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P3-42 CHARACTERISTICS AND CLINICAL OUTCOMES OF ACUTE MYOCARDIAL INFARCTION OF YOUNG PATIENTS IN KOREA
112
Abstracts of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13-16 December, 2007
CRP, troponin T and CK-MB levels were measured on admission. The status of myocardial tissue perfusion was assessed by ST-segment resolution, corrected TIMI frame count (CTFC), and myocardial blush grade (MBG) immediately after primary PCI. All patients were divided into two groups according to the BNP levels; patients with higher (H group, ≥ 80 pg/ml, n= 43) and those with lower BNP levels (L group,<80 pg/ml, n=59). Major adverse cardiac events were compared one month later between two groups. Result: There were no differences in demographic and angiographic characteristics between two groups. H group showed significantly higher troponin T (3.025±4.26 vs 0.196±0.355 ng/ml, P<0.001) and higher CRP level on admission (5.37±5.12 vs 4.64±1.53%, P<0.001). H group, had less rapid resolution of ST segment (42.69±24.85 vs 71.15±19.37%, P<0.001). H group showed high frequency on major adverse cardiac events of 1 month (0.35±0.68 vs 0.03±0.13%, P<0.001) Conclusion: Acute STEMI patients with higher BNP levels on admission showed inadequate myocardial tissue perfusion status after primary PCI. The plasma BNP level on admission may serve as a predictor of tissue perfusion after reperfusion therapy in patients with STEMI.
LV (5 patients), RV (4 patient), RA (2 patients), and LA (1 patient). There is one patient who had an arterial to arterial fistula involving the conal branch that feeds the LAD and LCX arteries. These fistulas were just incidental findings on coronary angiograms done on these patients for various indications. Coronary artery fistula was not a clinical diagnosis or a consideration prior to angiograms. Overall, six patients presented with angina or shortness of breath that can be attributed to the anomalous coronaries in light of the absence of significant CAD on their angiograms. Four are asymptomatic although three of them had significant CAD on angiograms. The presence of a CCF is also not associated with an increased incidence of CAD among these patients. The incidence of CAD among patients with CCF is 44% compared with 69% for the rest of the patients who underwent angiograms. Conclusions: The incidence of CCF in this series is 0.63%. The most commonly involved coronary artery is the LAD while the pulmonary artery is the most common drainage site. The most common symptom that may be attributed to coronary cameral fistula was angina and the presence of a CCF is not a risk factor for the development of CAD.
P3-44 P3-42 CHARACTERISTICS AND CLINICAL OUTCOMES OF ACUTE MYOCARDIAL INFARCTION OF YOUNG PATIENTS IN KOREA
AN INTERVENTION PROGRAM TO IMPROVE DOOR-TO-BALLOON TIME IN PRIMARY ANGIOPLASTY FOR PATIENTS WITH ACUTE ST-ELEVATION MYOCARDIAL INFARCTION – A SINGLE CENTER STUDY
Weon Kim, Won Yu Kang, Sang Chol Cho, Okja Choi, Yong Chan Cho, AnDuk Jeong, YoungKhen Ahn, Wan Kim, MyungHo Jeong. Heart center, Gwangju veterans Hospital, Heart Center, Chonnam National University Hospital, Korea
Chao-Lun Lai 1 , Chieh-Min Fan 2 , Kuang-Chao Tsai 2 , Chi-Yu Yang 1 , Shu-Hsun Chu 1 . 1 Cardiovascular Center, Far Eastern Memorial Hospital, Taiwan; 2 Department of Emergency Medicine, Far Eastern Memorial Hospital, Taiwan
Background: The objective was to analyze the risk factors, clinical, angiographic characteristics, and long-term mortality of AMI in the young patients in Korea. Methods: Clinical, angiographic results and clinical outcomes were analyzed in patients younger than 40 years admitted with an AMI diagnosis in Korea (Group I: 112, 36.5±4.1 years). We compared with AMI patients older than 70 years (Group II: 66, 76.5±4.5 years). Results: Male patients were higher than the female in both group, but higher in group I (94.6%) than group II (56.1%) ( p<0.001). We observed that young patients (Group I) are more frequently smokers (78.6% vs 48.5%, p<0.001) and