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Experience with FFR Guided PCI in a Regional Tertiary Referral Centre in North Queensland
Abstracts
S176
410 Exertional Syncope in Athletic Middle Aged Males Without Angina: Consider Ischaemic Ventricular Tachycardia V. Freeman ∗ , C. Hammett, P. Stewart, P. Martin Royal Brisbane and Women’s Hospital Cardiology, Herston, Australia Reduced classical ischaemic symptoms in athletic middle aged males may mask critical ischaemia. Critical ischaemia triggering ventricular arrhythmias presenting as syncope may be the first ischaemic presentation. We describe three athletic middle-aged males who presented with exertional syncope. All 3 denied frank classical ischaemic exertional symptoms and had above normal exertional tolerances. Routine non invasive cardiac investigations were normal, with their exercise tolerances above 10 METS. Ventricular tachycardia (VT) was demonstrated at electrophysiological study or on loop recorder tracings. Coronary angiography revealed critical single vessel coronary stenosis that were successfully revascularised by percutaneous coronary intervention (PCI). Post PCI, no further arrhythmias or syncope have occurred, In retrospect, all 3 report a minor decline in exercise tolerance, that had been attributed to ageing, had resolved post PCI. Possible contributors include a lack of cardiac awareness, ischaemic preconditioning, “pushing through’ minor initial exertional symptoms, attribution of minor symptoms to ageing or a combination of the above. Clinicians should maintain a high index of suspicion that exertional syncope in athletic middle aged males without angina may unmask critical ischaemia. This ischaemia may trigger VT, and direct coronary imaging with CTCA or angiography and appropriate revascularisation are needed. http://dx.doi.org/10.1016/j.hlc.2016.06.412 411 Experience with FFR Guided PCI in a Regional Tertiary Referral Centre in North Queensland P. Hegde ∗ , K. Gopal, S. Huey, V. Gowda, R. Yadav, R. Schrale, S. Bhaveja Townsville Hospital, Townsville, Australia Introduction: Robust clinical-outcome data favour FFRguided revascularisation, as compared with revascularisation guided by angiography alone in patients with stable coronary artery disease. TTH caters to population of a large geographical area. The interventional cardiologists at TTH, face multiple challenges in patient populations which includes lack of education, non- compliance and substance abuse. FFR is a useful tool to guide percutaneous coronary intervention (PCI) due to these problems. Aim of the study: To analyse the percentage of patients who had functional testing(FT) in the three months preceding the FFR procedure and compare outcomes.
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Also to analyse the percentage of patients who had unplanned hospitalisation in the six months post FFR guided PCI. Methods: Retrospective data was analysed from patient databases and Electronic medical records for 12 months starting January 2015. The first three months’ data which was available showed that 33 patients had FFR guided PCI. Patient characteristics
.............................................
Average age
61years
Male
81%
Diabetes
21%
Hypertension
33%
Current smokers
21%
LV dysfunction
15%
Indications for FFR Planned procedure (45%) Chest pain (36%) NSTEMI (6%) Arrhythmia (6%) Other (7%)
Results: Out of 33 patients, 6(18%) patients had FT, 3 months prior to the FFR. 4/6 (66%) had inducible ischaemia on FT. 2/4(50%) patients who had inducible ischaemia had haemodynamically flow limiting lesions on FFR. In 33 patients, 43 lesions were assessed by FFR out of which 6 (13.9%)were positive. The average FFR value was 0.86(0.640.97). Six patients had unplanned hospitalisation in the first 6 months with recurrent symptoms out of which 2 patients had intervention to the vessel which had a negative FFR. Two patients had FFR of a different vessel. Conclusions: A small percentage of patients had FT prior to FFR assessment. There was no significant correlation between FFR and FT. Another small percentage of patients needed PCI due to recurrent symptoms. More data analysis needs to be performed to obtain further information. http://dx.doi.org/10.1016/j.hlc.2016.06.413 412 Feasibility of Same-Day Discharge Post-Percutaneous Coronary Intervention A Single Centre Experience G. Gan ∗ , A. Bhat, R. Rehan, N. Goonetilleke, B. Changsiri, R. Denniss, D. Burgess, T. Tan Department of Cardiology, Blacktown Hospital, Blacktown, Australia Background: Elective coronary angiography with percutaneous intervention (PCI) has conventionally been followed by overnight observation, primarily due to concern regarding risk of peri-procedural adverse events. Given contemporary procedural techniques and anticoagulation strategies, these risks have become infrequent, with numerous studies
