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PM204 Association Of Cardiac Ischemic Score And Coronary Collateral Circulation
POSTER ABSTRACTS
PM200
PM203
Australian Experience with AbsorbTM Bioresorbable Scaffold Technology in "RealWorld" Coronary Disease
The Protective Effect Of Ischemic Postconditioning On Reperfusion Injury In Patients With St-Segment Elevation Acute Myocardial Infarction
Michael C. Nguyen*1, Nigel Jepson2, Paul Chia1, Mark Pitney2,3, Alan Whelan1, Liam Back2, Randall Hendriks4, Sze-yuan Ooi5, Rajesh Kanna1, Arman Ahmadi6 1 Cardiology, Fremantle Hospital, Perth, 2Prince of Wales Hospital, 3Cardiology, Sutherland Hospital, Sydney, 4Fremantle Hospital, Perth, 5Cardiology, Prince of Wales Hospital, Sydney, 6 Medicine, Notre Dame University, Perth, Australia Introduction: Coronary metallic stents have been the cornerstone of treatment for coronary arterial disease. Bioabsorbable coronary scaffolds represent a novel treatment option that allows the initial restoration of coronary flow and support of the vessel, however with subsequent resorption of the scaffold, the risks of stent thrombosis and need for long- term antiplatelet therapy can be potentially reduced. “Real world” data on the use of this technology in a more complex subset of patients and lesions is lacking. Objectives: We aimed to study the safety and efficacy of the AbsorbÔ bioabsorbable scaffold (ABRS) out to 30 days for the treatment of patients presenting with acute coronary syndrome (ACS) and stable angina, in a wide range of lesion subsets including primary PCI, chronic total occlusions (CTOs), bifurcations, long lesions and multi-vessel disease. Methods: Data was prospectively collected from 3 major tertiary hospitals in Australia (Fremantle Hospital, Western Australia, and Prince of Wales Public Hospital and Sutherland Hospital, New South Wales) between December 2010 and August 2013. Baseline demographics, presentation, as well as procedural data were collected. Both in-hospital and 30 day safety and efficacy outcomes were analysed. Results: In total, 155 patients were treated with 245 scaffolds (mean age 60yrs, 60% male) with 52% presenting with ACS (6% STEMI) and 10% undergoing multi-vessel intervention. There was a mean of 1.6 scaffolds/patient (range 1 to 5) with LAD, LCX, RCA and SVG treated in 39%, 22%, 35%, and 2.3% respectively. There was 100% procedural success and 99% device success (2 device delivery failures with subsequent successful treatment with drug-eluting stents). There were 2 in-hospital myocardial infarcts (Non Q wave, 1.3%) with no mortality. At 30 days, there were a total of 3 myocardial infarcts (1.9%) including 1 scaffold thrombosis (0.6%) requiring target vessel revascularization (0.6%). There was no mortality. Conclusion: This early local experience has demonstrated ABRS therapy to be highly safe and efficacious in a cohort of real-world patients with complex presentations and disease (including ACS, long lesions, multi-vessel disease and CTOs). Disclosure of Interest: None Declared
PM202 Establishing Chronic Total Occlusion Programme in a Tertiary Australian Centre Description of Early Experience Vimalraj Bogana Shanmugam*1, Dennis Wong2, Peter Psaltis2, Sujith Seneviratne3, Ian Meredith2, Yuvaraj Malaiapan2 1 Monash Heart, Interventional Cardiology, Monash Health, Monash Medical Centre, 2Monash Heart, Interventional Cardiology, 3Monash Health, Monash Medical Centre, Melbourne, Australia Introduction: Chronic total occlusions (CTO) represent a unique set of lesions for percutaneous coronary intervention (PCI) because of the complexity of techniques required to treat them, prompting recommendations for institutions to adopt dedicated CTO revascularisation programs. Objectives: The aim of our study was to investigate the baseline, Procedural characteristics and in-hospital outcomes during the initiation phase of establishment of a dedicated CTO programme. Methods: We retrospectively reviewed the CTO-PCI experience between January 2010 and December 2012 in a multi-operator single centre, which is one of the largest volume PCI centres in Australia. Data were collected for patient, lesional and procedural characteristics, including procedural success and in-hospital outcomes. Results: 82 CTO-PCI procedures were performed. Mean age of the overall cohort was 62.611.3 years with 85% males. Multivessel disease was present in 78%. The most common site of CTO was RCA (44%), followed