POSTER ABSTRACTS
Results: The study group comprised 86 consecutive patients between 2002 et 2013 with a mean age of 64 years 11.8 (extreme 37 and 88 years); the sex ratio was 3/1. 54.7 % of the patients had diabetes. The clinical presentation was unstable angina in 67.4%, acute myocardial infarction (MI) in 10.5 % and stable angina in 16.3% of cases. 59.6% of the patients had a syntax score less than 22 and only 2.1% had a score more than 33. Fifty seven percent of the procedures were performed with bare metal stents and 41.9% with drug-eluting stents. Procedural success was achieved in 100% of cases. Angiographic restenosis occurred in six patients (6.9%). Cumulative death occurred in 16 patients (18.6%). MACE at 30 day and 6-month was 8.3% and 22.2% respectively. The use of drug eluting stents was associated with lower rates of target vessel revascularization and major adverse cardiac events than use of bare metal stents. Variables that correlated with increased mortality or MACE were emergent PCI, ejection fraction <35% and renal failure. Conclusion: Stenting of LMCA stenosis may be a safe and effective alternative to CABG in carefully selected patients. Disclosure of Interest: None Declared
PM192
PM195
Hba1c Modified Clinical Syntax Score As A Prognostic Tool In Patients With Diabetes Mellitus And Multi-Vessel Coronary Artery Disease Treated With Primary Pci Natasa M. Milic*1, Marija Mirkovic2, Emilija M. Nestorovic3, MIljko R. Ristic3, Vesna D. Garovic4, Milan A. Nedeljkovic5 1 Department for Medical statistics and informatics, Medical Faculty University of Belgrade, Belgrade, 2Department for Cardiology, ZC Valjevo, Valjevo, 3Department for Cardac Surgery, Clinical Center of Serbia, Belgrade, Serbia, 4Department for nephrology and hypertension, Mayo Clinic, Rochester, United States, 5Department for Cardiology, Clinical Center of Serbia, Belgrade, Serbia Introduction: Clinical SYNTAX score (CSS) obtained by combination of clinical and angiographic parameters is the main score nowadays for MACCE risk assessment in patients treated with percutaneous coronary intervention (PCI), but the relation between glycosylated hemoglobin and prognosis in these patients has not been explained yet. Objectives: The aim of the study was to determine the prognostic value of CSS modification by HbA1c in patients with diabetes mellitus and multivessel coronary artery disease (CAD) treated with primary PCI. Methods: This is a prospective cohort study. All the examinees were treated by primary PCI, had diabetic treatment for longer than one year, and had multivessel CAD. CSS was calculated as the product of SYNTAX score and modified ACEF score. For the purpose of SYNTAX score calculation each lesion of coronary arteries with diameter stenosis 50% was scored in a blood vessel 1,5mm. Modified ACEF score was calculated using the formula: years/EF+1 point for every 10ml/min reduction in ClCr lower than 60ml/min to 1.73 m2. Prior to procedure glycosylated hemoglobin HbA1c was measured. MACCE (major cardiovascular and cerebrovascular adverse event) was defined as occurrence of IM, repeat revascularization, stroke or death during one year follow up period. Results: Survival analysis was determined in 136 patients. Univariate and multivariate Cox regression analysis demonstrated that both CSS and HbA1c were significant predictors of one year MACCE (p<0.001; RR¼5.449; 95%CI¼2.629-11.295 and p<0.001; RR¼2.434; 95%CI¼1.269-4.669, respectively for multivariate). The HbA1c modified CSS obtained by combination of CSS>27.5 and HbA1c>8 was the most significant predictor of one-year MACCE (p<0.001; RR¼ 5.292; 95%CI¼ 2.9979.343). Patients with CCS>27.5 and HbA1C>8 have median survival free of MACCE of 5 months. Conclusion: Calculation of HbA1c modified CSS leads to a better risk assessment for one year MACCE free survival in patients with diabetes and multivessel coronary disease treated by PCI. Disclosure of Interest: None Declared
PM193
Assessment of HbA1c levels in diabetic patients with Acute Coronary Syndromes is associated with improved outcomes Afik D. Snir*1, Karice Hyun2, Victoria Miller3, Mark Ryan4, Eric Yamen5, Rohan Rayasinghe6, Johnathon Waites7, Timothy Harrison8, Bernadette Aliprandi-Costa3, David Brieger3, the Concordance investigators 1 Faculty of Medicine, University of Sydney, 2The George Institute for Global Health, 3Concord Hospital, Sydney, 4Shoalhaven Hospital, Shoalhaven, 5Sir Charles Gairdner Hospital, Perth, 6The Gold Coast Hospital, Southport, 7Coffs Harbour Hospital, Coffs Harbour, 8Flinders Medical Centre, Adelaide, Australia Introduction: Assessment of HbA1c levels in Diabetic Mellitus (DM) patients following an ACS has been associated with optimisation of DM management. However, the association between assessment of HbA1c and ACS outcomes has not been described. Objectives: In this study we evaluate the frequency, predictors and outcomes following HbA1c assessment in DM patients presenting with an ACS in Australia. Methods: Demographic and clinical data were evaluated using the CONCORDANCE registry, obtained from 23 Hospitals across Australia. The analysis included 809 patients with a final diagnosis of ACS and admitted with a history of DM. Multilevel logistic regression was used to determine the independent predictors of HbA1c assessment. Patients outcomes were compared using Chi-squared tests, and adjusted odds