- Email: [email protected]
TCT-351: Impact of Statins on 12- month Clinical Outcomes in Patients with Acute Myocardial Infarction
http://www.aievolution.com/tct0901/
TUESDAY, SEPTEMBER 22, 2009, 8:00AM - 10:00AM
TCT-349
compared with 13.7% in DANAMI-2.
ST-Elevation Acute Myocardial Infarction Complicated By Cardiogenic Shock: Feasibility Of Area Wide Transfer PCI and Impact On Mortality In a Regional Network
Table 1. Patient characteristics Unselected No shock, PRAGUE-2, DANAMI-2, cohort, n=1232 n=1145 n=429 n=790 Age, years (range) 63 (29-95) 63 (29-95) 65 (28-89) 63 (23-94)
Ralf Birkemeyer1, Andreas Rillig1, Annette Koch1, Tomislaw Miljak1, Martin Soballa2, Albert Benzing1, Jochen Wöhrle3, Werner Jung1 1 Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany2Gesundheitszentren des Landkreises Rottweil, Rottweil, Germany3Universitätsklinik Ulm, Ulm, Germany Background: Current guidelines recommend primary percutaneous coronary intervention (PCI) as the appropriate treatment for STEMI patients ZLWK FDUGLRJHQLF VKRFN 1HYHUWKHOHVV URXWLQH WUDQVIHU RI WKRVH SDWLHQWV WR LQWHUYHQWLRQDO IDFLOLWLHV LV GLI¿FXOW WR RUJDQL]H LQ UXUDO VXUURXQGLQJV 2XU VWXG\ HYDOXDWHV WKH LPSDFW RI D UHJLRQDO QHWZRUN RQ JXLGHOLQH DGKHUHQFH of reperfusion therapy and outcome in patients with ST-elevation acute P\RFDUGLDOLQIDUFWLRQ 67(0, FRPSOLFDWHGE\FDUGLRJHQLFVKRFN Methods: All consecutive patients with acute STEMI (n = 347) admitted to any of the hospitals (5 non invasive and 1 invasive with established 24h/7d primary PCI service) in a 350.000 inhabitant rural area during the year 2002 (n = 184) and 2005 (n = 163) were included in a registry. The proportion RIVKRFNSDWLHQWVZDV Q UHVSHFWLYHO\ Q ,Q emergency medical services transferred all acute STEMI patients to the nearest emergency room, where reperfusion therapy was organised. In 2005 DQQRXQFHG WUDQVIHU IURP ¿UVW PHGLFDO FRQWDFW GLUHFWO\ WR WKH FDWKODE ZDV intended if anticipated transfer time was less than 60 minutes or in the case of VKRFNLUUHVSHFWLYHRIWUDQVIHUWLPH Results: 3ULPDU\ DQJLRSODVW\ LQ VKRFN SDWLHQWV LQFUHDVHG IURP WR ¿EULQRO\VLV GHFUHDVHG IURP WR DQG WKH QR UHYDVFXODULVDWLRQ rate from65 % to 19% (p = 0.02). Onset of pain to balloon time in primary angioplasty was reduced from median 287 min to 143 min. Overall 6-months mortality decreased from 85% to 57% (p = 0.05) is spite of the fact that the cardiac arrest rate increased from 28% in 2002 to 65 % in 2005. Conclusion: $ UXUDO P\RFDUGLDO LQIDUFWLRQ QHWZRUN VLJQL¿FDQWO\ LQFUHDVHG WKHRYHUDOODQGJXLGHOLQHDGKHUHQWXVHRIUHSHUIXVLRQWKHUDS\LQVKRFNSDWLHQWV ZLWKDEHQH¿FLDOLPSDFWRQPRUWDOLW\ TCT-350
P O S T E R A B S T R AC T S
Mortality Following Primary Percutaneous Coronary Intervention: Why Are We Doing Better Than the Original Trials? =XO¿TXDU$GDP6LPRQ/+HWKHULQJWRQ5REHUW0RUOH\-XVWLQ&DUWHU Jim A Hall, Robert Wright, Andrew G C Sutton, Douglas F Muir, Neil Swanson, Mark A de Belder The James Cook University Hospital, Middlesbrough, United Kingdom Background: DANAMI-2 and PRAGUE-2 were two of the largest trials that compared primary percutaneous coronary intervention (PPCI) with thrombolysis for ST elevation myocardial infarction (STEMI). We compared mortality from our regional PPCI registry to this historical data. Methods: Retrospective analysis of prospectively collected data on 1232 consecutive unselected patients presenting with STEMI between February 2004 and November 2008 was performed. Cox proportional-hazards models were used to estimate mortality. Results: Demographics of our cohort compared to trial data are shown 7DEOH ,QKRVSLWDO PRUWDOLW\ IRU SDWLHQWV ZLWKRXW FDUGLRJHQLF VKRFN ZDV 2.0% (1.1% for patients aged 75 years or less vs. 5.8% for those older than \HDUVS )RUSDWLHQWVZLWKFDUGLRJHQLFVKRFNLQKRVSLWDOPRUWDOLW\ was 35.6% (33% for those aged 75 years or less vs. 44% for those older than 75 years, p=0.448). In the unselected cohort, mortality at 30 days was 4.7% (95% CI 3.5-5.9%), whereas mortality for patients who presented without FDUGLRJHQLFVKRFNZDV &, 7KLVLVFRPSDUHGWRGD\ mortality of 6.8% and 6.6% in PRAGUE-2 and DANAMI-2 respectively. At 3 years, overall mortality was 10.2% (95% CI 8.2-12.2%) in our cohort,
