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P-391 Single-Bolus Eptifibatide is as Effective as Conventional Eptifibatide in Elective Percutaneous Coronary Intervention
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Abstracts of the 17th Asian Pacific Congress of Cardiology
infarction, recurrent angina and congestive cardiac failure were 1%, 1% and 5% respectively. Conclusion: Our findings suggest that favorable outcomes, matching the international data can be achieved in our patients with primary PCI in the management of life threatening illness like STEMI despite all the limitations. Primary PCI as a preferred method of reperfusion strategy needs to be practiced more often in our part of world. P-389 Improving Door-to-Balloon Time: Emergency Physician Activation of Percutaneous Coronary Intervention for STEMI at the ED Kim Poh Chan1 , Marcus Eng Hock Ong1 , Arul Earnest2 , Aaron Sung Lung Wong3 , Anantharaman Venkataraman1 , Terrance Siang Jin Chua3 , Swee Han Lim1 . 1 Department of Emergency Medicine, Singapore General Hospital, Singapore, 2 Principal Medical Statistician, Tan Tock Seng Hospital, Singapore, 3 Department of Cardiology, National Heart Centre, Singapore Introduction: Primary percutaneous coronary intervention (PCI) is usually offered as first line treatment for patients with acute STEMI at the Singapore General Hospital (SGH). Shorter door-to-balloon times (D2B) have been shown to minimize infarct size, improve left ventricular function and improve long-term survival. Objective: To reduce D2B in primary PCI for patients presenting to the ED with acute STEMI, by the adoption of ED Physician activated PCI. Previously, PCI could only be activated by the cardiologist. Method: The study was a prospective, observational study of patients who presented at the ED with STEMI and required PCI. All consecutive cases from 24 Jul 2007 were eligible based on inclusion and exclusion criteria. Cases with exclusion criteria were referred to the Cardiologist according to previous procedure. PCI would be activated by direct calling to the cardiovascular laboratory (CVL) during office hours or via the hospital operator during non-office hours. D2B time was tabulated for both ED and CVM activation. Two-sample Wilcoxon rank-sum (Mann Whitney) analysis of the median DTB timing was performed. Results: We recruited a total of 101 patients from 24 Jul to 4 Dec 2007. The median D2B time for ED and CVM activation was 80.5 mins and 106 mins respectively. 3 of the 34 cases activated by CVM showed only minor coronary artery diseases (false positives). Conclusion: ED activation of PCI resulted in a significant reduction in D2B and should be adopted as “standard of care” for all STEMI cases who meet the criteria for PCI. P-390 Neointimal Coverage on the Stent Struts Crossing a Side Branch in Different Type Stents: An Optical Coherence Tomography Study Yong Liu, Masato Mizukoshi, Atsushi Tanaka, Shigeho Takarada, Hironori Kitabata, Takashi Tanimoto, Akio Kuroi, Yu Arida, Hideyuki Ikejima, Hiroto Tsujioka, Kenichi Komukai, Kouhei Ishibashi, Keishi Okochi, Hideaki Kataiwa, Hiroki Matsumoto, Yuichi Ozaki, Akio Shimokado, Nobuo Nakamura, Kumiko Hirada, Toshio Imanishi, Takashi Akasaka. Department of Cardiology, Wakayama Medical University, Japan Background: Late thrombosis (LST) has mostly been concerned as the major clinic and potentially catastrophic complications after the drug-eluting stent (DES) implantation. Although the causes of LST haven’t been revealed exactly, bifurcation might be a high risk one due to the delayed endothelialization over the struts crossing the side
branch. We observed the neointima-coverage on the struts crossing the side branch in different types of stents including bare-metal stent (BMS), sirolimus-eluting stent (SES), and paclitaxel-eluting stent (PES), by using optical coherence tomography (OCT). Method and Result: 65 stents of 40 cases have been observed and 118 struts crossing a side branch were found totally, including 34 struts in BMS, 59 struts in SES, and 25 struts in PES, at a 9-month follow-up study. Among these, neotissue coverage around the struts were demonstrated in 20 (37.0%) in SES and 10 (40.0%) in PES, which was less than that in BMS (24 struts, 70.6%) (p < 0.05, respectively). The neotissue thickness (NTT) on the struts