ratios (OR) and 95% confidence intervals (CI) following multivariable analysis. Results: 351 (43.4%) of DM patients presenting with ACS had HbA1c levels measured in hospital. There was large variability observed between hospitals (range 9.5% to 88% of presenting patients). After adjusting for the clustering effect of hospital, patient factors independently associated with HbA1c assessment were younger age (OR 0.81, 95% CI 0.71-0.92 per 10yr interval) and undergoing cardiac catheterisation (OR 2.24, 95% CI 1.51-3.33). Assessment of HbA1c was not significantly associated with revascularisation or in-hospital or discharge therapies. After adjusting for GRACE risk score there was no association between HbA1c assessment and in hospital mortality (OR 0.34, 95% CI 0.10-1.12) or other major cardiovascular adverse events. However, HbA1c assessment was significantly associated with adjusted 6 month mortality (OR 0.20, 95% CI 0.04-0.998). Conclusion: In Australia, measurement of glycaemic control in diabetic patients with ACS varies greatly between centres. After adjusting for this, assessment of HbA1c is more likely in younger patients and is associated with higher frequencies of cardiac catheterisation. Assessment of HbA1c is not associated with greater revascularisation, medical therapies or improved in hospital outcomes, but in this analysis is associated with lower mortality in the 6 months following discharge. Disclosure of Interest: None Declared
PM196
Defining peri-procedural myocardial injury following percutaneous coronary intervention using high-sensitive troponin T assay 1
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Recent glycaemic control has no relationship with short term outcomes in diabetic patients with Acute Coronary Syndrome 1
Kevin Liou , Petrina Kellar* , Julia Isbister , Mark Pitney , Nigel Jepson , Robert Giles , Daniel Friedman1, Antony Lau1, Roger Allan1, Sze-Yuan Ooi1 Cardiology, Prince of Wales Hospital, Sydney, Australia
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Introduction: The Third Universal Definition of Myocardial Infarction defines peri-procedural myocardial injury (PMI) by post procedural elevation of biomarkers of myocardial injury that is five times the 99th percentile or more of the respective upper reference limit (URL). While worse clinical outcome has been demonstrated in those meeting the criteria for PMI with CKMB and conventional troponin I and T, such relationship to our knowledge has not been demonstrated in practice with the high-sensitive troponin T assay (hsTnT). Objectives: To determine the level at which an elevated hsTnT level becomes clinically significant after percutaneous coronary interventions (PCI). Methods: hsTnT was introduced at our institution in March 2011. A retrospective review of our angiographic database between May 2011 and April 2012 was performed. Cases were restricted to patients undergoing elective PCI to remove confounding effects of acute
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coronary syndrome on long term outcome. Data were analysed using SPSS. Statistical significance was defined as p<0.05. Results: Overall, 273 patients underwent elective PCI at our institution between May 2011 and April 2012. The mean age was 70.2 (+/- 9.9). 34% of the PCI were multivessel interventions, and procedural success to at least one, if not all lesions were achieved in 95.3% of patients without major complications. All patients were on adequate dual anti-platelet therapy at the time of the procedure. Post procedural hsTnT were available in 258 (92.5%) patients. The median hsTnT level was 36.5 (Range: 836) ng/L. Overall 78 (30.2%) patients had a post procedural hsTnT of more than 70 ng/L (5 times the URL). Follow up data was available for 263 (94.3%) patients. The composite end point of all cause mortality, myocardial infarction and stroke at 12 months occurred in 12 (4.6%) patients overall, and is significantly more common in patients with a post procedural hsTnT elevation to more than 70 ng/L (8% v.s. 2.4%; p ¼ 0.048). Conclusion: A hsTnT level of 70 ng/L appears to be a reasonable cut off for identifying PMI in patients undergoing elective PCI. Disclosure of Interest: None Declared
Afik D. Snir*1, Karice Hyun2, Heather Luker3, Jens Kilian4, Joseph Hung5, Jamie Rankin6, Rohan Rajaratnum7, Derek Chew8, Fiona Turnbull9, David Brieger3, the CONCORDANCE investigators 1 Faculty of Medicine, University of Sydney, 2The George Institute for Global Health, 3Concord Hospital, 4Bankstown Hospital, Sydney, 5Sir Charles Gairdner Hospital, 6Royal Perth Hospital, Perth, 7Campbelltown Hospital, Sydney, 8Flinders Medical Centre, Adelaide, 9The George Institute for International Health, Sydney, Australia Introduction: Elevation of glycosylated haemoglobin (HbA1c) levels in Diabetes Mellitus (DM) patients is an independent risk factor for symptomatic Coronary Artery Disease (CAD) including presentation with an Acute Coronary Syndrome (ACS). Both a history of DM and elevated admission blood glucose levels have been associated with a worse prognosis following ACS. However, the prognostic value of recent glycaemic control in diabetic patients following ACS presentation has not been established.
GHEART Vol 9/1S/2014
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March, 2014
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POSTER/2014 WCC Posters