- Email: [email protected]
Recurrent Very Late Stent Thrombosis
Abstracts
S230
Using complete data sets, the components of time to PCA from symptom onset (SO) in 604 patients with STEMI (241 ≤1 hour and 363 1-3 hours after symptom onset) who presented within the NSLHD were analysed and related to outcomes. 259 patients presented to the PCA hospital (PCAH) and 345 to the NPCAHs. Guidelines for the < 1 hr patients were met in 46% presenting to PCA hospital and 2.5% in those to NPCAHs. For the 1-3 hour cohort, 69% (PCAH) and 32% (NPCAH) met guidelines. In the < 1hr cohort, median time from NPCAH arrival to ECG was 6 min (2-18 min). Other delays to PCA were door in-door out time of 55 min (24-125 min) and travel time of 48 min (2684). Mortality in the NPCAH patients was 3.4% without any difference between the < 1 hr and 1-3hr groups. For patients presenting to the PCAH, median time to reperfusion in the < 1 and 1-3hr cohorts were 87 and 93 min. For patients presenting to NPCAHs, few met guidelines for PCA. The longest modifiable delay was the door-in door-out time. Nevertheless, outcomes were favourable. http://dx.doi.org/10.1016/j.hlc.2017.06.428 428 Procedural Complication Rates of Percutaneous Transluminal Septal Myocardial Ablation for Hypertrophic Obstructive Cardiomyopathy J. Nogic ∗ , L. McCormick, Y. Koh, M. Bak, R. Gooley, I. Meredith MonashHeart, Monash Health, Melbourne, Australia Background: Percutaneous Transluminal Septal Myocardial Ablation (PTSMA) can relieve symptoms of HOCM. We report immediate procedural outcomes at a tertiary centre over a 16-year period. Methods: Consecutive patients presenting for PTSMA from 2000-2016 were retrospectively analysed. All underwent coronary angiography to assess for suitable septal sub-branches. If appropriate, PTSMA was performed separately under GA with transoesophageal myocardial contrast echocardiographic (MCE) guidance. Results: 85 patients (age 60 ± 15yrs, 52% male) were considered; of these, 9 were excluded (2 - septals too small, 2 balloons could not be delivered into septals, and 5 - echocardiographic opacification of inappropriate myocardium due to extensive septal collaterals). 76 patients (89.4%) proceeded (mean procedural time 106 ± 24mins). An average of 2.2 ± 0.6 ml alcohol was injected into 1.1 ± 0.4 septal perforators. Ventricular arrhythmias necessitating cardioversion occurred in 3 patients (3.9%). Anterior MI due to LAD artery no-reflow occurred in 2 (2.6%). Tamponade occurred in 1 patient (1.3%) after removal of TPW. 14/64 patients (21.9%) required PPM implantation due to CHB. There were no ventricular septal ruptures or intra-procedural deaths. One patient (1.3%) died 3 days post following haemorrhagic stroke. Compared with baseline, PTSMA led to an immediate reduction in resting (51 ± 41 vs 82 ± 50 mmHg; p = 0.0001) and provoked (65 ± 44 vs 96 ± 37 mmHg; p = 0.0002) LVOT
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
gradients. Peak troponin and CK were 33 ± 27 (ug/L) and 1295 ± 792 (U/L) respectively. Conclusion: Sub-selective PTSMA guided by MCE is an effective treatment for reducing LVOT gradients in symptomatic patients with HOCM. Technically feasible in most patients, procedural success can be achieved safely with 2.2 ml of alcohol. http://dx.doi.org/10.1016/j.hlc.2017.06.429 429 Recurrent Very Late Stent Thrombosis S. Lovibond ∗ , M. Leung MonashHeart, Melbourne, Australia Stent thrombosis is a known severe complication following percutaneous coronary intervention. We present a case and accompanying imaging of very late stent thrombosis initially occurring at three years post initial stent deployment and then again at ten years, a presentation which has not previously been documented. The case highlights multiple pathological mechanisms for very late stent thrombosis including stent undersizing, malapposition and positive remodelling as well as risk factors such as the type of stent used and the length of the stented segment. It demonstrates the utility of IVUS in both the sizing and deployment of stents as well in identifying the aetiology at the time of very late stent thrombosis. Additionally, it isolates specific management issues arising in similar patients relating to duration of antiplatelet therapy as well as discussing the potential benefit of bio-absorbable and bio-resorbable stents in relation to stent thrombosis.
