- Email: [email protected]
PT159 Impact of Assessment and Treatment of Coronary Artery Disease on Prognosis of Patients on the Renal Transplantation Waiting List
- Comorbid depression in CHD patients is associated with decreased adherence to therapy, and reduces the chances of successful modification of other risk factors and participation in cardiac rehabilitation. - It is important to recognise depression in patients with CHD. A simple tool for initial screening, such as the Patient Health Questionnaire-2 (PHQ-2), or the Short-Form Cardiac Depression Scale (CDS), can be incorporated into usual clinical practice with minimal interference, and may increase uptake of screening. If screening is followed by comprehensive co-ordinated care, depression outcomes are likely to be improved. Grade of recommendation
Recommendation [1] 1. For patients with CHD, it is reasonable to screen for depression.
Grade A
2. Treatment of depression in CHD patients changes behavioural risk factors/ adherence
Grade B
3. Exercise is an effective treatment of depression in patients with CHD
Grade A
4. Exercise improves CHD outcomes in patients with CHD
Grade B
5. Psychological interventions improve depression in patients with CHD
Grade B
6. SSRIs improve depression in patients with CHD
Grade A
7. Collaborative care approach improves depression in patients with CHD
Grade B
Conclusion: The benefits of screening for and treating depression in CHD patients include improved quality of life, improved adherence to other therapies and potentially improved CHD outcomes. [1] Colquhoun DM, et al. Med J Aust 2013; 198 (9): 483-484. Disclosure of Interest: None Declared PT158 Clinical characteristics, etiology and occurrence of type 2 acute myocardial infarction Filip M. Szymanski*1, Krzysztof J. Filipiak1, Anna E. Platek1, Anna Szymanska2, Grzegorz Karpinski1, Grzegorz Opolski1 1 Cardiology Department, 2Department of Cardiology, Hypertension and Internal Diseases, The Medical University of Warsaw, Warsaw, Poland Introduction: Type 2 myocardial infarction is secondary to ischaemia due to either increased demand or decreased supply of oxygen, e.g. coronary artery spasm, anaemia, arrhythmia, coronary embolism, hypertension, or hypotension. Objectives: The aim of the study was to assess the occurrence and etiology of type 2 acute myocardial infarction (AMI), and to describe the clinical characteristics of study patients. Methods: Retrospectively, the medical records for patients hospitalized in Cardiology Department with AMI between 2009-2012 were reviewed. All patients underwent coronary angiography. Patients were categorized according to the etiology of the type 2 of AMI. Results: Among 2882 patients, we selected 58 (2%) [mean age 67.313; 60.3% female] with discharge diagnosis AMI type 2. 23 (39.6%) patients experiencing coronary artery spasm, 15 (25.9%) arrhythmias, 11 (19%) severe anaemia and 9 (15.5%) patients hypertension without significant coronary artery disease. 42 (72.4%) study patients were diagnosed as non-ST-segment elevation myocardial infarction, 14 (24.1%) as ST-segment elevation myocardial infarction and 2 (3.5%) patients as acute myocardial infarction in the presence of ventricular paced rhythm. 42 (72.4%) study patients had history of hypertension, 14 (24.1%) history of diabetes mellitus, 23 (39.7%) history of dyslipidemia, 24 (41.4%) family history of heart disease and 16 (27.6%) history of smoking. 34 (58.6%) patients suffered from chest pain of various intensity, 17 (29.3%) had palpitations, and 9 (15.5%) had dyspnea. Fainting was a manifestation of AMI in 8 patients (13.8%). The allcause mortality rate at 30 days was 5.2%, and at 6 months 6.9%. Conclusion: Type 2 AMI patients were more often female and diagnosed as non-STsegment elevation myocardial infarction. The prevalence of classical cardiovascular risk factors in this subgroup of patients was very high. Leading cause of AMI was coronary artery spasm. The outcome was similar to patients with AMI type 1. Disclosure of Interest: None Declared PT159 Impact of Assessment and Treatment of Coronary Artery Disease on Prognosis of Patients on the Renal Transplantation Waiting List Jose De Lima*1, Luis Henrique W. Gowdak1, Flavio J. de Paula2, Luiz A. Bortolotto1 1 Cardiology, Heart Institute (InCor) Hospital das Clinicas University of São Paulo Medical School, 2Urology, Renal Transplant Unit Hospital das Clinicas University of São Paulo Medical School, São Paulo, Brazil Introduction: The value of systematic assess of coronary artery disease (CAD) on the waiting list for renal transplantation is controversial.
