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Prevalence of obstructive coronary artery disease among patients undergoing coronary angiography at an Australian Tertiary Hospital
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Abstracts
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system, so it is particularly pertinent to ensure appropriate use of health care resources. The aim of this study is to evaluate the prevalence of coronary artery disease in a contemporary cohort of Australian patients undergoing coronary angiography. Methods: We retrospectively identified consecutive patients who underwent coronary angiography between July 1st, 2012 and June 30th, 2013 at The Royal Melbourne Hospital. Patients who had previous coronary bypass graft surgery and those undergoing pre-valvular surgery workup were excluded. Obstructive coronary disease was defined as a stenosis of more than 70% in at least one major coronary artery, or more than 50% in the left main coronary artery. Results: A total of 1,127 patients underwent diagnostic angiography for suspected coronary artery disease in the 12-month period. In this cohort, 14.3% had normal coronaries and 25.3% had non-obstructive coronary artery disease. The prevalence of obstructive coronary artery disease was 60.3%. Overall, 31.9% had single-vessel disease, 15.4% had doublevessel disease, 10.2% had triple-vessel disease, and 2.8% had left main disease. Amongst those who did not have troponin elevation, 57% had non-invasive functional testing prior to angiography. Conclusion: The prevalence of obstructive coronary artery disease is high in this cohort of patients undergoing coronary angiography. This suggests good patient selection and better use of health care resources.
APACHE III score predicts mortality in out of hospital cardiac arrest (OOHCA) patients with non-ST elevation myocardial infarction (NSTEMI) C. Tie *, T. Kuang, J. Loubser, C. Frampton, D. Knight, D. Smyth Canterbury District Health Board, Christchurch * Corresponding author. Background: There are few data to help guide in the decision of when and whether a patient presenting with OOHCA and NSTEMI should under angiogram and PCI. Which guides is difficult to determine Methods: Between January 2010 and December 2012, all patients admitted to intensive care unit (ICU) at Christchurch Hospital after OOHCA and NSTEMI were analysed. APACHE III score was extracted from medical records. APACHE III score is widely used in ICU to determine prognosis. We compared the outcome of the group who went for coronary angiogram +/- PCI within 12 hours of hospital arrival to those who did not. The primary endpoint is mortality at 6 months. Results: 78 patients admitted to ICU with OOHCA and NSTEMI within this time frame. 73% were male and the mean age was 62 +/- 17 years old. The mean APACHE III score was 0.69 +/- 0.20. Of these patients, 15 (19%) underwent coronary angiogram within 12 hours and 6 (40%) of these underwent culprit-lesion PCI. The APACHE III score was not significantly different in groups who did and did not undergo angiogram and PCI (0.71 +/- 0.16 vs. 0.69 +/- 0.20, p = 0.71) but it predicted survival (0.60 +/- 0.21 vs. 0.76 +/0.16, p = 0.00). There was a significantly better survival in group undergoing coronary angiogram and PCI [4/15 (27%) vs. 41/63 (65%), p = 0.01] Conclusion: Selective patients with OOHCA and NSTEMI should consider early coronary angiogram as this improves prognosis even though the chance of finding a treatable culprit lesion is less than half. APACHE III score can be a good guide for selecting these patients as it predicts survival. Larger studies are needed to definitively answer these hypotheses. http://dx.doi.org/10.1016/j.hlc.2014.04.236
P68 Prevalence of obstructive coronary artery disease among patients undergoing coronary angiography at an Australian Tertiary Hospital D. Tsang *, M. Yudi, S. Joshi Cardiology Department, The Royal Melbourne Hospital, Melbourne, Australia * Corresponding author. Background: Previous studies from overseas have suggested that many patients undergoing coronary angiograms are found to have normal coronary arteries. Excessive use of coronary angiography leads to wasteful health spending and puts patients at risk. Australia has a publicly funded health
http://dx.doi.org/10.1016/j.hlc.2014.04.237 P69 The Australian experience of government subsidisation of novel oral anticoagulants (NOACs) A. Vlachadis Castles 1,2*, W. van Gaal 1,2,3 1
The Northern Hospital, Cardiology Department, Melbourne, Australia 2 The Northern Hospital, Radiology Department Melbourne, Australia 3 University of Melbourne, Melbourne, Australia * Corresponding author.
