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Role of Angiographic Perfusion Score to Predict Clinical Outcomes in ACS Patients Undergoing PCI
S26
Abstracts
Heart, Lung and Circulation 2009;18S:S1–S31
ABSTRACTS
with AUC for cTnI (r = 0.503, p < 0.001), but not early cardiac function. Conclusion: Biomarkers alone (cTnI), at an appropriate threshold appear robust for the detection of Type V MI, without the use of supplementary evidence as suggested by the AHA/ESC criteria. doi:10.1016/j.hlc.2009.04.060 58 UNTREATED SEVERE AORTIC STENOSIS (AS) IS ASSOCIATED WITH POOR OUTCOMES S Perera 1,∗ , N Pasupati 1
Wijesinghe 2 , E
Ly 1 , G
Devlin 1 , S
1 Department of Cardiology, Waikato Hospital, Hamilton, New Zealand 2 Department of Interventional Cardiology and Research, St Paul’s Hospital, Vancouver, BC, Canada
Background: Severe AS is a common cause of morbidity and hospitalisation in the elderly. Surgical aortic valve replacement remains the gold standard of treatment but is often not considered due to excessive risk factors and comorbidities. We describe the burden of untreated severe AS at Waikato Hospital. Method: Consecutive patients with severe AS at Waikato hospital between January and December 2005 were studied retrospectively. Outcomes assessed included mortality, number of days spent in the hospital per year and ongoing symptoms (angina > CCS class 2, dyspnoea > NYHA class 2, syncope). Results: A total of 104 patients with severe AS were identified (mean age 76.6 ± 13.8 years, 52% men) during the 12-month period. Patients were divided into 3 groups according to management strategy. (Group 1: Not referred for surgery as asymptomatic, Group 2: Declined for surgery, Group 3: Accepted for surgery). Median follow up was 34 months.
Group 1 Group 2 Group 3
Number
All Cause Mortality
Hospital Days/100 pts/year
Symptoms on Follow-up
25 (24%) 38 (37%) 41 (39%)
36% 71% 22%
3.5 11.6 6
00% 64% 00%
Almost half of symptomatic patients (Group 2 vs. 3) were denied valve surgery due to co-morbidities. Symptomatic patients had a significant mortality (p < 0.001) benefit with less hospitalisations (p < 0.001) post-surgery. An unexpected finding was that 36% of asymptomatic patients died during follow-up but this was significantly lower compared to surgically declined symptomatic patients (p < 0.001). Conclusions: For symptomatic patients with severe AS who are denied surgery, alternative therapies such as transcatheter aortic valve implantation should be considered. doi:10.1016/j.hlc.2009.04.061
59 ROLE OF ANGIOGRAPHIC PERFUSION SCORE TO PREDICT CLINICAL OUTCOMES IN ACS PATIENTS UNDERGOING PCI A Puri 1,2,∗ , L Fischer 1 , R Sethi 1 , SK Dwivedi 1 , VS Narain 1 , RK Saran 1 , VK Puri 1 1 Department of Cardiology, CSM Medical University, Lucknow, India 2 Waikato Hospital, Hamilton, New Zealand
Background: TIMI flow grade (TFG) and TIMI myocardial perfusion grade (TMPG) are important entities for predicting outcomes following PCI and TMPG is considered sensitive and specific among them. Angiographic Perfusion Score (APS) combines epicardial flow and myocardial perfusion grade before and after PCI. This study done to validate the prognostic role of APS versus TMPG, in patients with ACS undergoing PCI. Methods: 226 patients were prospectively enrolled. TFG and TMPG were calculated as per classical definition. APS was derived by the sum of the TFG and TMPG before and after PCI with possible scores being 0–12. Failed perfusion was defined as APS of 0–3, partial perfusion as 4–9, and full perfusion as 10–12. Major adverse cardiac events (MACE) was defined as death, re-infarction or target vessel revascularization within 30 days. Results: There incidence of MACE was 64% (11/17) in those with failed reperfusion including 5 deaths. With partial reperfusion MACE was 4.95% (4/84) (p = 0.003) and with full reperfusion was 1.7% (2/120) (p = 0.001). However, when TMPG alone was reviewed, the incidence of MACE was scattered, being 9.8% (6/16) (p = NS) in TPMG 0; 9.4% (3/32) (p = NS) in TPMG 1; and 7.3% (7/96) (p = NS) in TPMG 2. However, those with TMPG 3 had MACE in 2.7% (1/37) (p = 0.001). There was no significant difference in MACE between the full perfusion APS and TMPG 3 (p = NS). Conclusion: Though not mutually exclusive both APS and TMPG are angiographic methods of risk stratification following PCI. APS is a better method in predicting short term MACE as compared to TMPG alone. doi:10.1016/j.hlc.2009.04.062 60 FRACTIONAL FLOW RESERVE AND LONG TERM OUTCOMES IN THE REAL WORLD A Puri ∗ , S Perera, K Abercrombie, G Devlin Department of Cardiology, Waikato Hospital, Hamilton, New Zealand Background: Coronary pressure derived fractional flow reserve (FFR) is an invasive index of the functional severity of coronary artery stenosis. The recently published FAME study identifies FFR ≥0.80 as being associated with a good clinical outcome at 12 months with conservative management. Our aim was to assess longer term outcomes of
