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PS147 The Effect of Glycated Hemoglobin (HbA1c) on Prognosis of Acute Myocardial Infarction With Diabetes Mellitus
POSTER ABSTRACTS
PS144
PS147
Prevalence of Metabolic Syndrome in Acute Coronary Syndrome in Nepalese Population
The Effect of Glycated Hemoglobin (HbA1c) on Prognosis of Acute Myocardial Infarction With Diabetes Mellitus
P. Karki*1, J. Lamsal2, M. Lamsal3 1 Internal Medicine & Cardiology Division, 2Internal Medicine, 3Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
D.-Y. Nah*1, Y. J. Kim2, J. H. Bae1, J. W. Chung1, M. H. Jeong3, on behalf of Korean Working Group on Myocardial Infarction 1 Cardiology, Dongguk University Gyeongju Hospital, Gyeongju, 2Cardiology, Yeungnam University Hospital, Daegu, 3Cardiology, Chonnam National University Hospital, Gwangju, Republic Of Korea
Introduction: Metabolic Syndrome (MetS) is rapidly increasing in prevalence worldwide as a consequence of the global epidemics of obesity and sedentary lifestyles. Presence of MetS increases the risk of Cardiovascular Disease (CVD) twice in next 5 to 10 years. In health care services the value of MetS derives largely from its potential to reduce the risk of CVD in the general population by treating the disease. Objectives: To study the prevalence of MetS in patients with Acute Coronary Syndrome (ACS) in Eastern Nepal as defined by new IDF 2005 criteria as well as by 2005 revised NCEP-ATPIII criteria proposed by AHA/NHLBI with ethnic specific cut off values for waist circumference. Methods: Hospital based cross-sectional study enrolling 103 cases of ACS conducted over a period of one year. ACS was diagnosed based on the criteria proposed by The Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction. We used the IDF consensus worldwide definition of the Metabolic Syndrome (2005) and the revised NCEP ATP III criteria as proposed by the AHA/NHLBI (2005) using the ethnic specific cut off points of waist circumference to define the MetS. Prevalence of MetS in ACS was sought by using the above two criteria and the association of individual components of MetS was seen with ACS. Results: Out of 103 patients, MetS was identified in 34.9% patients according to IDF 2005 criteria whereas 56.3% patients had MetS according to revised NCEP ATPIII criteria. The prevalence of MetS among males and females were 61.1% and 38.9% according to IDF criteria and 58.6% and 41.4% according to revised NCEP ATPIII criteria respectively. There were 22(13 males and 9 females) or 37.9% of all study subjects who were diagnosed by revised NCEP criteria but missed by the IDF criteria. Among the 5 individual components of Mets, Hypertension, high fasting blood sugar and increased waist circumference had significant association with MetS(P<0.05). Conclusion: The revised NCEP criteria seem to be more appropriate for diagnosing MetS given that the IDF criteria cannot identify high-risk patients who lack central obesity but who nevertheless show a clustering of metabolic risk factors mainly associated with bad lifestyle behaviors. Disclosure of Interest: None Declared PS146 Glucose-Insulin-Potassium Solution Protects Neonatal Rat Ventricular Myocyte in an in Vitro Coverslip Ischemia/Reperfusion Model D.-Y. Nah*1, I. S. Moon2, J. H. Bae1, J. W. Chung1, H.-J. Kweon3 1 Cardiology, Dongguk University Gyeongju Hospital, 2Anatomy, Dongguk University College of Medicine, Gyeongju, 3Family Medicine, Konkuk University Chungju Hospital, Chungju, Republic Of Korea Introduction: There are some conflicting and limited data regarding the beneficial effect of high glucose-insulin-potassium (GIK) solution in clinical study. Objectives: The aim of this study to investigate the effects of GIK solution on the suppression of reactive oxygen species (ROS) and upregulation of O-GlcNAcylation, which protects cells from ischemic injury. Methods: Neonatal rat ventricular myocyte (NRVM) were isolated from postnatal day 3w4 rat pups (Sprague-Dawley) and grown in the Dulbecco’s modified Eagle’s medium (DMEM) containing high glucose (4.5 g/L), fetal bovine serum and penicillin/streptomycin. The effects of GIK solution on ROS production, apoptosis, and the expression of O-GlcNAc and OGlcNAc transferase (OGT) were investigated in our ‘coverslip ischemic/reperfusion (I/R) model’. Results: When a 24-well culture plate and B12 mm coverslips were used, covering the culture for 3 hr resulted in the appropriate ischemic shock. In this 24-well/B12 mm coverslip/3 hr covering I/R model, glucose and insulin synergistically reduced ROS production, protected NRVM dose-dependently from apoptosis, and altered the expression of O-GlcNAc and OGT.
