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GW27-e0408 Cause and Characteristics of Ventricular Electrical Storm during PCI and Emergency Rescue
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 16, SUPPL S, 2016
CONCLUSIONS The 2D-STI RVLS parameters precisely reflected the impaired RV systolic function in the INFMI and RVMI patients, the RV global systolic function were even worse when RVMI involved, mainly for the RV free wall. However, few days after PCI, the RVLS parameters improved quickly and remarkably in both of the INFMI and RVMI patients. The study demonstrates that RVLS parameters could provide more early diagnostic and prognostic information of RV dysfunction in acute INFMI patients with and without RVMI and after successful PCI, right ventricular systolic function could recover rapidly in only few days. GW27-e0280 Impact of right coronary dominance on prevalence of multi-branch artery stenosis in patients with significant coronary artery disease Yan Bin,1 Gang Wang1 1 Department of Emergency Medicine, the Second Affiliated Hospital, Xi’an Jiaotong University OBJECTIVES The purpose of this study is to investigate the relationship between right coronary dominance and multi-branch artery stenosis in patients with significant coronary artery disease (sCAD). METHODS In this cross-sectional study, 1654 patients with sCAD (1236 males, 418 females) were evaluated with coronary angiography (CAG). The phynotype of coronary artery dominance was then divided into left dominance, right dominance and co-dominance based on CAG reports. Significant CAD was defined as 50% luminal narrowing in at least one of the epicardial coronary arteries. Multi-branch artery stenosis refers to two or three coronary arteries with significant luminal narrowing. Descriptive statistics are presented as percentages for discrete variables and as means (standard deviation) for continuous variables. Multivariate logistic regression was used to examine the relationship between artery stenosis and clinical parameters. RESULTS In our study, a total of 1500 patients (90.6%) with sCAD present right dominance. Left dominance was observed in 110 (6.7%) individuals and codominance in 44 patients (2.7%). Patients with right dominance had a lowest incidence of single artery stenosis, while they are more prone to have a highest prevalence of multi-branch artery stenosis (P<0.01). After multivariate logistic regression analysis, right dominance (OR 1.476; 95%CI 1.032-2.110; p¼0.033), age (OR 1.031; 95% CI 1.020-1.043; p<0.001), smoking (OR 1.594; 95%CI 1.265-2.008; p<0.001), diabetes (OR 1.527; 95%CI 1.001-2.328; p¼0.049) and hypertension (OR 1.311; 95%CI 1.036-1.661; p¼0.024) were significantly associated with the prevalence of multi-branch arteries stenosis. CONCLUSIONS Right coronary dominance may serve as a risk factor for multivessel coronary vascular lesions in patients with sCAD. Therefore, the assessment of coronary vessel dominance with CAG may further improve the risk stratification beyond the assessment of coronary stenosis. GW27-e0284 Application of An Interventional Upper Pad at Radial Vascular Access Sites in Percutaneous Coronary Intervention: Study protocol for A Randomized Trial Zhang Wenjie, Jinchuan Yan Affiliated Hospital of Jiangsu University OBJECTIVES To investigate the effect of an interventional upper pad at radial vascular access sites in PCI. METHODS This work describes a protocol for a clinical trial, and 590 patients with ischemic coronary heart disease, whose condition was stable over the previous three months, were enrolled in the controlled trial within one year, all between 25 and 80 years of age. The patients were divided into two groups in terms of whether or not an interventional upper pad was used in PCI. The experiment group (EG) (n¼319) received an interventional upper pad, whereas control group (CG) followed traditional post-interventional care (n¼225). The main outcome variables were the pain score of wrist metacarpus and swelling value of the forefinger’s circumference; Secondary outcome variables included the degree of overall comfort at the puncture limb. All outcome variables were measured at the beginning of the interventional period and again at 6 hours after PCI. Information on sex, age, operator and interventional type was also recorded. RESULTS Two sets of data were compared in terms of swelling value of the forefinger’s circumference at the interventional limb, pain score of wrist metacarpus, the forefinger peripheral SaO2 fluctuation, comfort state self-evaluation about the interventional limb between bilateral limbs at baseline and after six hours in PCI. Patient’s