of hypercholesterolemia (45.5% vs 13.6%, p<0.001), but show a lower prevalence of hypertension (23.2% vs 39.4%, p=0.022) and diabetes (11.6% vs 33.3%, p<0.001). LVEF was higher in group I (54.9±12.2% vs 50.5±13.9%, p=0.042). Lipid profiles were higher in group I, but homocysteine level was higher in group II. We observed that young patients are more frequently one vessel disease (79.5% vs 57.6%, p=0.007) and of pre-intervention TIMI III flow. 30-months clinical follow-up was done.There was no difference between the two groups in MACE, but cardiac death was higher in group II (2.0% vs 15.1%, p=0.002). Conclusion: AMI in young patients presents distinct clinical, angiographic characteristics and outcome with respect to the older group in Korea. Keywords: Myocardial infraction; Youth; Prognosis
Introduction: During the past decade, primary angioplasty has emerged as the preferred treatment strategy for acute ST-segment elevation myocardial infarction (acute STEMI). To improve the quality of care for patients with acute STEMI, we conducted an intervention program at Far Eastern Memorial Hospital to reduce the door-to-balloon time. Methods: For all patients presenting to the emergency department of Far Eastern Memorial Hospital with a chief complaint of acute ischemic chest pain, a registration form was incorporated into the patient’s medical records immediately after a diagnosis of acute STEMI was made. All the time sequences concerning different managements at different locations were recorded by nurses or physicians as instructions on the registration form. Door-to-balloon time was calculated off-line. We provided data feedback to department of emergency medicine and cardiovascular center monthly. Results: From March 2007 to May 2007, 30 patients were enrolled as the postintervention group. 116 patients admitted between April 2006 and Feb. 2007 served as pre-intervention group. The results were summarized in Table 1:
P3-43 CORONARY CAMERAL FISTULA: INCIDENCE, ANGIOGRAPHIC AND CLINICAL PRESENTATION
Jerome O. Laceda, Rodney Jimenez, Noel Naval. St. Luke’s Heart Institute, Quezon City, Philippines Background: Coronary Cameral fistulas (CCF) are rare form of congenital coronary anomalies. The objective of this study is to determine the incidence and review the clinical and angiographic presentation of CCF among patients of St. Luke’s Medical Center. We will also try to determine the relationship of these fistulas with coronary artery disease (CAD). Methods: The authors reviewed coronary angiograms done between January 2001 and December 2005 at our institution. Results: There are 3786 patients who underwent coronary angiograms between 2001 and 2005; twenty-four patients had CCF for an incidence of 0.63%. The most common artery involved in a fistulous connection is the LAD (13 patients), followed by the RCA (4 patients), OM (3 patients), LCX, PDA, and Conal branch (2 patients each) and LMCA, diagonal and septal branch (1 patient each). The pulmonary artery is the most common site of drainage (10 patients), followed by
Table 1.
No. of subjects Median of door-to-balloon time (min) Mean of the natural logarithm of the door-to-balloon time 95% confidence interval of the mean of the natural logarithm of the door-to-balloon time
Pre-intervention
Post-intervention
116 148.5
30 137.5
5.096±0.050
4.940±0.068
4.997∼5.194
4.802∼5.079
p value
0.034 (one-tailed)
Conclusions: Within 3 months, a registration program implemented at our hospital successfully reduced the door-to-balloon time of primary angioplasty for patients suffering from acute STEMI.
P3-45 THE EFFICACY AND SAFETY OF A PERCUTANEOUS FEMORAL ARTERY CLOSURE DEVICE AFTER DIAGNOSTIC AND THERAPEUTIC CARDIAC CATHETERIZATIONS – A SINGLE CENTER’S EXPERIENCE
Cheng-han Lee. National Cheng Kung University Hospital, Taiwan Objective: The purpose of this study was to evaluate the safety and efficacy of a hemostatic puncture closure device (Angio-Seal Vascular Closure Device) in patients undergoing diagnostic and therapeutic cardiac catheterizations.
