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PM150 Pre-Catheterisation High-Sensitivity Troponin T Level Predicts Major Adverse Cardiovascular Events After St-Elevation Myocardial Infarction
POSTER ABSTRACTS
12-month outcomes
BMS (n [ 1,764)
First generation DES (n [ 418)
Newer generation DES (n [ 352)
TVR n, %
121 (6.9%)
26 (6.2%)
10 (2.8%)*
MACE n, %
209 (11.9%)
47 (11.2%)
21 (6.0%)*
Mortality n, %
66 (3.7%)
17 (4.1%)
7 (2.0%)
ST n, %
23 (1.3%)
8 (2.0%)
0 (0%)*
*p value < 0.05 compared to BMS or first generation DES.
While first and newer generation DES groups had comparable clinical and procedural characteristics, both differed significantly from the BMS group. When these differences were taken into account on M-V analysis, newer generation DES was an independent predictor of reduced 12 month MACE (OR 0.42 [95% CI 0.26-0.69]) whereas first generation DES was not. Conclusion: Newer generation DES appear to have significant advantage over both BMS and first generation DES in STEMI PCI with improved efficacy and lower adverse outcomes. Disclosure of Interest: None Declared
PM148 Differences in the presentation, management and outcomes among patients presenting to cardiologists and non-cardiologists in Kerala, India. Results from the Kerala Acute Coronary Syndrome Registry
PM149 Association of Sex in the Management of STEMI: Equivalent door to balloon times do not equal identical total ischemia time Sarah J. Gutman*1,2,3, Adam W. Hutchison1,2,3, James Cameron1,2,3, Yuvaraj Malaiapan1,2,3, Paul Antonis1,2,3, Nitesh Nerlekar1,2,3, Dennis Wong1,2,3, Richard W. Harper1,2,3, Ian T. Meredith1,2,3 1 MonashHeart, Monash Health, 2Department of Medicine, Monash Medical Centre, 3Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia Introduction: Historically female sex has been associated with worse prognosis after ST elevation myocardial infarction (STEMI). Equivalent door to balloon times (D2BT) in females and males with STEMI has been extensively reported in the literature. Total ischaemic time is recognised as equally important in determining outcome. Objectives: To determine if sex related differences in total ischaemic time exist in a contemporary cohort of patients presenting with STEMI to a major primary percutaneous coronary intervention (PPCI) centre. Methods: A total of 1314 consecutive patients presented with ST elevation to our hospital network comprising a STEMI receiving centre and two non-PCI capable STEMI referral hospitals, between December 2007 and December 2012. Patients were excluded from the analysis if there was a resolution of pain and ST elevation in the ED (threatened STEMI), if they received treatment with thrombolysis, if they were current inpatients or if data regarding onset of pain was incomplete. We report here median [Interquartile Range] total ischaemic time and D2BT in the remaining patients (84%). Results: Of 1086 patients in the cohort, 20% (218) were female. Females experienced a longer total ischaemic time (209[181] minutes) compared to males (194 [136] minutes), P¼0.03, whilst D2BT was similar (72[62] and 77[55] minutes, females and males respectively, P¼0.72). Mean catheter laboratory door to balloon time was identical in the sexes (31 minutes). There was no statistically significant correlation between age and total ischaemic time.