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carpometacarpal pain score and swelling around the index finger roots in EG were lower than the CG, and the difference was statistically significant (P<0.05); fluctuation of SaO2 at the index finger endings did not change significantly between two groups of patients, and the difference was not statistically significant (P> 0.05). In EG the percentage of effect management about patients’ comfort state selfevaluation is 95.61%; otherwise, in control group it is only 16.89%. And the difference was statistically significant (P<0.05). CONCLUSIONS If the application of an interventional upper pad proves to be effective, the study will be shown that the application of the interventional upper pad can alleviate swelling and pain of wrist metacarpus and improve the degree of overall comfort after PCI. GW27-e0290 The association of coronary dominance with the anatomy distribution of artery stenosis in patients undergoing coronary angiography Yan Bin,1 Gang Wang1 1 Department of Emergency Medicine, the Second Affiliated Hospital, Xi’an Jiaotong University OBJECTIVES Coronary dominance has been found to be predictive for the prognosis of patients suffering coronary emergencies. In this study, the relationship between coronary dominance and the distribution of coronary artery stenosis was investigated. METHODS A total of 2225 patients (1545 males, mean age 58.510.3 years) with coronary artery disease (CAD) undergoing angiography between 2010 and 2014 were recruited in our study. RD anatomy was defined as the posterior descending artery (PDA) originating from the right coronary artery (RCA). LD anatomy was defined as one in which the PDA originated from the left circumflex artery (LCX). Co-dominant anatomy was defined when the PDA originated from the RCA in combination with a large posterolateral branch originating from the LCX reaching near the posterior interventricular groove. Patients included in the study were divided into 2 groups, based on a diagnostic coronary angiogram. Patients with left- or co-dominant anatomies were placed into the LD group (209 patients) and those with right-dominant anatomy were included in the RD group (2016 patients). Significant stenosis was defined as 50% luminal narrowing of the epicardial coronary arteries. Gensini Scores was also used to evaluate the severity of CAD. RESULTS There was no significantly statistic difference between the RD group and LD group in demographic characteristics and the explosion to CAD risk factor. Patients presenting with right coronary artery stenosis (40.5% vs. 29.2%; p<0.001) and three vessel disease (36.6% vs. 27.3%; p¼0.033) were significantly higher in the RD group. After assessment of Gensini scores, there were statistic significance between RD group and LD group (32.333.6 vs. 27.529.5; p¼0.028). Furthermore, the prevalence of inferior or posterior myocardial infarction was also significantly higher in the RD group (12.4% vs. 7.2%; p¼0.025). CONCLUSIONS Right coronary dominance tends to have right coronary artery stenosis, multivessel coronary vascular lesions and inferior or posterior myocardial infarction compared with left dominant and co-dominant anatomy. GW27-e0408 Cause and Characteristics of Ventricular Electrical Storm during PCI and Emergency Rescue Tongku Liu Affiliated hospital of Beihua University OBJECTIVES To study the cause and characteristics of ventricular electrical storm (VES) during the percutaneous coronary intervention (PCI) and the emergency rescue of VES. METHODS The cause and characteristics, direct current cardioversion (DC) and the use of anti-arrhythmic drugs for 36 patients with VES during PCI was studied from January, 2010 to January, 2016. Among 36 cases there were male 24(66.7%) and female 12(33.3%). Age of the patients was 43 to 77 (mean 63.8 9.7) years old. There were 21 cases (58.3%) with hypertension, 23 cases (63.9%) with diabetes, 7 cases (19.4%) with old myocardial infarction (OMI), and 22 (61.1%) smokers. Of them 30 patients (83.3%) suffered from acute ST segment elevation myocardial infarction (STEMI) and 6 patients (16.7%) suffered from non ST-elevation acute coronary syndrome (NST-ACS). Coronary angiography showed 13 cases (36.1%) with left anterior descending branch occlusion, 8 cases (22.2%) with left circumflex branch occlusion, 15 cases (41.7%) with right coronary artery occlusion and 3 cases with left