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
Objectives: To assess the impact of diagnosis and treatment of CAD on the incidence of CV events (myocardial infarction, unstable angina, cardiac arrest, major arrhythmia, heart failure, acute peripheral vascular syndrome) and death in patients on the transplant waiting list. Methods: Unicentric cohort study in 1429 chronic kidney disease patients (54 11 yo, 62% males, 69% Caucasians, 82% hypertensive, 41% diabetic, 39% with associated CVD, median follow-up 42 months) prospectively evaluated for CAD and treated according with AHA/ACCA guidelines between 1997 and 2013. All individuals underwent myocardial scan. Coronary angiography was restricted to patients with angina, altered scan and those with at least two of the following: age 50 yo, diabetes or CVD. Results: The incidence of events was 13%, 20%, and 33% for low-risk patients that did not undergo CA (G 1, n¼ 424), those with nonsignificant stenosis (G 2, n¼ 544) and those with 70% stenosis (G 3, n¼ 461), respectively, p< 0.0001; G 1v G 2 HR 2.17 %CI 1.583.08; G 2 v G 3 HR 1.72 %CI 1.35-2.22. The incidence of death also differed among groups (p< 0.0001). Among 448 patients with 70% stenosis, 349 received medical treatment, 41 were selected for PCI and 58 for CABG (intention to treat). The incidence of events were 34%, 24% and 41%, respectively, p¼ 0.39. The incidence of death also did not differ (p¼ 0.09). However, the difference between patients that actually underwent intervention (n¼ 59) with those who did not (n¼ 40), was significant for events (p¼ 0.004) and death (p¼ 0.0001). Four hundred-twelve patients underwent transplantation and the results for CAD assessment and treatment were similar. Conclusion: Clinical assess for CAD is a useful risk-stratification method for patients on the waiting list. Medical treatment is not inferior compared to intervention when properly selected. However, non-intervention when indicated according with current guidelines may have serious consequences. Disclosure of Interest: None Declared PT160 A greater decline in 30-day case fatality following incident myocardial infarction in diabetics than non-diabetics between 1998 and 2010 Lee Nedkoff*1, Matthew Knuiman1, Joe Hung1,2, Tom Briffa1 School of Population Health, 2School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia 1
Introduction: Early mortality following myocardial infarction (MI) is worse in diabetics than non-diabetics. Whether more aggressive risk factor management of diabetics as well as better treatment after MI onset have reduced this differential is unknown. Objectives: To measure population trends in 30-day case fatality following incident MI in patients with and without diabetes. Methods: All incident MIs in 35-84 year olds from 1998-2010 were identified from the WA Data Linkage System, using a 13-year hospitalisation history to identify incident MI and classify patients as diabetic. 30-day case-fatality was defined as all-cause death within 30-days of MI admission. Case-fatality was age-standardised by 5-year agegroup and trends analysed with age-adjusted logistic regression models by period (1998-2001, 2002-04, 2005-07, 2008-10). Variables associated with 30-day deaths from logistic regression (p<0.05) were entered into a multivariate model to test for differences in trends between diabetics and non-diabetics. Results: There were 26,610 incident MIs during the 13-year study period, with 1691 deaths occurring within 30 days (29.3% diabetics, 58.9% men). Unadjusted 30-day casefatality was highest in women in the first period (14.1% in diabetics and 12.4% in nondiabetics). Age-standardised case fatality fell from 9.0% to 2.6% in diabetic women and from 5.6% to 2.7% in non-diabetic women, and from 7.1% to 1.5% in diabetic men and from 3.6% to 2.1% in non-diabetic men. The strongest univariate predictors of 30-day deaths were increasing age, heart failure, prior stroke and chronic kidney disease, with PCI during the incident admission protective of 30-day deaths. After multivariate adjustment, the annual rate of decline in 30-day deaths was significantly greater in diabetic than nondiabetic