Abstracts of the 16th Asian Pacific Congress of Cardiology, Taipei, Taiwan, 13-16 December, 2007
CRP, troponin T and CK-MB levels were measured on admission. The status of myocardial tissue perfusion was assessed by ST-segment resolution, corrected TIMI frame count (CTFC), and myocardial blush grade (MBG) immediately after primary PCI. All patients were divided into two groups according to the BNP levels; patients with higher (H group, ≥ 80 pg/ml, n= 43) and those with lower BNP levels (L group,<80 pg/ml, n=59). Major adverse cardiac events were compared one month later between two groups. Result: There were no differences in demographic and angiographic characteristics between two groups. H group showed significantly higher troponin T (3.025±4.26 vs 0.196±0.355 ng/ml, P<0.001) and higher CRP level on admission (5.37±5.12 vs 4.64±1.53%, P<0.001). H group, had less rapid resolution of ST segment (42.69±24.85 vs 71.15±19.37%, P<0.001). H group showed high frequency on major adverse cardiac events of 1 month (0.35±0.68 vs 0.03±0.13%, P<0.001) Conclusion: Acute STEMI patients with higher BNP levels on admission showed inadequate myocardial tissue perfusion status after primary PCI. The plasma BNP level on admission may serve as a predictor of tissue perfusion after reperfusion therapy in patients with STEMI.
LV (5 patients), RV (4 patient), RA (2 patients), and LA (1 patient). There is one patient who had an arterial to arterial fistula involving the conal branch that feeds the LAD and LCX arteries. These fistulas were just incidental findings on coronary angiograms done on these patients for various indications. Coronary artery fistula was not a clinical diagnosis or a consideration prior to angiograms. Overall, six patients presented with angina or shortness of breath that can be attributed to the anomalous coronaries in light of the absence of significant CAD on their angiograms. Four are asymptomatic although three of them had significant CAD on angiograms. The presence of a CCF is also not associated with an increased incidence of CAD among these patients. The incidence of CAD among patients with CCF is 44% compared with 69% for the rest of the patients who underwent angiograms. Conclusions: The incidence of CCF in this series is 0.63%. The most commonly involved coronary artery is the LAD while the pulmonary artery is the most common drainage site. The most common symptom that may be attributed to coronary cameral fistula was angina and the presence of a CCF is not a risk factor for the development of CAD.
P3-44 P3-42 CHARACTERISTICS AND CLINICAL OUTCOMES OF ACUTE MYOCARDIAL INFARCTION OF YOUNG PATIENTS IN KOREA
AN INTERVENTION PROGRAM TO IMPROVE DOOR-TO-BALLOON TIME IN PRIMARY ANGIOPLASTY FOR PATIENTS WITH ACUTE ST-ELEVATION MYOCARDIAL INFARCTION – A SINGLE CENTER STUDY
Weon Kim, Won Yu Kang, Sang Chol Cho, Okja Choi, Yong Chan Cho, AnDuk Jeong, YoungKhen Ahn, Wan Kim, MyungHo Jeong. Heart center, Gwangju veterans Hospital, Heart Center, Chonnam National University Hospital, Korea
Chao-Lun Lai 1 , Chieh-Min Fan 2 , Kuang-Chao Tsai 2 , Chi-Yu Yang 1 , Shu-Hsun Chu 1 . 1 Cardiovascular Center, Far Eastern Memorial Hospital, Taiwan; 2 Department of Emergency Medicine, Far Eastern Memorial Hospital, Taiwan
Background: The objective was to analyze the risk factors, clinical, angiographic characteristics, and long-term mortality of AMI in the young patients in Korea. Methods: Clinical, angiographic results and clinical outcomes were analyzed in patients younger than 40 years admitted with an AMI diagnosis in Korea (Group I: 112, 36.5±4.1 years). We compared with AMI patients older than 70 years (Group II: 66, 76.5±4.5 years). Results: Male patients were higher than the female in both group, but higher in group I (94.6%) than group II (56.1%) ( p<0.001). We observed that young patients (Group I) are more frequently smokers (78.6% vs 48.5%, p<0.001) and of hypercholesterolemia (45.5% vs 13.6%, p<0.001), but show a lower