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 16, SUPPL S, 2016
main coronary artery (LM) occlusion. The routine PCI and stenting for all patients were performed. During PCI procedure heparin sodium 100u/kg was injected from the arterial sheath catheter. After PCI the loading doses of aspirin 300 mg and clopidogrel 300 mg were immediately application. Right ventricle pacing was used to the patients with sinus arrest, bradycardia and II or III degree atrioventricular block. RESULTS During PCI paroxysmal ventricular tachycardia (VT) and ventricular fibrillation (Vf) occurred two or more than two times in 30 patients with STEMI. VT and Vf happened in 26 cases (86.7%) when the infarction related artery (IRA) was opened lasting for 10-20 seconds. Vf happened in 4 cases with STEMI before PCI procedure. Vf occurred in 6 patients with NST-ACS after acute target coronary artery occlusion during PCI procedure. VT lasting for 5 seconds to 20 seconds induced Vf in 23 cases (63.9%). The ventricular premature beat (PVC) induced Vf in 13 cases (36.1%). The intravenous application of amiodarone, lidocaine or esmolol was effect on some patients with VT and Vf. All patients with Vf received two-way wave 200 joules DC shock including 2 cases with inferior wall STEMI who received 40 times and 58 times of DC shock (An average of six times of DC shock per case) was performed. Rescue survived patients was 31 cases (86.1. %). 5 cases (13.9%) died of cardiogenic shock. All survivors received stent implantation and regular oral tartaric acid metoprolol and dual antiplatelet. During the follow-up from 6 to 37 months (mean 26 months) VES did not happened again. CONCLUSIONS During PCI procedure VES are caused by acute myocardial ischemia leading to electrical instability and excessive activation of the sympathetic nervous. Characteristics of VES are prone to occur in 20 seconds of IRA opening. DC shock is primary measures and should be rapid implementation on the basis of antiarrhythmic drugs. Beta blocker is effect on the prevent of Vf.
METHODS Patients aged 18 years or older undergoing planed PCI were prospectively recruited between May 2014 and July 2015. CIN was defined as an increase in serum creatinine of 0.5 mg/dL within 48-72 h after the procedure. Plasma sklotho was measured by Enzyme Linked Immunosorbent Assay. The stratified analysis, interaction test, covariate screening and curve fitting were performed to explore the association between sklotho and CIN. A nomogram was then developed and validated using bootstrapped technique. This study was registered on Clinicaltrials.gov (NCT 02650336). RESULTS 192 patients aged 54.7512.19 years were selected, 32 (16.7%) patients were diagnosed with CIN. Logistic regression model indicated significant associations between CIN and sklotho, age>75 y, diabetes and Mehran risk score. Saturation effects analysis detected a two-stage change between sklotho and CIN, with the inflection point was 477.4 pg/ml. The area under the ROC curve was 0.758 and the sensitivity and specificity of this point were 90.6% and 53.9%, respectively. A nomogram was developed for the prediction of CIN and showed a bootstrapped-corrected area under the curve value of 0.913. In addition, sklotho significantly increased the predictive value of nomogram. CONCLUSIONS A strong association between sklotho and CIN was indentified in patients undergoing elective PCI. Lower level of sklotho would be well correlated with CIN. The nomogram with sklotho is a useful tool to predict CIN in patients undergone PCI. GW27-e0495 Effect of late percutaneous coronary intervention in patients with acute myocardial infarction on ventricular remodeling Xue Yajun,1 Ping Zhang,1 Jiyuan Lv2 Beijing Tsinghua Changgeng Hospital; 2Shanxi Medicial University affiliated First Hospital 1
GW27-e0434 Impact of CYP2C19 variants on drug efficacy of clopidogrel and 1-year clinical outcomes in coronary heart patients undergoing PCI 1
1
2
