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PW150 Predictive Factors of Long-Term Cardiovascular Death After A First Myocardial Infarction: A 9.6-Year Follow-Up Study
POSTER ABSTRACTS
PW149 The Characteristics and Trends of Poba in Current Des Era Manabu Moriya*1, Sugao Ishiwata1, Ohno Minoru1 1 Cardsiology, Toranomon Hospital, Tokyo, Japan Introduction: Although drug eluting stents (DES) are known to minimize the risk of restenosis, some of the cases are still selecting plain old balloon angioplasty (POBA) for some reasons. Objectives: The aim of this study is to clarify the characteristics and trends of POBA in current DES era. Methods: We examined the cases of POBA performed in our institute during years of 2008 to 2012 retrospectively. For control, bare metal stents (BMS) and DES implantation done in 2011 were analyzed. Results: During the period, 85 POBA, 63 BMS, 132 DES cases were identified. POBA cases were significantly older than BMS (69.5+/-10.7, 64.0+/-10.1, 67.6+/-9.5 year-old, POBA, BMS, DES, respectively, p<0.05). The device used were significantly smaller diameter in POBA than others (2.69+/-0.55, 3.07+/-0.49, 2.94+/-0.41 mm, POBA, BMS, DES, respectively, p<0.01). Within 218 cases (POBA 63, BMS 47, DES 108) completed follow up angiography, the rate of restenosis was significantly higher in POBA than BMS and DES (39.7%, 14.9%, 3.7%, POBA, BMS, DES, respectively, p<0.001). Unlike other strategies, restenosis cases in POBA used significantly larger devices than the other (2.90+/-0.64 vs. 2.61+/-0.49 mm, restenosis or not, p<0.05). After extracting the cases unable to classify, we create 3 categories for the reason of selecting POBA. 1; stent delivery failure or expected difficulty for stent delivery due to calcification etc. (n¼14), 2; intervention for in-stent restenosis or stent thrombosis (n¼34), 3; successful POBA for small vessels without complication (n¼14). According to it, category 1 showed significantly high probability for restenosis than others (1; 10/14, 71.4%, 2; 12/34, 35.3%, 3; 2/14, 14.3%, p<0.05) while category 3 showed nearly as good as BMS. Conclusion: POBA was done for older cases with smaller devices and showed significantly high probability for restenosis. We can interpret the categories of reason for POBA as follows; category 1 for negative selection, 3 for positive selection. Cases forced to select POBA had still unfavorable results whereas cases intentionally avoid stent implantation had tolerable outcome in current DES era. Disclosure of Interest: None Declared PW150 Predictive Factors of Long-Term Cardiovascular Death After A First Myocardial Infarction: A 9.6-Year Follow-Up Study Kais Ouerghi*1, Salem Abdessalem1, Amani Kallel1, Riadh Jemaa1, Rachid Mechmeche1 1 Cardiology, La Rabta Hospital, Tunis, Tunisia Introduction: Few studies have studied predictive factors of mortality in long term in patients who presented an acute coronary syndrome with ST segment elevation (STEMI) treated with fibrinolysis or percutaneous angioplasty. Objectives: We sought to assess the predicting factors of mortality, 9.6 years after first myocardial infarction. Methods: This is a prospective single-center longitudinal trial held between August 1997 and September 2011. Between August 1997 and august 2004, were randomly included 146 patients who had had a first nonfatal myocardial infarction during the first 30 days. After a mean follow up of 9.6 years, we recorded the event cardiovascular death. Results: The total number of cardiovascular death at 9.6 years is 18 with a mortality of 12.3%. The average time of death is 5.2 + / -4.8 years, ranging from 127 days to 13.4 years. Factors significantly predictive of cardiovascular death at 9.6 years in univariate analysis were age (p ¼ 0.002), diabetes (p ¼ 0.01) and multivessel coronary disease (p ¼ 0.05). There is a tendency to correlation of cardiovascular death at 9.6 years with history of hypertension (p ¼ 0.06). In multivariate analysis independent factors predictors of cardiovascular death are: age> 55 years (OR ¼ 8.53, 95% CI: 1.97, 36.96, p ¼ 0.004), diabetes (OR ¼ 4.3, 95% CI: 1.31, 14.15, p ¼ 0016) and the anterior territory of myocardial infarction (OR ¼ 5.5, 95% CI: 1.02, 29.66, p ¼ 0.047). There was no difference in mortality at 9.6 years between patients treated with fibrinolysis or coronary angioplasty. Conclusion: In our population predictors of cardiovascular mortality at 9.6 years after a first non-fatal myocardial infarction, in the multivariate analysis, are age, the anterior territory of the infarct and diabetes. Particular care in those patients should be held to reduce the long-term mortality. Disclosure of Interest: None Declared PW152 Initial Experience With The Pre-Hospital Assessment For Primary Angiogram (PAPA) Program For ST Elevation Myocardial Infarction Based On The Glasgow Algorithm At A Regional New South Wales Hospital Without Onsite Cardiac Surgery 1
