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Contemporary PCI Outcomes in the Elderly – A Single Centre Experience
Abstracts
399 Contemporary PCI Outcomes in the Elderly – A Single Centre Experience S. Nicolaides ∗ , D. Tong, A. Baradi, R. Whitbourn, A. Wilson, J. Layland, J. Gutman, A. Burns, P. Barlis, J. Somaratne, S. Palmer, N. Nadarajah, H. Adams, E. Paratz, S. Gutman, A. MacIsaac St Vincent’s Hospital, Melbourne, Australia Introduction: Despite increasing prevalence of cardiovascular disease in the elderly, they are often excluded from clinical revascularisation trials. Data on outcomes of contemporary PCI in the elderly is lacking. Objectives: To describe the clinical characteristics and outcomes of elderly patients undergoing PCI at St Vincent’s Hospital Melbourne. Methods: We analysed 140 patients >80 years old who underwent PCI between September 2012 and December 2015, representing 9.7% of total PCIs performed over the same period of time. Clinical and procedural characteristics, inhospital and 30-day outcomes are described. Results: The cohort had a mean age of 82.9±2.7 years and 59% were males. Medical comorbidities were diabetes (37%), previous MI (9%), cerebrovascular disease (12%) and peripheral vascular disease (10%). Mean baseline creatinine was 100±40 mmol/L. Presentation with STEMI, NSTEMI, and unstable angina were 10%, 32% and 57% respectively. Cardiogenic shock was present in 6%; 1 out of hospital cardiac arrest; 62% had multivessel disease. Procedural success rate was 99% with mean 1.5 stents per patient deployed and 80% received drug-eluting stents. 4% received glycoprotein IIb/IIIa inhibitors; 41% femoral approach; 9% suffered from periprocedural bleeding complications; and 4% developed contrastinduced nephropathy. In-hospital mortality was 3% (2 cardiac deaths, 1 anuric renal failure, 1 haemorrhagic stroke). There was no additional mortality or MACE event at 30 days. Conclusion: In a selected group of elderly patients, high PCI success rates can be achieved with favourable short-term outcomes. Further studies are warranted to examine the longterm outcomes of management strategies in this population. http://dx.doi.org/10.1016/j.hlc.2016.06.401 400 Contemporary Practice of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) at a Single Non-Transplant Centre: Survival Prediction Scores, Indications and Outcomes J. Xu 1,3,∗ , D. Leung 1,3 , R. Rajaratnam 1,3 , C. Mussap 1,3 , J. French 1,3 , C. Juergens 1,3 , M. Parr 2,3 , S. Lo 1,3 1 Department
of Cardiology, Liverpool Hospital, Sydney, Australia 2 Intensive Care Unit, Liverpool Hospital, Sydney, Australia 3 South Western Sydney Clinical School, University of NSW, Sydney, Australia
S171
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Introduction: Appropriate patient selection for ECMO remains challenging. The SAVE score is a recently reported survival prediction model for VA-ECMO but its wider applicability outside of refractory cardiogenic shock (RCS) patients remains unknown. Here we report the in-hospital outcomes and evaluate the performance of SAVE scores on patients undergoing VA-ECMO. Methods: We retrospectively identified 16 consecutive inpatients receiving VA-ECMO at Liverpool Hospital, Sydney between January 2010 and January 2016. All patients were categorised into 1 of 5 risk classes using the SAVE score. Results: Patient characteristics are presented in Table 1. Indications were RCS (62.5%); cardiac arrest (12.5%); backup for left main stenting (12.5%), and failure to wean from cardiopulmonary bypass following cardiac surgery (12.5%). Intra-aortic balloon pump (IABP) was used in 11 patients (6 prior to ECMO, 5 concurrent IABP and ECMO). Death occurred in 11 patients (68.8%). Of the 5 survivors 2 had prior IABP, and 2 had concurrent IABP and VA-ECMO. Complications occurred in 8 cases (50%): 5 major bleeding, 1 limb ischaemia, and 2 had both. Survivors had lower median risk category compared to non-survivors (3 vs 5, p = 0.05) (Figure 1). Conclusions: In our limited experience, the SAVE score may be a useful tool to assist with the difficult process of patient selection for VA-ECMO and improve the quality of care. In addition, a trial of IABP may aid patient triage.