by LCX (30%) and LAD (26%). By lesional QCA analysis, the frequencies of complex CTO angiographic features were: 13% for moderate-to-severe calcification, 26% for blunt or ambiguous proximal cap, 16% for angulation of the distal vessel greater than 45 and 34% for the presence bridging collaterals. Mean lesional length was 10.1+7.7 mm. Retrograde Rentrop grade III collaterals were observed in 30%. Adopting the Japanese CTO scoring system, 34% of lesions were classified as easy, 37% intermediate, 23% difficult and 6% very difficult. Procedures were undertaken by ten different operators with varying levels of experience, with all cases performed by antegrade guide-wire approach. Selected procedural characteristics included: re-attempt procedure,10%; mutiple access sites, 21%; more than one guide wire, 77%; additional support modality, 60%; DES, 97%; stent number, 1.60.9; total stent length, 40.124.5mm; fluroscopy time, 31.717.5 min; contrast volume, 257.2110.9 mL. Overall CTO success rate was 60%. In-hospital adverse outcomes, included: 3% mortality, 28% peri-procedural myocardial infarction, 17% emergency bypass surgery, 3% tamponade and 7% contrast-induced nephropathy. Conclusion: Modest success rates were achieved in a relatively conservative CTO cohort, in this single centre experience, prior to the initiation of a dedicated CTO revascularisation program. These results emphasise the need for Australian centres to adopt a systematic and specialised approach to CTO-PCI. Disclosure of Interest: None Declared
e104
Yue-Xi Wang*1, Rong A1 Cardiology, 1th Hospital affiliated to Inner Mongolia Medical University, Huhhot, China
1
Introduction: To observe the protective effect of ischemia postconditioning. Objectives: To observe the protective effect of ischemia postconditioning during the first minutes of reperfusion for the myocardial reperfusion injury in ST segment elevation acute myocardial infarction(STEMl) patients undergoing emergency percutaneous coronary intervention(PCI). Methods: STEMI patients undergoing emergency PCI in affiliated hospital of Inner Mongolia Medical University between Jan.2005 and Jan.2012, Were randomly divided into the control group(n¼40) without any intervention after PCI and the postconditioning(Pocs C) group(n¼50) with ischemia postconditioning within first 5 minutes of fellow by 3 episodes of 30 seconds inflation and 30 seconds deflation with the angioplasty balloon. Reperfusion arrhythmias, cTnT and CK-MB. corrected TIMI frame count(CTFC), wall motion score index(WMSI) and left ventricular ejection fraction(LVEF) by echocardiography were compared between the two groups. MI areas were evaluated with the ECT and myocardial blush grade(MBG) was measured. Results: The incidence of reperfusion arrhythmias-frequent ventricular premature 30%(12/40) in Pocs C group vs 46%(23/50) in control group, P<0.05, and short array ventricular tachycardia beat22.5%(9/40) vs 38%(19/50) in the two groups, P<0.05, as well as values of peaks cTnt[(0.840.21)ng/;L vs(1.270.48)u/L, P<0.01], CK-MB[(94.551.4)u/L vs (171.879.3)u/L, P<0.01]. CTFC(34.18.7vs29.27.5, P<0.05). WMSI(1.740.9 vs 2.10.6, P<0.05), and infarction area determined by ECT (17.2%3.6% vs 25.5%2.9%, P<0.05) were all significantly higher in the control group than in PostC group, while LVEF(49.3%4.7% vs 43.4%5.2%, P<0.05) and MBG(2.541.3 vs 1.411.1, P<0.05) were significantly higher in the PostC group than in control group. Conclusion: Ischemic postconditioning can significantly reduce myocardial reperfusion injury in patients with STEMI. Disclosure of Interest: Y.-X. Wang Consultancy for: No, R. A: None Declared PM204 Association Of Cardiac Ischemic Score And Coronary Collateral Circulation Jahanara Arzu*1, Abu Siddique1, Sajal K. Banerjee1, Akm F. Rahman1, Syed A. Ahsan1, MdMukhlesur Rahman1, Md A. Salim1, Manzoor Mahmood1 1 Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh Introduction: Coronary collateral circulation maintains myocardial perfusion in coronary atherosclerotic disease. The indicators of cardiac ischemia: -Angina pectoris (AP) on exertion, during emotion, previous myocardial infarction (MI) and prior coronary intervention are associated with presence of coronary collateral circulation. Objectives: 1) To assess the correlation between cardiac ischemic score and coronary collaterals. 