S. Harikrishnan*1, Panniyammakal Jeemon2, Dorairaj Prabhakaran2, G. Vijayaraghavan3, C. G. Bahuleyan4, K. Suresh5, Tiny Nair6, Sunitha Viswanathan7, Mark Huffman8, P. P. Mohanan9, For the Kerala ACS Registry 1 Sree Chitra Tirunal Institute of Medical SCiences and Technology, Trivandrum, 2Centre for Chronic Disease Control, New Delhi, 3Kerala Institute of Medical Sciences, 4Ananthapuri Hospital, 5SK Hospital, 6PRS Hospital, 7Government Medical College, Trivandrum, India, 8 Northwestern University Feinberg School of Medicine, Chicago, United States, 9West Fort Hi-Tech Hospital, Trissur, India Introduction: Optimal in-hospital and discharge medical therapy improves patient outcomes in acute coronary syndrome (ACS). Objectives: To evaluate differences in patient characteristics, treatment, and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) who seek care from cardiologists and non-cardiologist physicians in Kerala. Methods: The data were restricted to STEMI patients (n¼9,568) in the Kerala Acute Coronary Syndrome Registry of 25,718 consecutive admissions. The optimal in-hospital ACS medical therapy was defined as receiving the following 5 medications: aspirin, clopidogrel, heparin, b-blocker, and statin. Similarly the optimal discharge ACS medical therapy was defined as receiving all of the above therapies except heparin. The patient characteristics, treatment, and outcomes were compared between these two groups. A multiple logistic regression model was used to estimate the risk for total in-hospital mortality in both patient groups and adjusted for age, sex, body mass index (BMI) hypertension, diabetes, smoking and prior history of myocardial infarction (MI). Results:
Variables
Cardiologists (N[6617)
Non-Cardiologists (N[2951)
Age, years (mean, SD)
60.63 (12.17)
59.78 (12.03)
Body Mass Index, Kg/m2 (mean, SD)
22.96 (3.59)
23.34 (3.67)
P value 0.001 <0.001
Symptom to door time, >6 hours (n, %)
3133 (47.66)
782 (26.72)
Hypertension, (n, %)
3173 (47.94)
1081 (36.63)
<0.001 <0.001
Diabetes, (n, %)
2456 (37.11)
858 (29.07)
<0.001
Smoking, (n, %)
2424 (36.63)
952 (32.26)
<0.001
Prior Myocardial Infarction, (n, %)
962 (14.54)
295 (10.00)
<0.001
Conclusion: In this prospectively collected cohort, women with STEMI exhibited longer total ischaemic times despite similar D2BTs. Further research is required to determine the causes for longer pain to door times in women. This may be a contributing factor to worse outcomes in women with STEMI. Disclosure of Interest: None Declared PM150
The unadjusted in-hospital death rate were higher in patients seeking care from cardiologists (8.7%) compared to patients seeking care from non-physician cardiologists (5.2%). However, after accounting for the patient characteristics and risk factor profile the probability of death during hospitalization was significantly lower in patients seeking treatment from cardiologists (adjusted OR¼0.54; 95% CI: 0.35, 0.72). Conclusion: Despite adverse risk profile, STEMI patients who presented to cardiologists were more likely to receive optimal in-hospital and discharge medical care, which likely contributed to lower adjusted mortality rates compared with patients presenting to noncardiologist physicians. Disclosure of Interest: None Declared
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Pre-Catheterisation High-Sensitivity Troponin T Level Predicts Major Adverse Cardiovascular Events After St-Elevation Myocardial Infarction Tom Kai Ming Wang*1, Timothy Snow1, Timothy Watson1,2, James Stewart1, Mark Webster1,2, Peter Ruygrok1,2, Harvey White1,2 1 Green Lane Cardiovascular Service, Auckland City Hospital, 2Department of Medicine, University of Auckland, Auckland, New Zealand Introduction: Cardiac troponins have limited use in the context of ST-elevation myocardial infarction (STEMI) given the urgency for intervention. Recently developed high-sensitivity troponin (hs-TnT) assays have increased sensitivity and enable more rapid diagnosis for MI.
GHEART Vol 9/1S/2014
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March, 2014
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POSTER/2014 WCC Posters
Results: Initially there were no significant differences in the HMGB1 and hsCRP levels (P both>0.05) between groups A and B. After one week, atorvastatin reduced HMGB1 from baseline by 19.4% compared with 8.7% in group B (P <0.05). However, there was still no significant change in hsCRP levels between the two groups (P >0.05). At six weeks, the HMGB1 and hsCRP concentrations were similarly decreased in both atorvastatin-treated and control groups (P both <0.01). MACEs in group A were not different from those in group B (6.1% atorvastatin vs. 6.9% without atorvastatin; P >0.05). Furthermore, there was no rhabdomyolysis or liver dysfunction (aminotransferase increase) observed in either group during the six weeks follow-up period. Conclusion: The use of low-dose atorvastatin (10 mg/day) can provide an attractive approach for early treatment of patients with unstable angina. Moreover, Short-term lowdose atorvastatin therapy does not reduce MACEs or increase adverse effects despite its influence on HMGB1 concentrations. These data suggest that serum HMGB1 level could serve as an earlier and more efficient indicator than hsCRP of low-dose atorvastatin antiinflammatory activity. Disclosure of Interest: None Declared
PM151
1
