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Long-Term Outcome Following Patent Foramen Ovale (PFO) Closure
Abstracts
S215
391 Long-Term Clinical Outcomes and Predictors of All-Cause Mortality After Rotational Atherectomy Xu 1,2,∗ ,
Ang 1 ,
Akrawi 1 ,
J. T. D. A. Hopkins 1,2 , C. Mussap 1,2 , J. French 1,2 , R. Rajaratnam 1,2 , C. Juergens 1,2 , S. Lo 1,2 1 Liverpool
Hospital, Sydney, Australia of New South Wales, Sydney,
2 University
Australia Introduction: Rotational atherectomy (RA) is an effective strategy to facilitate stenting of complex calcific coronary lesions. There has been renewed interest due to increasing lesion complexity attempted. We aimed to examine the impact of clinical and procedural characteristics on long-term outcomes in patients undergoing RA. Methods and Results: We retrospectively analysed 95 consecutive patients undergoing RA at our hospital (Jan 2005Dec 2015). Mean age 71.6 years, 73% male, 34% diabetes, 34% chronic kidney disease (eGFR<60 mL/min/1.73m2 ), 8% trans-radial approach. Right-coronary-artery most frequently treated (40%), then left-anterior-descending (25%), left-circumflex (15%), protected left-main (10%), unprotected left-main (6%), side-branches (3%). Chronic total occlusions were 4%, bifurcation-lesions 43%, in-stent-restenosis 2%. Severe angiographic calcification noted in 85%, 35% failed angioplasty previously (undilatable/uncrossable). Mean target-lesion SYNTAX-score was high (10.5 ± 5.8). Intracoronary imaging used in 10%. Average contrast use per-case 186.2 ± 49.9 mL. Most common burr size was 1.5 mm (57%), averaging 1.2 burrs per-case. Average burrto-artery ratio 0.42. Median stent length 24 mm (IQR 18-40). Majority received drug-eluting-stents (59%). Angiographic success achieved in all cases. No in-hospital deaths or stroke seen. Periprocedural myocardial infarction (MI) occurred in 6%. At 30-days, major-adverse-cardiac-events (death/MI/target-lesion-revascularisation) was 8%, and at 12-months 10%. All-cause mortality was 27% after mean follow-up 4.7 ± 3.4years. Multivariate regression analysis identified the following independent predictors of all-cause mortality: age>75 (HR6.3; CI 2.0-19.5; p = 0.001), contrast use>300 mL (HR10.9; CI 1.7-68.2; p = 0.011), and bifurcationlesions (HR4.3; CI 1.3-14.0; p = 0.015). Conclusions: RA remains an effective adjunct for treating complex coronary lesions. Independent predictors of all-cause mortality were identified. These observations may further enhance patient selection for RA. http://dx.doi.org/10.1016/j.hlc.2017.06.392
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392 Long-Term Outcome Following Patent Foramen Ovale (PFO) Closure K. Balakrishnan ∗ , G. Koshy, B. Thompson, B. Herman Launceston General Hospital, Launceston, Australia Background: Patent foramen ovale (PFO) is present in up to 25% of the general population. PFO closure in cryptogenic stroke is controversial with studies showing mixed results. We report long-term outcomes following PFO closure in our institution. Methods: Consecutive patients undergoing PFO closure between 2008 and 2012 were included. Baseline characteristic and indication for closure were recorded. Follow up was carried out at 5-years by reviewing medical records and telephone interview. Outcomes measured included recurrence of cerebrovascular events (CVE), migraine severity and procedure-related adverse events. Results: A total of 39 PFO closures were performed in out institution between 2008 and 2012. Baseline patient characteristics are listed in Table 1. The most common indication for closure was cryptogenic CVE (54%) followed by migraines (18%) (Table 1). 18% of patients had a prior history of CVE and migraines. One patient developed recurrent CVE during 5-year follow up. Persistent migraine was noted 14% (2 out of 14 patients). Two patients experienced transient selflimiting atrial arrhythmias. One patient developed a major retroperitoneal bleed which was successfully treated. No procedure-related death was recorded. Discussion: The most common indication for PFO closure was cryptogenic CVE followed by migraines. This procedure was well tolerated with a very low risk of adverse event. PFO closure resulted in significant improvement in migraines and very low recurrence of CVE. Conclusion: Long-term follow up of PFO closure in our institution showed improvement in migraine severity and low risk of CVE recurrence.
