia
Background: The incidence of complete heart block (CHB) requiring permanent pacemaker (PPM) implantation following CoreValve (Medtronic, Minneapolis, MN, USA) implantation is approximately 30%. This study
aimed to assess whether the atrioventricular node (AVN) in these patients recovers at short-term follow-up, resulting in reduced ventricular pacing (VP) rates. Method: We analysed data from 151 consecutive CoreValve implantations at the Alfred and Epworth Hospitals, Melbourne. All patients had temporary pacing wires placed prior to procedure commencement and were monitored for ≥5 days postoperatively. Those with sustained rhythm disturbances had PPM implantation. PPMs were checked within 24 h and between one and three months. Where possible, managed ventricular pacing algorithms were instituted. Results: Of 151patients (51% male, mean age 83 ± 5.4 years), 45 (30%) received PPM 3.5 ± 2.8 days post-TAVI (range 1–11 days). Two patients died prior to follow-up and 15 had private PPM follow-up. Short-term follow-up data were available for 28 patients (sick sinus syndrome; n = 1, 45% VP); 1◦ AV block and left bundle branch block (n = 1, 17% VP); and 26 for CHB. Of patients with CHB, 6 had atrial fibrillation with 48 ± 27% VP, 12 remained in CHB with average 92 ± 21%VP and the remaining eight (31%) patients had a degree of AVN recovery with minimal (11 ± 18%) ventricular pacing, predominantly in those with residual 1◦ AV block. There were similar postTAVI implant times for patients with AVN recovery (4.4 days, range 1–9) and persisting CHB (3 days, range 1–10), p = 0.33. Conclusion: In our large CoreValve cohort, 31% of patients with CHB post-implant demonstrated significant AVN recovery at short-term follow-up. http://dx.doi.org/10.1016/j.hlc.2013.05.305 304 Calcific Plaque Predicts Stent Malapposition in Acute Coronary Syndrome Patients V. Mutha 1,2,∗ , M. Asrar Ul Haq 1,2 , S. Gocuk 1,2 , S. Al Daher 1,3 , N. Rudd 1,2 , W. Van Gaal 1,2 , P. Barlis 1,2 1 Northern
Hospital, Australia of Melbourne, Australia 3 Monash University, Australia 2 University
Background: Suboptimal stent expansion or malapposition has been linked with thrombus formation as well as stent thrombosis. Aim: To examine lesion factors leading to suboptimal stent expansion. Method: A total of 30 patients who underwent percutaneous intervention for acute coronary syndromes were included in this study. Patients were randomly assigned to either Biolimus-eluting stainless steel stent or everolimuseluting cobalt chromium stent. Results: Average age of cohort was 62 years of age and 50% (n = 15) patients presented with non ST elevation myocardial infarctions. Twenty percent (n = 6) were diabetics. A total of 8316 stent struts were analysed from 36 OCT pullback loops. Patients with greater than 5% strut malapposition (despite stent type) had significantly more calcified plaque