Comparison of late vascular response after Everolimus-Eluting Stents and Bare Metal Stents implantation in ST-segment Elevation Myocardial Infarction; An Optical Coherence Tomography Study Tomoko Tohda*1, Yasushi Ino1, Takashi Kubo1, Takashi Tanimoto1, Yoshiki Matsuo1, Takashi Yamano1, Tomoyuki Yamaguchi1, Kumiko Hirata1, Atsushi Tanaka1, Toshio Imanishi1, Takashi Akasaka1 1 Cardiovascular medicine, Japan/Wakayama Medical Universiy, Wakayama, Japan Introduction: Implantation of drug-eluting stents (DES) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) reduces in-stent restenosis compared with bare metal stents (BMS), however, the long-term risk of DES use in STEMI has been pointed. Previous pathological and optical coherence tomography (OCT) study reported that first generation DES use in STEMI resulted in higher rates of uncovered and malapposed stent struts at follow-up. The long-term safety of second generation everolimus-eluting stents (EES) use in STEMI remains unknown. Objectives: We used OCT to examine vascular response including strut coverage and malapposition in patients with STEMI treated with EES and BMS. Methods: We enrolled 102 patients with STEMI who underwent primary stenting and 10month follow-up OCT (EES: 61 patients and BMS 41 patients). Results: A total of 21366 stent struts were analyzed. There were no significant differences in the percentage of uncovered and apposed struts and the percentage of uncovered and malapposed struts between 2 stents (1.6 2.3 % versus 1.2 2.0 %, P¼0.379 and 0.6 1.2 % versus 0.4 0.9 %, P¼0.596, respectively). The mean neointimal thickness was smaller in EES lesions (104 39 mm vs. 388 148 mm, P<0.001). Intra-stent thrombus was observed in 13 % of EES lesions and 10 % of BMS lesions (p ¼ 0.758). The frequencies of in-stent binary restenosis and target lesion revascularization were higher in EES compaed with BMS (3 % vs. 17 %, p ¼ 0.028 and 2 % vs. 12 %, p ¼ 0.037, respectively). Conclusion: In STEMI patients undergoing primary PCI, there are no significant differences in the percentage of uncovered struts and malapposed struts, and the incidence of intra-stent thrombus at 10-month follow-up between EES and BMS. On the other hands, EES as compared with BMS significantly reduces neointimal hyperplasia. EES has a potential to achieve low late loss without sacrificing safety. Disclosure of Interest: None Declared
PM155 Discharge diagnoses and use of aspirin in men and women with chest pain referred for elective coronary angiography and without obstructive coronary artery disease Karin G. Schenck-Gustafsson*1, Nina Johnston1, Clara Thörn2 Dept. of Meciine, Centre for Gender Medicine, Cardiac Unit, Karolinska Instiutet, Stockholm, 2 Dept. of Cardiology, 2Dept. of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
Introduction: Chest pain is a common reason for healthcare visits. Coronary artery disease (CAD) is an important differential diagnosis to exclude. Coronary angiography is seen as the gold standard method to confirm CAD. However when obstructive disease is not present speculations flourish as to the etiology of chest pain and proper treatment. Objectives: To investigate the diagnoses and recommendations for use of aspirin at discharge in men and women with chest pain referred for elective coronary angiography and without obstructive CAD. Methods: 65 men and 35 women admitted because of chest pain during 2010-2012 for a first time elective coronary angiography at Uppsala University Hospital, Sweden were included. All patients were free of previous heart disease, stroke and peripheral artery disease. Among these, 21.5% of the men and 54.3% the women were without obstructive CAD (defined as <50% stenosis in any epicardial artery). Journal charts were examined for diagnoses and use of aspirin at discharge. Results: In the whole patient cohort, the median time for investigation from referral for a first non-invasive test to coronary angiography was 5 months. The most frequent discharge diagnosis in patients without obstructive CAD was unspecified chest pain (ICD:R07.4) in 57.1% of men and 36.8% of women followed by angina (ICD:I20.8, I20.9) in 21.4% of men and 31.6% of women. At discharge 63% men and 29% of women with unspecified chest pain compared to 100% of men and 83% of women with an angina diagnosis were recommended continued use of aspirin. Conclusion: We found that in chest pain patients referred for diagnostic coronary angiography and without obstructive CAD, investigation times were lengthy, in many patients resulted in an unclear diagnosis and recommendations for continued use of aspirin despite lack of indication. In patients receiving an angina diagnosis less women than men were discharged with aspirin. More research needs to be focused on the etiology of chest pain and reasons for underuse of recommended therapy in women with non-obstructive CAD. Disclosure of Interest: None Declared
PM156 Does Low on Treatment Platelet Reactivity Identify Acs Patients At Increased Risk of Bleeding? Lisa Johnston*1,2, Ana Holley1,2, Michael Chen-Xu2, Ali Al-Sinan2, Peter Larsen2, Scott Harding2
PM154 Effect of Low-Dose Atorvastatin on Hmgb1 In Patients With Unstable Angina Jian Yang*1, Jun Yang1, Jia W. Ding1, Song Li1, Xin X. Li1 1 Department of Cardiology, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang, China Introduction: High mobility group box 1 (HMGB1) protein has emerged as a very important pro-inflammatory cytokine in coronary heart disease. Our previous study demonstrated that serum HMGB1 level was correlated with the severity of coronary artery stenosis. Anti-inflammatory effects of statins have attracted considerable interest in reducing coronary events. Objectives: In the present study, we will evaluate the effect of low-dose atorvastatin treatment on HMGB1 and clinical outcomes in patients with unstable angina. Methods: Sixty-nine patients with unstable angina were randomly divided into two groups. Group A (n¼35) received atorvastatin 10 mg/day for six weeks in addition to standard antianginal treatment. Group B (n¼34) received standard anti-anginal treatment without atorvastatin. Serum HMGB1 level was determined with a commercially available ELISA kit. Serum high-sensitivity CRP (hsCRP) concentration was measured by chemiluminescence immunoassay. Blood samples were taken from the patients at 0, 1 and 6 weeks of this study. Meanwhile, the incidence of major adverse cardiovascular events (MACEs): myocardial infarction (MI), recurrent angina, cardiac death and treatment emergent adverse effects were recorded.