Sun Hong, Hong Sun, Hui Chen 1 Department of Pharmacy, Provincial Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou; 2Hypertension Laboratory, Provincial Clinical College of Fujian Medical University, Fujian Provincial Cardiovascular Disease Institute, Fujian Province OBJECTIVES To investigate the impact of CYP2C19 metabolizers on clopidogrel-mediated platelet, inflammatory, endothelial effects and the risk prediction of major adverse cardiovascular events (MACE) in coronary heart patients undergoing percutaneous coronary intervention (PCI). METHODS We detected the residual platelet aggregation rate (RPA), maximal aggregation rate (MAR) and the plasma levels of sCD40L, sPselectin, MMP-9, sVCAM-1 and sE-selectin after 24 hours of PCI in 559 patients undergoing PCI treated with clopidogrel, and followed up for one year for MACE. The levels of RPA, MAR, sE-selectin, sCD40l, sPselectin, MMP-9 and sVCAM-1 in CYP2C19 intermediate metabolizers (IM), poor metabolizers (PM) or both together patients were higher than those in extensive metabolizers (EM) patients. RESULTS During one-year follow-up, there were 69 cases (13.3%) suffering MACE. The risk of MACE in CYP2C19 IMþPM patients is 2.664 times higher than that in CYP2C19 EM patients (OR¼2.664(1.3975.193), P¼0.004). Our results suggest that CYP2C19 metabolizers modulate clopidogrel drug efficacy in coronary heart patients undergoing PCI and further impact on the risk of MACE. CONCLUSIONS Thus it is benefit for coronary heart patients undergoing PCI treated with clopidogrel if carried out individualized treatment according to CYP2C19 metabolizers. GW27-e0476 A nomogram to predict contrast induced nephropathy in patients undergoing percutaneous coronary intervention: is the “anti-aging” agent klotho a candidate predictor? Xiaodong Zhuang, Xun Hu, Zhimin Du, Yue Guo, Feifei Li, Xinxue Liao Department of Cardiology, the First Affiliated Hospital, Sun Yat-sen University OBJECTIVES Contrast-induced nephropathy (CIN) has been the third leading cause of hospital-acquired acute kidney injury (AKI). Emerging evidence has revealed that soluble klotho (sklotho) could be a novel biomarker for early AKI diagnosis. We aim to assess the predictive role of sklotho for CIN and develop a prediction nomogram in patients undergoing percutaneous coronary intervention (PCI).
OBJECTIVES To observe impact of late percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) on ventricular remodeling. METHODS Between June 2013 and March 2015, chose 58 patients treated with late PCI during 7 days and 3 months after AMI, and 50 patients without PCI after AMI as control group. Optimal therapy for all patients included drugs known to carry prognostic benefits after AMI. Both groups took 99TCm-MIBI myocardial perfusion imaging test assessing left ventricular size and function at 1 month and 9 months after AMI. Regarding left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF). RESULTS LVEDV, LVESV and LVEF were similar between the two groups in 1 month after AMI. However, significant changes in LVEDV [(102.625.6)ml vs (117.228.5)ml P¼0.035] and LVESV [(55.120.6)ml vs (66.428.7)ml P¼0.043] were observed within two groups at 9 months，and the LVEF of PCI group increased dramatically than control group [(56.19.6)% vs (47.413.2)% P¼0.006]. CONCLUSIONS Late percutaneous coronary intervention in patients with AMI is an effective therapy, prevent ventricular remodeling efficiently and protect left ventricular function. GW27-e0507 Observation and treatment of common problems in percutaneous coronary intervention via radial artery approach Chen Zongning, Chen Zongning, Sheng Yang Song Yunnan province lijiang city hospital OBJECTIVES To investigate the common problems and related complications of the radial artery approach for coronary intervention, and to deal with the problems related to the coronary intervention in the radial artery approach. METHODS From January 2010 to June 2010 to hospital heart internal medicine clinic in parallel by transradial approach coronary interventional diagnosis and treatment of patients with 276 cases, observed and recorded all patients underwent transradial artery coronary interventional diagnosis and treatment and analyzes the reasons. RESULTS 276 cases of transradial coronary intervention in patients underwent transradial coronary angiography in 184 cases, including 26 cases of patients with coronary angiography failed, and femoral artery coronary angiography; and transradial coronary intervention in 92 patients, 2 patients with interventional therapy after the failure the femoral artery interventional therapy, to cause the main reason of