130D
Male, % Diabetes, % Cardiogenic shock, % Symptom to balloon time, mins (IQR) Previous MI, % Previous PCI, % Stent use, % GpIIbIIIa inhibitor use, %
71 9.7 7.1
277
224 (171-317)
16 8.9 93
71 9.2 0 197 (137296) 15 8.6 93
14 0.9 56
11 4.3 80
91
92
-
39
197 (137-298)
70 25 2.0
74 7.4 0
Conclusion: Our data compare favourably with that from the DANAMI-2 and PRAGUE-2 trials. Patient characteristics in these pivotal PPCI trials DQG RXU UHJLVWU\ GLIIHU EXW WKH NH\ GLIIHUHQFH EHWZHHQ RXU FRKRUW DQG WKH WULDOV PD\ EH WKH ORZHU V\PSWRPWREDOORRQ WLPH 7KLV UHÀHFWV WKH geographical area being served by PPCI centres as well as the system of care for the transfer of patients. Our data support the need for optimised local and regional transfer protocols to minimise delays to treatment. TCT-351 Impact of Statins on 12- month Clinical Outcomes in Patients with Acute Myocardial Infarction Lin Wang1, Seung Woon Rha1, Ji Young Park1, Kanhaiya L Poddar1, Byoung Geol Choi1, Ji Bak Kim1, SeoungYong Shin1, Un Jung Choi1, Cheol Ung Choi1, Hong Euy Lim1, Jin Won Kim1, Eung Ju Kim1, Chang Gyu Park1, Hong Seog Seo1, Dong Joo Oh1, Young Keun Ahn2, Myung Ho Jeong2, Other KAMIR Investigators 1 Korea University Guro Hospital, Seoul, Republic of Korea2ChonNam National University Hospital, Gwangju, Republic of Korea Background:There are very limited data regarding role of statin in managing acute myocardial infarction (AMI), especially in drug-eluting stent (DES) era. Method: The current data came from the Korea Acute Myocardial Infarction Registry (KAMIR) study, which consisted of 6729 consecutive AMI patients from November 2005 to April 2008. Statin administration was depend on the physician’s discretion at that period and a total 5160 patients were routinely received statin from the presentation time. We investigated the clinical outcomes with propensity score (PS) adjustment between 5160 statin-naïve patients and those without statin treatment (n=1569) up to 12-months. Results: The baseline characteristics were similar between the two groups except that the patients in Statins group were younger than those in no statin group (62.0±12.4 vs 63.7±12.1, p<0.05). Mortality, repeat percutaneous coronary intervention (PCI) including target lesion & vessel revacularization (TLR & TVR), recurrent AMI and total major adverse cardiac event (MACE) ZHUHVLJQL¿FDQWO\ORZHULQWKHVWDWLQJURXS 7DEOH 6WDWLQDGPLQLVWUDWLRQZDV associated with less incidence of MACE at 12 months (ORunadjusted:0.526, 95% CI: 0.448-0.619, P<0.01; ORadjusted by ps:0.627, 95% CI: 0.516-0.762, P<0.01). Clinical Outcomes at 12-month Variables, N (%)
No Statin(N=1569 pts)
Statins (N=5160 pts)
P-value
Total Death
64(4.1)
104(2.0)
<0.001 <0.001
Cardiac Death
43(2.7)
67(1.3)
Repeat-PCI
136(8.5)
255(4.9)
<0.001
TLR
44(2.8)
102(2.0)
0.049
TVR
59(3.8)
148(2.9)
0.073
Non-TVR
77(4.9)
107(2.1)
<0.001
Re-AMI
24(1.5)
37(0.7)
0.003
Total MACE
228(14.5)
406(7.9)
<0.001
Conclusion: Routine administration of Statins in AMI patients showed better 12-month clinical outcomes compared with those who didn’t receive routine statin therapy.
