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Drug-eluting Stents Versus Coronary Artery Bypass Graft Surgery in Left Main Coronary Artery Disease—A Meta-analysis of Randomised and Nonrandomised Studies
Results: Depressive symptoms were highest among those ≤59 years followed by ≥80, 70–79 and 60–69 age groups (66%, 59%, 54% and 52%, respectively). Using Cox proportional hazard regression, depression scores significantly predicted ACM (hazard ratio [HR], 1.033; 95% confidence interval [CI], 1.008–1.059; p = 0.01), and remained unchanged when controlling for age group and history of myocardial infarction (MI), stent, and peripheral vascular disease (p = 0.03). In subgroup analyses, the effect of increasing depression scores on ACM was only significant in the 70–79 age group, even after adjustment for relevant confounders (HR 1.056, p = 0.03). Mortality was less influenced by depression scores compared to independent co-morbid predictors: history of MI and stroke (≥80 and 70–79 years) and diabetes (≤59 years) (p < 0.05). Absent stent history (≥80 and 60–69 years) and private insurance (≥80 years) were associated with a lower ACM (p < 0.04). Conclusion: Findings suggest age group differences among predictors for mortality in CHD, and underscore the importance of early assessment and management of depressive symptoms. http://dx.doi.org/10.1016/j.hlc.2012.05.097 88 Drug-eluting Stents Versus Coronary Artery Bypass Graft Surgery in Left Main Coronary Artery Disease—A Metaanalysis of Randomised and Nonrandomised Studies C. Cao 1,2 , C. Manganas 2 , M. Vallely 1 , P. Bannon 1 , S. Munkholm-Larsen 1 , T. Yan 1 , S. Ang 2,∗ 1 The
Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia 2 St George Hospital, Sydney, NSW, Australia Due to confidentiality reasons, the text of this abstract has been withheld from publication. 89 Dual or Triple Therapy with Warfarin and Anti-platelet Agents after STEMI or Elective PCI with Drug-eluting Stents? Results from a Multi-centre Registry D. Eccleston 1,∗ , M. Horrigan 1 , P. Sage 2 , T. Rafter 3 1 Warringal
Private Hospital, Australia Hospital Adelaide, Australia 3 Wesley Hospital Brisbane, Australia 2 Wakefield
Background: Current guidelines recommend warfarin (OAC) after STEMI for patients with AF, LV dysfunction or extensive regional wall motion abnormalities, however OAC increases bleeding, cost and has poor treatment compliance. Recent data also suggest OAC offers little benefit over aspirin alone after STEMI reperfusion. We report long-term outcome data in patients having warfarin postSTEMI PCI from the national multi-centre Heart Care Group registry.
CSANZ 2012 Abstracts
S37
Methods: We prospectively collected follow-up data on 2590 consecutive patients undergoing elective and 244 STEMI-PCI from 2008 to 2010. We compared 12 month MACCE (death, MI, PCI, CABG, CVA) between patients taking OAC vs no OAC, with or without valve disease. We stratified MACCE by infarct site (LAD vs non-LAD), antiplatelet therapy (single vs dual APT) and stent type (DES vs. BMS). Results: 10.2% of STEMI patients received OAC at discharge. OAC patients were older than NoOAC (72.7 ± 9 vs 68.4 ± 7 years), heavier (90.2 ± 17 vs 85.6 ± 18 kg) and had worse renal function (eGRF 59.9 ± 22 vs 70.9 ± 17). Diabetes (%) Chronic kidney disease (%) Prior MI (%) Chronic heart failure (%) Prior CABG (%) Prior valve surgery (%) Atrial fibrillation (%) Cerebrovascular disease (%) Obstructive sleep apnoea (%) DES (%) MACCE at 12 months (%)
Warfarin
No Warfarin
33.8 9.4 42.2 20.3 21.9 10.8 53.1 26.2 13.8 53.2 6.2
21.0 3.3 23.0 4.2 10.8 0.4 2.8 6.5 6.3 71.3 1.3
p 0.013 0.02 0.001 <0.001 0.013 <0.001 <0.001 <0.001 0.035 <0.001 0.014
Conclusion: Excluding patients with valvular heart disease, warfarin provides no additional reduction in MACCE post-STEMI PCI beyond DAPT alone. http://dx.doi.org/10.1016/j.hlc.2012.05.099 90 Dynamic Changes to the Proximal Reference Segment Luminal Dimension during Percutaneous Coronary Intervention an Optical Coherence Tomography (OCT) Study A. Incani ∗ , K. Poon, M. Savage, M. Pincus, A. Small, N. Bett, R. Chua, A. Mishra, D. Walters, C. Raffel The Prince Charles Hospital, Australia Background: It is generally accepted that the distal luminal reference segment will vasodilate after successful treatment of an upstream lesion following percutaneous coronary intervention (PCI). However, there is little data on the behaviour of the proximal reference segment following PCI. We sought to analyse any change in proximal reference segment luminal dimensions following