CONCLUSIONS The 2D-STI RVLS parameters precisely reflected the impaired RV systolic function in the INFMI and RVMI patients, the RV global systolic function were even worse when RVMI involved, mainly for the RV free wall. However, few days after PCI, the RVLS parameters improved quickly and remarkably in both of the INFMI and RVMI patients. The study demonstrates that RVLS parameters could provide more early diagnostic and prognostic information of RV dysfunction in acute INFMI patients with and without RVMI and after successful PCI, right ventricular systolic function could recover rapidly in only few days. GW27-e0280 Impact of right coronary dominance on prevalence of multi-branch artery stenosis in patients with significant coronary artery disease Yan Bin,1 Gang Wang1 1 Department of Emergency Medicine, the Second Affiliated Hospital, Xi’an Jiaotong University OBJECTIVES The purpose of this study is to investigate the relationship between right coronary dominance and multi-branch artery stenosis in patients with significant coronary artery disease (sCAD). METHODS In this cross-sectional study, 1654 patients with sCAD (1236 males, 418 females) were evaluated with coronary angiography (CAG). The phynotype of coronary artery dominance was then divided into left dominance, right dominance and co-dominance based on CAG reports. Significant CAD was defined as 50% luminal narrowing in at least one of the epicardial coronary arteries. Multi-branch artery stenosis refers to two or three coronary arteries with significant luminal narrowing. Descriptive statistics are presented as percentages for discrete variables and as means (standard deviation) for continuous variables. Multivariate logistic regression was used to examine the relationship between artery stenosis and clinical parameters. RESULTS In our study, a total of 1500 patients (90.6%) with sCAD present right dominance. Left dominance was observed in 110 (6.7%) individuals and codominance in 44 patients (2.7%). Patients with right dominance had a lowest incidence of single artery stenosis, while they are more prone to have a highest prevalence of multi-branch artery stenosis (P<0.01). After multivariate logistic regression analysis, right dominance (OR 1.476; 95%CI 1.032-2.110; p¼0.033), age (OR 1.031; 95% CI 1.020-1.043; p<0.001), smoking (OR 1.594; 95%CI 1.265-2.008; p<0.001), diabetes (OR 1.527; 95%CI 1.001-2.328; p¼0.049) and hypertension (OR 1.311; 95%CI 1.036-1.661; p¼0.024) were significantly associated with the prevalence of multi-branch arteries stenosis. CONCLUSIONS Right coronary dominance may serve as a risk factor for multivessel coronary vascular lesions in patients with sCAD. Therefore, the assessment of coronary vessel dominance with CAG may further improve the risk stratification beyond the assessment of coronary stenosis. GW27-e0284 Application of An Interventional Upper Pad at Radial Vascular Access Sites in Percutaneous Coronary Intervention: Study protocol for A Randomized Trial Zhang Wenjie, Jinchuan Yan Affiliated Hospital of Jiangsu University OBJECTIVES To investigate the effect of an interventional upper pad at radial vascular access sites in PCI. METHODS This work describes a protocol for a clinical trial, and 590 patients with ischemic coronary heart disease, whose condition was stable over the previous three months, were enrolled in the controlled trial within one year, all between 25 and 80 years of age. The patients were divided into two groups in terms of whether or not an interventional upper pad was used in PCI. The experiment group (EG) (n¼319) received an interventional upper pad, whereas control group (CG) followed traditional post-interventional care (n¼225). The main outcome variables were the pain score of wrist metacarpus and swelling value of the forefinger’s circumference; Secondary outcome variables included the degree of overall comfort at the puncture limb. All outcome variables were measured at the beginning of the interventional period and again at 6 hours after PCI. Information on sex, age, operator and interventional type was also recorded. RESULTS Two sets of data were compared in terms of swelling value of the forefinger’s circumference at the interventional limb, pain score of wrist metacarpus, the forefinger peripheral SaO2 fluctuation, comfort state self-evaluation about the interventional limb between bilateral limbs at baseline and after six hours in PCI. Patient’s