http://dx.doi.org/10.1016/j.hlc.2016.06.402
399 Contemporary PCI Outcomes in the Elderly – A Single Centre Experience S. Nicolaides ∗ , D. Tong, A. Baradi, R. Whitbourn, A. Wilson, J. Layland, J. Gutman, A. Burns, P. Barlis, J. Somaratne, S. Palmer, N. Nadarajah, H. Adams, E. Paratz, S. Gutman, A. MacIsaac St Vincent’s Hospital, Melbourne, Australia Introduction: Despite increasing prevalence of cardiovascular disease in the elderly, they are often excluded from clinical revascularisation trials. Data on outcomes of contemporary PCI in the elderly is lacking. Objectives: To describe the clinical characteristics and outcomes of elderly patients undergoing PCI at St Vincent’s Hospital Melbourne. Methods: We analysed 140 patients >80 years old who underwent PCI between September 2012 and December 2015, representing 9.7% of total PCIs performed over the same period of time. Clinical and procedural characteristics, inhospital and 30-day outcomes are described. Results: The cohort had a mean age of 82.9±2.7 years and 59% were males. Medical comorbidities were diabetes (37%), previous MI (9%), cerebrovascular disease (12%) and peripheral vascular disease (10%). Mean baseline creatinine was 100±40 mmol/L. Presentation with STEMI, NSTEMI, and unstable angina were 10%, 32% and 57% respectively. Cardiogenic shock was present in 6%; 1 out of hospital cardiac arrest; 62% had multivessel disease. Procedural success rate was 99% with mean 1.5 stents per patient deployed and 80% received drug-eluting stents. 4% received glycoprotein IIb/IIIa inhibitors; 41% femoral approach; 9% suffered from periprocedural bleeding complications; and 4% developed contrastinduced nephropathy. In-hospital mortality was 3% (2 cardiac deaths, 1 anuric renal failure, 1 haemorrhagic stroke). There was no additional mortality or MACE event at 30 days. Conclusion: In a selected group of elderly patients, high PCI success rates can be achieved with favourable short-term outcomes. Further studies are warranted to examine the longterm outcomes of management strategies in this population. http://dx.doi.org/10.1016/j.hlc.2016.06.401 400 Contemporary Practice of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) at a Single Non-Transplant Centre: Survival Prediction Scores, Indications and Outcomes J. Xu 1,3,∗ , D. Leung 1,3 , R. Rajaratnam 1,3 , C. Mussap 1,3 , J. French 1,3 , C. Juergens 1,3 , M. Parr 2,3 , S. Lo 1,3 1 Department
of Cardiology, Liverpool Hospital, Sydney, Australia 2 Intensive Care Unit, Liverpool Hospital, Sydney, Australia 3 South Western Sydney Clinical School, University of NSW, Sydney, Australia
S171
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Introduction: Appropriate patient selection for ECMO remains challenging. The SAVE score is a recently reported survival prediction model for VA-ECMO but its wider applicability outside of refractory cardiogenic shock (RCS) patients remains unknown. Here we report the in-hospital outcomes and evaluate the performance of SAVE scores on patients undergoing VA-ECMO. Methods: We retrospectively identified 16 consecutive inpatients receiving VA-ECMO at Liverpool Hospital, Sydney between January 2010 and January 2016. All patients were categorised into 1 of 5 risk classes using the SAVE score. Results: Patient characteristics are presented in Table 1. Indications were RCS (62.5%); cardiac arrest (12.5%); backup for left main stenting (12.5%), and failure to wean from cardiopulmonary bypass following cardiac surgery (12.5%). Intra-aortic balloon pump (IABP) was used in 11 patients (6 prior to ECMO, 5 concurrent IABP and ECMO). Death occurred in 11 patients (68.8%). Of the 5 survivors 2 had prior IABP, and 2 had concurrent IABP and VA-ECMO. Complications occurred in 8 cases (50%): 5 major bleeding, 1 limb ischaemia, and 2 had both. Survivors had lower median risk category compared to non-survivors (3 vs 5, p = 0.05) (Figure 1). Conclusions: In our limited experience, the SAVE score may be a useful tool to assist with the difficult process of patient selection for VA-ECMO and improve the quality of care. In addition, a trial of IABP may aid patient triage.
http://dx.doi.org/10.1016/j.hlc.2016.06.402