men (-7%/year vs -1%/year, p<0.01), and was also greater, although not significantly so, in diabetic than non-diabetic women (-8%/year vs -4%/year, p¼0.16). Conclusion: Early case-fatality following incident MI has improved significantly over the past decade in diabetics and non-diabetics, with greater absolute declines seen in diabetic men and women. These findings are consistent with improved acute MI care and possibly better control of cardiovascular risk profile in diabetics. Disclosure of Interest: None Declared PT161 Long-term mortality in diabetics and non-diabetics after incident myocardial infarction Lee Nedkoff*1, Matthew Knuiman1, Joe Hung1,2, Tom Briffa1 School of Population Health, 2School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia 1
Introduction: Post-myocardial infarction (MI) survival is worse in diabetics than non-diabetics, however it is unclear if this differential in mortality has reduced over time. Objectives: To measure population trends in 5-year mortality after incident MI in patients with and without diabetes, and determine whether the gap in mortality has changed over time. Methods: The Western Australian Data Linkage System was used to identify incident MIs in 35-84 year olds from 1998-2005. Cases were stratified by diabetes status based on 13-year hospitalisation history. All-cause and cardiovascular disease (CVD) deaths within 5-years in patients surviving 30-days were identified. Men and women were analysed separately. Unadjusted mortality for incident MIs were estimated from Kaplan-Meier curves. Hazard ratios (HR) for 5-year mortality in diabetics compared with non-diabetics
e197
POSTER ABSTRACTS
Methods: An expert working group reviewed new evidence in this area. Literature searches used key search phrases, including stress, depression, anxiety, acute coronary syndromes, adherence, treatment and screening. Recommendations were made for screening, referral and treatment based on this evidence [1]. The Cardiac Society of Australia and New Zealand and the Royal Australian and New Zealand College of Psychiatrists have endorsed the content. Results: The prevalence of depression is high in patients with CHD and it has a significant negative impact on the patient’s quality of life and prognosis.
Recommendation [1] 1. For patients with CHD, it is reasonable to screen for depression.
Grade A
2. Treatment of depression in CHD patients changes behavioural risk factors/ adherence
Grade B
3. Exercise is an effective treatment of depression in patients with CHD
Grade A
4. Exercise improves CHD outcomes in patients with CHD
Grade B
5. Psychological interventions improve depression in patients with CHD
Grade B
6. SSRIs improve depression in patients with CHD
Grade A
7. Collaborative care approach improves depression in patients with CHD
Grade B
Conclusion: The benefits of screening for and treating depression in CHD patients include improved quality of life, improved adherence to other therapies and potentially improved CHD outcomes. [1] Colquhoun DM, et al. Med J Aust 2013; 198 (9): 483-484. Disclosure of Interest: None Declared PT158 Clinical characteristics, etiology and occurrence of type 2 acute myocardial infarction Filip M. Szymanski*1, Krzysztof J. Filipiak1, Anna E. Platek1, Anna Szymanska2, Grzegorz Karpinski1, Grzegorz Opolski1 1 Cardiology Department, 2Department of Cardiology, Hypertension and Internal Diseases, The Medical University of Warsaw, Warsaw, Poland Introduction: Type 2 myocardial infarction is secondary to ischaemia due to either increased demand or decreased supply of oxygen, e.g. coronary artery spasm, anaemia, arrhythmia, coronary embolism, hypertension, or hypotension. Objectives: The aim of the study was to assess the occurrence and etiology of type 2 acute myocardial infarction (AMI), and to describe the clinical characteristics of study patients. Methods: Retrospectively, the medical records for patients hospitalized in Cardiology Department with AMI between 2009-2012 were reviewed. All patients underwent coronary angiography. Patients were categorized according to the etiology of the type 2 of AMI. Results: Among 2882 patients, we selected 58 (2%) [mean age 67.313; 60.3% female] with discharge diagnosis AMI type 2. 