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PP-019 Does Preoperative Usage of Low Molecular Weight Heparin Cause Heparin Resistance on-pump Coronary Bypass Graft Patients
MARCH 10e13, 2016 PCI. Therefore, MHR may be used as a simple and reliable indicator of CIN after primary PCI patients.
- PP-019 Does Preoperative Usage of Low Molecular Weight Heparin Cause Heparin Resistance on-pump Coronary Bypass Graft Patients. Onur Saydam1, Mehmet Atay1, Ulas¸ Kumbasar2, Metin Demircin2. 1Department of Cardiovascular Surgery, Karaman State Hospital, Karaman, Turkey; 2Department of Cardiovascular Surgery, Medicine Faculty Hacettepe Hospital, Ankara, Turkey.
Figure 1. Comparison of preoperative Platelet Counts between the groups.
Introduction: Heparin resistance (HR) is defined as need for higher than normal heparin doses to induce sufficient anticoagulation for cardiopulmonary bypass. The definitions, causes and effects of HR are still controversial in cardiac surgery practice. Our study specifically compared adult patients undergoing on-pump coronary artery by-pass graft (CABG) surgery who have received preoperative low molecular weight heparin (LMWH) with a control group who had not received any anticoagulants before surgery. Material- Methods: Data were retrospectively reviewed from adult patients who undergone isolated on-pump CABG surgery. Patients were stratified into 4 groups according on medical regimen and presence of HR. The groups receiving preoperative LMWH was showen as LMWHþ, where as the groups who does not receive preoperative LMWH was shown as LMWH -. The groups presense intraoperative HR was showen as HRþ and the groups without intraoperative HR was showen as HR-. Results: Group 1 (n¼55) (LMWH-/HR-), Group 2 (n¼5) (LMWH-/ HRþ), Group 3 (n¼55) (LMWHþ/HR-), Group 4 (n¼24) (LMWHþ/ HRþ). All patients in Group 3 and 4 had been treated with subcutaneous injections of enoxaparin 0,01cc/kg body weight twice daily for at least 3 days prior to surgery, and the last dose was given 12 hours before surgery. Compared to the patients who had not received any anticoagulants preoperatively, patients who were treated with preoperative LMWH developed significantly higher ratio of intraoperative HR and compared to other groups, mortality rate was significantly higher in Group 4(LMWHþ/ HRþ). Discussion: Our study is a rare research which specificaly compared adult patients undergoing on-pump CABG surgery who have received
Figure 2. Comparison of preoperative CPB time between the groups.
Figure 3. Comparison of preoperative Aortic Clamp Time between the groups. preoperative LMWH with a control group who had not received any anticoagulants before surgery. In conclusion, preoperative treatment of patients undergoing on-pump CABG surgery with LMWH preoperatively may cause HR. Corrective and preventive arrangements with close follow-up should be performed in this
Demographic, Clinical characteristics and Operative Patient Data LWMH (-)
Age Gender (F/M) Weight (kg) Preoperative Platelet Count ( 1000 mL) Preoperative Medication Acetylsalicylic Acid Preoperative MedicationClopidogrel Intraoperative Patients Data CPB (min) Aortic Clamp Time (min) Basal ACT (sec) After Heparin ACT (sec) After Protamine ACT (sec) Intraoperative FFP (unite) Intraoperative Thrombocyte (unite) Re-Exploration Exitus
LWMH(þ)
Group 1 HR(n¼55)
Group 2 HRþ (n¼5)
Group 3 HR(n¼55)
Group 4 HRþ (n¼24)
66 10 22/33 77 12 777 249 74 25 1 69 21 41 15 126 16 662 231 133 22 2.1 0.9 0.3 1.3 0 1
63 11 2/3 77 7 168 70 5 0 86 15 55 11 119 18 357 33 154 7 2.1 0.9 0.3 1.5 0 0
63 9 20/35 80 12 275 85 21 0 67 31 40 20 125 15 604 172 128 19 3.8 1.8 1.0 2.2 0 0
65 11 6/18 80 16 197 75 10 2 95 61 50 20 122 15 349 56 133 25 4.5 1.8 2.2 3.1 2 4
P value
p¼0.463 p¼0.658 p¼0.598 P<0.001 p¼0.620 p¼0.179 p¼0.033 P¼0.022 p¼0.654 p<0.001 p¼0.034 P<0.001 p¼0.001 P¼0.980 p¼0.013
Data are mean SD; LMWH, Abbreviations: Low Molecule Weight Heparin; HR, Heparin Resistance; F, Female; M, Male; CPB, Cardio-pulmonary bypass time (minute); ACT, Active Coagulation Time; FFP, Fresh Frozen Plasma. The American Journal of Cardiologyâ MARCH 10e13, 2016 12th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Oral
S49
P O S T E R A B S T R A C T S
MARCH 10e13, 2016 group of patients. However, further prospective clinical researches in larger patient populations are necessary to encourage our results.