was significantly less in SES and PES compared with that of BMS (72±16 mm, 84±14 mm vs 122±32 mm, p < 0.01 respectively), although on significant difference between SES and PES (72±16 mm vs 84±14 mm, p = 0.0617). Conclusion: OCT allow us to visualize the struts crossing a side branch precisely and to measure the neointimal coverage thickness on them quantitatively. Delayed endothelialization in SES and PES obviously in comparison with BMS might be related to one of the causes of late thrombosis in the bifurcation. P-391 Single-Bolus Eptifibatide is as Effective as Conventional Eptifibatide in Elective Percutaneous Coronary Intervention Syed Ali Ahsan, KMHS Sirajul Haque, Md. Abu Siddique, Mohammad Salman, Md. Mukhlesur Rahman. Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh Objectives: To evaluate the effectiveness of single fixed dose bolus of Eptifibatide in elective percutaneous coronary intervention. Methods: The outcomes of 85 consecutive patients who underwent elective coronary stenting from January 2007 to December 2007 were assessed prospectively. 44 subjects received Eptifibatide (15 mg single bolus) after crossing the lesion and 41 subjects did not received Eptifibatide. All the subjects were treated with aspirin and clopidogrel before and after the procedure and all received single bolus of clopidogrel (300 mg) before the procedure. All of them received weight adjusted doses of Heparin before and after the procedure. Major adverse cardiac events were assessed during hospital stay and one month after the procedure. CK-MB was measured in all post procedure symtomatic patients. Results: Mean age of the subjects was 51.1±8.9 years, 78 (91.8%) were male, 29 (31.1%) were diabetic and 45 (52.9%) were hypertensive. 40 (47.1%) were presented with myocardial infarction, 40 (47.1%) with stable angina and 5 (5.9%) with unstable angina. 80 (94.1%) received bare metal stents and 5 (5.9%) received drug eluting stents. 5 (5.9%) developed in hospital myocardial infarction and 3 (3.5%) in hospital NQMI in the group who did not received Eptifibatide (p = 0.017). 1 (1.2%) had major bleeding in Eptifibatide group (p = 0.33). Conclusion: Single bolus of Eptifibatide is a safe and highly cost-effective alternative to conventional regimens.
Abstracts of the 17th Asian Pacific Congress of Cardiology
infarction, recurrent angina and congestive cardiac failure were 1%, 1% and 5% respectively. Conclusion: Our findings suggest that favorable outcomes, matching the international data can be achieved in our patients with primary PCI in the management of life threatening illness like STEMI despite all the limitations. Primary PCI as a preferred method of reperfusion strategy needs to be practiced more often in our part of world. P-389 Improving Door-to-Balloon Time: Emergency Physician Activation of Percutaneous Coronary Intervention for STEMI at the ED Kim Poh Chan1 , Marcus Eng Hock Ong1 , Arul Earnest2 , Aaron Sung Lung Wong3 , Anantharaman Venkataraman1 , Terrance Siang Jin Chua3 , Swee Han Lim1 . 1 Department of Emergency Medicine, Singapore General Hospital, Singapore, 2 Principal Medical Statistician, Tan Tock Seng Hospital, Singapore, 3 Department of Cardiology, National Heart Centre, Singapore Introduction: Primary percutaneous coronary intervention (PCI) is usually offered as first line treatment for patients with acute STEMI at the Singapore General Hospital (SGH). Shorter door-to-balloon times (D2B) have been shown to minimize infarct size, improve left ventricular function and improve long-term survival. Objective: To reduce D2B in primary PCI for patients presenting to the ED with acute STEMI, by the adoption of ED Physician activated PCI. Previously, PCI could only be activated by the cardiologist. Method: The study was a prospective, observational study of patients who presented at the ED with STEMI and required PCI. All consecutive cases from 24 Jul 2007 were eligible based on inclusion and exclusion criteria. Cases with exclusion criteria were referred to the Cardiologist according to previous procedure. PCI would be activated by direct calling to the cardiovascular laboratory (CVL) during office hours or via the hospital operator during non-office hours. D2B time was tabulated for both ED and CVM activation. Two-sample Wilcoxon rank-sum (Mann Whitney) analysis of the median DTB timing was performed. Results: We recruited a total of 101 patients from 24 Jul to 4 Dec 2007. The median D2B time for ED and CVM activation was 80.5 mins and 106 mins respectively. 