23 (39.6%) patients experiencing coronary artery spasm, 15 (25.9%) arrhythmias, 11 (19%) severe anaemia and 9 (15.5%) patients hypertension without significant coronary artery disease. 42 (72.4%) study patients were diagnosed as non-ST-segment elevation myocardial infarction, 14 (24.1%) as ST-segment elevation myocardial infarction and 2 (3.5%) patients as acute myocardial infarction in the presence of ventricular paced rhythm. 42 (72.4%) study patients had history of hypertension, 14 (24.1%) history of diabetes mellitus, 23 (39.7%) history of dyslipidemia, 24 (41.4%) family history of heart disease and 16 (27.6%) history of smoking. 34 (58.6%) patients suffered from chest pain of various intensity, 17 (29.3%) had palpitations, and 9 (15.5%) had dyspnea. Fainting was a manifestation of AMI in 8 patients (13.8%). The allcause mortality rate at 30 days was 5.2%, and at 6 months 6.9%. Conclusion: Type 2 AMI patients were more often female and diagnosed as non-STsegment elevation myocardial infarction. The prevalence of classical cardiovascular risk factors in this subgroup of patients was very high. Leading cause of AMI was coronary artery spasm. The outcome was similar to patients with AMI type 1. Disclosure of Interest: None Declared PT159 Impact of Assessment and Treatment of Coronary Artery Disease on Prognosis of Patients on the Renal Transplantation Waiting List Jose De Lima*1, Luis Henrique W. Gowdak1, Flavio J. de Paula2, Luiz A. Bortolotto1 1 Cardiology, Heart Institute (InCor) Hospital das Clinicas University of São Paulo Medical School, 2Urology, Renal Transplant Unit Hospital das Clinicas University of São Paulo Medical School, São Paulo, Brazil Introduction: The value of systematic assess of coronary artery disease (CAD) on the waiting list for renal transplantation is controversial.
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
Objectives: To assess the impact of diagnosis and treatment of CAD on the incidence of CV events (myocardial infarction, unstable angina, cardiac arrest, major arrhythmia, heart failure, acute peripheral vascular syndrome) and death in patients on the transplant waiting list. Methods: Unicentric cohort study in 1429 chronic kidney disease patients (54 11 yo, 62% males, 69% Caucasians, 82% hypertensive, 41% diabetic, 39% with associated CVD, median follow-up 42 months) prospectively evaluated for CAD and treated according with AHA/ACCA guidelines between 1997 and 2013. All individuals underwent myocardial scan. Coronary angiography was restricted to patients with angina, altered scan and those with at least two of the following: age 50 yo, diabetes or CVD. Results: The incidence of events was 13%, 20%, and 33% for low-risk patients that did not undergo CA (G 1, n¼ 424), those with nonsignificant stenosis (G 2, n¼ 544) and those with 70% stenosis (G 3, n¼ 461), respectively, p< 0.0001; G 1v G 2 HR 2.17 %CI 1.583.08; G 2 v G 3 HR 1.72 %CI 1.35-2.22. The incidence of death also differed among groups (p< 0.0001). Among 448 patients with 70% stenosis, 349 received medical treatment, 41 were selected for PCI and 58 for CABG (intention to treat). The incidence of events were 34%, 24% and 41%, respectively, p¼ 0.39. The incidence of death also did not differ (p¼ 0.09). However, the difference between patients that actually underwent intervention (n¼ 59) with those who did not (n¼ 40), was significant for events (p¼ 0.004) and death (p¼ 0.0001). Four hundred-twelve patients underwent transplantation and the results for CAD assessment and treatment were similar. Conclusion: Clinical assess for CAD is a useful risk-stratification method for patients on the waiting list. Medical treatment is not inferior compared to intervention when properly selected. However, non-intervention when indicated according with current guidelines may have serious consequences. Disclosure of Interest: None Declared PT160 A greater decline in 30-day case fatality following incident myocardial infarction in diabetics than non-diabetics between 1998 and 2010 Lee Nedkoff*1, Matthew Knuiman1, Joe Hung1,2, Tom Briffa1 School of Population Health, 2School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia 1