Abstracts
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http://dx.doi.org/10.1016/j.hlc.2017.06.393 393 Long-Term Outcomes After Percutaneous Coronary Intervention (PCI) to an Unprotected Left Main Coronary Artery (LMCA) in Cardiogenic Shock: Observations From the Melbourne Interventional Group (MIG) Registry Yeoh 1,∗ ,
Andrianopoulos 2 ,
Reid 2,3 ,
J. N. C. A. Brennan 2 , M. Yudi 1 , G. Proimos 1 , R. Chan 1 , S. Noaman 4 , E. Oqueli 5 , S. Picardo 1 , A. Ajani 6 , W. Chan 4 , O. Farouque 1 , D. Clark 1 1 Austin
Hospital, Melbourne, Australia Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Australia 3 Curtin University, Perth, Australia 4 Alfred Hospital , Melbourne, Australia 5 Ballarat Base Hospital, Ballarat, Australia 6 Royal Melbourne Hospital, Melbourne, Australia 2 Monash
Background: Recent trials support the use of PCI with drug eluting stents as an alternative to coronary artery bypass grafting (CABG) in selected stable patients. In cardiogenic shock, urgent revascularisation is optimal. We review the MIG experience on unprotected LMCA PCI in cardiogenic shock. Method: Excluding patients with previous bypass surgery, consecutive patients presenting with cardiogenic shock undergoing PCI from the MIG registry between 2005-2016 were analysed, comparing those with LMCA PCI to nonLMCA PCI. Results: A total of 601 patients (3.2% of all PCI patients without previous CABG) presented in cardiogenic shock. 45 (7.5%) patients had unprotected LMCA PCI. Patients undergoing unprotected LMCA PCI were older (70.1years vs 65.8years, p = 0.01) with the same rate of male predominance (77.8% vs 72.1%, p = 0.75), hypertension (70.5% vs 56.8%, p = 0.08), diabetes (22.7% vs 24.6%, p = 0.78) and hypercholesterolaemia (52.3% vs 47.1%, p = 0.51). In cardiogenic shock, the in hospital mortality with unprotected LMCA PCI is 64.4%
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compared to 36.5% with non LMCA PCI, with long-term mortality linked to the national death index (NDI) in the LMCA PCI group being 80.0%. Unprotected LMCA PCI in the setting of cardiogenic shock is an independent predictor of long-term mortality (HR 1.59, 95% CI 1.003-2.527, p = 0.048). Conclusion: Outcomes after PCI to unprotected LMCA in cardiogenic shock are poor, with the excess in mortality occurring early. It may be beneficial for on table discussions regarding urgent coronary bypass grafting in this setting.
http://dx.doi.org/10.1016/j.hlc.2017.06.394 394 Long-Term Outcomes After Percutaneous Coronary Intervention (PCI) to an Unprotected Left Main Coronary Artery (LMCA): 10 Year Observations From the Melbourne Interventional Group (MIG) Registry J. Yeoh 1,∗ , N. Andrianopoulos 2 , C. Reid 2,3 , A. Brennan 2 , M. Yudi 1 , G. Proimos 1 , R. Chan 1 , S. Noaman 4 , E. Oqueli 5 , S. Picardo 1 , A. Ajani 6 , W. Chan 4 , O. Farouque 1 , D. Clark 1 1 Austin
Hospital, Melbourne, Australia Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Australia 3 Curtin University, Perth, Australia 4 Alfred Hospital, Melbourne, Australia 5 Ballarat Hospital, Ballarat, Australia 6 Royal Melbourne Hospital, Melbourne, Australia 2 Monash
Background: Patients with significant LMCA disease usually proceed to bypass surgery. Recent trials concluded PCI may be an acceptable alternative to coronary artery bypass grafting (CABG) in selected patients. We reviewed the MIG experience on unprotected LMCA stenting. Method: Excluding patients with previous CABG and cardiogenic shock, all consecutive patients undergoing PCI from the MIG registry between 2005-2016 were analysed, comparing those with unprotected LMCA PCI to non-LMCA PCI. Results: A total of 17468 patients were included with 49 patients (0.28%) having LMCA PCI. Patients with LMCA
S215
391 Long-Term Clinical Outcomes and Predictors of All-Cause Mortality After Rotational Atherectomy Xu 1,2,∗ ,
Ang 1 ,
Akrawi 1 ,
J. T. D. A. Hopkins 1,2 , C. Mussap 1,2 , J. French 1,2 , R. Rajaratnam 1,2 , C. Juergens 1,2 , S. Lo 1,2 1 Liverpool