Conclusion: The high GIK solution protects NRVM from I/R injury in vitro by reducing ROS and altering O-GlcNAcylation. Disclosure of Interest: None Declared
e38
Introduction: The prognostic role of glycated hemoglobin (HbA1c) in acute myocardial infarction (AMI) patients with diabetes mellitus (DM) are still controversial. Objectives: To determine the contribution of HbA1c level at admission on prognosis of AMI patients with DM. Methods: A total of 2,679 AMI with DM in KorMI (Korean Working Group on Myocardial Infarction) registry between January 2008 and August 2011. There are 1,360 ST segment elevation myocardial infarction and 1,319 non ST segment elevation myocardial infarction. Plasma HbA1c levels were available for all patients. We categorized the patients according to HbA1c level, Group I <6%, Group II 6w6.9%, Group III 7w8.9% and Group IV 9%. and the patients were divided into two group based on HbA1c 6.0% level.1-month and 12month major adverse cardiac event (MACE) was defined as either all cause of death, myocardial infarction and any type of revascularization. Results: The rate of 1 month MACE was not different among groups (14.4% in Group I, 8.1% in Group II, 8.2% in Group III, 8.7% in Group IV, p¼0.141) and also the rate of 12 month MACE was not different among groups (39.1% in Group I, 25.5% in Group II, 25.4% in Group III, 26.1% in Group IV, p¼0.084). In binary logistic regression analysis, less than 6.0% HbA1c was independent predictor of MACE (OR 2.8. 95% CI, 1.63-4.80). HbA1c <6.0
HbA1c ‡6.0
Patient Number
201
2,478
1-month MACE
29 (14.4%)
205 (8.3%)
p<0.01
12-month MACE
43 (21.4%)
322 (13.0%)
p<0.001
Conclusion: Less than 6.0% HbA1c on admission might be an important poor prognostic factor in AMI patients with DM at 1-month and 12-month follow-up. Disclosure of Interest: None Declared PS152 Ivabradine in Patients With Non-ST Elevation Acute Coronary Syndrome and Primary Percutaneous Intervention. Valeria: A Pilot Study F. A. Reyes*1, F. G. Padilla2, F. J. Robles3 1 Cardiología intervencionista, Centro Cardiovascular Puerta de Hierro, Zapopan, 2Cardiología intervencionista, Instituto Cardiovascular de Guadalajara, Guadalajara, 3Cardiología, Centro Cardiovascular Puerta de Hierro, Zapopan, Mexico Introduction: Non-ST elevation acute coronary syndrome (NSTE-ACS) is the commonest acute presentation of coronary artery disease. Despite an increase in the rate of primary percutaneous coronary intervention (PCI), medical therapy continues to retain a central rol in the treatment of these frail patients and heart rate (HR) at discharge correlates with mortality. Ivabradine is a pure HR reducing agent that has no effect on blood pressure and increases coronary flow reserve, being a new option that could improve the prognosis of this population. Objectives: To evaluate the safety and efficacy of ivabradine prior to PCI in patients with NSTE-ACS. Methods: We included 20 patients with NSTE-ACS (7315 years, 10 women), in sinus rythm and with HR > 70 bpm; Killip Kimball I-II. In addition to standard therapy prior to the PCI, all subjects received ivabradine 5mg twice for those who were previously with beta blockers or ivabradine 7.5mg twice alone when betablocker was not tolerated, with a follow-up period of 2412 months. Results: HR was reduced after the treatment with ivabradine (8513 vs 5905 bpm, p¼0.01), without differences in blood pressure (126/7824/17 vs 123/7420/12mmHg). Ivabradine was well tolerated and with a lower incidence of heart failure-related symptoms in accordance with the classification of NYHA compared to baseline (Class III 60%, IV 40% vs Class I 90%, II 10%). The 20 patients remained free of anginal symptoms. On echocardiography performed at baseline and post-treatment (average 2 months) observed improvement in ejection fraction (4717 vs 5908%, p¼0.01). Serum biomarkers decreased in comparison with the baseline (B-type natriuretic peptide 376228 vs 14084 pg/ml, also high sensitivity C-reactive protein 6.11.8 vs 1.751.5mg/l, p¼0.04). During follow-up were not observed cardiovascular death, non fatal myocardial infarction, recurrent symptomatic ischemia, urgent revascularization or worsening symptoms of heart failure. Conclusion: This pilot study shows that ivabradine can be used safely in combination with successful PCI to decrease the HR in patients with NSTE-ACS. Further studies are needed to characterize its effects on this population. Disclosure of Interest: None Declared
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS
PS144
PS147