- PP-020
P O S T E R
Conclusions: The severity of ED is an independent factor predicting the extent of CAD. The early detection of ED enables to make a cardiovascular evaluation. Therefore, taking the cardiovascular risk factors under an aggressive treatment may contribute to prevent the cardiovascular cases which may develop in the future.
The Relation between Erectile Dysfunction and Extent of Coronary Artery Disease in the Patients with Stable Coronary Artery Disease. Hikmet Hamur1, Hakan Duman2, Ercument Keskin3, Sinan Inci4, Zafer Kucuksu1, Husnu Degirmenci1, Ergun Topal1. 1 Department of Cardiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey; 2Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey; 3Department of Urology, Faculty of Medicine, Erzincan University, Erzincan, Turkey; 4Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey.
- PP-021
Objective: Erectile dysfunction (ED) and coronary artery disease (CAD) are closely related as a result of endothelial dysfunction leading to the restriction of blood flow. ED is a potential independent risk factor of CAD. We investigated the prevalence and severity of ED, the extent of CAD and the time interval between the symptoms of ED and CAD in the stable coronary artery patients. Methods: 161 patients applied coronary angiography were divided into two groups according to SYNTAX score as group 1 (n¼81) SYNTAX score 22, and group 2 (n¼80) SYNTAX score >22. The prevalence and severity of ED was determined by using The International Index of Erectile Function (IIEF). Results: The prevalence of ED was 43.2% in group 1 and 61.3% in group 2 (P¼0.022). The score of IIEF was 23.1 (15-29) in group 1, 19.3 (6-29) in group 2; there was a significant difference (P¼0.000). In the multivariate logistic regression analysis carried out in order to determine the independent predictors on Syntax score, it was found that LDL (odds ratio: 1.032, 95% confidence interval: 1.009-1.055, P¼0.007) and IIEF score (odds ratio: 0.825, 95% confidence interval: 0.733-0.928, P¼0.001) were the independent predictors. The time between the symptoms of ED and CAD 30.1 4.8 months in group 1, and 40.5 4.3 months in group 2 (P¼0.000).
Objective: We investigated whether serum bilirubin level (a marker of heme oxygenase activity) is a predictor of trombus burden in patients with acute myocardial infarction. Methods: Patients (n ¼ 229; male 72.9%; mean age 63 13.4 years) who were admitted with ST-elevation myocardial infarction (STEMI) were enrolled. Patients were divided into 2 groups. Group 1 was defined as low thrombus burden and group 2 was defined as high thrombus burden. Results: Patients with high-thrombus burden had higher total bilirubin levels (14.36 [4.27 e 22.91] vs 7.69 [2.39 e 20.34] mmol/L, p¼<.001) and direct bilirubin levels (3.08 [2.13 e 8.38] vs 1.71 [0.51 e 6.49] mmol/L, p¼<.001). At multivariate analysis, total bilirubin (odds ratio: 1.054, 95% confidence interval: 1.031 e 1.079, p¼<.001) was the independent predictor of high thrombus burden. Conclusions: Total bilirubin level is independently associated with high thrombus burden in patients with STEMI.
A B S T R A C T S
Bilirubin Levels and Thrombus Burden in Patients with ST-elevation Myocardial Infarction. Hikmet Hamur1, Hakan Duman2, Eftal Murat Bakirci1, Zafer Kucuksu1, Selami Demirelli3, Kamuran Kalkan3, Husnu Degirmenci1. 1 Department of Cardiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey; 2Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey; 3Department of Cardiology, Training and Research Hospital, Erzurum, Turkey.
Figure 1. Total bilirubin levels between low and high thrombus burden groups.
- PP-022
Figure 1. The receiver-operating characteristic (ROC) curve of international index of erectile function (IIEF) score for predicting the higher Syntax score.
Association of Coronary Atherosclerosis and Latent Chronic Kidney Disease in Turkish Population. Suat Görmel1, Emre Yalçınkaya4, Mustafa Köklü2, Uygar agdas¸ Yüksel2, Barıs¸ Bugan3, Murat Çelik2, Cem Barçın2, Yalçın Gökoglan2, Kutsi Hasan Kabul2, Erol Gürsoy2, Salim Yas¸ar5, Erkan Yıldırım2. 1Beytepe Military Hospital; 2Department of Cardiology, Gulhane Military Medical Faculty, Ankara, Turkey; 3Girne Military Hospital; 4Aksaz Military Hospital; 5Etimesgut Military Hospital.