S176
410 Exertional Syncope in Athletic Middle Aged Males Without Angina: Consider Ischaemic Ventricular Tachycardia V. Freeman ∗ , C. Hammett, P. Stewart, P. Martin Royal Brisbane and Women’s Hospital Cardiology, Herston, Australia Reduced classical ischaemic symptoms in athletic middle aged males may mask critical ischaemia. Critical ischaemia triggering ventricular arrhythmias presenting as syncope may be the first ischaemic presentation. We describe three athletic middle-aged males who presented with exertional syncope. All 3 denied frank classical ischaemic exertional symptoms and had above normal exertional tolerances. Routine non invasive cardiac investigations were normal, with their exercise tolerances above 10 METS. Ventricular tachycardia (VT) was demonstrated at electrophysiological study or on loop recorder tracings. Coronary angiography revealed critical single vessel coronary stenosis that were successfully revascularised by percutaneous coronary intervention (PCI). Post PCI, no further arrhythmias or syncope have occurred, In retrospect, all 3 report a minor decline in exercise tolerance, that had been attributed to ageing, had resolved post PCI. Possible contributors include a lack of cardiac awareness, ischaemic preconditioning, “pushing through’ minor initial exertional symptoms, attribution of minor symptoms to ageing or a combination of the above. Clinicians should maintain a high index of suspicion that exertional syncope in athletic middle aged males without angina may unmask critical ischaemia. This ischaemia may trigger VT, and direct coronary imaging with CTCA or angiography and appropriate revascularisation are needed. http://dx.doi.org/10.1016/j.hlc.2016.06.412 411 Experience with FFR Guided PCI in a Regional Tertiary Referral Centre in North Queensland P. Hegde ∗ , K. Gopal, S. Huey, V. Gowda, R. Yadav, R. Schrale, S. Bhaveja Townsville Hospital, Townsville, Australia Introduction: Robust clinical-outcome data favour FFRguided revascularisation, as compared with revascularisation guided by angiography alone in patients with stable coronary artery disease. TTH caters to population of a large geographical area. The interventional cardiologists at TTH, face multiple challenges in patient populations which includes lack of education, non- compliance and substance abuse. FFR is a useful tool to guide percutaneous coronary intervention (PCI) due to these problems. Aim of the study: To analyse the percentage of patients who had functional testing(FT) in the three months preceding the FFR procedure and compare outcomes.
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .
Also to analyse the percentage of patients who had unplanned hospitalisation in the six months post FFR guided PCI. Methods: Retrospective data was analysed from patient databases and Electronic medical records for 12 months starting January 2015. The first three months’ data which was available showed that 33 patients had FFR guided PCI. Patient characteristics
.............................................
Average age
61years
Male
81%
Diabetes
21%
Hypertension
33%
Current smokers
21%
LV dysfunction
15%
Indications for FFR Planned procedure (45%) Chest pain (36%) NSTEMI (6%) Arrhythmia (6%) Other (7%)
Results: Out of 33 patients, 6(18%) patients had FT, 3 months prior to the FFR. 4/6 (66%) had inducible ischaemia on FT. 2/4(50%) patients who had inducible ischaemia had haemodynamically flow limiting lesions on FFR. In 33 patients, 43 lesions were assessed by FFR out of which 6 (13.9%)were positive. The average FFR value was 0.86(0.640.97). Six patients had unplanned hospitalisation in the first 6 months with recurrent symptoms out of which 2 patients had intervention to the vessel which had a negative FFR. Two patients had FFR of a different vessel. Conclusions: A small percentage of patients had FT prior to FFR assessment. There was no significant correlation between FFR and FT. Another small percentage of patients needed PCI due to recurrent symptoms. More data analysis needs to be performed to obtain further information. http://dx.doi.org/10.1016/j.hlc.2016.06.413 412 Feasibility of Same-Day Discharge Post-Percutaneous Coronary Intervention A Single Centre Experience G. Gan ∗ , A. Bhat, R. Rehan, N. Goonetilleke, B. Changsiri, R. Denniss, D. Burgess, T. Tan Department of Cardiology, Blacktown Hospital, Blacktown, Australia Background: Elective coronary angiography with percutaneous intervention (PCI) has conventionally been followed by overnight observation, primarily due to concern regarding risk of peri-procedural adverse events. Given contemporary procedural techniques and anticoagulation strategies, these risks have become infrequent, with numerous studies