2) To provide an attractive treatment option, in patients with ischemic heart disease, who are unsuitable for conventional revascularization therapies. Methods: In this observational cross sectional study in Bangabandhu Sheikh Mujib Medical University, 128 patients with history of angina pectoris (AP) on exertion, emotion and or MI and or previous coronary intervention were enrolled. The cardiac ischemic score (range 1-4) was calculated by adding 1 point for each of the above four clinical factors, which can be easily assessed. Presence of coronary collaterals in coronary angiogram was defined as Rentrop grade 1. Patients were divided into two groups. Group A patients having Rentrop grade 0 and Group B patients are with collateral circulation, having Rentrop grade 1-3. Patients having cardiac ischemic score (range 1-4) are compared in these groups. Results: Maximum (83.3%) patients of Group B with coronary collateral circulation had cardiac ischemic score 2-4, but majority (86.4%) of Group A patients without collaterals showed the score only 1 (p < 0.001). All the components of cardiac ischemic score like AP on exertion, during emotions, previous MI and h/o PTCA or CABG were significantly higher in Group-B than those in Group-A (p ¼ 0.005, p < 0.001, p ¼ 0.007 and p ¼ 0.048 respectively). The mean duration of AP until index CAG or PTCA was also staggeringly higher in Group-B than that in Group-A (40.8 25.8 vs. 13.1 17.4, p < 0.001). The mean duration since MI until index CAG or PTCA was also much higher in the former group than that in the later group (39.6 32.9 vs. 11.6 23.0, p ¼ 0.003). The incidence of multi vessel coronary disease was significantly higher in Group-B (66.7%) than that in Group-A (40.9%) (p ¼ 0.005). Conclusion: The cardiac ischemic score is strongly associated with the presence of coronary collaterals. Disclosure of Interest: None Declared PM205 Is there a long-term prognostic significance of the new-onset atrial arrhythmias in patients with acute myocardial infarction treated with thrombolytic therapy? 15-year follow-up Branislav S. S. Stefanovic*1, Predrag Mitrovic1, Gordana Matic2, Aleksandra Milosevic2, Mina Radovanovic1, Nebojsa Radovanovic1, Gordana Krljanac1, Ana Karadzic2, Ana Novakovic2, Aleksandra Janicijevic2 1 Cardiology Clinic, Belgrade University Medical Faculty, 2Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
PM200
PM203
Australian Experience with AbsorbTM Bioresorbable Scaffold Technology in "RealWorld" Coronary Disease
The Protective Effect Of Ischemic Postconditioning On Reperfusion Injury In Patients With St-Segment Elevation Acute Myocardial Infarction
Michael C. Nguyen*1, Nigel Jepson2, Paul Chia1, Mark Pitney2,3, Alan Whelan1, Liam Back2, Randall Hendriks4, Sze-yuan Ooi5, Rajesh Kanna1, Arman Ahmadi6 1 Cardiology, Fremantle Hospital, Perth, 2Prince of Wales Hospital, 3Cardiology, Sutherland Hospital, Sydney, 4Fremantle Hospital, Perth, 5Cardiology, Prince of Wales Hospital, Sydney, 6 Medicine, Notre Dame University, Perth, Australia Introduction: Coronary metallic stents have been the cornerstone of treatment for coronary arterial disease. Bioabsorbable coronary scaffolds represent a novel treatment option that allows the initial restoration of coronary flow and support of the vessel, however with subsequent resorption of the scaffold, the risks of stent thrombosis and need for long- term antiplatelet therapy can be potentially reduced. “Real world” data on the use of this technology in a more complex subset of patients and lesions is lacking. Objectives: We aimed to study the safety and efficacy of the AbsorbÔ bioabsorbable scaffold (ABRS) out to 30 days for the treatment of patients presenting with acute coronary syndrome (ACS) and stable angina, in a wide range of lesion subsets including primary PCI, chronic total occlusions (CTOs), bifurcations, long lesions and multi-vessel disease. Methods: Data was prospectively collected from 3 major tertiary hospitals in Australia (Fremantle Hospital, Western Australia, and Prince of Wales Public Hospital and Sutherland Hospital, New South Wales) between December 2010 and August 2013. Baseline demographics, presentation, as well as procedural data were collected. Both in-hospital and 30 day safety and efficacy outcomes were analysed. Results: In total, 155 patients were treated with 245 scaffolds (mean age 60yrs, 60% male) with 52% presenting with ACS (6% STEMI) and 10% undergoing multi-vessel intervention. There was a mean of 1.6 scaffolds/patient (range 1 to 5) with LAD, LCX, RCA and SVG treated in 39%, 22%, 35%, and 