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carpometacarpal pain score and swelling around the index finger roots in EG were lower than the CG, and the difference was statistically significant (P<0.05); fluctuation of SaO2 at the index finger endings did not change significantly between two groups of patients, and the difference was not statistically significant (P> 0.05). In EG the percentage of effect management about patients’ comfort state selfevaluation is 95.61%; otherwise, in control group it is only 16.89%. And the difference was statistically significant (P<0.05). CONCLUSIONS If the application of an interventional upper pad proves to be effective, the study will be shown that the application of the interventional upper pad can alleviate swelling and pain of wrist metacarpus and improve the degree of overall comfort after PCI. GW27-e0290 The association of coronary dominance with the anatomy distribution of artery stenosis in patients undergoing coronary angiography Yan Bin,1 Gang Wang1 1 Department of Emergency Medicine, the Second Affiliated Hospital, Xi’an Jiaotong University OBJECTIVES Coronary dominance has been found to be predictive for the prognosis of patients suffering coronary emergencies. In this study, the relationship between coronary dominance and the distribution of coronary artery stenosis was investigated. METHODS A total of 2225 patients (1545 males, mean age 58.510.3 years) with coronary artery disease (CAD) undergoing angiography between 2010 and 2014 were recruited in our study. RD anatomy was defined as the posterior descending artery (PDA) originating from the right coronary artery (RCA). LD anatomy was defined as one in which the PDA originated from the left circumflex artery (LCX). Co-dominant anatomy was defined when the PDA originated from the RCA in combination with a large posterolateral branch originating from the LCX reaching near the posterior interventricular groove. Patients included in the study were divided into 2 groups, based on a diagnostic coronary angiogram. Patients with left- or co-dominant anatomies were placed into the LD group (209 patients) and those with right-dominant anatomy were included in the RD group (2016 patients). Significant stenosis was defined as 50% luminal narrowing of the epicardial coronary arteries. Gensini Scores was also used to evaluate the severity of CAD. RESULTS There was no significantly statistic difference between the RD group and LD group in demographic characteristics and the explosion to CAD risk factor. Patients presenting with right coronary artery stenosis (40.5% vs. 29.2%; p<0.001) and three vessel disease (36.6% vs. 27.3%; p¼0.033) were significantly higher in the RD group. After assessment of Gensini scores, there were statistic significance between RD group and LD group (32.333.6 vs. 27.529.5; p¼0.028). Furthermore, the prevalence of inferior or posterior myocardial infarction was also significantly higher in the RD group (12.4% vs. 7.2%; p¼0.025). CONCLUSIONS Right coronary dominance tends to have right coronary artery stenosis, multivessel coronary vascular lesions and inferior or posterior myocardial infarction compared with left dominant and co-dominant anatomy. GW27-e0408 Cause and Characteristics of Ventricular Electrical Storm during PCI and Emergency Rescue Tongku Liu Affiliated hospital of Beihua University OBJECTIVES To study the cause and characteristics of ventricular electrical storm (VES) during the percutaneous coronary intervention (PCI) and the emergency rescue of VES. METHODS The cause and characteristics, direct current cardioversion (DC) and the use of anti-arrhythmic drugs for 36 patients with VES during PCI was studied from January, 2010 to January, 2016. Among 36 cases there were male 24(66.7%) and female 12(33.3%). Age of the patients was 43 to 77 (mean 63.8 9.7) years old. There were 21 cases (58.3%) with hypertension, 23 cases (63.9%) with diabetes, 7 cases (19.4%) with old myocardial infarction (OMI), and 22 (61.1%) smokers. Of them 30 patients (83.3%) suffered from acute ST segment elevation myocardial infarction (STEMI) and 6 patients (16.7%) suffered from non ST-elevation acute coronary syndrome (NST-ACS). Coronary angiography showed 13 cases (36.1%) with left anterior descending branch occlusion, 8 cases (22.2%) with left circumflex branch occlusion, 15 cases (41.7%) with right coronary artery occlusion and 3 cases with left