The American Journal of Cardiology® |
September 21-25, 2009
|
TCT Abstracts/POSTER
TUESDAY, SEPTEMBER 22, 2009, 8:00AM - 10:00AM
TCT-349
compared with 13.7% in DANAMI-2.
ST-Elevation Acute Myocardial Infarction Complicated By Cardiogenic Shock: Feasibility Of Area Wide Transfer PCI and Impact On Mortality In a Regional Network
Table 1. Patient characteristics Unselected No shock, PRAGUE-2, DANAMI-2, cohort, n=1232 n=1145 n=429 n=790 Age, years (range) 63 (29-95) 63 (29-95) 65 (28-89) 63 (23-94)
Ralf Birkemeyer1, Andreas Rillig1, Annette Koch1, Tomislaw Miljak1, Martin Soballa2, Albert Benzing1, Jochen Wöhrle3, Werner Jung1 1 Schwarzwald-Baar-Klinikum, Villingen-Schwenningen, Germany2Gesundheitszentren des Landkreises Rottweil, Rottweil, Germany3Universitätsklinik Ulm, Ulm, Germany Background: Current guidelines recommend primary percutaneous coronary intervention (PCI) as the appropriate treatment for STEMI patients ZLWK FDUGLRJHQLF VKRFN 1HYHUWKHOHVV URXWLQH WUDQVIHU RI WKRVH SDWLHQWV WR LQWHUYHQWLRQDO IDFLOLWLHV LV GLI¿FXOW WR RUJDQL]H LQ UXUDO VXUURXQGLQJV 2XU VWXG\ HYDOXDWHV WKH LPSDFW RI D UHJLRQDO QHWZRUN RQ JXLGHOLQH DGKHUHQFH of reperfusion therapy and outcome in patients with ST-elevation acute P\RFDUGLDOLQIDUFWLRQ 67(0, FRPSOLFDWHGE\FDUGLRJHQLFVKRFN Methods: All consecutive patients with acute STEMI (n = 347) admitted to any of the hospitals (5 non invasive and 1 invasive with established 24h/7d primary PCI service) in a 350.000 inhabitant rural area during the year 2002 (n = 184) and 2005 (n = 163) were included in a registry. The proportion RIVKRFNSDWLHQWVZDV Q UHVSHFWLYHO\ Q ,Q emergency medical services transferred all acute STEMI patients to the nearest emergency room, where reperfusion therapy was organised. In 2005 DQQRXQFHG WUDQVIHU IURP ¿UVW PHGLFDO FRQWDFW GLUHFWO\ WR WKH FDWKODE ZDV intended if anticipated transfer time was less than 60 minutes or in the case of VKRFNLUUHVSHFWLYHRIWUDQVIHUWLPH Results: 3ULPDU\ DQJLRSODVW\ LQ VKRFN SDWLHQWV LQFUHDVHG IURP WR ¿EULQRO\VLV GHFUHDVHG IURP WR DQG WKH QR UHYDVFXODULVDWLRQ rate from65 % to 19% (p = 0.02). Onset of pain to balloon time in primary angioplasty was reduced from median 287 min to 143 min. Overall 6-months mortality decreased from 85% to 57% (p = 0.05) is spite of the fact that the cardiac arrest rate increased from 28% in 2002 to 65 % in 2005. Conclusion: $ UXUDO P\RFDUGLDO LQIDUFWLRQ QHWZRUN VLJQL¿FDQWO\ LQFUHDVHG WKHRYHUDOODQGJXLGHOLQHDGKHUHQWXVHRIUHSHUIXVLRQWKHUDS\LQVKRFNSDWLHQWV ZLWKDEHQH¿FLDOLPSDFWRQPRUWDOLW\ TCT-350
P O S T E R A B S T R AC T S
Mortality Following Primary Percutaneous Coronary Intervention: Why Are We Doing Better Than the Original Trials? =XO¿TXDU$GDP6LPRQ/+HWKHULQJWRQ5REHUW0RUOH\-XVWLQ&DUWHU Jim A Hall, Robert Wright, Andrew G C Sutton, Douglas F Muir, Neil Swanson, Mark A de Belder The James Cook University Hospital, Middlesbrough, United Kingdom Background: DANAMI-2 and PRAGUE-2 were two of the largest trials that compared primary percutaneous coronary intervention (PPCI) with thrombolysis for ST elevation myocardial infarction (STEMI). We compared mortality from our regional PPCI registry to this historical data. Methods: Retrospective analysis of prospectively collected data on 1232 consecutive unselected patients presenting with STEMI between February 2004 and November 2008 was performed. Cox proportional-hazards models were used to estimate mortality. Results: Demographics of our cohort compared to trial data are shown 7DEOH ,QKRVSLWDO PRUWDOLW\ IRU SDWLHQWV ZLWKRXW FDUGLRJHQLF VKRFN ZDV 2.0% (1.1% for patients aged 75 years or less vs. 5.8% for those older than \HDUVS )RUSDWLHQWVZLWKFDUGLRJHQLFVKRFNLQKRVSLWDOPRUWDOLW\ was 35.6% (33% for those aged 75 years or less vs. 44% for those older than 75 years, p=0.448). In the unselected cohort, mortality at 30 days was 4.7% (95% CI 3.5-5.9%), whereas mortality for patients who presented without FDUGLRJHQLFVKRFNZDV &, 7KLVLVFRPSDUHGWRGD\ mortality of 6.8% and 6.6% in PRAGUE-2 and DANAMI-2 respectively. At 3 years, overall mortality was 10.2% (95% CI 8.2-12.2%) in our cohort,