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POSTER/2014 WCC Posters
1 School of Biological Sciences, Victoria University of Wellington, 2Wellington Cardiovascular Research Group, Wellington, New Zealand
Introduction: The use of antiplatelet and antithrombotic therapy in acute coronary syndromes (ACS) has shown to be effective at decreasing ischaemic risk. However, this benefit is negated in some patients by an increase in bleeding risk and bleeding is associated with worse short and long-term outcomes. Low on treatment platelet reactivity (LPR) has been associated with an increase in bleeding in patients undergoing PCI. The CRUSADE bleeding score has also been shown to predict bleeding risk in ACS patients. Whether LPR adds additional value to a risk score such as CRUSADE is unknown. Objectives: To investigate the predictive nature of LPR and the CRUSADE bleeding score, in a New Zealand ACS population. Methods: Patients with ACS on dual antiplatelet therapy (aspirin and clopidogrel) treated with an invasive strategy were enrolled into this prospective observation study. Platelet reactivity was measured on treatment using the Multiplate analyser. CRUSADE risk score was calculated in all patients at admission and BARC type 2, 3 and 5 bleeding (BARC 4 CABG-related bleeding excluded) was examined at 30 days. Patients pretreated with GPIIb/ IIIa inhibitors or undergoing primary PCI were excluded from the study. Results: We enrolled 553 patients, mean age 62, 24% STEMI, 66.3% NSTEMI, 60% had PCI and in 80% a radial access site was used. We observed bleeding in 36 patients (6.5%). The majority of bleeding events were a BARC 2 bleed (91%) with the remainder being type
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POSTER ABSTRACTS
Objectives: We assessed whether admission hs-TnT levels predict major adverse cardiovascular events (MACE) after STEMI. Methods: Patients admitted for acute coronary catheterisation for presumed STEMI diagnosis between October 2010-September 2011 at Auckland City Hospital were included if hs-TnT levels were measured before cardiac catheterisation. Characteristics and major adverse cardiovascular events (MACE: death, myocardial infarction and revascularisation) at 30 days and 1 year were collected from clinical records. Results: Median pre-catheterisation hs-TnT level in the 173 STEMI patients studied was 59ng/L (lower quartile 19, upper quartile 310). Incidences of MACE at 30 days and 1 year were 10% (17) and 18% (31) respectively. C-statistics and 95% confidence interval (95% CI) for hs-TnT on admission at detecting MACE at 30 days and 1 year were 0.800 (0.6960.904) and 0.750 (0.655-0.845) respectively, with the optimal cut-point of 225ng/L giving sensitivities/specificities of 76.5%/75.6% and 64.5%/78.2% respectively. Pre-catheterisation log(hs-TnT) independently predicted both MACE at 30 days with odds ratio 7.61, 95%CI (2.33-24.8) and 1 year with hazards ratio 2.88, 95%CI (1.79-4.63), as did age and cardiogenic shock. Age, Maori or Pacific ethnicity and chronic respiratory disease were independent predictors of hs-TnT>225ng/L on admission. Conclusion: Pre-catheterisation hs-TnT level in STEMI patients independently predicted MACE at 30 days and 1-year. This has implications for future STEMI risk stratification and model development. Disclosure of Interest: None Declared
12-month outcomes
BMS (n [ 1,764)
First generation DES (n [ 418)
Newer generation DES (n [ 352)
TVR n, %
121 (6.9%)
26 (6.2%)
10 (2.8%)*
MACE n, %
209 (11.9%)
47 (11.2%)
21 (6.0%)*
Mortality n, %
66 (3.7%)
17 (4.1%)
7 (2.0%)
ST n, %
23 (1.3%)
8 (2.0%)
0 (0%)*
*p value < 0.05 compared to BMS or first generation DES.