S50 The American Journal of Cardiologyâ MARCH 10e13, 2016 12th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Oral
- PP-019 Does Preoperative Usage of Low Molecular Weight Heparin Cause Heparin Resistance on-pump Coronary Bypass Graft Patients. Onur Saydam1, Mehmet Atay1, Ulas¸ Kumbasar2, Metin Demircin2. 1Department of Cardiovascular Surgery, Karaman State Hospital, Karaman, Turkey; 2Department of Cardiovascular Surgery, Medicine Faculty Hacettepe Hospital, Ankara, Turkey.
Figure 1. Comparison of preoperative Platelet Counts between the groups.
Introduction: Heparin resistance (HR) is defined as need for higher than normal heparin doses to induce sufficient anticoagulation for cardiopulmonary bypass. The definitions, causes and effects of HR are still controversial in cardiac surgery practice. Our study specifically compared adult patients undergoing on-pump coronary artery by-pass graft (CABG) surgery who have received preoperative low molecular weight heparin (LMWH) with a control group who had not received any anticoagulants before surgery. Material- Methods: Data were retrospectively reviewed from adult patients who undergone isolated on-pump CABG surgery. Patients were stratified into 4 groups according on medical regimen and presence of HR. The groups receiving preoperative LMWH was showen as LMWHþ, where as the groups who does not receive preoperative LMWH was shown as LMWH -. The groups presense intraoperative HR was showen as HRþ and the groups without intraoperative HR was showen as HR-. Results: Group 1 (n¼55) (LMWH-/HR-), Group 2 (n¼5) (LMWH-/ HRþ), Group 3 (n¼55) (LMWHþ/HR-), Group 4 (n¼24) (LMWHþ/ HRþ). All patients in Group 3 and 4 had been treated with subcutaneous injections of enoxaparin 0,01cc/kg body weight twice daily for at least 3 days prior to surgery, and the last dose was given 12 hours before surgery. Compared to the patients who had not received any anticoagulants preoperatively, patients who were treated with preoperative LMWH developed significantly higher ratio of intraoperative HR and compared to other groups, mortality rate was significantly higher in Group 4(LMWHþ/ HRþ). Discussion: Our study is a rare research which specificaly compared adult patients undergoing on-pump CABG surgery who have received
Figure 2. Comparison of preoperative CPB time between the groups.
Figure 3. Comparison of preoperative Aortic Clamp Time between the groups. preoperative LMWH with a control group who had not received any anticoagulants before surgery. In conclusion, preoperative treatment of patients undergoing on-pump CABG surgery with LMWH preoperatively may cause HR. Corrective and preventive arrangements with close follow-up should be performed in this
Demographic, Clinical characteristics and Operative Patient Data LWMH (-)
Age Gender (F/M) Weight (kg) Preoperative Platelet Count ( 1000 mL) Preoperative Medication Acetylsalicylic Acid Preoperative MedicationClopidogrel Intraoperative Patients Data CPB (min) Aortic Clamp Time (min) Basal ACT (sec) After Heparin ACT (sec) After Protamine ACT (sec) Intraoperative FFP (unite) Intraoperative Thrombocyte (unite) Re-Exploration Exitus
LWMH(þ)
Group 1 HR(n¼55)
Group 2 HRþ (n¼5)
Group 3 HR(n¼55)
Group 4 HRþ (n¼24)
66 10 22/33 77 12 777 249 74 25 1 69 21 41 15 126 16 662 231 133 22 2.1 0.9 0.3 1.3 0 1
63 11 2/3 77 7 168 70 5 0 86 15 55 11 119 18 357 33 154 7 2.1 0.9 0.3 1.5 0 0
63 9 20/35 80 12 275 85 21 0 67 31 40 20 125 15 604 172 128 19 3.8 1.8 1.0 2.2 0 0
65 11 6/18 80 16 197 75 10 2 95 61 50 20 122 15 349 56 133 25 4.5 1.8 2.2 3.1 2 4
P value
p¼0.463 p¼0.658 p¼0.598 P<0.001 p¼0.620 p¼0.179 p¼0.033 P¼0.022 p¼0.654 p<0.001 p¼0.034 P<0.001 p¼0.001 P¼0.980 p¼0.013
Data are mean SD; LMWH, Abbreviations: Low Molecule Weight Heparin; HR, Heparin Resistance; F, Female; M, Male; CPB, Cardio-pulmonary bypass time (minute); ACT, Active Coagulation Time; FFP, Fresh Frozen Plasma. The American Journal of Cardiologyâ MARCH 10e13, 2016 12th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Oral
S49
P O S T E R A B S T R A C T S
MARCH 10e13, 2016 group of patients. However, further prospective clinical researches in larger patient populations are necessary to encourage our results.
