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GW27-e0159 Comparison of different risk scores for predicting contrast induced nephropathy and clinical outcomes after primary percutaneous coronary intervention
C90
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 16, SUPPL S, 2016
present study, 2 subgroup analyses were preformed: 1) antiplatelettreated subgroup (n¼61): we evaluated the impact of loading doses of ticagrelor (vs clopidogrel) on PMI in the antiplatelet-treated patients; 2) antiplatelet-naive subgroup (n¼53): we analyzed the effects of ticagrelor (vs clopidogrel) on PMI in patients who didn’t receive antiplatelet treatment. The cardiac troponin I (cTnI), creatine kinase-MB (CK-MB) and high-sensitive C-reactive protein (hs-CRP) were determined before, and 8, 24 hours after PCI. All patients received standard diagnostic angiography and PCI procedure. And drug-eluting stents (DESs) were deployed after prior balloon angioplasty. The use of platelet glycoprotein (GP) IIb/IIIa receptor antagonists was a decision of individual operator. Patients in the ticagrelor group received aspirin and ticagrelor for 1 week, then changed to use aspirin and clopidogrel. RESULTS Baseline clinical, angiographic and PCI procedural characteristics were similar between the two groups except that ticagrelor group had more male patients (p¼0.045), higher use rate of b-blockers (p¼0.034) than did clopidogrel group. The overall incidence of PMI was 37.7%. Ticagrelor group showed a significantly lower incidence of PMI compared to clopidogrel group (28.1% vs 47.4%, p¼0.034). However, subgroup analyses showed that the incidences of PMI were comparable between ticagrelor group and clopidogrel group regardless antiplatelet-treated or not (antiplatelet-naive group: 24.0% vs 42.9%, p¼0.148; antiplatelet-treated group: 31.2% vs 51.7%, p¼0.104). In addition, the levels of hs-CRP before and after PCI were similar between the comparing groups. Multivariable logistic analysis performed in the overall study population showed that the use of ticagrelor [hazard ratio (HR): 0.35; 95% confidence interval (CI): 0.15-0.82; p¼0.016] was an independent predictor of PMI. CONCLUSIONS Pretreatment with the loading dose of ticagrelor can significantly lower the incidence of PCI related PMI in patients with ACS underoing selective PCI as compared with clopidogrel. Further study with larger study population is needed to get definite conclusions. GW27-e0100 Eveluation of Multidisciplinary Collaborative Care Management in Patients with both Acute Coronary Syndrome and Depression and/or Anxiety Disorders Liang Feng,1 Liuzhuang Zhao,1 Xiuhua Ma1 1 Department of Cardiology, Daxing Hospital, Capital University of Medical Science, Beijing, China OBJECTIVES The aim of this study was to examine whether collaborative care can improve clinical outcomes in patients with both ACS and depression and/or anxiety. METHODS In the present study, depression and/or anxiety were screened by using SDS and SAS questionnaire in 318 patients with acute coronary syndrome(ACS), and 96 (30.19%) ACS patients with depression and/or anxiety disorders were randomized into the multidisciplinary collaborative care management group (MCCM, n¼49) and the usual physician care management group (UPCM, n¼47). The ACS patients withoutdepression and/or anxiety were served as control group. One year of multidisciplinary collaborative care was provided by multidisciplinary team to the patients in the MCCM group. The effect and adherence for cardiovascular risk factors management, psychological interventions and health education were followed up at 6 months after enrollment. At 1 year follow-up, cardiac outcomes for patients in UPCM group was compareded with patients with ACS (ACS ptients without depression and/or anxiety). The effect of multidisciplinary collaborative care management were evaluated in the patients in MCCM group compared with UPCM group at 1 year. RESULTS At 6 months after ACS, mental disorder are associated with increased risk for clinical outcomes, most risk factors worsened more significantly in patients in UPCM group compared with ACS group. The majority of parameters for risk factors improved more significantly in the patients in the MCCM group compared with UPCM group at 6 months follow up. At 1 year follow-up, cardiac death (p¼0.03), composite events of cardiac death and non-fatal MI (p¼0.002), episodes of angina (p 0.0005) occured more significantly in patients in UPCM group than ACS group. At 1 year after multidisciplinary collaborative care management, cardiac outcome measures for the patients in the MCCM group were significantly better for composite events of cardiac death and non-fatal MI (6.12% vs 23.40%, p¼0.016), cardiac function (NYHA class III or IV, 0% vs 25%, p¼0.05), and angina pectoris attacks (21.28%
