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Hospital survival in patients with out of hospital cardiac arrest undergoing percutaneous coronary intervention
S214
Heart, Lung and Circulation 2009;18S:S1–S286
Abstracts
ABSTRACTS
a pathologist. Stains performed included haematoxylin & eosin, oil red o, Picro-Mallory and van Gieson. Imaging software (Image Pro Plus, Media Cybernetics, USA) was used to measure absolute and percentage areas of each plaque component: fibrous, thrombus, lipid, red blood cells and cholesterol clefts. Spearman’s correlations were used as appropriate. Results: A total of 26 lesions were analyzed with the mean age of SVG of 14.4 (±4.4) years. Every FilterWire yielded some material (1–33 mg). All samples contained red blood cells, 69% have lipid component, 65% have plaque thrombus, 50% have fibrous plaque and 23% have cholesterol clefts. The embolic material weight correlated with the amount of cholesterol clefts (r = 1.0; p < 0.001), plaque thrombus (r = 0.557; p = 0.020) and sum of all components (r = 0.436; p = 0.023). Samples containing cholesterol clefts were heavier than those that did not (17.5 mg vs. 5.5 mg; p = 0.002). Conclusion: There is a positive correlation between histological composition of embolic material and amount of debris generated during saphenous vein graft intervention. The risk of greater embolic tendency may be greater with vein graft plaques that yield debris rich in thrombus and cholesterol. doi:10.1016/j.hlc.2009.05.529 484 HOSPITAL SURVIVAL IN PATIENTS WITH OUT OF HOSPITAL CARDIAC ARREST UNDERGOING PERCUTANEOUS CORONARY INTERVENTION H.S. Lim 1,2, , O. Farouque 1 , C.C.S. Lim 3,4 , N. Andrianopoulos 5 , A.L. Brennan 5 , M. Moore 3 , G. New 3 , A.E. Ajani 6 , S.J. Duffy 7 , D.J. Clark 1 , on behalf of the Melbourne Interventional Group 1 Austin
Health, Melbourne, Australia Research Centre, Royal Adelaide Hospital, Adelaide, Australia 3 Box Hill Hospital, Melbourne, Australia 4 John Radcliffe Hospital, Oxford, United Kingdom 5 Monash Centre for Cardiovascular Research and Education in Therapeutics, Melbourne, Australia 6 Royal Melbourne Hospital, Melbourne, Australia 7 Alfred Hospital, Melbourne, Australia 2 Cardiovascular
Aim: To study patients with an out of hospital cardiac arrest (OHCA) undergoing percutaneous coronary intervention (PCI) and the factors associated with in-hospital mortality. Background: The decision to perform PCI in patients with OHCA is challenging with the uncertainty of eventual recovery. Methods: We examined 63 patients who underwent PCI after presenting with OHCA, compared to 5008 consecutive patients who underwent PCI for an acute coronary syndrome (ACS) from the Melbourne Interventional Group registry. Results: For the OHCA cohort, mean age was 62.2 ± 12.0 years, 79.4% were males, 14.3% had diabetes, 9.7% with renal failure (vs. 4.1% in the ACS group, p < 0.05), 33.3%
were in cardiogenic shock (vs. 4.3%, p < 0.001) and 87.3% presented with STEMI (vs. 49.4%, p < 0.001). Procedural success was 95.2% in the OHCA cohort vs. 96.5% (ACS group), p = 0.49. In-hospital mortality was 36.5% in the OHCA cohort vs. 2.5%, p < 0.001. The OHCA cohort was dichotomized to hospital survivors vs. non-survivors with significant associations with in-hospital mortality listed below: Variables
Hospital survivors (n = 40)
Hospital non-survivors (n = 23)
p-Value
Cardiogenic shock, n (%) IABP (intra-aortic balloon pump) use Unsuccessful procedure
7 (17.1) 9 (22.0)
15 (65.2) 12 (52.2)
<0.001 0.025
3 (13.0)
0.043
0 (0)
Conclusion: OHCA patients undergoing PCI had a significantly higher in-hospital mortality rate compared with patients with ACS. Within this cohort, in-hospital mortality was associated with patients in cardiogenic shock, IABP use and an unsuccessful procedure. doi:10.1016/j.hlc.2009.05.530 485 IMMEDIATE ST RESOLUTION ON INTRACORONARY ECG DURING PRIMARY PCI PREDICTS EXTENT OF MYOCARDIAL INJURY USING CARDIAC MRI M.C. Leung 1 , D.T.L.