3 of the 34 cases activated by CVM showed only minor coronary artery diseases (false positives). Conclusion: ED activation of PCI resulted in a significant reduction in D2B and should be adopted as “standard of care” for all STEMI cases who meet the criteria for PCI. P-390 Neointimal Coverage on the Stent Struts Crossing a Side Branch in Different Type Stents: An Optical Coherence Tomography Study Yong Liu, Masato Mizukoshi, Atsushi Tanaka, Shigeho Takarada, Hironori Kitabata, Takashi Tanimoto, Akio Kuroi, Yu Arida, Hideyuki Ikejima, Hiroto Tsujioka, Kenichi Komukai, Kouhei Ishibashi, Keishi Okochi, Hideaki Kataiwa, Hiroki Matsumoto, Yuichi Ozaki, Akio Shimokado, Nobuo Nakamura, Kumiko Hirada, Toshio Imanishi, Takashi Akasaka. Department of Cardiology, Wakayama Medical University, Japan Background: Late thrombosis (LST) has mostly been concerned as the major clinic and potentially catastrophic complications after the drug-eluting stent (DES) implantation. Although the causes of LST haven’t been revealed exactly, bifurcation might be a high risk one due to the delayed endothelialization over the struts crossing the side
branch. We observed the neointima-coverage on the struts crossing the side branch in different types of stents including bare-metal stent (BMS), sirolimus-eluting stent (SES), and paclitaxel-eluting stent (PES), by using optical coherence tomography (OCT). Method and Result: 65 stents of 40 cases have been observed and 118 struts crossing a side branch were found totally, including 34 struts in BMS, 59 struts in SES, and 25 struts in PES, at a 9-month follow-up study. Among these, neotissue coverage around the struts were demonstrated in 20 (37.0%) in SES and 10 (40.0%) in PES, which was less than that in BMS (24 struts, 70.6%) (p < 0.05, respectively). The neotissue thickness (NTT) on the struts was significantly less in SES and PES compared with that of BMS (72±16 mm, 84±14 mm vs 122±32 mm, p < 0.01 respectively), although on significant difference between SES and PES (72±16 mm vs 84±14 mm, p = 0.0617). Conclusion: OCT allow us to visualize the struts crossing a side branch precisely and to measure the neointimal coverage thickness on them quantitatively. Delayed endothelialization in SES and PES obviously in comparison with BMS might be related to one of the causes of late thrombosis in the bifurcation. P-391 Single-Bolus Eptifibatide is as Effective as Conventional Eptifibatide in Elective Percutaneous Coronary Intervention Syed Ali Ahsan, KMHS Sirajul Haque, Md. Abu Siddique, Mohammad Salman, Md. Mukhlesur Rahman. Department of Cardiology, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh Objectives: To evaluate the effectiveness of single fixed dose bolus of Eptifibatide in elective percutaneous coronary intervention. Methods: The outcomes of 85 consecutive patients who underwent elective coronary stenting from January 2007 to December 2007 were assessed prospectively. 44 subjects received Eptifibatide (15 mg single bolus) after crossing the lesion and 41 subjects did not received Eptifibatide. All the subjects were treated with aspirin and clopidogrel before and after the procedure and all received single bolus of clopidogrel (300 mg) before the procedure. All of them received weight adjusted doses of Heparin before and after the procedure. Major adverse cardiac events were assessed during hospital stay and one month after the procedure. CK-MB was measured in all post procedure symtomatic patients. Results: Mean age of the subjects was 51.1±8.9 years, 78 (91.8%) were male, 29 (31.1%) were diabetic and 45 (52.9%) were hypertensive. 40 (47.1%) were presented with myocardial infarction, 40 (47.1%) with stable angina and 5 (5.9%) with unstable angina. 80 (94.1%) received bare metal stents and 5 (5.9%) received drug eluting stents. 5 (5.9%) developed in hospital myocardial infarction and 3 (3.5%) in hospital NQMI in the group who did not received Eptifibatide (p = 0.017). 1 (1.2%) had major bleeding in Eptifibatide group (p = 0.33). Conclusion: Single bolus of Eptifibatide is a safe and highly cost-effective alternative to conventional regimens.