http://dx.doi.org/10.1016/j.hlc.2017.06.430 430 Reducing Delay to Reperfusion in a Contemporary Primary PCI Service A. Malancioiu 3,∗ , J. Milne 2 , P. Garrahy 3 , R. Lim 1,2,3 1 The
University of Queensland, Brisbane, Australia 2 Queensland Cardiac Outcomes Registry, Brisbane, Australia 3 The Princess Alexandra Hospital, Brisbane, Australia Background: Primary PCI is preferred for STEMI when no reperfusion delay is expected, but evidence-based targets
S230
Using complete data sets, the components of time to PCA from symptom onset (SO) in 604 patients with STEMI (241 ≤1 hour and 363 1-3 hours after symptom onset) who presented within the NSLHD were analysed and related to outcomes. 259 patients presented to the PCA hospital (PCAH) and 345 to the NPCAHs. Guidelines for the < 1 hr patients were met in 46% presenting to PCA hospital and 2.5% in those to NPCAHs. For the 1-3 hour cohort, 69% (PCAH) and 32% (NPCAH) met guidelines. In the < 1hr cohort, median time from NPCAH arrival to ECG was 6 min (2-18 min). Other delays to PCA were door in-door out time of 55 min (24-125 min) and travel time of 48 min (2684). Mortality in the NPCAH patients was 3.4% without any difference between the < 1 hr and 1-3hr groups. For patients presenting to the PCAH, median time to reperfusion in the < 1 and 1-3hr cohorts were 87 and 93 min. For patients presenting to NPCAHs, few met guidelines for PCA. The longest modifiable delay was the door-in door-out time. Nevertheless, outcomes were favourable. http://dx.doi.org/10.1016/j.hlc.2017.06.428 428 Procedural Complication Rates of Percutaneous Transluminal Septal Myocardial Ablation for Hypertrophic Obstructive Cardiomyopathy J. Nogic ∗ , L. McCormick, Y. Koh, M. Bak, R. Gooley, I. Meredith MonashHeart, Monash Health, Melbourne, Australia Background: Percutaneous Transluminal Septal Myocardial Ablation (PTSMA) can relieve symptoms of HOCM. We report immediate procedural outcomes at a tertiary centre over a 16-year period. Methods: Consecutive patients presenting for PTSMA from 2000-2016 were retrospectively analysed. All underwent coronary angiography to assess for suitable septal sub-branches. If appropriate, PTSMA was performed separately under GA with transoesophageal myocardial contrast echocardiographic (MCE) guidance. Results: 85 patients (age 60 ± 15yrs, 52% male) were considered; of these, 9 were excluded (2 - septals too small, 2 balloons could not be delivered into septals, and 5 - echocardiographic opacification of inappropriate myocardium due to extensive septal collaterals). 76 patients (89.4%) proceeded (mean procedural time 106 ± 24mins). An average of 2.2 ± 0.6 ml alcohol was injected into 1.1 ± 0.4 septal perforators. Ventricular arrhythmias necessitating cardioversion occurred in 3 patients (3.9%). Anterior MI due to LAD artery no-reflow occurred in 2 (2.6%). Tamponade occurred in 1 patient (1.3%) after removal of TPW. 14/64 patients (21.9%) required PPM implantation due to CHB. There were no ventricular septal ruptures or intra-procedural deaths. One patient (1.3%) died 3 days post following haemorrhagic stroke. Compared with baseline, PTSMA led to an immediate reduction in resting (51 ± 41 vs 82 ± 50 mmHg; p = 0.0001) and provoked (65 ± 44 vs 96 ± 37 mmHg; p = 0.0002) LVOT
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
gradients. Peak troponin and CK were 33 ± 27 (ug/L) and 1295 ± 792 (U/L) respectively. Conclusion: Sub-selective PTSMA guided by MCE is an effective treatment for reducing LVOT gradients in symptomatic patients with HOCM. Technically feasible in most patients, procedural success can be achieved safely with 2.2 ml of alcohol. http://dx.doi.org/10.1016/j.hlc.2017.06.429 429 Recurrent Very Late Stent Thrombosis S. Lovibond ∗ , M. Leung MonashHeart, Melbourne, Australia Stent thrombosis is a known severe complication following percutaneous coronary intervention. We present a case and accompanying imaging of very late stent thrombosis initially occurring at three years post initial stent deployment and then again at ten years, a presentation which has not previously been documented. The case highlights multiple pathological mechanisms for very late stent thrombosis including stent undersizing, malapposition and positive remodelling as well as risk factors such as the type of stent used and the length of the stented segment. It demonstrates the utility of IVUS in both the sizing and deployment of stents as well in identifying the aetiology at the time of very late stent thrombosis. Additionally, it isolates specific management issues arising in similar patients relating to duration of antiplatelet therapy as well as discussing the potential benefit of bio-absorbable and bio-resorbable stents in relation to stent thrombosis.
http://dx.doi.org/10.1016/j.hlc.2017.06.430 430 Reducing Delay to Reperfusion in a Contemporary Primary PCI Service A. Malancioiu 3,∗ , J. Milne 2 , P. Garrahy 3 , R. Lim 1,2,3 1 The
University of Queensland, Brisbane, Australia 2 Queensland Cardiac Outcomes Registry, Brisbane, Australia 3 The Princess Alexandra Hospital, Brisbane, Australia Background: Primary PCI is preferred for STEMI when no reperfusion delay is expected, but evidence-based targets