Prevalence of Metabolic Syndrome in Acute Coronary Syndrome in Nepalese Population
The Effect of Glycated Hemoglobin (HbA1c) on Prognosis of Acute Myocardial Infarction With Diabetes Mellitus
P. Karki*1, J. Lamsal2, M. Lamsal3 1 Internal Medicine & Cardiology Division, 2Internal Medicine, 3Biochemistry, B.P. Koirala Institute of Health Sciences, Dharan, Nepal
D.-Y. Nah*1, Y. J. Kim2, J. H. Bae1, J. W. Chung1, M. H. Jeong3, on behalf of Korean Working Group on Myocardial Infarction 1 Cardiology, Dongguk University Gyeongju Hospital, Gyeongju, 2Cardiology, Yeungnam University Hospital, Daegu, 3Cardiology, Chonnam National University Hospital, Gwangju, Republic Of Korea
Introduction: Metabolic Syndrome (MetS) is rapidly increasing in prevalence worldwide as a consequence of the global epidemics of obesity and sedentary lifestyles. Presence of MetS increases the risk of Cardiovascular Disease (CVD) twice in next 5 to 10 years. In health care services the value of MetS derives largely from its potential to reduce the risk of CVD in the general population by treating the disease. Objectives: To study the prevalence of MetS in patients with Acute Coronary Syndrome (ACS) in Eastern Nepal as defined by new IDF 2005 criteria as well as by 2005 revised NCEP-ATPIII criteria proposed by AHA/NHLBI with ethnic specific cut off values for waist circumference. Methods: Hospital based cross-sectional study enrolling 103 cases of ACS conducted over a period of one year. ACS was diagnosed based on the criteria proposed by The Joint European Society of Cardiology/American College of Cardiology Committee for the Redefinition of Myocardial Infarction. We used the IDF consensus worldwide definition of the Metabolic Syndrome (2005) and the revised NCEP ATP III criteria as proposed by the AHA/NHLBI (2005) using the ethnic specific cut off points of waist circumference to define the MetS. Prevalence of MetS in ACS was sought by using the above two criteria and the association of individual components of MetS was seen with ACS. Results: Out of 103 patients, MetS was identified in 34.9% patients according to IDF 2005 criteria whereas 56.3% patients had MetS according to revised NCEP ATPIII criteria. The prevalence of MetS among males and females were 61.1% and 38.9% according to IDF criteria and 58.6% and 41.4% according to revised NCEP ATPIII criteria respectively. There were 22(13 males and 9 females) or 37.9% of all study subjects who were diagnosed by revised NCEP criteria but missed by the IDF criteria. Among the 5 individual components of Mets, Hypertension, high fasting blood sugar and increased waist circumference had significant association with MetS(P<0.05). Conclusion: The revised NCEP criteria seem to be more appropriate for diagnosing MetS given that the IDF criteria cannot identify high-risk patients who lack central obesity but who nevertheless show a clustering of metabolic risk factors mainly associated with bad lifestyle behaviors. Disclosure of Interest: None Declared PS146 Glucose-Insulin-Potassium Solution Protects Neonatal Rat Ventricular Myocyte in an in Vitro Coverslip Ischemia/Reperfusion Model D.-Y. Nah*1, I. S. Moon2, J. H. Bae1, J. W. Chung1, H.-J. Kweon3 1 Cardiology, Dongguk University Gyeongju Hospital, 2Anatomy, Dongguk University College of Medicine, Gyeongju, 3Family Medicine, Konkuk University Chungju Hospital, Chungju, Republic Of Korea Introduction: There are some conflicting and limited data regarding the beneficial effect of high glucose-insulin-potassium (GIK) solution in clinical study. Objectives: The aim of this study to investigate the effects of GIK solution on the suppression of reactive oxygen species (ROS) and upregulation of O-GlcNAcylation, which protects cells from ischemic injury. Methods: Neonatal rat ventricular myocyte (NRVM) were isolated from postnatal day 3w4 rat pups (Sprague-Dawley) and grown in the Dulbecco’s modified Eagle’s medium (DMEM) containing high glucose (4.5 g/L), fetal bovine serum and penicillin/streptomycin. The effects of GIK solution on ROS production, apoptosis, and the expression of O-GlcNAc and OGlcNAc transferase (OGT) were investigated in our ‘coverslip ischemic/reperfusion (I/R) model’. Results: When a 24-well culture plate and B12 mm coverslips were used, covering the culture for 3 hr resulted in the appropriate ischemic shock. In this 24-well/B12 mm coverslip/3 hr covering I/R model, glucose and insulin synergistically reduced ROS production, protected NRVM dose-dependently from apoptosis, and altered the expression of O-GlcNAc and OGT.