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Giuseppe Femia* , Daniel Devenney , Antonio Tiberio , Prathap Hegde , Nguyen Dang , William McKenzie1, Dwain Owensby1, Pratap Shetty1, Aaron Yeung1, Astin Lee1 1 The Wollongong Hospital Cardiology Department, Wollongong, Australia Introduction: The Wollongong Hospital Cardiology Department provides primary percutaneous coronary intervention (PPCI) service to a high-risk population of approximately 350 000 residents. To enable ST elevation myocardial infarcts (STEMIs) access to timely cardiology care and improve first medical contact to lab/balloon (FMCL/B) times and
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cardiovascular outcomes, the Glasgow algorithm was implemented and termed pre hospital assessment for primary angiogram (PAPA). In this program, pre-hospital ECGs are preformed for patents with chest pain and those that satisfy the ST elevation algorithm are reviewed by the on call interventionist. Patients deemed appropriate are brought directly to the catheterization lab without attending the emergency department. Objectives: Evaluate the effectiveness of the Glasgow algorithm as a method to improve intervention times and cardiovascular outcomes. Methods: This study was conducted at a center where PPCI is routinely performed for all STEMIs. All ECGs that satisfied the Glasgow algorithm between March 31st and August 1st 2013 were retrospectively evaluated for FMCL/B times and primary and secondary outcomes. Hospital transfers and out of hospital cardiac arrests were excluded. Primary outcomes included in hospital death, cardiogenic shock and recurrent MI at 30 days. Secondary outcomes included acute kidney injury and bleeding. Results: 35 pre-hospital ECGs satisfied the algorithm but only 22 (62.8%) were deemed appropriate by the on call interventionist. Of the 22 patients, 19 (54.3%) underwent PPCI, 1 (2.9%) was medically unstable and not suitable for investigation and 2 (5.7%) had no identifiable culprit lesion and were treated medically. On review of the 13 rejected ECGs, zero had ST elevation but 3 had troponin rises and required coronary intervention. Median FMCL/B times were 45 (19-52) and 78 (55-116) minutes respectively. FMCB was within 90 minutes for 17 (89%) and within 120 minutes for 19 (100%) of the patients. The positive predictive value (PPV) for the algorithm was 66% for STEMIs and 54% for intervention. Clinical follow-up at 30 days was available for 34 patients; there were 4 (18.1%) primary outcomes with 1 (4.5%) in hospital death and 2 (9.1%) secondary outcomes. Conclusion: Initial data indicates that within the PAPA program, haemodynamically stable patients with suspected STEMIs can be safely and effectively identified with the Glasgow algorithm and transported directly for PPCI. Disclosure of Interest: None Declared PW153 The Safety of Remote PCI in 1,543 Patients in Rural New South Wales without Cardiac Surgery Onsite Colin-John Perrins*1, Arnagretta Hunter1,2, Craig McLachlan1, Hassan Assareh1,3, Peter Ruchin1,2, Michael McCready1,2, Joseph Suttie1,2, Paul Roy4, Gerard Carroll1,2 1 Faculty of Medicine, Rural Clinical School, UNSW, 2Riverina Cardiology, Wagga Wagga, 3 Simpson Centre for Health Services Research, Australian Institute of Health Innovation, Faculty of Medicine, UNSW, 4St Vincent’s Clinic, Sydney, Australia Introduction: Historically there are concerns about PCI at centres without onsite cardiac surgery. This policy effectively rules out the gold standard of care for patients with STEMI and ACS in regional and remote areas. While this policy remains controversial, a growing international body of research indicates the safety and efficacy of PCI without cardiac surgery onsite. Wagga Wagga, NSW offers regional PCI for urgent and elective cases and is the furthest from cardiac surgical backup that has been published to date internationally. Objectives: To describe demographics and cardiac risk factors of patients undergoing PCI in Wagga Wagga. To model procedural factors associated with adverse outcomes while adjusting for baseline risk factors. To audit major adverse cardiac events