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Outcomes of Obese and Morbidly Obese Patients Undergoing Percutaneous Coronary Intervention
Abstracts
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culptrit vessel occlusion or significant stenosis was present in 56%, 52%, 58% and 44% in groups 1-4, respectively. In the selected group with an initial shockable rhythm, a cultprit lesion was present in 19% of patients in group 4. ST-elevation predicted a culptrit lesion in the VF cohort with 61% sensitivity, 75% specificity and positive predictive value of 50%. A normal ECG predicted minor coronary disease or less with 36% sensitivity, 78% specificity and a negative predictive value of 73%. Conclusion: The post resuscitation ECG is not a reliable tool to guide the decision for coronary angiography as an acute culprit lesion was seen in one in five patients with a normal ECG. http://dx.doi.org/10.1016/j.hlc.2016.06.121 121 Outcomes of Anaemic Patients Presenting with Acute Coronary Syndrome (ACS): An Analysis of the Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events (CONCORDANCE) R. Huynh 1,∗ , K. Hyun 2 , M. D Souza 1 , N. Kangaharan 3 , P. Shetty 4 , J. Mariani 5 , J. Kilian 6 , J. Hung 7 , M. Ryan 8 , D. Chew 9 , D. Brieger 1 1 Department
of Cardiology, Concord Hospital, Sydney, Australia 2 The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia 3 Department of Cardiology, Royal Darwin Hospital, Darwin, Australia 4 Department of Cardiology, Sutherland Heart Clinic, Sydney, Australia 5 Cardiology, Bairnsdale Hospital, Melbourne, Australia 6 Department of Cardiology, Bankstown Hospital, Sydney, Australia 7 Department of Cardiology, Sir Charles Gairdner Hospital, Perth, Australia 8 Department of Cardiology, Nowra Private Hospital, Nowra, Australia 9 Department of Cardiology, Monash Medical Centre, Melbourne, Australia Objectives: Anaemia commonly accompanies ACS and is associated with poorer outcomes. This study examines the associations between anaemia, management and outcomes in an Australian ACS population. Methods: This analysis of the CONCORDANCE database included 8665 ACS patients presenting to 41 Australian hospitals. Baseline characteristics, management and outcomes were compared between patients with anaemia (Hb≤130 for males, Hb≤120 g/L for females) and non-anaemia. Results: 1880 (21.7%) patients presenting with ACS were anaemic. These patients were older (72yrs vs. 63yrs, p<0.0001), with higher prevalence of comorbidities. STEMI patients with anaemia were less likely to be emergently
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reperfused with either thrombolytic therapy (22% vs. 33%, p<0.0001) or primary percutaneous coronary intervention (PCI) (45 vs. 51% p=0.033). For all ACS, anaemic patients less frequently received: coronary angiography (63% vs. 86%, p<0.0001); drug eluting stents if undergoing PCI (50% vs. 58%, p<0.0001); dual antiplatelet therapy (80% vs. 89%, p<0.0001) and parenteral anticoagulants (82% vs. 88%, p<0.0001). Heart failure (20% vs. 9%, p<0.0001), renal failure (13% vs. 4%, p<0.0001), and reinfarction (4% vs. 2%, p=0.0006) were more common among anaemic patients. There was a near-linear relationship between admission haemoglobin and in hospital mortality. Conclusions: Anaemic patients with ACS are a high risk group less likely to undergo invasive and antithrombotic therapy. The optimal haemoglobin level in this population warrants further investigation. http://dx.doi.org/10.1016/j.hlc.2016.06.122 122 Outcomes of Obese and Morbidly Obese Patients Undergoing Percutaneous Coronary Intervention E. Paratz ∗ , L. Wilkinson, A. MacIsaac St Vincent’s Hospital, Melbourne, Australia Purpose: To quantify the influence of obesity and morbid obesity on PCI outcomes. Methods: 1,082 patients from a single institution were categorised as non-obese (NO, BMI <30 kg/m2 , n=688), obese (O, BMI 30-40 kg/m2 , n=354) or morbidly obese (MO, BMI ≥40 kg/m2 , n=40). Demographic variables and procedural outcomes were collated, and multiple regression performed to assess effect of BMI class on procedural outcomes. Monte Carlo simulations modelled radiation dosimetric data. Results: Obese and morbidly obese patients were younger (p=0.016), more frequently female (p=0.036), had better renal function (p<0.0001), were more commonly diabetic (p<0.0001), and with a prior history of PCI (p=0.01). Complication rates were not increased, with no difference in rates of major adverse cardiovascular or cerebrovascular events, acute kidney injury, bleeding, length of stay, 30-day readmission or 30-day mortality. However, obese and morbidly obese patients had increased mean contrast use (p=0.034), fluoroscopic dose area product (p<0.0001) and entrance air kerma (p<0.0001). Dosimetric simulations demonstrated both obese and morbidly obese patients received mean peak radiation skin doses above the threshold for transient skin effects (p<0.0001). Effective radiation dose was increased in obese but not morbidly obese patients (p<0.0001 for NO vs O, p=0.449 for NO vs MO). Conclusion: PCI can be performed in obese and morbidly obese patients without elevated risk for most clinical outcomes. However, radiation dosage is increased beyond the threshold that could cause transient skin effects and increased late effects. Strategies should be pursued to minimise radiation dose in PCI for obese and morbidly obese patients. http://dx.doi.org/10.1016/j.hlc.2016.06.123