prevalence of hypertension (23.2% vs 39.4%, p=0.022) and diabetes (11.6% vs 33.3%, p<0.001). LVEF was higher in group I (54.9±12.2% vs 50.5±13.9%, p=0.042). Lipid profiles were higher in group I, but homocysteine level was higher in group II. We observed that young patients are more frequently one vessel disease (79.5% vs 57.6%, p=0.007) and of pre-intervention TIMI III flow. 30-months clinical follow-up was done.There was no difference between the two groups in MACE, but cardiac death was higher in group II (2.0% vs 15.1%, p=0.002). Conclusion: AMI in young patients presents distinct clinical, angiographic characteristics and outcome with respect to the older group in Korea. Keywords: Myocardial infraction; Youth; Prognosis
Introduction: During the past decade, primary angioplasty has emerged as the preferred treatment strategy for acute ST-segment elevation myocardial infarction (acute STEMI). To improve the quality of care for patients with acute STEMI, we conducted an intervention program at Far Eastern Memorial Hospital to reduce the door-to-balloon time. Methods: For all patients presenting to the emergency department of Far Eastern Memorial Hospital with a chief complaint of acute ischemic chest pain, a registration form was incorporated into the patient’s medical records immediately after a diagnosis of acute STEMI was made. All the time sequences concerning different managements at different locations were recorded by nurses or physicians as instructions on the registration form. Door-to-balloon time was calculated off-line. We provided data feedback to department of emergency medicine and cardiovascular center monthly. Results: From March 2007 to May 2007, 30 patients were enrolled as the postintervention group. 116 patients admitted between April 2006 and Feb. 2007 served as pre-intervention group. The results were summarized in Table 1:
P3-43 CORONARY CAMERAL FISTULA: INCIDENCE, ANGIOGRAPHIC AND CLINICAL PRESENTATION
Jerome O. Laceda, Rodney Jimenez, Noel Naval. St. Luke’s Heart Institute, Quezon City, Philippines Background: Coronary Cameral fistulas (CCF) are rare form of congenital coronary anomalies. The objective of this study is to determine the incidence and review the clinical and angiographic presentation of CCF among patients of St. Luke’s Medical Center. We will also try to determine the relationship of these fistulas with coronary artery disease (CAD). Methods: The authors reviewed coronary angiograms done between January 2001 and December 2005 at our institution. Results: There are 3786 patients who underwent coronary angiograms between 2001 and 2005; twenty-four patients had CCF for an incidence of 0.63%. The most common artery involved in a fistulous connection is the LAD (13 patients), followed by the RCA (4 patients), OM (3 patients), LCX, PDA, and Conal branch (2 patients each) and LMCA, diagonal and septal branch (1 patient each). The pulmonary artery is the most common site of drainage (10 patients), followed by
Table 1.
No. of subjects Median of door-to-balloon time (min) Mean of the natural logarithm of the door-to-balloon time 95% confidence interval of the mean of the natural logarithm of the door-to-balloon time
Pre-intervention
Post-intervention
116 148.5
30 137.5
5.096±0.050
4.940±0.068
4.997∼5.194
4.802∼5.079
p value
0.034 (one-tailed)
Conclusions: Within 3 months, a registration program implemented at our hospital successfully reduced the door-to-balloon time of primary angioplasty for patients suffering from acute STEMI.
P3-45 THE EFFICACY AND SAFETY OF A PERCUTANEOUS FEMORAL ARTERY CLOSURE DEVICE AFTER DIAGNOSTIC AND THERAPEUTIC CARDIAC CATHETERIZATIONS – A SINGLE CENTER’S EXPERIENCE
Cheng-han Lee. National Cheng Kung University Hospital, Taiwan Objective: The purpose of this study was to evaluate the safety and efficacy of a hemostatic puncture closure device (Angio-Seal Vascular Closure Device) in patients undergoing diagnostic and therapeutic cardiac catheterizations.