Wong 2 , R.
Das 2 , K.
Soon 2 , G.
Chacko 2 , G.W.H. Liew 2 , M.A. Brown 2 , M.I. Worthley 2 , K.S.L. Teo 2 , S.G. Worthley 2 1 Monash Cardiovascular Research Centre, MonashHEART and Monash University Department of Medicine (MMC), Melbourne, Australia 2 Cardiovascular Research Centre, Royal Adelaide Hospital and Adelaide University, Adelaide, Australia
Purpose: Primary percutaneous coronary intervention (PPCI) is effective in achieving TIMI 3 flow in ST elevation myocardial infarction (STEMI), however microvascular perfusion remains impaired in 30–40% of patients, leading to higher mortality. Intracoronary ECG ST segment resolution (IC-STR) is a simple and novel method that may predict the extent of myocardial injury. Method: Twenty-two consecutive patients (age 59 ± 9, M = 22) presenting with STEMI had intracoronary unipolar ST segment measurement before and after (5,10,15 min) achieving TIMI 3 flow with PPCI. Surface 12 lead ECGs (two analysis methods: Sum of ST deviation (SumST) in all leads and maximal single lead (MaxST)) were performed at 60–90 mins, 3, 6, 12, 18, 24 h after achieving TIMI 3 flow. Gadolinium enhanced cardiac MRI(CMR) was performed between days 3 and 6 after PPCI, assessing function (EF%, wall motion score), infarct mass, microvascular obstruction (MVO) size, MVO score, transmural score and T2-weighted oedema score on a 16 segment model. Peak CK was measured. Statisti-
Heart, Lung and Circulation 2009;18S:S1–S286
Abstracts
ABSTRACTS
a pathologist. Stains performed included haematoxylin & eosin, oil red o, Picro-Mallory and van Gieson. Imaging software (Image Pro Plus, Media Cybernetics, USA) was used to measure absolute and percentage areas of each plaque component: fibrous, thrombus, lipid, red blood cells and cholesterol clefts. Spearman’s correlations were used as appropriate. Results: A total of 26 lesions were analyzed with the mean age of SVG of 14.4 (±4.4) years. Every FilterWire yielded some material (1–33 mg). All samples contained red blood cells, 69% have lipid component, 65% have plaque thrombus, 50% have fibrous plaque and 23% have cholesterol clefts. The embolic material weight correlated with the amount of cholesterol clefts (r = 1.0; p < 0.001), plaque thrombus (r = 0.557; p = 0.020) and sum of all components (r = 0.436; p = 0.023). Samples containing cholesterol clefts were heavier than those that did not (17.5 mg vs. 5.5 mg; p = 0.002). Conclusion: There is a positive correlation between histological composition of embolic material and amount of debris generated during saphenous vein graft intervention. The risk of greater embolic tendency may be greater with vein graft plaques that yield debris rich in thrombus and cholesterol. doi:10.1016/j.hlc.2009.05.529 484 HOSPITAL SURVIVAL IN PATIENTS WITH OUT OF HOSPITAL CARDIAC ARREST UNDERGOING PERCUTANEOUS CORONARY INTERVENTION H.S. Lim 1,2, , O. Farouque 1 , C.C.S. Lim 3,4 , N. Andrianopoulos 5 , A.L. Brennan 5 , M. Moore 3 , G. New 3 , A.E. Ajani 6 , S.J. Duffy 7 , D.J. Clark 1 , on behalf of the Melbourne Interventional Group 1 Austin
Health, Melbourne, Australia Research Centre, Royal Adelaide Hospital, Adelaide, Australia 3 Box Hill Hospital, Melbourne, Australia 4 John Radcliffe Hospital, Oxford, United Kingdom 5 Monash Centre for Cardiovascular Research and Education in Therapeutics, Melbourne, Australia 6 Royal Melbourne Hospital, Melbourne, Australia 7 Alfred Hospital, Melbourne, Australia 2 Cardiovascular