- PP-020
P O S T E R
Conclusions: The severity of ED is an independent factor predicting the extent of CAD. The early detection of ED enables to make a cardiovascular evaluation. Therefore, taking the cardiovascular risk factors under an aggressive treatment may contribute to prevent the cardiovascular cases which may develop in the future.
The Relation between Erectile Dysfunction and Extent of Coronary Artery Disease in the Patients with Stable Coronary Artery Disease. Hikmet Hamur1, Hakan Duman2, Ercument Keskin3, Sinan Inci4, Zafer Kucuksu1, Husnu Degirmenci1, Ergun Topal1. 1 Department of Cardiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey; 2Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey; 3Department of Urology, Faculty of Medicine, Erzincan University, Erzincan, Turkey; 4Department of Cardiology, Aksaray State Hospital, Aksaray, Turkey.
- PP-021
Objective: Erectile dysfunction (ED) and coronary artery disease (CAD) are closely related as a result of endothelial dysfunction leading to the restriction of blood flow. ED is a potential independent risk factor of CAD. We investigated the prevalence and severity of ED, the extent of CAD and the time interval between the symptoms of ED and CAD in the stable coronary artery patients. Methods: 161 patients applied coronary angiography were divided into two groups according to SYNTAX score as group 1 (n¼81) SYNTAX score 22, and group 2 (n¼80) SYNTAX score >22. The prevalence and severity of ED was determined by using The International Index of Erectile Function (IIEF). Results: The prevalence of ED was 43.2% in group 1 and 61.3% in group 2 (P¼0.022). The score of IIEF was 23.1 (15-29) in group 1, 19.3 (6-29) in group 2; there was a significant difference (P¼0.000). In the multivariate logistic regression analysis carried out in order to determine the independent predictors on Syntax score, it was found that LDL (odds ratio: 1.032, 95% confidence interval: 1.009-1.055, P¼0.007) and IIEF score (odds ratio: 0.825, 95% confidence interval: 0.733-0.928, P¼0.001) were the independent predictors. The time between the symptoms of ED and CAD 30.1 4.8 months in group 1, and 40.5 4.3 months in group 2 (P¼0.000).
Objective: We investigated whether serum bilirubin level (a marker of heme oxygenase activity) is a predictor of trombus burden in patients with acute myocardial infarction. Methods: Patients (n ¼ 229; male 72.9%; mean age 63 13.4 years) who were admitted with ST-elevation myocardial infarction (STEMI) were enrolled. Patients were divided into 2 groups. Group 1 was defined as low thrombus burden and group 2 was defined as high thrombus burden. Results: Patients with high-thrombus burden had higher total bilirubin levels (14.36 [4.27 e 22.91] vs 7.69 [2.39 e 20.34] mmol/L, p¼<.001) and direct bilirubin levels (3.08 [2.13 e 8.38] vs 1.71 [0.51 e 6.49] mmol/L, p¼<.001). At multivariate analysis, total bilirubin (odds ratio: 1.054, 95% confidence interval: 1.031 e 1.079, p¼<.001) was the independent predictor of high thrombus burden. Conclusions: Total bilirubin level is independently associated with high thrombus burden in patients with STEMI.
A B S T R A C T S
Bilirubin Levels and Thrombus Burden in Patients with ST-elevation Myocardial Infarction. Hikmet Hamur1, Hakan Duman2, Eftal Murat Bakirci1, Zafer Kucuksu1, Selami Demirelli3, Kamuran Kalkan3, Husnu Degirmenci1. 1 Department of Cardiology, Faculty of Medicine, Erzincan University, Erzincan, Turkey; 2Department of Cardiology, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey; 3Department of Cardiology, Training and Research Hospital, Erzurum, Turkey.
Figure 1. Total bilirubin levels between low and high thrombus burden groups.
- PP-022
Figure 1. The receiver-operating characteristic (ROC) curve of international index of erectile function (IIEF) score for predicting the higher Syntax score.
Association of Coronary Atherosclerosis and Latent Chronic Kidney Disease in Turkish Population. Suat Görmel1, Emre Yalçınkaya4, Mustafa Köklü2, Uygar agdas¸ Yüksel2, Barıs¸ Bugan3, Murat Çelik2, Cem Barçın2, Yalçın Gökoglan2, Kutsi Hasan Kabul2, Erol Gürsoy2, Salim Yas¸ar5, Erkan Yıldırım2. 1Beytepe Military Hospital; 2Department of Cardiology, Gulhane Military Medical Faculty, Ankara, Turkey; 3Girne Military Hospital; 4Aksaz Military Hospital; 5Etimesgut Military Hospital.
S50 The American Journal of Cardiologyâ MARCH 10e13, 2016 12th INTERNATIONAL CONGRESS OF UPDATE IN CARDIOLOGY AND CARDIOVASCULAR SURGERY ABSTRACTS / Oral