Hospital, Sydney, Australia of New South Wales, Sydney,
2 University
Australia Introduction: Rotational atherectomy (RA) is an effective strategy to facilitate stenting of complex calcific coronary lesions. There has been renewed interest due to increasing lesion complexity attempted. We aimed to examine the impact of clinical and procedural characteristics on long-term outcomes in patients undergoing RA. Methods and Results: We retrospectively analysed 95 consecutive patients undergoing RA at our hospital (Jan 2005Dec 2015). Mean age 71.6 years, 73% male, 34% diabetes, 34% chronic kidney disease (eGFR<60 mL/min/1.73m2 ), 8% trans-radial approach. Right-coronary-artery most frequently treated (40%), then left-anterior-descending (25%), left-circumflex (15%), protected left-main (10%), unprotected left-main (6%), side-branches (3%). Chronic total occlusions were 4%, bifurcation-lesions 43%, in-stent-restenosis 2%. Severe angiographic calcification noted in 85%, 35% failed angioplasty previously (undilatable/uncrossable). Mean target-lesion SYNTAX-score was high (10.5 ± 5.8). Intracoronary imaging used in 10%. Average contrast use per-case 186.2 ± 49.9 mL. Most common burr size was 1.5 mm (57%), averaging 1.2 burrs per-case. Average burrto-artery ratio 0.42. Median stent length 24 mm (IQR 18-40). Majority received drug-eluting-stents (59%). Angiographic success achieved in all cases. No in-hospital deaths or stroke seen. Periprocedural myocardial infarction (MI) occurred in 6%. At 30-days, major-adverse-cardiac-events (death/MI/target-lesion-revascularisation) was 8%, and at 12-months 10%. All-cause mortality was 27% after mean follow-up 4.7 ± 3.4years. Multivariate regression analysis identified the following independent predictors of all-cause mortality: age>75 (HR6.3; CI 2.0-19.5; p = 0.001), contrast use>300 mL (HR10.9; CI 1.7-68.2; p = 0.011), and bifurcationlesions (HR4.3; CI 1.3-14.0; p = 0.015). Conclusions: RA remains an effective adjunct for treating complex coronary lesions. Independent predictors of all-cause mortality were identified. These observations may further enhance patient selection for RA. http://dx.doi.org/10.1016/j.hlc.2017.06.392
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392 Long-Term Outcome Following Patent Foramen Ovale (PFO) Closure K. Balakrishnan ∗ , G. Koshy, B. Thompson, B. Herman Launceston General Hospital, Launceston, Australia Background: Patent foramen ovale (PFO) is present in up to 25% of the general population. PFO closure in cryptogenic stroke is controversial with studies showing mixed results. We report long-term outcomes following PFO closure in our institution. Methods: Consecutive patients undergoing PFO closure between 2008 and 2012 were included. Baseline characteristic and indication for closure were recorded. Follow up was carried out at 5-years by reviewing medical records and telephone interview. Outcomes measured included recurrence of cerebrovascular events (CVE), migraine severity and procedure-related adverse events. Results: A total of 39 PFO closures were performed in out institution between 2008 and 2012. Baseline patient characteristics are listed in Table 1. The most common indication for closure was cryptogenic CVE (54%) followed by migraines (18%) (Table 1). 18% of patients had a prior history of CVE and migraines. One patient developed recurrent CVE during 5-year follow up. Persistent migraine was noted 14% (2 out of 14 patients). Two patients experienced transient selflimiting atrial arrhythmias. One patient developed a major retroperitoneal bleed which was successfully treated. No procedure-related death was recorded. Discussion: The most common indication for PFO closure was cryptogenic CVE followed by migraines. This procedure was well tolerated with a very low risk of adverse event. PFO closure resulted in significant improvement in migraines and very low recurrence of CVE. Conclusion: Long-term follow up of PFO closure in our institution showed improvement in migraine severity and low risk of CVE recurrence.