PCI using optical coherence tomography (OCT). Methods: All OCT studies that included pre and post PCI runs with a clear reference segment (minimal plaque, within 10 mm of the proximal end of the lesion, absence of side-branches) were analysed. Z-offset recalibration was performed and proximal reference luminal dimensions measured [minimum diameter (MiD), mean diameter (MeD), and cross-sectional area (CSA)]. All measurements were taken pre and post PCI and given as a mean (standard deviation). Results: Thirty-four patients were included. All proximal reference measurements increased after PCI. Mean MiD increased by 4.4% from 3.04 (0.55) mm to 3.17 (0.60) mm, p = 0.026. MeD increased by 4.2% from 3.29 (0.55) mm to 3.42 (0.59) mm, p = 0.0078. Mean CSA
ABSTRACTS
Heart, Lung and Circulation 2012;21:S1–S142
Baird Institute for Applied Heart and Lung Surgical Research, Sydney, Australia 2 St George Hospital, Sydney, NSW, Australia Due to confidentiality reasons, the text of this abstract has been withheld from publication. 89 Dual or Triple Therapy with Warfarin and Anti-platelet Agents after STEMI or Elective PCI with Drug-eluting Stents? Results from a Multi-centre Registry D. Eccleston 1,∗ , M. Horrigan 1 , P. Sage 2 , T. Rafter 3 1 Warringal
Private Hospital, Australia Hospital Adelaide, Australia 3 Wesley Hospital Brisbane, Australia 2 Wakefield
Background: Current guidelines recommend warfarin (OAC) after STEMI for patients with AF, LV dysfunction or extensive regional wall motion abnormalities, however OAC increases bleeding, cost and has poor treatment compliance. Recent data also suggest OAC offers little benefit over aspirin alone after STEMI reperfusion. We report long-term outcome data in patients having warfarin postSTEMI PCI from the national multi-centre Heart Care Group registry.
CSANZ 2012 Abstracts
S37
Methods: We prospectively collected follow-up data on 2590 consecutive patients undergoing elective and 244 STEMI-PCI from 2008 to 2010. We compared 12 month MACCE (death, MI, PCI, CABG, CVA) between patients taking OAC vs no OAC, with or without valve disease. We stratified MACCE by infarct site (LAD vs non-LAD), antiplatelet therapy (single vs dual APT) and stent type (DES vs. BMS). Results: 10.2% of STEMI patients received OAC at discharge. OAC patients were older than NoOAC (72.7 ± 9 vs 68.4 ± 7 years), heavier (90.2 ± 17 vs 85.6 ± 18 kg) and had worse renal function (eGRF 59.9 ± 22 vs 70.9 ± 17). Diabetes (%) Chronic kidney disease (%) Prior MI (%) Chronic heart failure (%) Prior CABG (%) Prior valve surgery (%) Atrial fibrillation (%) Cerebrovascular disease (%) Obstructive sleep apnoea (%) DES (%) MACCE at 12 months (%)
Warfarin
No Warfarin
33.8 9.4 42.2 20.3 21.9 10.8 53.1 26.2 13.8 53.2 6.2
21.0 3.3 23.0 4.2 10.8 0.4 2.8 6.5 6.3 71.3 1.3
p 0.013 0.02 0.001 <0.001 0.013 <0.001 <0.001 <0.001 0.035 <0.001 0.014
Conclusion: Excluding patients with valvular heart disease, warfarin provides no additional reduction in MACCE post-STEMI PCI beyond DAPT alone. http://dx.doi.org/10.1016/j.hlc.2012.05.099 90 Dynamic Changes to the Proximal Reference Segment Luminal Dimension during Percutaneous Coronary Intervention an Optical Coherence Tomography (OCT) Study A. Incani ∗ , K. Poon, M. Savage, M. Pincus, A. Small, N. Bett, R. Chua, A. Mishra, D. Walters, C. Raffel The Prince Charles Hospital, Australia Background: It is generally accepted that the distal luminal reference segment will vasodilate after successful treatment of an upstream lesion following percutaneous coronary intervention (PCI). However, there is little data on the behaviour of the proximal reference segment following PCI. We sought to analyse any change in proximal reference segment luminal dimensions following PCI using optical coherence tomography (OCT). Methods: All OCT studies that included pre and post PCI runs with a clear reference segment (minimal plaque, within 10 mm of the proximal end of the lesion, absence of side-branches) were analysed. Z-offset recalibration was performed and proximal reference luminal dimensions measured [minimum diameter (MiD), mean diameter (MeD), and cross-sectional area (CSA)]. All measurements were taken pre and post PCI and given as a mean (standard deviation). Results: Thirty-four patients were included. All proximal reference measurements increased after PCI. Mean MiD increased by 4.4% from 3.04 (0.55) mm to 3.17 (0.60) mm, p = 0.026. MeD increased by 4.2% from 3.29 (0.55) mm to 3.42 (0.59) mm, p = 0.0078. Mean CSA
ABSTRACTS
Heart, Lung and Circulation 2012;21:S1–S142