- Email: [email protected]
TCT-626 Long-term mortality of vasospastic angina with documented ST-segment depression during ergonovine provocation: Data form Asan Vasospastic Angina Registry
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 70, NO. 18, SUPPL B, 2017
B277
METHODS This was a retrospective cohort study of 1499 patients with STEMI diagnosis who underwent primary PCI between January 2008 and December 2015. We performed a propensity score matched analysis to obtain two groups of 262 patients paired according to DES or BMS implantation and well balanced regarding: baseline characteristics, laboratory data, clinical data, anatomical and procedural data and medication at discharge (Table 1). RESULTS During follow-up (median 1015 days) DES patients had lower rates of all-cause mortality (6.5% vs 12.2%, p 0.049), MACE (16.4% vs 25.2%, p 0.049) and a patient-oriented combined endpoint (POCE) of all-cause death, any myocardial infarction and any revascularization (12.6% vs 22.5%, p 0.017). No differences in definitive stent thrombosis were observed. Total cohort BMS
Matched cohort BMS
(n[983) DES (n[374)
(n[262) DES (n P-Value
65 (14) 62 (12)
<0.001
Male sex
76.5% 81.6%
0.037
Diabetes
19.9% 28.6% 46.6%
Age (years)
Dyslipidemia GFR (mL/min) Hemoglobin (g/dL) CRUSADE score Infarct-related artery LAD CX RCA Stent lengh Stent diameter
0.001 0.012
54.3% 83 (37) 97 (38) 14.3 (1.8) 14.6 (2.9) 27 (18) 22 (14) 40.5% 42.8% 15.4%
<0.001 0.018 <0.001 0.033
26.0% 24.8% 51.1%
0.911 0.764 0.862
0.378
12.4 (1.6) 14.4(1.7)
0.860
21 (14) 22 (13)
0.581
40.8% 38.2% 17.2%
0.130
39.3% 0.003 <0.001
CONCLUSION Among survivors following AMI without HF or LVDS, the use of BB was associated with a lower risk of death and cardiovascular death at any time point up to 3 years. CATEGORIES CORONARY: Acute Coronary Syndromes
96 (44) 93 (35)
20.2% 42.0%
36.4%
3.2 (0.5) 3.1 (0.5)
80.9% 81.3%
P-Value 0.847
51.9%
18.5% 43.2%
25.6 (13.5) 28.3 (15.4)
[262) 62 (14) 63 (12)
26.2 (15.1) 26.5(13.9)
0.821
3.2 (0.5) 3.2 (0.5)
0.482
CONCLUSION In our real-world primary PCI registry the use of DES over BMS provides benefits to STEMI patients in terms of lower long term mortality, MACE and POCE. CATEGORIES CORONARY: Acute Coronary Syndromes TCT-625 Clinical impacts of Beta-blockers in patients following acute myocardial infarction without heart failure or left ventricular dysfunction(left ventricular ejection fraction>40%) Hanbit Park,1 Minsoo Kim,1 Sang Yong Om,1 Yong-Hoon Yoon,1 Sang-Cheol Cho,1 Osung Kwon,1 Ungjeong Do,1 Kyusup Lee,1 Do-yoon Kang,1 Cheol Hyun Lee,1 Pil Hyung Lee,1 Jung-Min Ahn,1 Duk-Woo Park,1 Soo-Jin Kang,1 Seung-Whan Lee,1 Young-Hak Kim,1 Cheol Whan Lee,1 Seong-Wook Park,1 Seung-Jung Park1 1 Asan Medical Center, Seoul, Korea, Republic of BACKGROUND For acute myocardial infarction(AMI) without heart failure(HF), it is unclear if beta blockers(BB) are associated with reduced mortality. OBJECTIVE To investigate the association between BB use and longterm mortality in patients with AMI without HF or left ventricular systolic dysfunction(LVDS, left ventricular ejection fraction > 40%). METHODS We prospective enrolled consecutive 16,254 patients who received DES between April, 2008 and December, 2013, using data from the Interventional Cardiology Research Incooperation SocietyDrug-Eluting Stents Registry. A Total of 2,459 patients were identified to receive BB following AMI without HF or LVDS. The primary end points were death and cardiovascular death. RESULTS Of 919 patients with ST-segment elevation myocardial infarction and 1,540 patients with non-ST-segment elevation myocardial infarction, 687(74.8%) and 1,084(70.4%) received BB, respectively. There were differences on 3-year overall mortality(11.7% vs. 3.3%, p<0.001) and 3-year cardiovascular mortality(3.7% vs. 0.5%, p<0.001) between BB group and non-BB group. And after multivariate adjustment, there were significant differences on 3-year overall mortality(Hazard ratio 0.566, 95% confidence interval 0.379-0.847, p¼0.006) and 3-year cardiovascular mortality(Hazard ratio 0.306, 95% confidence interval 0.126-0.748, p¼0.009) between BB group and non-BB group.