vs 85%, p 0.0005), compared with the patients in UPCM group. The patients in MCCM group achieved significant mental and social functioning improvements on appetite (p 0.0005), sleep (p 0.0005), and job back (p¼0.007), compared with patients in UPCM group. CONCLUSIONS After ACS, 30.19% of patients had depression and/or anxiety disorders, which led to poorer modification of risk factors for coronary heart disease, and associated with poorer cardiac outcomes and reduced quality of life. The multidisciplinary collaborative care management had better effects on cardiac outcomes and quality of life in ACS patients with depression and/or anxiety. GW27-e0159 Comparison of different risk scores for predicting contrast induced nephropathy and clinical outcomes after primary percutaneous coronary intervention Yuanhui Liu, Yong Liu, Ji-yan Chen, Ning Tan Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Ac OBJECTIVES Accurate risk stratification for contrast-induced nephropathy (CIN) is important in the management of patients with STsegment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). We aimed to compare the prognostic value of validated risk scores for CIN. METHODS We prospectively enrolled 422 consecutive patients treated with primary PCI for STEMI. Mehran, Gao, Chen, Age, Creatinine (SCr), and Ejection Fraction (ACEF); Age, Glomerular Filtration Rate, and Ejection Fraction (AGEF); and GRACE risk scores were calculated for each patient. The prognostic accuracy of the 6 scores for CIN, and in-hospital and 3-year all-cause mortality and major adverse clinical events (MACEs), was assessed using the c-statistic for discrimination and the Hosmer-Lemeshow test for calibration. CIN was defined as either CIN-narrow (rise in SCr 0.5 mg/dL) or CINbroad (rise in SCr 0.5 mg/dL) and/or a 25% increase in baseline (SCr). RESULTS These six risk scores all had relatively high predictive value for CIN-narrow (C statistic range 0.746 to 0.873), as well with good calibration for most of them. In addition, these six risk scores also displayed well for prediction of in-hospital death (0.784 to 0.936) and in hospital MACEs (0.685 to 0.763) or 3 year all-cause mortality (0.655 to 0.871). ACEF and AGEF risk score have both better discrimination and calibration for CIN-narrow, in-hospital outcomes, comparing with other risk scores. However, these six risk score all did not perform as well and had low predictive accuracy for CIN-broad (0.555 to 0.643) and 3-year MACEs (0.541 to 0.619). CONCLUSIONS Risk scores for predicting CIN perform well in stratifying the risk of CIN-narrow, in-hospital death or MACEs, and 3-year all-cause mortality in STEMI patients undergoing primary PCI. The ACEF and AGEF risk scores appear to have greater prognostic value. GW27-e0190 The Effects of Acute STEMI Clinical Pathway in the Treatment of Emergency PCI Yijun Zhou, Zi Ye, Zhenhua Huang, Peng Jiang, Xiaoyong Xiao, Zhihao Liu, Yan Xiong, Jinli Liao, Yingxiong Huang, Wanwan Zhang, Hong Zhan The Emergency Department of The First Affiliated Hospital, Sun YatSen University OBJECTIVES To better understand the diagnostic and prognostic effects of the STEMI clinical pathway on the treatment of STEMI patients with emergency PCI. METHODS Dividing the 285 cases in our hospital diagnosed with acute myocardial infarction by emergency diagnosis and treated with emergency PCI into two groups: control group (2006w2009) and receiving the clinical pathway group (2010w2013), and compared with general clinical parameters, D2B time, follow-up indicators and score of EQ-5D/EQ-VAS. RESULTS Compared to control group, the average D2B time was reduced to 88 minutes (45.8%), and the rate of D2B time reaching the standard was 41.69% inreceiving the clinical pathway group (P<0.001). Meanwhile, the peak value of CK-MB was obviously decreased to 2.84 hours (19.2%), the average days of hospitalization was shorten to 4.49 days (30.5%). After PCI, the blood flow evaluated by TIMI3 creteria was significantly increased (79.4% vs 94.3%), and