While first and newer generation DES groups had comparable clinical and procedural characteristics, both differed significantly from the BMS group. When these differences were taken into account on M-V analysis, newer generation DES was an independent predictor of reduced 12 month MACE (OR 0.42 [95% CI 0.26-0.69]) whereas first generation DES was not. Conclusion: Newer generation DES appear to have significant advantage over both BMS and first generation DES in STEMI PCI with improved efficacy and lower adverse outcomes. Disclosure of Interest: None Declared
PM148 Differences in the presentation, management and outcomes among patients presenting to cardiologists and non-cardiologists in Kerala, India. Results from the Kerala Acute Coronary Syndrome Registry
PM149 Association of Sex in the Management of STEMI: Equivalent door to balloon times do not equal identical total ischemia time Sarah J. Gutman*1,2,3, Adam W. Hutchison1,2,3, James Cameron1,2,3, Yuvaraj Malaiapan1,2,3, Paul Antonis1,2,3, Nitesh Nerlekar1,2,3, Dennis Wong1,2,3, Richard W. Harper1,2,3, Ian T. Meredith1,2,3 1 MonashHeart, Monash Health, 2Department of Medicine, Monash Medical Centre, 3Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia Introduction: Historically female sex has been associated with worse prognosis after ST elevation myocardial infarction (STEMI). Equivalent door to balloon times (D2BT) in females and males with STEMI has been extensively reported in the literature. Total ischaemic time is recognised as equally important in determining outcome. Objectives: To determine if sex related differences in total ischaemic time exist in a contemporary cohort of patients presenting with STEMI to a major primary percutaneous coronary intervention (PPCI) centre. Methods: A total of 1314 consecutive patients presented with ST elevation to our hospital network comprising a STEMI receiving centre and two non-PCI capable STEMI referral hospitals, between December 2007 and December 2012. Patients were excluded from the analysis if there was a resolution of pain and ST elevation in the ED (threatened STEMI), if they received treatment with thrombolysis, if they were current inpatients or if data regarding onset of pain was incomplete. We report here median [Interquartile Range] total ischaemic time and D2BT in the remaining patients (84%). Results: Of 1086 patients in the cohort, 20% (218) were female. Females experienced a longer total ischaemic time (209[181] minutes) compared to males (194 [136] minutes), P¼0.03, whilst D2BT was similar (72[62] and 77[55] minutes, females and males respectively, P¼0.72). Mean catheter laboratory door to balloon time was identical in the sexes (31 minutes). There was no statistically significant correlation between age and total ischaemic time.
S. Harikrishnan*1, Panniyammakal Jeemon2, Dorairaj Prabhakaran2, G. Vijayaraghavan3, C. G. Bahuleyan4, K. Suresh5, Tiny Nair6, Sunitha Viswanathan7, Mark Huffman8, P. P. Mohanan9, For the Kerala ACS Registry 1 Sree Chitra Tirunal Institute of Medical SCiences and Technology, Trivandrum, 2Centre for Chronic Disease Control, New Delhi, 3Kerala Institute of Medical Sciences, 4Ananthapuri Hospital, 5SK Hospital, 6PRS Hospital, 7Government Medical College, Trivandrum, India, 8 Northwestern University Feinberg School of Medicine, Chicago, United States, 9West Fort Hi-Tech Hospital, Trissur, India Introduction: Optimal in-hospital and discharge medical therapy improves patient outcomes in acute coronary syndrome (ACS). Objectives: To evaluate differences in patient characteristics, treatment, and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) who seek care from cardiologists and non-cardiologist physicians in Kerala. Methods: The data were restricted to STEMI patients (n¼9,568) in the Kerala Acute Coronary Syndrome Registry of 25,718 consecutive admissions. The optimal in-hospital ACS medical therapy was defined as receiving the following 5 medications: aspirin, clopidogrel, heparin, b-blocker, and statin. Similarly the optimal discharge ACS medical therapy was defined as receiving all of the above therapies except heparin. The patient characteristics, treatment, and outcomes were compared between these two groups. A multiple logistic regression model was used to estimate the risk for total in-hospital mortality in both patient groups and adjusted for age, sex, body mass index (BMI) hypertension, diabetes, smoking and prior history of myocardial infarction (MI). Results:
Variables
Cardiologists (N[6617)
Non-Cardiologists (N[2951)
Age, years (mean, SD)
60.63 (12.17)
59.78 (12.03)
Body Mass Index, Kg/m2 (mean, SD)
22.96 (3.59)
23.34 (3.67)
P value 0.001 <0.001
Symptom to door time, >6 hours (n, %)
3133 (47.66)
782 (26.72)
Hypertension, (n, %)
3173 (47.94)
1081 (36.63)
<0.001 <0.001
Diabetes, (n, %)
2456 (37.11)
858 (29.07)
<0.001
Smoking, (n, %)
2424 (36.63)
952 (32.26)
<0.001