Conclusion: The high GIK solution protects NRVM from I/R injury in vitro by reducing ROS and altering O-GlcNAcylation. Disclosure of Interest: None Declared
e38
Introduction: The prognostic role of glycated hemoglobin (HbA1c) in acute myocardial infarction (AMI) patients with diabetes mellitus (DM) are still controversial. Objectives: To determine the contribution of HbA1c level at admission on prognosis of AMI patients with DM. Methods: A total of 2,679 AMI with DM in KorMI (Korean Working Group on Myocardial Infarction) registry between January 2008 and August 2011. There are 1,360 ST segment elevation myocardial infarction and 1,319 non ST segment elevation myocardial infarction. Plasma HbA1c levels were available for all patients. We categorized the patients according to HbA1c level, Group I <6%, Group II 6w6.9%, Group III 7w8.9% and Group IV 9%. and the patients were divided into two group based on HbA1c 6.0% level.1-month and 12month major adverse cardiac event (MACE) was defined as either all cause of death, myocardial infarction and any type of revascularization. Results: The rate of 1 month MACE was not different among groups (14.4% in Group I, 8.1% in Group II, 8.2% in Group III, 8.7% in Group IV, p¼0.141) and also the rate of 12 month MACE was not different among groups (39.1% in Group I, 25.5% in Group II, 25.4% in Group III, 26.1% in Group IV, p¼0.084). In binary logistic regression analysis, less than 6.0% HbA1c was independent predictor of MACE (OR 2.8. 95% CI, 1.63-4.80). HbA1c <6.0
HbA1c ‡6.0
Patient Number
201
2,478
1-month MACE
29 (14.4%)
205 (8.3%)
p<0.01
12-month MACE
43 (21.4%)
322 (13.0%)
p<0.001
Conclusion: Less than 6.0% HbA1c on admission might be an important poor prognostic factor in AMI patients with DM at 1-month and 12-month follow-up. Disclosure of Interest: None Declared PS152 Ivabradine in Patients With Non-ST Elevation Acute Coronary Syndrome and Primary Percutaneous Intervention. Valeria: A Pilot Study F. A. Reyes*1, F. G. Padilla2, F. J. Robles3 1 Cardiología intervencionista, Centro Cardiovascular Puerta de Hierro, Zapopan, 2Cardiología intervencionista, Instituto Cardiovascular de Guadalajara, Guadalajara, 3Cardiología, Centro Cardiovascular Puerta de Hierro, Zapopan, Mexico Introduction: Non-ST elevation acute coronary syndrome (NSTE-ACS) is the commonest acute presentation of coronary artery disease. Despite an increase in the rate of primary percutaneous coronary intervention (PCI), medical therapy continues to retain a central rol in the treatment of these frail patients and heart rate (HR) at discharge correlates with mortality. Ivabradine is a pure HR reducing agent that has no effect on blood pressure and increases coronary flow reserve, being a new option that could improve the prognosis of this population. Objectives: To evaluate the safety and efficacy of ivabradine prior to PCI in patients with NSTE-ACS. Methods: We included 20 patients with NSTE-ACS (7315 years, 10 women), in sinus rythm and with HR > 70 bpm; Killip Kimball I-II. In addition to standard therapy prior to the PCI, all subjects received ivabradine 5mg twice for those who were previously with beta blockers or ivabradine 7.5mg twice alone when betablocker was not tolerated, with a follow-up period of 2412 months. Results: HR was reduced after the treatment with ivabradine (8513 vs 5905 bpm, p¼0.01), without differences in blood pressure (126/7824/17 vs 123/7420/12mmHg). Ivabradine was well tolerated and with a lower incidence of heart failure-related symptoms in accordance with the classification of NYHA compared to baseline (Class III 60%, IV 40% vs Class I 90%, II 10%). The 20 patients remained free of anginal symptoms. On echocardiography performed at baseline and post-treatment (average 2 months) observed improvement in ejection fraction (4717 vs 5908%, p¼0.01). Serum biomarkers decreased in comparison with the baseline (B-type natriuretic peptide 376228 vs 14084 pg/ml, also high sensitivity C-reactive protein 6.11.8 vs 1.751.5mg/l, p¼0.04). During follow-up were not observed cardiovascular death, non fatal myocardial infarction, recurrent symptomatic ischemia, urgent revascularization or worsening symptoms of heart failure. Conclusion: This pilot study shows that ivabradine can be used safely in combination with successful PCI to decrease the HR in patients with NSTE-ACS. Further studies are needed to characterize its effects on this population. Disclosure of Interest: None Declared
GHEART Vol 11/2S/2016
j
June, 2016
j
POSTER/WCC_2016-POSTERS