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 16, SUPPL S, 2016
present study, 2 subgroup analyses were preformed: 1) antiplatelettreated subgroup (n¼61): we evaluated the impact of loading doses of ticagrelor (vs clopidogrel) on PMI in the antiplatelet-treated patients; 2) antiplatelet-naive subgroup (n¼53): we analyzed the effects of ticagrelor (vs clopidogrel) on PMI in patients who didn’t receive antiplatelet treatment. The cardiac troponin I (cTnI), creatine kinase-MB (CK-MB) and high-sensitive C-reactive protein (hs-CRP) were determined before, and 8, 24 hours after PCI. All patients received standard diagnostic angiography and PCI procedure. And drug-eluting stents (DESs) were deployed after prior balloon angioplasty. The use of platelet glycoprotein (GP) IIb/IIIa receptor antagonists was a decision of individual operator. Patients in the ticagrelor group received aspirin and ticagrelor for 1 week, then changed to use aspirin and clopidogrel. RESULTS Baseline clinical, angiographic and PCI procedural characteristics were similar between the two groups except that ticagrelor group had more male patients (p¼0.045), higher use rate of b-blockers (p¼0.034) than did clopidogrel group. The overall incidence of PMI was 37.7%. Ticagrelor group showed a significantly lower incidence of PMI compared to clopidogrel group (28.1% vs 47.4%, p¼0.034). However, subgroup analyses showed that the incidences of PMI were comparable between ticagrelor group and clopidogrel group regardless antiplatelet-treated or not (antiplatelet-naive group: 24.0% vs 42.9%, p¼0.148; antiplatelet-treated group: 31.2% vs 51.7%, p¼0.104). In addition, the levels of hs-CRP before and after PCI were similar between the comparing groups. Multivariable logistic analysis performed in the overall study population showed that the use of ticagrelor [hazard ratio (HR): 0.35; 95% confidence interval (CI): 0.15-0.82; p¼0.016] was an independent predictor of PMI. CONCLUSIONS Pretreatment with the loading dose of ticagrelor can significantly lower the incidence of PCI related PMI in patients with ACS underoing selective PCI as compared with clopidogrel. Further study with larger study population is needed to get definite conclusions. GW27-e0100 Eveluation of Multidisciplinary Collaborative Care Management in Patients with both Acute Coronary Syndrome and Depression and/or Anxiety Disorders Liang Feng,1 Liuzhuang Zhao,1 Xiuhua Ma1 1 Department of Cardiology, Daxing Hospital, Capital University of Medical Science, Beijing, China OBJECTIVES The aim of this study was to examine whether collaborative care can improve clinical outcomes in patients with both ACS and depression and/or anxiety. METHODS In the present study, depression and/or anxiety were screened by using SDS and SAS questionnaire in 318 patients with acute coronary syndrome(ACS), and 96 (30.19%) ACS patients with depression and/or anxiety disorders were randomized into the multidisciplinary collaborative care management group (MCCM, n¼49) and the usual physician care management group (UPCM, n¼47). The ACS patients withoutdepression and/or anxiety were served as control group. One year of multidisciplinary collaborative care was provided by multidisciplinary team to the patients in the MCCM group. The effect and adherence for cardiovascular risk factors management, psychological interventions and health education were followed up at 6 months after enrollment. At 1 year follow-up, cardiac outcomes for patients in UPCM group was compareded with patients with ACS (ACS ptients without depression and/or anxiety). The effect of multidisciplinary collaborative care management were evaluated in the patients in MCCM group compared with UPCM group at 1 year. RESULTS At 6 months after ACS, mental disorder are associated with increased risk for clinical outcomes, most risk factors worsened more significantly in patients in UPCM group compared with ACS group. The majority of parameters for risk factors improved more significantly in the patients in the MCCM group compared with UPCM group at 6 months follow up. At 1 year follow-up, cardiac death (p¼0.03), composite events of cardiac death and non-fatal MI (p¼0.002), episodes of angina (p 0.0005) occured more significantly in patients in UPCM group than ACS group. At 1 year after multidisciplinary collaborative care management, cardiac outcome measures for the patients in the MCCM group were significantly better for composite events of cardiac death and non-fatal MI (6.12% vs 23.40%, p¼0.016), cardiac function (NYHA class III or IV, 0% vs 25%, p¼0.05), and angina pectoris attacks (21.28%
