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CT Coronary Angiography can Effectively Rule Out Significant Coronary Artery Disease in Patients Undergoing Cardiac Surgery
412
Heart, Lung and Circulation 2011;20:376–419
Abstracts
ABSTRACTS
was performed in 24.4%, roofline in 63.4%, mitral isthmus line in 31.7%, and ablation of complex fractionated atrial electrograms in 29.3%. Mean procedure time was 4.6 ± 1.0 hours. A second procedure was performed in 16.7% during 12 month follow up, and in a total of 44.4% during on-going follow up. Prior to ablation the mean number of anti-arrhythmic drugs taken was 1.2 ± 0.4 per patient, and this decreased to 0.2 ± 0.4 after PVI, with 80.6% of patients in sinus rhythm and free of antiarrhythmic drugs at the time of follow up. No patient had three procedures. Conclusion: Long term outcomes of pulmonary vein isolation for AF at our centre are good, with the majority of patients drug free and in sinus rhythm after one year. These results are comparable to international reports. Follow up at 12 months Total (n = 36) Success without drugs Single procedure (%) 50.0 Success with or without drugs Single procedure (%) 61.1 Success without drugs ≥1 procedure (%) 72.2 Success with or without drugs ≥1 procedure (%) 91.7
In those <50 years old, significantly more Maori smoked (67% (95% CI 43, 85), n = 21) than non-Maori (38% (95% CI 27, 50), n = 79), p = 0.026 and more Maori reported current marijuana use (33%(15,57), n = 21) than non-Maori (11% (5.3, 21), p = 0.039. The age adjusted odds ratio of current marijuana use was 5.4 (95% CI 2.2, 13.3), p = 0.0002, for Maori versus non-Maori. Conclusions: There is a high incidence of cigarette smoking in CCU patients, associated with a significant likelihood of current marijuana use. Very high levels of smoking and marijuana use was noted in patients
On-going follow up
Paroxysmal AF (n = 21)
Nonparoxysmal AF (n = 15)
Total (n = 36)
Paroxysmal AF (n = 21)
Nonparoxysmal AF (n = 15)
52.4
46.7
44.4
47.6
40.0
61.9
60.0
47.2
52.4
40.0
71.4
73.3
77.8
76.2
80.0
95.2
86.7
94.4
95.2
93.3
doi:10.1016/j.hlc.2011.03.094 High Levels of Marijuana Use in Younger Coronary Care Patients – Correlation with Cigarette Smoking Status and Ethnicity R.M. Swindells 1,∗ , P. Chrisstoffels 1 , G. Gamble 2 , M.E. Legget 1,2 1 Coronary
Care Unit, Auckland City Hospital, New Zealand of Medicine, University of Auckland, Auckland, New Zealand
2 Department
Background: The use of marijuana is not routinely recorded as a risk factor in acute coronary syndromes, but is as harmful as cigarette smoking. The aim of this study was to determine the prevalence of marijuana use in CCU patients and correlate this with cigarette smoking status and ethnicity. Methods: A prospective audit was carried out over a six month period in 2010, recording smoking status, marijuana use and frequency, age and ethnicity. Comparisons were by Fishers exact test and odds ratios were calculated using logistic regression (SAS v9.2). Results: 488 out of 901 (54%) patients responded. Twentyone percent were current smokers and 5% current marijuana users. Fifteen percent (95% CI 8.5, 22), n = 104) of current smokers were also marijuana users compared with 2.6% (95% CI 1.3, 4.7, n = 384) of non-smokers (p < 0.00001). More Maori smoked (46% (95% CI 32, 59), n = 55) than non-Maori (18% (95% CI 15, 22), n = 433), p < 0.0001, similarly more Maori reported current marijuana use (22% (95% CI 12, 35), n = 55) than non-Maori (3.7% (2.1, 5.9), n = 433, p < 0.0001.
CT Coronary Angiography can Effectively Rule Out Significant Coronary Artery Disease in Patients Undergoing Cardiac Surgery T.S.P. Tan ∗ , J.C. Huang, R. Gabriel, T. Sutton, N. van Pelt Cardiology Department, Middlemore Hospital, Auckland, New Zealand Background: Computed tomography coronary angiography (CTCA) is an accurate non-invasive method exclude coronary artery disease (CAD), and may be a safe and cost effective initial evaluation prior to cardiac surgery in place of invasive coronary angiography. Methods: Patients referred for CTCA prior to cardiac surgery were prospectively evaluated from May 2008 to November 2010. All patients underwent ECG gated CTCA on a 64 slice scanner and graded as having no CAD, mild CAD or significant CAD. Clinical parameters evaluated included the Duke score. Results: Forty-five patients (mean age 54yrs, 36% male) were evaluated. The median Duke score was 16. Thirty-nine patients (87%) were scheduled for valve surgery and six patients (13%) for non valvular surgery. The median calcium score was 0 (IQR:42,150). CTCA showed no CAD in 19 patients (42%), mild CAD in 20 (44%) and significant CAD in five patients(11%). Patients with significant CAD and one patient with an uninterpretable result underwent ICA. The positive predictive value for significant CAD detected by CTCA was 80%. Patients with significant CAD had a higher Duke score (median 42 (IQR: 15, 49) vs 15 (IQR: 6, 26)) and higher calcium score (median 490 (IQR: 253, 674) vs 0 (0, 57) compared with patients with no or mild CAD. Nine patients (20%) had significant non-cardiac findings detected by CTCA, of whom seven required further investigations. Conclusion: CTCA is an effective alternative to ICA prior to cardiac surgery in the relatively low risk population. Only 13% of patients required ICA, potentially leading to significant cost savings. doi:10.1016/j.hlc.2011.03.096