Background: NOACs offer physicians an alternative to warfarin for stroke prevention in atrial fibrillation (AF). The Pharmaceutical Benefits Scheme (PBS) is the system whereby the Australian Government subsidises medications for defined indications. Initially NOACs were only subsidised for specific venous thromboembolism treatment and prevention indications. Authorities to prescribe NOACs for prevention of stroke in at-risk patients with AF were added to the PBS in August 2013 for rivaroxaban, and September 2013 for apixaban and dabigatran. The purpose of this study is to explore the effect of government subsidisation on prescription rates for NOACs and warfarin. Methods: Medicare Australia statistics from June to December 2013 inclusive analysed to determine the number of PBS prescriptions processed for NOACs and warfarin. Information on prescription for different indications is not
Abstracts
P67
system, so it is particularly pertinent to ensure appropriate use of health care resources. The aim of this study is to evaluate the prevalence of coronary artery disease in a contemporary cohort of Australian patients undergoing coronary angiography. Methods: We retrospectively identified consecutive patients who underwent coronary angiography between July 1st, 2012 and June 30th, 2013 at The Royal Melbourne Hospital. Patients who had previous coronary bypass graft surgery and those undergoing pre-valvular surgery workup were excluded. Obstructive coronary disease was defined as a stenosis of more than 70% in at least one major coronary artery, or more than 50% in the left main coronary artery. Results: A total of 1,127 patients underwent diagnostic angiography for suspected coronary artery disease in the 12-month period. In this cohort, 14.3% had normal coronaries and 25.3% had non-obstructive coronary artery disease. The prevalence of obstructive coronary artery disease was 60.3%. Overall, 31.9% had single-vessel disease, 15.4% had doublevessel disease, 10.2% had triple-vessel disease, and 2.8% had left main disease. Amongst those who did not have troponin elevation, 57% had non-invasive functional testing prior to angiography. Conclusion: The prevalence of obstructive coronary artery disease is high in this cohort of patients undergoing coronary angiography. This suggests good patient selection and better use of health care resources.
APACHE III score predicts mortality in out of hospital cardiac arrest (OOHCA) patients with non-ST elevation myocardial infarction (NSTEMI) C. Tie *, T. Kuang, J. Loubser, C. Frampton, D. Knight, D. Smyth Canterbury District Health Board, Christchurch * Corresponding author. Background: There are few data to help guide in the decision of when and whether a patient presenting with OOHCA and NSTEMI should under angiogram and PCI. Which guides is difficult to determine Methods: Between January 2010 and December 2012, all patients admitted to intensive care unit (ICU) at Christchurch Hospital after OOHCA and NSTEMI were analysed. APACHE III score was extracted from medical records. APACHE III score is widely used in ICU to determine prognosis. We compared the outcome of the group who went for coronary angiogram +/- PCI within 12 hours of hospital arrival to those who did not. The primary endpoint is mortality at 6 months. Results: 78 patients admitted to ICU with OOHCA and NSTEMI within this time frame. 73% were male and the mean age was 62 +/- 17 years old. The mean APACHE III score was 0.69 +/- 0.20. Of these patients, 15 (19%) underwent coronary angiogram within 12 hours and 6 (40%) of these underwent culprit-lesion PCI. The APACHE III score was not significantly different in groups who did and did not undergo angiogram and PCI (0.71 +/- 0.16 vs. 0.69 +/- 0.20, p = 0.71) but it predicted survival (0.60 +/- 0.21 vs. 0.76 +/0.16, p = 0.00). There was a significantly better survival in group undergoing coronary angiogram and PCI [4/15 (27%) vs. 41/63 (65%), p = 0.01] Conclusion: Selective patients with OOHCA and NSTEMI should consider early coronary angiogram as this improves prognosis even though the chance of finding a treatable culprit lesion is less than half. APACHE III score can be a good guide for selecting these patients as it predicts survival. Larger studies are needed to definitively answer these hypotheses. http://dx.doi.org/10.1016/j.hlc.2014.04.236
P68 Prevalence of obstructive coronary artery disease among patients undergoing coronary angiography at an Australian Tertiary Hospital D. Tsang *, M. Yudi, S. Joshi Cardiology Department, The Royal Melbourne Hospital, Melbourne, Australia * Corresponding author. Background: Previous studies from overseas have suggested that many patients undergoing coronary angiograms are found to have normal coronary arteries. Excessive use of coronary angiography leads to wasteful health spending and puts patients at risk. Australia has a publicly funded health
http://dx.doi.org/10.1016/j.hlc.2014.04.237 P69 The Australian experience of government subsidisation of novel oral anticoagulants (NOACs) A. Vlachadis Castles 1,2*, W. van Gaal 1,2,3 1
The Northern Hospital, Cardiology Department, Melbourne, Australia 2 The Northern Hospital, Radiology Department Melbourne, Australia 3 University of Melbourne, Melbourne, Australia * Corresponding author.
Background: NOACs offer physicians an alternative to warfarin for stroke prevention in atrial fibrillation (AF). The Pharmaceutical Benefits Scheme (PBS) is the system whereby the Australian Government subsidises medications for defined indications. Initially NOACs were only subsidised for specific venous thromboembolism treatment and prevention indications. Authorities to prescribe NOACs for prevention of stroke in at-risk patients with AF were added to the PBS in August 2013 for rivaroxaban, and September 2013 for apixaban and dabigatran. The purpose of this study is to explore the effect of government subsidisation on prescription rates for NOACs and warfarin. Methods: Medicare Australia statistics from June to December 2013 inclusive analysed to determine the number of PBS prescriptions processed for NOACs and warfarin. Information on prescription for different indications is not