in-hospital and at 30 days. The 30-day MACE outcome combines mortality, myocardial infarction, cerebrovascular accident and target lesion revascularisation (TLR). Methods: A retrospective audit was undertaken from June 2004 to June 2013 of patients receiving PCI in Wagga Wagga, NSW. A cohort of 1,543 consecutive patients was included in the study with no exclusion criteria. Multivariate logistic models were used to investigate the association between procedural factors 30-day PCI outcomes. Results: Patients received emergency PCI for STEMI (18.3%), Non-ST-Elevation Acute Coronary Syndrome (26.4%) or symptomatic relief in Stable Coronary Disease (55.3%). Angiographic success for all patients was 97%. 5 patients died in hospital over 9 years (0.3%): three of these patients presented late with severe anterior STEMI (one having failed thrombolysis), one re-infarcted after PCI, one suffered respiratory arrest. The rate of 30-day MACE was low for all patients (3.2%) and 7.6% for the STEMI group. The difference was additional repeat TLR procedures post PCI for STEMI (3.5%). The patients with stents inserted were less likely to have a 30-day MACE (OR¼0.127, p¼0.001). The significant decrease in 30-day MACE over time (OR¼0.739, p¼0.001) was seen alongside the increase in DES usage (OR¼1.077, p¼0.043). Conclusion: The cohort of patients who have undergone PCI without surgical backup in Wagga Wagga represent a range of indications and baseline risk reflective of the higher rates of cardiovascular disease in rural Australia. The rate of angiographic success has been high and the rates of adverse effects have been very low compared to international standards. This audit adds support for regional models of care for ACS without cardiac surgery on site. Disclosure of Interest: None Declared PW154 Predictors of Stent Thrombosis After Percutaneous Coronary Intervention in Acute Coronary Syndrome: KICS registry Masahide Nagano*1, Seiji Hokimoto2, Koichi Nakao3, Hisao Ogawa4, Saiseikai Kumamoto Hospital 1 Division of Cardiology, Saiseikai Kumamoto Hospital, 2Division of Cardiology, Kumamoto University, 3Saiseikai Kumamoto Hospital, 4Kumamoto University, Kumamoto, Japan Introduction: Stent thrombosis (ST) has emerged as a severe complication of percutaneous coronary interventions (PCI) in acute coronary syndrome (ACS). The occurrence of ST is
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters
PW149 The Characteristics and Trends of Poba in Current Des Era Manabu Moriya*1, Sugao Ishiwata1, Ohno Minoru1 1 Cardsiology, Toranomon Hospital, Tokyo, Japan Introduction: Although drug eluting stents (DES) are known to minimize the risk of restenosis, some of the cases are still selecting plain old balloon angioplasty (POBA) for some reasons. Objectives: The aim of this study is to clarify the characteristics and trends of POBA in current DES era. Methods: We examined the cases of POBA performed in our institute during years of 2008 to 2012 retrospectively. For control, bare metal stents (BMS) and DES implantation done in 2011 were analyzed. Results: During the period, 85 POBA, 63 BMS, 132 DES cases were identified. POBA cases were significantly older than BMS (69.5+/-10.7, 64.0+/-10.1, 67.6+/-9.5 year-old, POBA, BMS, DES, respectively, p<0.05). The device used were significantly smaller diameter in POBA than others (2.69+/-0.55, 3.07+/-0.49, 2.94+/-0.41 mm, POBA, BMS, DES, respectively, p<0.01). Within 218 cases (POBA 63, BMS 47, DES 108) completed follow up angiography, the rate of restenosis was significantly higher in POBA than BMS and DES (39.7%, 14.9%, 3.7%, POBA, BMS, DES, respectively, p<0.001). Unlike other strategies, restenosis cases in POBA used significantly larger devices than the other (2.90+/-0.64 vs. 2.61+/-0.49 mm, restenosis or not, p<0.05). After extracting the cases unable to classify, we create 3 categories for the reason of selecting POBA. 1; stent delivery failure or expected difficulty for stent delivery due to calcification etc. (n¼14), 2; intervention for in-stent restenosis or stent thrombosis (n¼34), 3; successful POBA for small vessels without complication (n¼14). According to it, category 1 showed significantly high probability for restenosis than others (1; 10/14, 71.4%, 2; 12/34, 35.3%, 3; 2/14, 14.3%, p<0.05) while category 3 showed nearly as good as BMS. Conclusion: POBA was done for older cases with smaller devices and showed significantly high probability for restenosis. We can interpret the categories of reason for POBA as follows; category 1 for negative