Aim: To study patients with an out of hospital cardiac arrest (OHCA) undergoing percutaneous coronary intervention (PCI) and the factors associated with in-hospital mortality. Background: The decision to perform PCI in patients with OHCA is challenging with the uncertainty of eventual recovery. Methods: We examined 63 patients who underwent PCI after presenting with OHCA, compared to 5008 consecutive patients who underwent PCI for an acute coronary syndrome (ACS) from the Melbourne Interventional Group registry. Results: For the OHCA cohort, mean age was 62.2 ± 12.0 years, 79.4% were males, 14.3% had diabetes, 9.7% with renal failure (vs. 4.1% in the ACS group, p < 0.05), 33.3%
were in cardiogenic shock (vs. 4.3%, p < 0.001) and 87.3% presented with STEMI (vs. 49.4%, p < 0.001). Procedural success was 95.2% in the OHCA cohort vs. 96.5% (ACS group), p = 0.49. In-hospital mortality was 36.5% in the OHCA cohort vs. 2.5%, p < 0.001. The OHCA cohort was dichotomized to hospital survivors vs. non-survivors with significant associations with in-hospital mortality listed below: Variables
Hospital survivors (n = 40)
Hospital non-survivors (n = 23)
p-Value
Cardiogenic shock, n (%) IABP (intra-aortic balloon pump) use Unsuccessful procedure
7 (17.1) 9 (22.0)
15 (65.2) 12 (52.2)
<0.001 0.025
3 (13.0)
0.043
0 (0)
Conclusion: OHCA patients undergoing PCI had a significantly higher in-hospital mortality rate compared with patients with ACS. Within this cohort, in-hospital mortality was associated with patients in cardiogenic shock, IABP use and an unsuccessful procedure. doi:10.1016/j.hlc.2009.05.530 485 IMMEDIATE ST RESOLUTION ON INTRACORONARY ECG DURING PRIMARY PCI PREDICTS EXTENT OF MYOCARDIAL INJURY USING CARDIAC MRI M.C. Leung 1 , D.T.L.
Wong 2 , R.
Das 2 , K.
Soon 2 , G.
Chacko 2 , G.W.H. Liew 2 , M.A. Brown 2 , M.I. Worthley 2 , K.S.L. Teo 2 , S.G. Worthley 2 1 Monash Cardiovascular Research Centre, MonashHEART and Monash University Department of Medicine (MMC), Melbourne, Australia 2 Cardiovascular Research Centre, Royal Adelaide Hospital and Adelaide University, Adelaide, Australia
Purpose: Primary percutaneous coronary intervention (PPCI) is effective in achieving TIMI 3 flow in ST elevation myocardial infarction (STEMI), however microvascular perfusion remains impaired in 30–40% of patients, leading to higher mortality. Intracoronary ECG ST segment resolution (IC-STR) is a simple and novel method that may predict the extent of myocardial injury. Method: Twenty-two consecutive patients (age 59 ± 9, M = 22) presenting with STEMI had intracoronary unipolar ST segment measurement before and after (5,10,15 min) achieving TIMI 3 flow with PPCI. Surface 12 lead ECGs (two analysis methods: Sum of ST deviation (SumST) in all leads and maximal single lead (MaxST)) were performed at 60–90 mins, 3, 6, 12, 18, 24 h after achieving TIMI 3 flow. Gadolinium enhanced cardiac MRI(CMR) was performed between days 3 and 6 after PPCI, assessing function (EF%, wall motion score), infarct mass, microvascular obstruction (MVO) size, MVO score, transmural score and T2-weighted oedema score on a 16 segment model. Peak CK was measured. Statisti-