Heart, Lung and Circulation 2011;20:376–419
Abstracts
ABSTRACTS
was performed in 24.4%, roofline in 63.4%, mitral isthmus line in 31.7%, and ablation of complex fractionated atrial electrograms in 29.3%. Mean procedure time was 4.6 ± 1.0 hours. A second procedure was performed in 16.7% during 12 month follow up, and in a total of 44.4% during on-going follow up. Prior to ablation the mean number of anti-arrhythmic drugs taken was 1.2 ± 0.4 per patient, and this decreased to 0.2 ± 0.4 after PVI, with 80.6% of patients in sinus rhythm and free of antiarrhythmic drugs at the time of follow up. No patient had three procedures. Conclusion: Long term outcomes of pulmonary vein isolation for AF at our centre are good, with the majority of patients drug free and in sinus rhythm after one year. These results are comparable to international reports. Follow up at 12 months Total (n = 36) Success without drugs Single procedure (%) 50.0 Success with or without drugs Single procedure (%) 61.1 Success without drugs ≥1 procedure (%) 72.2 Success with or without drugs ≥1 procedure (%) 91.7
In those <50 years old, significantly more Maori smoked (67% (95% CI 43, 85), n = 21) than non-Maori (38% (95% CI 27, 50), n = 79), p = 0.026 and more Maori reported current marijuana use (33%(15,57), n = 21) than non-Maori (11% (5.3, 21), p = 0.039. The age adjusted odds ratio of current marijuana use was 5.4 (95% CI 2.2, 13.3), p = 0.0002, for Maori versus non-Maori. Conclusions: There is a high incidence of cigarette smoking in CCU patients, associated with a significant likelihood of current marijuana use. Very high levels of smoking and marijuana use was noted in patients
On-going follow up
Paroxysmal AF (n = 21)
Nonparoxysmal AF (n = 15)
Total (n = 36)
Paroxysmal AF (n = 21)
Nonparoxysmal AF (n = 15)
52.4
46.7
44.4
47.6
40.0
61.9
60.0
47.2
52.4
40.0
71.4
73.3
77.8
76.2
80.0
95.2
86.7
94.4
95.2
93.3
doi:10.1016/j.hlc.2011.03.094 High Levels of Marijuana Use in Younger Coronary Care Patients – Correlation with Cigarette Smoking Status and Ethnicity R.M. Swindells 1,∗ , P. Chrisstoffels 1 , G. Gamble 2 , M.E. Legget 1,2 1 Coronary
Care Unit, Auckland City Hospital, New Zealand of Medicine, University of Auckland, Auckland, New Zealand
2 Department
Background: The use of marijuana is not routinely recorded as a risk factor in acute coronary syndromes, but is as harmful as cigarette smoking. The aim of this study was to determine the prevalence of marijuana use in CCU patients and correlate this with cigarette smoking status and ethnicity. Methods: A prospective audit was carried out over a six month period in 2010, recording smoking status, marijuana use and frequency, age and ethnicity. Comparisons were by Fishers exact test and odds ratios were calculated using logistic regression (SAS v9.2). Results: 488 out of 901 (54%) patients responded. Twentyone percent were current smokers and 5% current marijuana users. Fifteen percent (95% CI 8.5, 22), n = 104) of current smokers were also marijuana users compared with 2.6% (95% CI 1.3, 4.7, n = 384) of non-smokers (p < 0.00001). More Maori smoked (46% (95% CI 32, 59), n = 55) than non-Maori (18% (95% CI 15, 22), n = 433), p < 0.0001, similarly more Maori reported current marijuana use (22% (95% CI 12, 35), n = 55) than non-Maori (3.7% (2.1, 5.9), n = 433, p < 0.0001.
CT Coronary Angiography can Effectively Rule Out Significant Coronary Artery Disease in Patients Undergoing Cardiac Surgery T.S.P. Tan ∗ , J.C. Huang, R. Gabriel, T. Sutton, N. van Pelt Cardiology Department, Middlemore Hospital, Auckland, New Zealand Background: Computed tomography coronary angiography (CTCA) is an accurate non-invasive method exclude coronary artery disease (CAD), and may be a safe and cost effective initial evaluation prior to cardiac surgery in place of invasive coronary angiography. Methods: Patients referred for CTCA prior to cardiac surgery were prospectively evaluated from May 2008 to November 2010. All patients underwent ECG gated CTCA on a 64 slice scanner and graded as having no CAD, mild CAD or significant CAD. Clinical parameters evaluated included the Duke score. Results: Forty-five patients (mean age 54yrs, 36% male) were evaluated. The median Duke score was 16. Thirty-nine patients (87%) were scheduled for valve surgery and six patients (13%) for non valvular surgery. The median calcium score was 0 (IQR:42,150). CTCA showed no CAD in 19 patients (42%), mild CAD in 20 (44%) and significant CAD in five patients(11%). Patients with significant CAD and one patient with an uninterpretable result underwent ICA. The positive predictive value for significant CAD detected by CTCA was 80%. Patients with significant CAD had a higher Duke score (median 42 (IQR: 15, 49) vs 15 (IQR: 6, 26)) and higher calcium score (median 490 (IQR: 253, 674) vs 0 (0, 57) compared with patients with no or mild CAD. Nine patients (20%) had significant non-cardiac findings detected by CTCA, of whom seven required further investigations. Conclusion: CTCA is an effective alternative to ICA prior to cardiac surgery in the relatively low risk population. Only 13% of patients required ICA, potentially leading to significant cost savings. doi:10.1016/j.hlc.2011.03.096