Abstracts
Heart, Lung and Circulation 2009;18S:S1–S31
ABSTRACTS
with AUC for cTnI (r = 0.503, p < 0.001), but not early cardiac function. Conclusion: Biomarkers alone (cTnI), at an appropriate threshold appear robust for the detection of Type V MI, without the use of supplementary evidence as suggested by the AHA/ESC criteria. doi:10.1016/j.hlc.2009.04.060 58 UNTREATED SEVERE AORTIC STENOSIS (AS) IS ASSOCIATED WITH POOR OUTCOMES S Perera 1,∗ , N Pasupati 1
Wijesinghe 2 , E
Ly 1 , G
Devlin 1 , S
1 Department of Cardiology, Waikato Hospital, Hamilton, New Zealand 2 Department of Interventional Cardiology and Research, St Paul’s Hospital, Vancouver, BC, Canada
Background: Severe AS is a common cause of morbidity and hospitalisation in the elderly. Surgical aortic valve replacement remains the gold standard of treatment but is often not considered due to excessive risk factors and comorbidities. We describe the burden of untreated severe AS at Waikato Hospital. Method: Consecutive patients with severe AS at Waikato hospital between January and December 2005 were studied retrospectively. Outcomes assessed included mortality, number of days spent in the hospital per year and ongoing symptoms (angina > CCS class 2, dyspnoea > NYHA class 2, syncope). Results: A total of 104 patients with severe AS were identified (mean age 76.6 ± 13.8 years, 52% men) during the 12-month period. Patients were divided into 3 groups according to management strategy. (Group 1: Not referred for surgery as asymptomatic, Group 2: Declined for surgery, Group 3: Accepted for surgery). Median follow up was 34 months.
Group 1 Group 2 Group 3
Number
All Cause Mortality
Hospital Days/100 pts/year
Symptoms on Follow-up
25 (24%) 38 (37%) 41 (39%)
36% 71% 22%
3.5 11.6 6
00% 64% 00%
Almost half of symptomatic patients (Group 2 vs. 3) were denied valve surgery due to co-morbidities. Symptomatic patients had a significant mortality (p < 0.001) benefit with less hospitalisations (p < 0.001) post-surgery. An unexpected finding was that 36% of asymptomatic patients died during follow-up but this was significantly lower compared to surgically declined symptomatic patients (p < 0.001). Conclusions: For symptomatic patients with severe AS who are denied surgery, alternative therapies such as transcatheter aortic valve implantation should be considered. doi:10.1016/j.hlc.2009.04.061
59 ROLE OF ANGIOGRAPHIC PERFUSION SCORE TO PREDICT CLINICAL OUTCOMES IN ACS PATIENTS UNDERGOING PCI A Puri 1,2,∗ , L Fischer 1 , R Sethi 1 , SK Dwivedi 1 , VS Narain 1 , RK Saran 1 , VK Puri 1 1 Department of Cardiology, CSM Medical University, Lucknow, India 2 Waikato Hospital, Hamilton, New Zealand
Background: TIMI flow grade (TFG) and TIMI myocardial perfusion grade (TMPG) are important entities for predicting outcomes following PCI and TMPG is considered sensitive and specific among them. Angiographic Perfusion Score (APS) combines epicardial flow and myocardial perfusion grade before and after PCI. This study done to validate the prognostic role of APS versus TMPG, in patients with ACS undergoing PCI. Methods: 226 patients were prospectively enrolled. TFG and TMPG were calculated as per classical definition. APS was derived by the sum of the TFG and TMPG before and after PCI with possible scores being 0–12. Failed perfusion was defined as APS of 0–3, partial perfusion as 4–9, and full perfusion as 10–12. Major adverse cardiac events (MACE) was defined as death, re-infarction or target vessel revascularization within 30 days. Results: There incidence of MACE was 64% (11/17) in those with failed reperfusion including 5 deaths. With partial reperfusion MACE was 4.95% (4/84) (p = 0.003) and with full reperfusion was 1.7% (2/120) (p = 0.001). However, when TMPG alone was reviewed, the incidence of MACE was scattered, being 9.8% (6/16) (p = NS) in TPMG 0; 9.4% (3/32) (p = NS) in TPMG 1; and 7.3% (7/96) (p = NS) in TPMG 2. However, those with TMPG 3 had MACE in 2.7% (1/37) (p = 0.001). There was no significant difference in MACE between the full perfusion APS and TMPG 3 (p = NS). Conclusion: Though not mutually exclusive both APS and TMPG are angiographic methods of risk stratification following PCI. APS is a better method in predicting short term MACE as compared to TMPG alone. doi:10.1016/j.hlc.2009.04.062 60 FRACTIONAL FLOW RESERVE AND LONG TERM OUTCOMES IN THE REAL WORLD A Puri ∗ , S Perera, K Abercrombie, G Devlin Department of Cardiology, Waikato Hospital, Hamilton, New Zealand Background: Coronary pressure derived fractional flow reserve (FFR) is an invasive index of the functional severity of coronary artery stenosis. The recently published FAME study identifies FFR ≥0.80 as being associated with a good clinical outcome at 12 months with conservative management. Our aim was to assess longer term outcomes of