130D
Male, % Diabetes, % Cardiogenic shock, % Symptom to balloon time, mins (IQR) Previous MI, % Previous PCI, % Stent use, % GpIIbIIIa inhibitor use, %
71 9.7 7.1
277
224 (171-317)
16 8.9 93
71 9.2 0 197 (137296) 15 8.6 93
14 0.9 56
11 4.3 80
91
92
-
39
197 (137-298)
70 25 2.0
74 7.4 0
Conclusion: Our data compare favourably with that from the DANAMI-2 and PRAGUE-2 trials. Patient characteristics in these pivotal PPCI trials DQG RXU UHJLVWU\ GLIIHU EXW WKH NH\ GLIIHUHQFH EHWZHHQ RXU FRKRUW DQG WKH WULDOV PD\ EH WKH ORZHU V\PSWRPWREDOORRQ WLPH 7KLV UHÀHFWV WKH geographical area being served by PPCI centres as well as the system of care for the transfer of patients. Our data support the need for optimised local and regional transfer protocols to minimise delays to treatment. TCT-351 Impact of Statins on 12- month Clinical Outcomes in Patients with Acute Myocardial Infarction Lin Wang1, Seung Woon Rha1, Ji Young Park1, Kanhaiya L Poddar1, Byoung Geol Choi1, Ji Bak Kim1, SeoungYong Shin1, Un Jung Choi1, Cheol Ung Choi1, Hong Euy Lim1, Jin Won Kim1, Eung Ju Kim1, Chang Gyu Park1, Hong Seog Seo1, Dong Joo Oh1, Young Keun Ahn2, Myung Ho Jeong2, Other KAMIR Investigators 1 Korea University Guro Hospital, Seoul, Republic of Korea2ChonNam National University Hospital, Gwangju, Republic of Korea Background:There are very limited data regarding role of statin in managing acute myocardial infarction (AMI), especially in drug-eluting stent (DES) era. Method: The current data came from the Korea Acute Myocardial Infarction Registry (KAMIR) study, which consisted of 6729 consecutive AMI patients from November 2005 to April 2008. Statin administration was depend on the physician’s discretion at that period and a total 5160 patients were routinely received statin from the presentation time. We investigated the clinical outcomes with propensity score (PS) adjustment between 5160 statin-naïve patients and those without statin treatment (n=1569) up to 12-months. Results: The baseline characteristics were similar between the two groups except that the patients in Statins group were younger than those in no statin group (62.0±12.4 vs 63.7±12.1, p<0.05). Mortality, repeat percutaneous coronary intervention (PCI) including target lesion & vessel revacularization (TLR & TVR), recurrent AMI and total major adverse cardiac event (MACE) ZHUHVLJQL¿FDQWO\ORZHULQWKHVWDWLQJURXS 7DEOH 6WDWLQDGPLQLVWUDWLRQZDV associated with less incidence of MACE at 12 months (ORunadjusted:0.526, 95% CI: 0.448-0.619, P<0.01; ORadjusted by ps:0.627, 95% CI: 0.516-0.762, P<0.01). Clinical Outcomes at 12-month Variables, N (%)
No Statin(N=1569 pts)
Statins (N=5160 pts)
P-value
Total Death
64(4.1)
104(2.0)
<0.001 <0.001
Cardiac Death
43(2.7)
67(1.3)
Repeat-PCI
136(8.5)
255(4.9)
<0.001
TLR
44(2.8)
102(2.0)
0.049
TVR
59(3.8)
148(2.9)
0.073
Non-TVR
77(4.9)
107(2.1)
<0.001
Re-AMI
24(1.5)
37(0.7)
0.003
Total MACE
228(14.5)
406(7.9)
<0.001
Conclusion: Routine administration of Statins in AMI patients showed better 12-month clinical outcomes compared with those who didn’t receive routine statin therapy.
The American Journal of Cardiology® |
September 21-25, 2009
|
TCT Abstracts/POSTER