Prior Myocardial Infarction, (n, %)
962 (14.54)
295 (10.00)
<0.001
Conclusion: In this prospectively collected cohort, women with STEMI exhibited longer total ischaemic times despite similar D2BTs. Further research is required to determine the causes for longer pain to door times in women. This may be a contributing factor to worse outcomes in women with STEMI. Disclosure of Interest: None Declared PM150
The unadjusted in-hospital death rate were higher in patients seeking care from cardiologists (8.7%) compared to patients seeking care from non-physician cardiologists (5.2%). However, after accounting for the patient characteristics and risk factor profile the probability of death during hospitalization was significantly lower in patients seeking treatment from cardiologists (adjusted OR¼0.54; 95% CI: 0.35, 0.72). Conclusion: Despite adverse risk profile, STEMI patients who presented to cardiologists were more likely to receive optimal in-hospital and discharge medical care, which likely contributed to lower adjusted mortality rates compared with patients presenting to noncardiologist physicians. Disclosure of Interest: None Declared
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Pre-Catheterisation High-Sensitivity Troponin T Level Predicts Major Adverse Cardiovascular Events After St-Elevation Myocardial Infarction Tom Kai Ming Wang*1, Timothy Snow1, Timothy Watson1,2, James Stewart1, Mark Webster1,2, Peter Ruygrok1,2, Harvey White1,2 1 Green Lane Cardiovascular Service, Auckland City Hospital, 2Department of Medicine, University of Auckland, Auckland, New Zealand Introduction: Cardiac troponins have limited use in the context of ST-elevation myocardial infarction (STEMI) given the urgency for intervention. Recently developed high-sensitivity troponin (hs-TnT) assays have increased sensitivity and enable more rapid diagnosis for MI.
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
Results: Initially there were no significant differences in the HMGB1 and hsCRP levels (P both>0.05) between groups A and B. After one week, atorvastatin reduced HMGB1 from baseline by 19.4% compared with 8.7% in group B (P <0.05). However, there was still no significant change in hsCRP levels between the two groups (P >0.05). At six weeks, the HMGB1 and hsCRP concentrations were similarly decreased in both atorvastatin-treated and control groups (P both <0.01). MACEs in group A were not different from those in group B (6.1% atorvastatin vs. 6.9% without atorvastatin; P >0.05). Furthermore, there was no rhabdomyolysis or liver dysfunction (aminotransferase increase) observed in either group during the six weeks follow-up period. Conclusion: The use of low-dose atorvastatin (10 mg/day) can provide an attractive approach for early treatment of patients with unstable angina. Moreover, Short-term lowdose atorvastatin therapy does not reduce MACEs or increase adverse effects despite its influence on HMGB1 concentrations. These data suggest that serum HMGB1 level could serve as an earlier and more efficient indicator than hsCRP of low-dose atorvastatin antiinflammatory activity. Disclosure of Interest: None Declared
PM151
1
Comparison of late vascular response after Everolimus-Eluting Stents and Bare Metal Stents implantation in ST-segment Elevation Myocardial Infarction; An Optical Coherence Tomography Study Tomoko Tohda*1, Yasushi Ino1, Takashi Kubo1, Takashi Tanimoto1, Yoshiki Matsuo1, Takashi Yamano1, Tomoyuki Yamaguchi1, Kumiko Hirata1, Atsushi Tanaka1, Toshio Imanishi1, Takashi Akasaka1 1 Cardiovascular medicine, Japan/Wakayama Medical Universiy, Wakayama, Japan Introduction: Implantation of drug-eluting stents (DES) in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) reduces in-stent restenosis compared with bare metal stents (BMS), however, the long-term risk of DES use in STEMI has been pointed. Previous pathological and optical coherence tomography (OCT) study reported that first generation DES use in STEMI resulted in higher rates of uncovered and malapposed stent struts at follow-up. The long-term safety of second generation everolimus-eluting stents (EES) use in STEMI remains unknown. Objectives: We used OCT to examine vascular response including strut coverage and malapposition in patients with STEMI treated with EES and BMS. Methods: We enrolled 102 patients with STEMI who underwent primary stenting and 10month follow-up OCT (EES: 61 patients and BMS 41 patients). Results: A total of 21366 stent struts were analyzed. There were no significant differences in the percentage of uncovered and apposed struts and the percentage of uncovered and malapposed struts between 2 stents (1.6 2.3 % versus 1.2 2.0 %, P¼0.379 and 0.6 1.2 % versus 0.4 0.9 %, P¼0.596, respectively). The mean neointimal thickness was smaller in EES lesions (104 39 mm vs. 388 148 mm, P<0.001). Intra-stent thrombus was observed in 13 % of EES lesions and 10 % of BMS lesions (p ¼ 0.758). The frequencies of in-stent binary restenosis and target lesion revascularization were higher in EES compaed with BMS (3 % vs. 17 %, p ¼ 0.028 and 2 % vs. 12 %, p ¼ 0.037, respectively). Conclusion: In STEMI patients undergoing primary PCI, there are no significant differences in the percentage of uncovered struts and malapposed struts, and the incidence of intra-stent thrombus at 10-month follow-up between EES and BMS. On the other hands, EES as compared with BMS significantly reduces neointimal hyperplasia. EES has a potential to achieve low late loss without sacrificing safety. Disclosure of Interest: None Declared