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culptrit vessel occlusion or significant stenosis was present in 56%, 52%, 58% and 44% in groups 1-4, respectively. In the selected group with an initial shockable rhythm, a cultprit lesion was present in 19% of patients in group 4. ST-elevation predicted a culptrit lesion in the VF cohort with 61% sensitivity, 75% specificity and positive predictive value of 50%. A normal ECG predicted minor coronary disease or less with 36% sensitivity, 78% specificity and a negative predictive value of 73%. Conclusion: The post resuscitation ECG is not a reliable tool to guide the decision for coronary angiography as an acute culprit lesion was seen in one in five patients with a normal ECG. http://dx.doi.org/10.1016/j.hlc.2016.06.121 121 Outcomes of Anaemic Patients Presenting with Acute Coronary Syndrome (ACS): An Analysis of the Cooperative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events (CONCORDANCE) R. Huynh 1,∗ , K. Hyun 2 , M. D Souza 1 , N. Kangaharan 3 , P. Shetty 4 , J. Mariani 5 , J. Kilian 6 , J. Hung 7 , M. Ryan 8 , D. Chew 9 , D. Brieger 1 1 Department
of Cardiology, Concord Hospital, Sydney, Australia 2 The George Institute for Global Health, Sydney Medical School, University of Sydney, Sydney, Australia 3 Department of Cardiology, Royal Darwin Hospital, Darwin, Australia 4 Department of Cardiology, Sutherland Heart Clinic, Sydney, Australia 5 Cardiology, Bairnsdale Hospital, Melbourne, Australia 6 Department of Cardiology, Bankstown Hospital, Sydney, Australia 7 Department of Cardiology, Sir Charles Gairdner Hospital, Perth, Australia 8 Department of Cardiology, Nowra Private Hospital, Nowra, Australia 9 Department of Cardiology, Monash Medical Centre, Melbourne, Australia Objectives: Anaemia commonly accompanies ACS and is associated with poorer outcomes. This study examines the associations between anaemia, management and outcomes in an Australian ACS population. Methods: This analysis of the CONCORDANCE database included 8665 ACS patients presenting to 41 Australian hospitals. Baseline characteristics, management and outcomes were compared between patients with anaemia (Hb≤130 for males, Hb≤120 g/L for females) and non-anaemia. Results: 1880 (21.7%) patients presenting with ACS were anaemic. These patients were older (72yrs vs. 63yrs, p<0.0001), with higher prevalence of comorbidities. STEMI patients with anaemia were less likely to be emergently
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reperfused with either thrombolytic therapy (22% vs. 33%, p<0.0001) or primary percutaneous coronary intervention (PCI) (45 vs. 51% p=0.033). For all ACS, anaemic patients less frequently received: coronary angiography (63% vs. 86%, p<0.0001); drug eluting stents if undergoing PCI (50% vs. 58%, p<0.0001); dual antiplatelet therapy (80% vs. 89%, p<0.0001) and parenteral anticoagulants (82% vs. 88%, p<0.0001). Heart failure (20% vs. 9%, p<0.0001), renal failure (13% vs. 4%, p<0.0001), and reinfarction (4% vs. 2%, p=0.0006) were more common among anaemic patients. There was a near-linear relationship between admission haemoglobin and in hospital mortality. Conclusions: Anaemic patients with ACS are a high risk group less likely to undergo invasive and antithrombotic therapy. The optimal haemoglobin level in this population warrants further investigation. http://dx.doi.org/10.1016/j.hlc.2016.06.122 122 Outcomes of Obese and Morbidly Obese Patients Undergoing Percutaneous Coronary Intervention E. Paratz ∗ , L. Wilkinson, A. MacIsaac St Vincent’s Hospital, Melbourne, Australia Purpose: To quantify the influence of obesity and morbid obesity on PCI outcomes. Methods: 1,082 patients from a single institution were categorised as non-obese (NO, BMI <30 kg/m2 , n=688), obese (O, BMI 30-40 kg/m2 , n=354) or morbidly obese (MO, BMI ≥40 kg/m2 , n=40). Demographic variables and procedural outcomes were collated, and multiple regression performed to assess effect of BMI class on procedural outcomes. Monte Carlo simulations modelled radiation dosimetric data. Results: Obese and morbidly obese patients were younger (p=0.016), more frequently female (p=0.036), had better renal function (p<0.0001), were more commonly diabetic (p<0.0001), and with a prior history of PCI (p=0.01). Complication rates were not increased, with no difference in rates of major adverse cardiovascular or cerebrovascular events, acute kidney injury, bleeding, length of stay, 30-day readmission or 30-day mortality. However, obese and morbidly obese patients had increased mean contrast use (p=0.034), fluoroscopic dose area product (p<0.0001) and entrance air kerma (p<0.0001). Dosimetric simulations demonstrated both obese and morbidly obese patients received mean peak radiation skin doses above the threshold for transient skin effects (p<0.0001). Effective radiation dose was increased in obese but not morbidly obese patients (p<0.0001 for NO vs O, p=0.449 for NO vs MO). Conclusion: PCI can be performed in obese and morbidly obese patients without elevated risk for most clinical outcomes. However, radiation dosage is increased beyond the threshold that could cause transient skin effects and increased late effects. Strategies should be pursued to minimise radiation dose in PCI for obese and morbidly obese patients. http://dx.doi.org/10.1016/j.hlc.2016.06.123