2.3% respectively. There was 100% procedural success and 99% device success (2 device delivery failures with subsequent successful treatment with drug-eluting stents). There were 2 in-hospital myocardial infarcts (Non Q wave, 1.3%) with no mortality. At 30 days, there were a total of 3 myocardial infarcts (1.9%) including 1 scaffold thrombosis (0.6%) requiring target vessel revascularization (0.6%). There was no mortality. Conclusion: This early local experience has demonstrated ABRS therapy to be highly safe and efficacious in a cohort of real-world patients with complex presentations and disease (including ACS, long lesions, multi-vessel disease and CTOs). Disclosure of Interest: None Declared
PM202 Establishing Chronic Total Occlusion Programme in a Tertiary Australian Centre Description of Early Experience Vimalraj Bogana Shanmugam*1, Dennis Wong2, Peter Psaltis2, Sujith Seneviratne3, Ian Meredith2, Yuvaraj Malaiapan2 1 Monash Heart, Interventional Cardiology, Monash Health, Monash Medical Centre, 2Monash Heart, Interventional Cardiology, 3Monash Health, Monash Medical Centre, Melbourne, Australia Introduction: Chronic total occlusions (CTO) represent a unique set of lesions for percutaneous coronary intervention (PCI) because of the complexity of techniques required to treat them, prompting recommendations for institutions to adopt dedicated CTO revascularisation programs. Objectives: The aim of our study was to investigate the baseline, Procedural characteristics and in-hospital outcomes during the initiation phase of establishment of a dedicated CTO programme. Methods: We retrospectively reviewed the CTO-PCI experience between January 2010 and December 2012 in a multi-operator single centre, which is one of the largest volume PCI centres in Australia. Data were collected for patient, lesional and procedural characteristics, including procedural success and in-hospital outcomes. Results: 82 CTO-PCI procedures were performed. Mean age of the overall cohort was 62.611.3 years with 85% males. Multivessel disease was present in 78%. The most common site of CTO was RCA (44%), followed by LCX (30%) and LAD (26%). By lesional QCA analysis, the frequencies of complex CTO angiographic features were: 13% for moderate-to-severe calcification, 26% for blunt or ambiguous proximal cap, 16% for angulation of the distal vessel greater than 45 and 34% for the presence bridging collaterals. Mean lesional length was 10.1+7.7 mm. Retrograde Rentrop grade III collaterals were observed in 30%. Adopting the Japanese CTO scoring system, 34% of lesions were classified as easy, 37% intermediate, 23% difficult and 6% very difficult. Procedures were undertaken by ten different operators with varying levels of experience, with all cases performed by antegrade guide-wire approach. Selected procedural characteristics included: re-attempt procedure,10%; mutiple access sites, 21%; more than one guide wire, 77%; additional support modality, 60%; DES, 97%; stent number, 1.60.9; total stent length, 40.124.5mm; fluroscopy time, 31.717.5 min; contrast volume, 257.2110.9 mL. Overall CTO success rate was 60%. In-hospital adverse outcomes, included: 3% mortality, 28% peri-procedural myocardial infarction, 17% emergency bypass surgery, 3% tamponade and 7% contrast-induced nephropathy. Conclusion: Modest success rates were achieved in a relatively conservative CTO cohort, in this single centre experience, prior to the initiation of a dedicated CTO revascularisation program. These results emphasise the need for Australian centres to adopt a systematic and specialised approach to CTO-PCI. Disclosure of Interest: None Declared
e104
Yue-Xi Wang*1, Rong A1 Cardiology, 1th Hospital affiliated to Inner Mongolia Medical University, Huhhot, China
1
Introduction: To observe the protective effect of ischemia postconditioning. Objectives: To observe the protective effect of ischemia postconditioning during the first minutes of reperfusion for the myocardial reperfusion injury in ST segment elevation acute myocardial infarction(STEMl) patients undergoing emergency percutaneous coronary intervention(PCI). Methods: STEMI patients undergoing emergency PCI in affiliated hospital of Inner Mongolia Medical University between Jan.2005 and Jan.2012, Were randomly divided into the control group(n¼40) without any intervention after PCI and the postconditioning(Pocs C) group(n¼50) with ischemia postconditioning within first 5 minutes of fellow