Introduction: Early mortality following myocardial infarction (MI) is worse in diabetics than non-diabetics. Whether more aggressive risk factor management of diabetics as well as better treatment after MI onset have reduced this differential is unknown. Objectives: To measure population trends in 30-day case fatality following incident MI in patients with and without diabetes. Methods: All incident MIs in 35-84 year olds from 1998-2010 were identified from the WA Data Linkage System, using a 13-year hospitalisation history to identify incident MI and classify patients as diabetic. 30-day case-fatality was defined as all-cause death within 30-days of MI admission. Case-fatality was age-standardised by 5-year agegroup and trends analysed with age-adjusted logistic regression models by period (1998-2001, 2002-04, 2005-07, 2008-10). Variables associated with 30-day deaths from logistic regression (p<0.05) were entered into a multivariate model to test for differences in trends between diabetics and non-diabetics. Results: There were 26,610 incident MIs during the 13-year study period, with 1691 deaths occurring within 30 days (29.3% diabetics, 58.9% men). Unadjusted 30-day casefatality was highest in women in the first period (14.1% in diabetics and 12.4% in nondiabetics). Age-standardised case fatality fell from 9.0% to 2.6% in diabetic women and from 5.6% to 2.7% in non-diabetic women, and from 7.1% to 1.5% in diabetic men and from 3.6% to 2.1% in non-diabetic men. The strongest univariate predictors of 30-day deaths were increasing age, heart failure, prior stroke and chronic kidney disease, with PCI during the incident admission protective of 30-day deaths. After multivariate adjustment, the annual rate of decline in 30-day deaths was significantly greater in diabetic than nondiabetic men (-7%/year vs -1%/year, p<0.01), and was also greater, although not significantly so, in diabetic than non-diabetic women (-8%/year vs -4%/year, p¼0.16). Conclusion: Early case-fatality following incident MI has improved significantly over the past decade in diabetics and non-diabetics, with greater absolute declines seen in diabetic men and women. These findings are consistent with improved acute MI care and possibly better control of cardiovascular risk profile in diabetics. Disclosure of Interest: None Declared PT161 Long-term mortality in diabetics and non-diabetics after incident myocardial infarction Lee Nedkoff*1, Matthew Knuiman1, Joe Hung1,2, Tom Briffa1 School of Population Health, 2School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia 1
Introduction: Post-myocardial infarction (MI) survival is worse in diabetics than non-diabetics, however it is unclear if this differential in mortality has reduced over time. Objectives: To measure population trends in 5-year mortality after incident MI in patients with and without diabetes, and determine whether the gap in mortality has changed over time. Methods: The Western Australian Data Linkage System was used to identify incident MIs in 35-84 year olds from 1998-2005. Cases were stratified by diabetes status based on 13-year hospitalisation history. All-cause and cardiovascular disease (CVD) deaths within 5-years in patients surviving 30-days were identified. Men and women were analysed separately. Unadjusted mortality for incident MIs were estimated from Kaplan-Meier curves. Hazard ratios (HR) for 5-year mortality in diabetics compared with non-diabetics
e197
POSTER ABSTRACTS
Methods: An expert working group reviewed new evidence in this area. Literature searches used key search phrases, including stress, depression, anxiety, acute coronary syndromes, adherence, treatment and screening. Recommendations were made for screening, referral and treatment based on this evidence [1]. The Cardiac Society of Australia and New Zealand and the Royal Australian and New Zealand College of Psychiatrists have endorsed the content. Results: The prevalence of depression is high in patients with CHD and it has a significant negative impact on the patient’s quality of life and prognosis.