PM155 Discharge diagnoses and use of aspirin in men and women with chest pain referred for elective coronary angiography and without obstructive coronary artery disease Karin G. Schenck-Gustafsson*1, Nina Johnston1, Clara Thörn2 Dept. of Meciine, Centre for Gender Medicine, Cardiac Unit, Karolinska Instiutet, Stockholm, 2 Dept. of Cardiology, 2Dept. of Medical Sciences and Cardiology, Uppsala University, Uppsala, Sweden
Introduction: Chest pain is a common reason for healthcare visits. Coronary artery disease (CAD) is an important differential diagnosis to exclude. Coronary angiography is seen as the gold standard method to confirm CAD. However when obstructive disease is not present speculations flourish as to the etiology of chest pain and proper treatment. Objectives: To investigate the diagnoses and recommendations for use of aspirin at discharge in men and women with chest pain referred for elective coronary angiography and without obstructive CAD. Methods: 65 men and 35 women admitted because of chest pain during 2010-2012 for a first time elective coronary angiography at Uppsala University Hospital, Sweden were included. All patients were free of previous heart disease, stroke and peripheral artery disease. Among these, 21.5% of the men and 54.3% the women were without obstructive CAD (defined as <50% stenosis in any epicardial artery). Journal charts were examined for diagnoses and use of aspirin at discharge. Results: In the whole patient cohort, the median time for investigation from referral for a first non-invasive test to coronary angiography was 5 months. The most frequent discharge diagnosis in patients without obstructive CAD was unspecified chest pain (ICD:R07.4) in 57.1% of men and 36.8% of women followed by angina (ICD:I20.8, I20.9) in 21.4% of men and 31.6% of women. At discharge 63% men and 29% of women with unspecified chest pain compared to 100% of men and 83% of women with an angina diagnosis were recommended continued use of aspirin. Conclusion: We found that in chest pain patients referred for diagnostic coronary angiography and without obstructive CAD, investigation times were lengthy, in many patients resulted in an unclear diagnosis and recommendations for continued use of aspirin despite lack of indication. In patients receiving an angina diagnosis less women than men were discharged with aspirin. More research needs to be focused on the etiology of chest pain and reasons for underuse of recommended therapy in women with non-obstructive CAD. Disclosure of Interest: None Declared
PM156 Does Low on Treatment Platelet Reactivity Identify Acs Patients At Increased Risk of Bleeding? Lisa Johnston*1,2, Ana Holley1,2, Michael Chen-Xu2, Ali Al-Sinan2, Peter Larsen2, Scott Harding2
PM154 Effect of Low-Dose Atorvastatin on Hmgb1 In Patients With Unstable Angina Jian Yang*1, Jun Yang1, Jia W. Ding1, Song Li1, Xin X. Li1 1 Department of Cardiology, The First College of Clinical Medical Sciences, China Three Gorges University, Yichang, China Introduction: High mobility group box 1 (HMGB1) protein has emerged as a very important pro-inflammatory cytokine in coronary heart disease. Our previous study demonstrated that serum HMGB1 level was correlated with the severity of coronary artery stenosis. Anti-inflammatory effects of statins have attracted considerable interest in reducing coronary events. Objectives: In the present study, we will evaluate the effect of low-dose atorvastatin treatment on HMGB1 and clinical outcomes in patients with unstable angina. Methods: Sixty-nine patients with unstable angina were randomly divided into two groups. Group A (n¼35) received atorvastatin 10 mg/day for six weeks in addition to standard antianginal treatment. Group B (n¼34) received standard anti-anginal treatment without atorvastatin. Serum HMGB1 level was determined with a commercially available ELISA kit. Serum high-sensitivity CRP (hsCRP) concentration was measured by chemiluminescence immunoassay. Blood samples were taken from the patients at 0, 1 and 6 weeks of this study. Meanwhile, the incidence of major adverse cardiovascular events (MACEs): myocardial infarction (MI), recurrent angina, cardiac death and treatment emergent adverse effects were recorded.