by 3 episodes of 30 seconds inflation and 30 seconds deflation with the angioplasty balloon. Reperfusion arrhythmias, cTnT and CK-MB. corrected TIMI frame count(CTFC), wall motion score index(WMSI) and left ventricular ejection fraction(LVEF) by echocardiography were compared between the two groups. MI areas were evaluated with the ECT and myocardial blush grade(MBG) was measured. Results: The incidence of reperfusion arrhythmias-frequent ventricular premature 30%(12/40) in Pocs C group vs 46%(23/50) in control group, P<0.05, and short array ventricular tachycardia beat22.5%(9/40) vs 38%(19/50) in the two groups, P<0.05, as well as values of peaks cTnt[(0.840.21)ng/;L vs(1.270.48)u/L, P<0.01], CK-MB[(94.551.4)u/L vs (171.879.3)u/L, P<0.01]. CTFC(34.18.7vs29.27.5, P<0.05). WMSI(1.740.9 vs 2.10.6, P<0.05), and infarction area determined by ECT (17.2%3.6% vs 25.5%2.9%, P<0.05) were all significantly higher in the control group than in PostC group, while LVEF(49.3%4.7% vs 43.4%5.2%, P<0.05) and MBG(2.541.3 vs 1.411.1, P<0.05) were significantly higher in the PostC group than in control group. Conclusion: Ischemic postconditioning can significantly reduce myocardial reperfusion injury in patients with STEMI. Disclosure of Interest: Y.-X. Wang Consultancy for: No, R. A: None Declared PM204 Association Of Cardiac Ischemic Score And Coronary Collateral Circulation Jahanara Arzu*1, Abu Siddique1, Sajal K. Banerjee1, Akm F. Rahman1, Syed A. Ahsan1, MdMukhlesur Rahman1, Md A. Salim1, Manzoor Mahmood1 1 Cardiology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh Introduction: Coronary collateral circulation maintains myocardial perfusion in coronary atherosclerotic disease. The indicators of cardiac ischemia: -Angina pectoris (AP) on exertion, during emotion, previous myocardial infarction (MI) and prior coronary intervention are associated with presence of coronary collateral circulation. Objectives: 1) To assess the correlation between cardiac ischemic score and coronary collaterals. 2) To provide an attractive treatment option, in patients with ischemic heart disease, who are unsuitable for conventional revascularization therapies. Methods: In this observational cross sectional study in Bangabandhu Sheikh Mujib Medical University, 128 patients with history of angina pectoris (AP) on exertion, emotion and or MI and or previous coronary intervention were enrolled. The cardiac ischemic score (range 1-4) was calculated by adding 1 point for each of the above four clinical factors, which can be easily assessed. Presence of coronary collaterals in coronary angiogram was defined as Rentrop grade 1. Patients were divided into two groups. Group A patients having Rentrop grade 0 and Group B patients are with collateral circulation, having Rentrop grade 1-3. Patients having cardiac ischemic score (range 1-4) are compared in these groups. Results: Maximum (83.3%) patients of Group B with coronary collateral circulation had cardiac ischemic score 2-4, but majority (86.4%) of Group A patients without collaterals showed the score only 1 (p < 0.001). All the components of cardiac ischemic score like AP on exertion, during emotions, previous MI and h/o PTCA or CABG were significantly higher in Group-B than those in Group-A (p ¼ 0.005, p < 0.001, p ¼ 0.007 and p ¼ 0.048 respectively). The mean duration of AP until index CAG or PTCA was also staggeringly higher in Group-B than that in Group-A (40.8 25.8 vs. 13.1 17.4, p < 0.001). The mean duration since MI until index CAG or PTCA was also much higher in the former group than that in the later group (39.6 32.9 vs. 11.6 23.0, p ¼ 0.003). The incidence of multi vessel coronary disease was significantly higher in Group-B (66.7%) than that in Group-A (40.9%) (p ¼ 0.005). Conclusion: The cardiac ischemic score is strongly associated with the presence of coronary collaterals. Disclosure of Interest: None Declared PM205 Is there a long-term prognostic significance of the new-onset atrial arrhythmias in patients with acute myocardial infarction treated with thrombolytic therapy? 15-year follow-up Branislav S. S. Stefanovic*1, Predrag Mitrovic1, Gordana Matic2, Aleksandra Milosevic2, Mina Radovanovic1, Nebojsa Radovanovic1, Gordana Krljanac1, Ana Karadzic2, Ana Novakovic2, Aleksandra Janicijevic2 1 Cardiology Clinic, Belgrade University Medical Faculty, 2Cardiology Clinic, Clinical Center of Serbia, Belgrade, Serbia
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters