Changing Survival of Patients with Heart Failure in New Zealand over 18 Years

S6

Abstracts

Heart, Lung and Circulation 2007;16:S1–S201

ABSTRACTS

Results: At 2 years, the Endeavor stent, as compared with the BMS, reduced the risk of target lesion revascularisation by 55.8%, from 14.7% to 6.5% (P < 0.0001), and the rate of major cardiac adverse events by 46.5%, from 18.7% to 10.0% (P < 0.0001). The risk of stent thrombosis was very low in each group (0.5% for patients who received the Endeavor group, 1.2% for patients who received the BMS), and there were no instances of late stent thrombosis after 14 days. The 3-year Endeavor II clinical results will be available in August 2007. Conclusion: The reduction in intimal hyperplasia and improvement in stenosis severity with the Endeavor stent resulted in a profound decrease in follow-up clinical endpoints at 2 years compared with the BMS, while at the same time there was no late stent thrombosis. The 3-year data can provide further confirmation regarding the long-term safety and efficacy of the Endeavor stent.

(log rank p = 0.016). Premature cessation of clopidogrel was documented in 4.9% of patients alive at 30-day followup and these patients had increased 12-month mortality (14.5% vs. 1.6%, p < 0.0001) and MACE (27.7% vs. 13.2%, p = 0.001). Conclusions: These data suggest that in patients treated with DES, longer (≥12 months) planned duration of clopidogrel results in reduced 12-month mortality, and that premature cessation of clopidogrel results in significantly higher event rates. Randomised studies are urgently needed to address this issue.

doi:10.1016/j.hlc.2007.06.016

13 Changing Survival of Patients with Heart Failure in New Zealand over 18 Years

12 The Effect of Intended Duration of Clopidogrel Use on Early and Late Mortality and Major Adverse Cardiac Events in Patients with Drug-Eluting Stents M.J. Butler 1,∗ , D. Eccleston 2 , A.E. Ajani 2,4 , J. Lefkovits 2 , D.J. Clark 3 , N. Andrianopoulos 4 , A. Brennan 4 , C.M. Reid 4 , C. Farrington 1 , A.S. Walton 1 , A.M. Dart 1 , S.J. Duffy 1,4 , on behalf of the Melbourne Interventional Group (MIG) 1 Department

of Cardiology, Alfred Hospital, Australia; of Cardiology, Royal Melbourne Hospital, Australia; 3 Department of Cardiology, Austin Hospital, Australia; 4 Department of Epidemiology, Monash University, Vic, Australia 2 Department

Background: The optimal duration of clopidogrel use for prevention of stent thrombosis with drug-eluting stents (DES) use is uncertain. Methods: We analysed 1312 patients who underwent percutaneous coronary intervention (PCI) with DES implantation in the Melbourne Interventional Group (MIG) registry who had 12-month follow-up. We compared outcomes at 30 days and 12 months in three patient groups according to planned duration of clopidogrel use: ≤3 months, 6 months and ≥12 months. Results: The mean age of patients undergoing PCI was 65.6 ± 11.9 (S.D.) years; 27% were female. Procedural success was similar among patient groups (p = 0.62). At 30-day follow-up there was no difference in mortality (p = 0.48) or MACE (p = 0.68) between the groups. Patients with planned clopidogrel duration of ≥12 months had decreased mortality at 12 months compared to the two shorter duration groups (3.3% vs. 6.4%, p < 0.01). However, this group had similar rates of target vessel revascularisation (8.0% vs. 6.9%, p = 0.49), myocardial infarction (7.0% vs. 7.9%, p = 0.53), and MACE (15.7% vs. 17.0%, p = 0.52). Kaplan–Meier analysis demonstrated improved cumulative survival with planned clopidogrel use of ≥12 months

doi:10.1016/j.hlc.2007.06.017 POSTER SESSION Moderated Posters

C.A. Wasywich 1,∗ , G.D. Gamble 2 , R.N. Doughty 2 1 Auckland City Hospital, Auckland, New Zealand; 2 The Uni-

versity of Auckland, Auckland, New Zealand Background: Studies have reported improved survival for heart failure (HF) patients during the 1990s. It is uncertain whether survival has continued to improve recently. The aims of this study were to determine temporal changes in survival for patients after HF hospitalisation (HFH) in New Zealand (NZ) 1988–2005. Methods: National statistics for hospital admissions for HFH were obtained from the NZ Health Information Service (1988–2005) using ICD codes for HF as the primary or secondary diagnosis. Mortality data was obtained for all patients after first HFH. HF-specific casemix was calculated from ICD codes to assess comorbidity. Results: Between 1988 and 2005 there were 186,681 HFH, involving 103,318 individuals. The number of HFH per year increased from 7576 in 1988 to 11,158 in 2005. Median age increased from 71.7 to 77.4 years. Median length of stay decreased from 8 to 5 days (1988–1999) then remained stable to 2003. HF-specific casemix increased from 2.4 to 3.0. Thirty-day and 6-month mortality rates decreased from 1988 to 1999 then stabilised from 1999 to 2003. 1988

1991

1994

1996

1998

2000

2002

2003

30-day mortality, %

15.2

14.2

12.8

12.8

11.0

11.0

11.4

11.3

6-month mortality, %

30.1

27.9

26.2

24.2

21.9

21.7

21.7

19.7

Conclusions: Survival after first HFH in NZ improved during the 1990s but is unchanged since 1999, despite increasing patient age and comorbidity. These improved outcomes may, in part, reflect evidence based HF pharmacotherapy. Despite these improvements, mortality

remains high reinforcing the importance of further improvements in HF management. doi:10.1016/j.hlc.2007.06.018

Abstracts

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15 Role of Vascular Territory in Global and Regional Abnormalities of Left Ventricular Rotation and Torsion in Patients with Myocardial Ischaemia and Infarction

14 Plasma Coenzyme Q10 (CoQ10 ) is an Independent Predictor of Survival in Chronic Heart Failure (CHF)

M. Bansal ∗ , R. Leano, T.H. Marwick

S. Molyneux 1,∗ , C. Florkowski 1 , M. Richards 2 , P. George 1

Background: LV torsion, attributed to the helical arrangement of subendocardial fibres, is recognized as an important determinant of systolic and diastolic function. The site of regional ischaemia and infarction may therefore influence torsion. Methods: Dobutamine stress echo was performed in 88 patients (46 with prior MI; 42 without MI, normal LV systolic function). Speckle tracking (EchoPAC PC, GE Medical Systems) was used for off-line measurement of global and regional LV systolic rotation and torsion using basal and apical short axis views at baseline and peak dose dobutamine (Pk). Results: At Pk, comparison of 13 pts with RCA ischaemia with non-ischaemic patients showed lower LV basal rotation (Table) and torsion (5 ± 8 vs. 15 ± 9, p = 0.02) than controls, due to impaired inferior wall torsion. LAD ischaemia did not provoke these changes. However, global torsion of LAD infarcts (5 ± 5) was less than non-LAD infarcts (10 ± 7, p < 0.001), with similar findings for resting basal rotation and regional torsion. On multivariate analysis, ischaemia or infarct territory was a predictor of these torsional abnormalities, independent of extent of ischaemia/infarct and haemodynamic parameters. Conclusions: Ischaemia is largely a subendocardial process; impairment of maximally rotating inferoseptal segts with RCA involvement gives disproportionate reduction of basal rotation. Transmural impairment in infarction compromises both epicardial and endocardial twist in the base. Hence, not only the site but also the transmural extent of myocardial dysfunction influences torsion.

1 Biochemistry

Unit, Canterbury Health Laboratories, Christchurch, New Zealand; 2 Cardioendocrine Research Group, Christchurch Hospital, Christchurch, New Zealand Background: Patients with CHF have low plasma concentration of CoQ10 , an essential cofactor for mitochondrial electron transport and myocardial energy supply. Additionally, low plasma total cholesterol (TC) concentrations have been associated with higher mortality in heart failure. Low plasma CoQ10 may contribute to this association, given that it is strongly associated with plasma LDLcholesterol, although this has not been investigated. Methods: We assayed stored plasma samples from 236 patients admitted to hospital with CHF, with a median (range) duration of follow-up of 2.69 (0.12–5.75) years, for LDL-cholesterol, TC and total CoQ10 . Results: Median age at admission was 77 years. Median (range) CoQ10 concentrations were 0.68 (0.18–1.75) ␮mol/L, compared with 0.90 (0.47–1.80) ␮mol/L in healthy individuals (un-matched, n = 205) (p < 0.001). The CoQ10 concentration for best prediction of mortality (established using ROC-curves) for the CHF patients was 0.73 ␮mol/L, and data was split at this level for further analysis. Kaplan–Meier curves showed that in the CHF patients lower CoQ10 is significantly (p < 0.001) associated with mortality (54/22 events (deaths) in the CoQ10 above/below 0.73 ␮mol/L groups). Multivariate analysis using dichotomous data showed that age at admission, nBNP, estimated GFR (MDRD) and CoQ10 , though not LDL-cholesterol, were all independent and significant predictors of mortality. Conclusion: Plasma CoQ10 concentration was an independent predictor of mortality in this cohort. CoQ10 deficiency may be implicated in the long-term prognosis of CHF, and there is a rationale for controlled intervention studies with CoQ10 . Funding: Funding was received from The National Heart Foundation of New Zealand, and Tishcon Corp.

University of Queensland, Brisbane, Australia

Table. Rotation in scar/ischaemia Control Av basal rotation −8 ± 4 at rest (scar) Av basal rotation −9 ± 5 at peak (ischaemia)

Non-LAD

p value

−6 ± 4

−3 ± 6

<0.001

−3 ± 6

−7 ± 6

0.013

doi:10.1016/j.hlc.2007.06.020 doi:10.1016/j.hlc.2007.06.019

LAD infarct

ABSTRACTS

Heart, Lung and Circulation 2007;16:S1–S201