Abstracts
S216
http://dx.doi.org/10.1016/j.hlc.2017.06.393 393 Long-Term Outcomes After Percutaneous Coronary Intervention (PCI) to an Unprotected Left Main Coronary Artery (LMCA) in Cardiogenic Shock: Observations From the Melbourne Interventional Group (MIG) Registry Yeoh 1,∗ ,
Andrianopoulos 2 ,
Reid 2,3 ,
J. N. C. A. Brennan 2 , M. Yudi 1 , G. Proimos 1 , R. Chan 1 , S. Noaman 4 , E. Oqueli 5 , S. Picardo 1 , A. Ajani 6 , W. Chan 4 , O. Farouque 1 , D. Clark 1 1 Austin
Hospital, Melbourne, Australia Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Australia 3 Curtin University, Perth, Australia 4 Alfred Hospital , Melbourne, Australia 5 Ballarat Base Hospital, Ballarat, Australia 6 Royal Melbourne Hospital, Melbourne, Australia 2 Monash
Background: Recent trials support the use of PCI with drug eluting stents as an alternative to coronary artery bypass grafting (CABG) in selected stable patients. In cardiogenic shock, urgent revascularisation is optimal. We review the MIG experience on unprotected LMCA PCI in cardiogenic shock. Method: Excluding patients with previous bypass surgery, consecutive patients presenting with cardiogenic shock undergoing PCI from the MIG registry between 2005-2016 were analysed, comparing those with LMCA PCI to nonLMCA PCI. Results: A total of 601 patients (3.2% of all PCI patients without previous CABG) presented in cardiogenic shock. 45 (7.5%) patients had unprotected LMCA PCI. Patients undergoing unprotected LMCA PCI were older (70.1years vs 65.8years, p = 0.01) with the same rate of male predominance (77.8% vs 72.1%, p = 0.75), hypertension (70.5% vs 56.8%, p = 0.08), diabetes (22.7% vs 24.6%, p = 0.78) and hypercholesterolaemia (52.3% vs 47.1%, p = 0.51). In cardiogenic shock, the in hospital mortality with unprotected LMCA PCI is 64.4%
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compared to 36.5% with non LMCA PCI, with long-term mortality linked to the national death index (NDI) in the LMCA PCI group being 80.0%. Unprotected LMCA PCI in the setting of cardiogenic shock is an independent predictor of long-term mortality (HR 1.59, 95% CI 1.003-2.527, p = 0.048). Conclusion: Outcomes after PCI to unprotected LMCA in cardiogenic shock are poor, with the excess in mortality occurring early. It may be beneficial for on table discussions regarding urgent coronary bypass grafting in this setting.
http://dx.doi.org/10.1016/j.hlc.2017.06.394 394 Long-Term Outcomes After Percutaneous Coronary Intervention (PCI) to an Unprotected Left Main Coronary Artery (LMCA): 10 Year Observations From the Melbourne Interventional Group (MIG) Registry J. Yeoh 1,∗ , N. Andrianopoulos 2 , C. Reid 2,3 , A. Brennan 2 , M. Yudi 1 , G. Proimos 1 , R. Chan 1 , S. Noaman 4 , E. Oqueli 5 , S. Picardo 1 , A. Ajani 6 , W. Chan 4 , O. Farouque 1 , D. Clark 1 1 Austin
Hospital, Melbourne, Australia Centre of Cardiovascular Research and Education in Therapeutics, Melbourne, Australia 3 Curtin University, Perth, Australia 4 Alfred Hospital, Melbourne, Australia 5 Ballarat Hospital, Ballarat, Australia 6 Royal Melbourne Hospital, Melbourne, Australia 2 Monash
Background: Patients with significant LMCA disease usually proceed to bypass surgery. Recent trials concluded PCI may be an acceptable alternative to coronary artery bypass grafting (CABG) in selected patients. We reviewed the MIG experience on unprotected LMCA stenting. Method: Excluding patients with previous CABG and cardiogenic shock, all consecutive patients undergoing PCI from the MIG registry between 2005-2016 were analysed, comparing those with unprotected LMCA PCI to non-LMCA PCI. Results: A total of 17468 patients were included with 49 patients (0.28%) having LMCA PCI. Patients with LMCA