GHEART Vol 9/1S/2014
j
March, 2014
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POSTER/2014 WCC Posters
1 School of Biological Sciences, Victoria University of Wellington, 2Wellington Cardiovascular Research Group, Wellington, New Zealand
Introduction: The use of antiplatelet and antithrombotic therapy in acute coronary syndromes (ACS) has shown to be effective at decreasing ischaemic risk. However, this benefit is negated in some patients by an increase in bleeding risk and bleeding is associated with worse short and long-term outcomes. Low on treatment platelet reactivity (LPR) has been associated with an increase in bleeding in patients undergoing PCI. The CRUSADE bleeding score has also been shown to predict bleeding risk in ACS patients. Whether LPR adds additional value to a risk score such as CRUSADE is unknown. Objectives: To investigate the predictive nature of LPR and the CRUSADE bleeding score, in a New Zealand ACS population. Methods: Patients with ACS on dual antiplatelet therapy (aspirin and clopidogrel) treated with an invasive strategy were enrolled into this prospective observation study. Platelet reactivity was measured on treatment using the Multiplate analyser. CRUSADE risk score was calculated in all patients at admission and BARC type 2, 3 and 5 bleeding (BARC 4 CABG-related bleeding excluded) was examined at 30 days. Patients pretreated with GPIIb/ IIIa inhibitors or undergoing primary PCI were excluded from the study. Results: We enrolled 553 patients, mean age 62, 24% STEMI, 66.3% NSTEMI, 60% had PCI and in 80% a radial access site was used. We observed bleeding in 36 patients (6.5%). The majority of bleeding events were a BARC 2 bleed (91%) with the remainder being type
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POSTER ABSTRACTS
Objectives: We assessed whether admission hs-TnT levels predict major adverse cardiovascular events (MACE) after STEMI. Methods: Patients admitted for acute coronary catheterisation for presumed STEMI diagnosis between October 2010-September 2011 at Auckland City Hospital were included if hs-TnT levels were measured before cardiac catheterisation. Characteristics and major adverse cardiovascular events (MACE: death, myocardial infarction and revascularisation) at 30 days and 1 year were collected from clinical records. Results: Median pre-catheterisation hs-TnT level in the 173 STEMI patients studied was 59ng/L (lower quartile 19, upper quartile 310). Incidences of MACE at 30 days and 1 year were 10% (17) and 18% (31) respectively. C-statistics and 95% confidence interval (95% CI) for hs-TnT on admission at detecting MACE at 30 days and 1 year were 0.800 (0.6960.904) and 0.750 (0.655-0.845) respectively, with the optimal cut-point of 225ng/L giving sensitivities/specificities of 76.5%/75.6% and 64.5%/78.2% respectively. Pre-catheterisation log(hs-TnT) independently predicted both MACE at 30 days with odds ratio 7.61, 95%CI (2.33-24.8) and 1 year with hazards ratio 2.88, 95%CI (1.79-4.63), as did age and cardiogenic shock. Age, Maori or Pacific ethnicity and chronic respiratory disease were independent predictors of hs-TnT>225ng/L on admission. Conclusion: Pre-catheterisation hs-TnT level in STEMI patients independently predicted MACE at 30 days and 1-year. This has implications for future STEMI risk stratification and model development. Disclosure of Interest: None Declared