selection, 3 for positive selection. Cases forced to select POBA had still unfavorable results whereas cases intentionally avoid stent implantation had tolerable outcome in current DES era. Disclosure of Interest: None Declared PW150 Predictive Factors of Long-Term Cardiovascular Death After A First Myocardial Infarction: A 9.6-Year Follow-Up Study Kais Ouerghi*1, Salem Abdessalem1, Amani Kallel1, Riadh Jemaa1, Rachid Mechmeche1 1 Cardiology, La Rabta Hospital, Tunis, Tunisia Introduction: Few studies have studied predictive factors of mortality in long term in patients who presented an acute coronary syndrome with ST segment elevation (STEMI) treated with fibrinolysis or percutaneous angioplasty. Objectives: We sought to assess the predicting factors of mortality, 9.6 years after first myocardial infarction. Methods: This is a prospective single-center longitudinal trial held between August 1997 and September 2011. Between August 1997 and august 2004, were randomly included 146 patients who had had a first nonfatal myocardial infarction during the first 30 days. After a mean follow up of 9.6 years, we recorded the event cardiovascular death. Results: The total number of cardiovascular death at 9.6 years is 18 with a mortality of 12.3%. The average time of death is 5.2 + / -4.8 years, ranging from 127 days to 13.4 years. Factors significantly predictive of cardiovascular death at 9.6 years in univariate analysis were age (p ¼ 0.002), diabetes (p ¼ 0.01) and multivessel coronary disease (p ¼ 0.05). There is a tendency to correlation of cardiovascular death at 9.6 years with history of hypertension (p ¼ 0.06). In multivariate analysis independent factors predictors of cardiovascular death are: age> 55 years (OR ¼ 8.53, 95% CI: 1.97, 36.96, p ¼ 0.004), diabetes (OR ¼ 4.3, 95% CI: 1.31, 14.15, p ¼ 0016) and the anterior territory of myocardial infarction (OR ¼ 5.5, 95% CI: 1.02, 29.66, p ¼ 0.047). There was no difference in mortality at 9.6 years between patients treated with fibrinolysis or coronary angioplasty. Conclusion: In our population predictors of cardiovascular mortality at 9.6 years after a first non-fatal myocardial infarction, in the multivariate analysis, are age, the anterior territory of the infarct and diabetes. Particular care in those patients should be held to reduce the long-term mortality. Disclosure of Interest: None Declared PW152 Initial Experience With The Pre-Hospital Assessment For Primary Angiogram (PAPA) Program For ST Elevation Myocardial Infarction Based On The Glasgow Algorithm At A Regional New South Wales Hospital Without Onsite Cardiac Surgery 1
1
1
1
1
Giuseppe Femia* , Daniel Devenney , Antonio Tiberio , Prathap Hegde , Nguyen Dang , William McKenzie1, Dwain Owensby1, Pratap Shetty1, Aaron Yeung1, Astin Lee1 1 The Wollongong Hospital Cardiology Department, Wollongong, Australia Introduction: The Wollongong Hospital Cardiology Department provides primary percutaneous coronary intervention (PPCI) service to a high-risk population of approximately 350 000 residents. To enable ST elevation myocardial infarcts (STEMIs) access to timely cardiology care and improve first medical contact to lab/balloon (FMCL/B) times and
e290
cardiovascular outcomes, the Glasgow algorithm was implemented and termed pre hospital assessment for primary angiogram (PAPA). In this program, pre-hospital ECGs are preformed for patents with chest pain and those that satisfy the ST elevation algorithm are reviewed by the on call interventionist. Patients deemed appropriate are brought directly to the catheterization lab without attending the emergency department. Objectives: Evaluate the effectiveness of the Glasgow algorithm as a method to improve intervention times and cardiovascular outcomes. Methods: This study was conducted at a center where PPCI is routinely performed for all STEMIs. All ECGs that satisfied the Glasgow algorithm between March 31st and August 1st 2013 were retrospectively evaluated for FMCL/B times and primary and secondary outcomes. Hospital transfers and out of hospital cardiac arrests were excluded. Primary outcomes included in hospital death, cardiogenic shock and recurrent MI at 30 days. Secondary outcomes included acute kidney injury and bleeding. Results: 35 pre-hospital ECGs satisfied the algorithm but only 22 (62.8%) were deemed appropriate by the on call interventionist. Of the 22 patients, 19 (54.3%) underwent PPCI, 1 (2.9%) was medically unstable and not suitable for investigation and 2 (5.7%) had no identifiable culprit lesion and were