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 68, NO. 16, SUPPL S, 2016
main coronary artery (LM) occlusion. The routine PCI and stenting for all patients were performed. During PCI procedure heparin sodium 100u/kg was injected from the arterial sheath catheter. After PCI the loading doses of aspirin 300 mg and clopidogrel 300 mg were immediately application. Right ventricle pacing was used to the patients with sinus arrest, bradycardia and II or III degree atrioventricular block. RESULTS During PCI paroxysmal ventricular tachycardia (VT) and ventricular fibrillation (Vf) occurred two or more than two times in 30 patients with STEMI. VT and Vf happened in 26 cases (86.7%) when the infarction related artery (IRA) was opened lasting for 10-20 seconds. Vf happened in 4 cases with STEMI before PCI procedure. Vf occurred in 6 patients with NST-ACS after acute target coronary artery occlusion during PCI procedure. VT lasting for 5 seconds to 20 seconds induced Vf in 23 cases (63.9%). The ventricular premature beat (PVC) induced Vf in 13 cases (36.1%). The intravenous application of amiodarone, lidocaine or esmolol was effect on some patients with VT and Vf. All patients with Vf received two-way wave 200 joules DC shock including 2 cases with inferior wall STEMI who received 40 times and 58 times of DC shock (An average of six times of DC shock per case) was performed. Rescue survived patients was 31 cases (86.1. %). 5 cases (13.9%) died of cardiogenic shock. All survivors received stent implantation and regular oral tartaric acid metoprolol and dual antiplatelet. During the follow-up from 6 to 37 months (mean 26 months) VES did not happened again. CONCLUSIONS During PCI procedure VES are caused by acute myocardial ischemia leading to electrical instability and excessive activation of the sympathetic nervous. Characteristics of VES are prone to occur in 20 seconds of IRA opening. DC shock is primary measures and should be rapid implementation on the basis of antiarrhythmic drugs. Beta blocker is effect on the prevent of Vf.
METHODS Patients aged 18 years or older undergoing planed PCI were prospectively recruited between May 2014 and July 2015. CIN was defined as an increase in serum creatinine of 0.5 mg/dL within 48-72 h after the procedure. Plasma sklotho was measured by Enzyme Linked Immunosorbent Assay. The stratified analysis, interaction test, covariate screening and curve fitting were performed to explore the association between sklotho and CIN. A nomogram was then developed and validated using bootstrapped technique. This study was registered on Clinicaltrials.gov (NCT 02650336). RESULTS 192 patients aged 54.7512.19 years were selected, 32 (16.7%) patients were diagnosed with CIN. Logistic regression model indicated significant associations between CIN and sklotho, age>75 y, diabetes and Mehran risk score. Saturation effects analysis detected a two-stage change between sklotho and CIN, with the inflection point was 477.4 pg/ml. The area under the ROC curve was 0.758 and the sensitivity and specificity of this point were 90.6% and 53.9%, respectively. A nomogram was developed for the prediction of CIN and showed a bootstrapped-corrected area under the curve value of 0.913. In addition, sklotho significantly increased the predictive value of nomogram. CONCLUSIONS A strong association between sklotho and CIN was indentified in patients undergoing elective PCI. Lower level of sklotho would be well correlated with CIN. The nomogram with sklotho is a useful tool to predict CIN in patients undergone PCI. GW27-e0495 Effect of late percutaneous coronary intervention in patients with acute myocardial infarction on ventricular remodeling Xue Yajun,1 Ping Zhang,1 Jiyuan Lv2 Beijing Tsinghua Changgeng Hospital; 2Shanxi Medicial University affiliated First Hospital 1
GW27-e0434 Impact of CYP2C19 variants on drug efficacy of clopidogrel and 1-year clinical outcomes in coronary heart patients undergoing PCI 1
1
2