vs 85%, p 0.0005), compared with the patients in UPCM group. The patients in MCCM group achieved significant mental and social functioning improvements on appetite (p 0.0005), sleep (p 0.0005), and job back (p¼0.007), compared with patients in UPCM group. CONCLUSIONS After ACS, 30.19% of patients had depression and/or anxiety disorders, which led to poorer modification of risk factors for coronary heart disease, and associated with poorer cardiac outcomes and reduced quality of life. The multidisciplinary collaborative care management had better effects on cardiac outcomes and quality of life in ACS patients with depression and/or anxiety. GW27-e0159 Comparison of different risk scores for predicting contrast induced nephropathy and clinical outcomes after primary percutaneous coronary intervention Yuanhui Liu, Yong Liu, Ji-yan Chen, Ning Tan Guangdong Cardiovascular Institute, Guangdong General Hospital, Guangdong Ac OBJECTIVES Accurate risk stratification for contrast-induced nephropathy (CIN) is important in the management of patients with STsegment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). We aimed to compare the prognostic value of validated risk scores for CIN. METHODS We prospectively enrolled 422 consecutive patients treated with primary PCI for STEMI. Mehran, Gao, Chen, Age, Creatinine (SCr), and Ejection Fraction (ACEF); Age, Glomerular Filtration Rate, and Ejection Fraction (AGEF); and GRACE risk scores were calculated for each patient. The prognostic accuracy of the 6 scores for CIN, and in-hospital and 3-year all-cause mortality and major adverse clinical events (MACEs), was assessed using the c-statistic for discrimination and the Hosmer-Lemeshow test for calibration. CIN was defined as either CIN-narrow (rise in SCr 0.5 mg/dL) or CINbroad (rise in SCr 0.5 mg/dL) and/or a 25% increase in baseline (SCr). RESULTS These six risk scores all had relatively high predictive value for CIN-narrow (C statistic range 0.746 to 0.873), as well with good calibration for most of them. In addition, these six risk scores also displayed well for prediction of in-hospital death (0.784 to 0.936) and in hospital MACEs (0.685 to 0.763) or 3 year all-cause mortality (0.655 to 0.871). ACEF and AGEF risk score have both better discrimination and calibration for CIN-narrow, in-hospital outcomes, comparing with other risk scores. However, these six risk score all did not perform as well and had low predictive accuracy for CIN-broad (0.555 to 0.643) and 3-year MACEs (0.541 to 0.619). CONCLUSIONS Risk scores for predicting CIN perform well in stratifying the risk of CIN-narrow, in-hospital death or MACEs, and 3-year all-cause mortality in STEMI patients undergoing primary PCI. The ACEF and AGEF risk scores appear to have greater prognostic value. GW27-e0190 The Effects of Acute STEMI Clinical Pathway in the Treatment of Emergency PCI Yijun Zhou, Zi Ye, Zhenhua Huang, Peng Jiang, Xiaoyong Xiao, Zhihao Liu, Yan Xiong, Jinli Liao, Yingxiong Huang, Wanwan Zhang, Hong Zhan The Emergency Department of The First Affiliated Hospital, Sun YatSen University OBJECTIVES To better understand the diagnostic and prognostic effects of the STEMI clinical pathway on the treatment of STEMI patients with emergency PCI. METHODS Dividing the 285 cases in our hospital diagnosed with acute myocardial infarction by emergency diagnosis and treated with emergency PCI into two groups: control group (2006w2009) and receiving the clinical pathway group (2010w2013), and compared with general clinical parameters, D2B time, follow-up indicators and score of EQ-5D/EQ-VAS. RESULTS Compared to control group, the average D2B time was reduced to 88 minutes (45.8%), and the rate of D2B time reaching the standard was 41.69% inreceiving the clinical pathway group (P<0.001). Meanwhile, the peak value of CK-MB was obviously decreased to 2.84 hours (19.2%), the average days of hospitalization was shorten to 4.49 days (30.5%). After PCI, the blood flow evaluated by TIMI3 creteria was significantly increased (79.4% vs 94.3%), and