treated medically. On review of the 13 rejected ECGs, zero had ST elevation but 3 had troponin rises and required coronary intervention. Median FMCL/B times were 45 (19-52) and 78 (55-116) minutes respectively. FMCB was within 90 minutes for 17 (89%) and within 120 minutes for 19 (100%) of the patients. The positive predictive value (PPV) for the algorithm was 66% for STEMIs and 54% for intervention. Clinical follow-up at 30 days was available for 34 patients; there were 4 (18.1%) primary outcomes with 1 (4.5%) in hospital death and 2 (9.1%) secondary outcomes. Conclusion: Initial data indicates that within the PAPA program, haemodynamically stable patients with suspected STEMIs can be safely and effectively identified with the Glasgow algorithm and transported directly for PPCI. Disclosure of Interest: None Declared PW153 The Safety of Remote PCI in 1,543 Patients in Rural New South Wales without Cardiac Surgery Onsite Colin-John Perrins*1, Arnagretta Hunter1,2, Craig McLachlan1, Hassan Assareh1,3, Peter Ruchin1,2, Michael McCready1,2, Joseph Suttie1,2, Paul Roy4, Gerard Carroll1,2 1 Faculty of Medicine, Rural Clinical School, UNSW, 2Riverina Cardiology, Wagga Wagga, 3 Simpson Centre for Health Services Research, Australian Institute of Health Innovation, Faculty of Medicine, UNSW, 4St Vincent’s Clinic, Sydney, Australia Introduction: Historically there are concerns about PCI at centres without onsite cardiac surgery. This policy effectively rules out the gold standard of care for patients with STEMI and ACS in regional and remote areas. While this policy remains controversial, a growing international body of research indicates the safety and efficacy of PCI without cardiac surgery onsite. Wagga Wagga, NSW offers regional PCI for urgent and elective cases and is the furthest from cardiac surgical backup that has been published to date internationally. Objectives: To describe demographics and cardiac risk factors of patients undergoing PCI in Wagga Wagga. To model procedural factors associated with adverse outcomes while adjusting for baseline risk factors. To audit major adverse cardiac events in-hospital and at 30 days. The 30-day MACE outcome combines mortality, myocardial infarction, cerebrovascular accident and target lesion revascularisation (TLR). Methods: A retrospective audit was undertaken from June 2004 to June 2013 of patients receiving PCI in Wagga Wagga, NSW. A cohort of 1,543 consecutive patients was included in the study with no exclusion criteria. Multivariate logistic models were used to investigate the association between procedural factors 30-day PCI outcomes. Results: Patients received emergency PCI for STEMI (18.3%), Non-ST-Elevation Acute Coronary Syndrome (26.4%) or symptomatic relief in Stable Coronary Disease (55.3%). Angiographic success for all patients was 97%. 5 patients died in hospital over 9 years (0.3%): three of these patients presented late with severe anterior STEMI (one having failed thrombolysis), one re-infarcted after PCI, one suffered respiratory arrest. The rate of 30-day MACE was low for all patients (3.2%) and 7.6% for the STEMI group. The difference was additional repeat TLR procedures post PCI for STEMI (3.5%). The patients with stents inserted were less likely to have a 30-day MACE (OR¼0.127, p¼0.001). The significant decrease in 30-day MACE over time (OR¼0.739, p¼0.001) was seen alongside the increase in DES usage (OR¼1.077, p¼0.043). Conclusion: The cohort of patients who have undergone PCI without surgical backup in Wagga Wagga represent a range of indications and baseline risk reflective of the higher rates of cardiovascular disease in rural Australia. The rate of angiographic success has been high and the rates of adverse effects have been very low compared to international standards. This audit adds support for regional models of care for ACS without cardiac surgery on site. Disclosure of Interest: None Declared PW154 Predictors of Stent Thrombosis After Percutaneous Coronary Intervention in Acute Coronary Syndrome: KICS registry Masahide Nagano*1, Seiji Hokimoto2, Koichi Nakao3, Hisao Ogawa4, Saiseikai Kumamoto Hospital 1 Division of Cardiology, Saiseikai Kumamoto Hospital, 2Division of Cardiology, Kumamoto University, 3Saiseikai Kumamoto Hospital, 4Kumamoto University, Kumamoto, Japan Introduction: Stent thrombosis (ST) has emerged as a severe complication of percutaneous coronary interventions (PCI) in acute coronary syndrome (ACS). The occurrence of ST is
GHEART Vol 9/1S/2014
j
March, 2014
j
POSTER/2014 WCC Posters