Sun Hong, Hong Sun, Hui Chen 1 Department of Pharmacy, Provincial Clinical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou; 2Hypertension Laboratory, Provincial Clinical College of Fujian Medical University, Fujian Provincial Cardiovascular Disease Institute, Fujian Province OBJECTIVES To investigate the impact of CYP2C19 metabolizers on clopidogrel-mediated platelet, inflammatory, endothelial effects and the risk prediction of major adverse cardiovascular events (MACE) in coronary heart patients undergoing percutaneous coronary intervention (PCI). METHODS We detected the residual platelet aggregation rate (RPA), maximal aggregation rate (MAR) and the plasma levels of sCD40L, sPselectin, MMP-9, sVCAM-1 and sE-selectin after 24 hours of PCI in 559 patients undergoing PCI treated with clopidogrel, and followed up for one year for MACE. The levels of RPA, MAR, sE-selectin, sCD40l, sPselectin, MMP-9 and sVCAM-1 in CYP2C19 intermediate metabolizers (IM), poor metabolizers (PM) or both together patients were higher than those in extensive metabolizers (EM) patients. RESULTS During one-year follow-up, there were 69 cases (13.3%) suffering MACE. The risk of MACE in CYP2C19 IMþPM patients is 2.664 times higher than that in CYP2C19 EM patients (OR¼2.664(1.3975.193), P¼0.004). Our results suggest that CYP2C19 metabolizers modulate clopidogrel drug efficacy in coronary heart patients undergoing PCI and further impact on the risk of MACE. CONCLUSIONS Thus it is benefit for coronary heart patients undergoing PCI treated with clopidogrel if carried out individualized treatment according to CYP2C19 metabolizers. GW27-e0476 A nomogram to predict contrast induced nephropathy in patients undergoing percutaneous coronary intervention: is the “anti-aging” agent klotho a candidate predictor? Xiaodong Zhuang, Xun Hu, Zhimin Du, Yue Guo, Feifei Li, Xinxue Liao Department of Cardiology, the First Affiliated Hospital, Sun Yat-sen University OBJECTIVES Contrast-induced nephropathy (CIN) has been the third leading cause of hospital-acquired acute kidney injury (AKI). Emerging evidence has revealed that soluble klotho (sklotho) could be a novel biomarker for early AKI diagnosis. We aim to assess the predictive role of sklotho for CIN and develop a prediction nomogram in patients undergoing percutaneous coronary intervention (PCI).
OBJECTIVES To observe impact of late percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI) on ventricular remodeling. METHODS Between June 2013 and March 2015, chose 58 patients treated with late PCI during 7 days and 3 months after AMI, and 50 patients without PCI after AMI as control group. Optimal therapy for all patients included drugs known to carry prognostic benefits after AMI. Both groups took 99TCm-MIBI myocardial perfusion imaging test assessing left ventricular size and function at 1 month and 9 months after AMI. Regarding left ventricular end-diastolic volume (LVEDV), left ventricular end-systolic volume (LVESV) and left ventricular ejection fraction (LVEF). RESULTS LVEDV, LVESV and LVEF were similar between the two groups in 1 month after AMI. However, significant changes in LVEDV [(102.625.6)ml vs (117.228.5)ml P¼0.035] and LVESV [(55.120.6)ml vs (66.428.7)ml P¼0.043] were observed within two groups at 9 months，and the LVEF of PCI group increased dramatically than control group [(56.19.6)% vs (47.413.2)% P¼0.006]. CONCLUSIONS Late percutaneous coronary intervention in patients with AMI is an effective therapy, prevent ventricular remodeling efficiently and protect left ventricular function. GW27-e0507 Observation and treatment of common problems in percutaneous coronary intervention via radial artery approach Chen Zongning, Chen Zongning, Sheng Yang Song Yunnan province lijiang city hospital OBJECTIVES To investigate the common problems and related complications of the radial artery approach for coronary intervention, and to deal with the problems related to the coronary intervention in the radial artery approach. METHODS From January 2010 to June 2010 to hospital heart internal medicine clinic in parallel by transradial approach coronary interventional diagnosis and treatment of patients with 276 cases, observed and recorded all patients underwent transradial artery coronary interventional diagnosis and treatment and analyzes the reasons. RESULTS 276 cases of transradial coronary intervention in patients underwent transradial coronary angiography in 184 cases, including 26 cases of patients with coronary angiography failed, and femoral artery coronary angiography; and transradial coronary intervention in 92 patients, 2 patients with interventional therapy after the failure the femoral artery interventional therapy, to cause the main reason of