TCT-626 Long-term mortality of vasospastic angina with documented ST-segment depression during ergonovine provocation: Data form Asan Vasospastic Angina Registry Hanbit Park,1 Minsoo Kim,1 Sang Yong Om,1 Yong-Hoon Yoon,1 Sang-Cheol Cho,1 Osung Kwon,1 Ungjeong Do,1 Kyusup Lee,1 Do-yoon Kang,1 Cheol Hyun Lee,1 Pil Hyung Lee,1 Jung-Min Ahn,1 Duk-Woo Park,1 Soo-Jin Kang,1 Seung-Whan Lee,1 Young-Hak Kim,1 Cheol Whan Lee,1 Seong-Wook Park,1 Seung-Jung Park1 1 Asan Medical Center, Seoul, Korea, Republic of BACKGROUND Patients with vasospastic angina(VSA) were not always presented with ST-segment elevation(STE) on electrocardiogram(ECG). Some patients presented with ST-segment depression(STD) on ECG. Long-term prognosis of STD type VSA remains unknown. OBJECTIVES To investigate the long-term mortality of STD type VSA. METHODS Between March 1996 and September 2014, a total of 1779 VSA patients were enrolled in the ASAN VSA Registry from 13 heart centers in South Korea. The primary endpoint was defined as 5-year overall death. A median follow-up duration was 8.1 years (interquartile range: 4.3–11.6 years). RESULTS The VSAs were diagnosed by ergonovine stress coronary angiography(1036 [58.2%]) and ergonovine stress echocardiography(743 [41.8%]). Among the study patients, 503 patients(28.3%) showed STE on ECG, 234 patients(13.1%) showed STD, and 1042 patients(58.6%) showed no ST-segment deviation. Number of medications among STE, STD and No ST-segment change group was not shown difference (2.3 0.8 vs. 2.3 0.8 vs. 2.3 0.8, p ¼ 0.792). There was a difference on 5-year overall mortality among STE, STD, and No ST-segment change group(4.2% vs. 8.1% vs. 3.9%, p¼0.024). After multivariate adjustment, there was a significant difference on 5year overall mortality between STD group and non-STD group(Hazard ratio 2.26, 95% confidence interval 1.287-3.849, p¼0.004).
B278
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 70, NO. 18, SUPPL B, 2017
CONCLUSION STD type VSA was associated with a higher risk of 5-year overall death than Non-STD type VSA. CATEGORIES CORONARY: Acute Coronary Syndromes
while respiratory failure was the leading non-cardiac cause (14.3%). Several variables in socioeconomic status, comorbidities, in-hospital treatment were identified as independent predictors for 30-day readmissions.
TCT-627 Electrocardiographic parameters, peak of cardiac markers and diagnosis delay in patients with acute left circumflex occlusion Pedro Pérez-Díaz,1 Alfonso Jurado-Román,1 Ignacio Sanchez-Perez,1 María Thiscal López Lluva,1 Ramón Maseda Uriza,1 Jesus Piqueras-Flores,1 Fernando Lozano1 1 University General Hospital of Ciudad Real, Ciudad Real, Spain BACKGROUND Left circumflex occlusion is underdiagnosed in most of reperfusion studies about Myocardial Infarction, due to its poor electrocardiographic expressiveness and late diagnosis. This late diagnosis leads to higher infarct size and time to opening of the artery. METHODS Observational retrospective study including 628 coronary angiographies in a single university hospital between July 2016 and April 2017. We analyzed baseline and angiographic characteristics, clinical presentation, delay from diagnosis to emergency unit, cardiac biomarkers, electrocardiographic parameters and presentation of arrhythmias during admission. RESULTS 293 patients (70.1% male; 67.2 12.5 years) with acute coronary syndrome (ACS) were analyzed, of which left anterior descending (LAD), left circumflex (Cx) and right coronary artery (RCA) were occluded in 12.5%, 5.5% and 17.2% respectively. 73% of cases with left circumflex occlusion presented as ST Segment Elevation Myocardial Infarction (STEMI) and 26% were initially diagnosed as Non-ST Segment Elevation Myocardial Infarction (NSTEMI). We found no differences in baseline characteristics comparing patients with Cx as the culprit artery with the others. Peak creatine phosphokinase was significantly higher in Cx occlusion than in RCA (1604.7 þ- 909.6 UI/l vs 360.7 þ- 338.7 UI/l, p¼0.019) in NSTEMI. The most frequent ECG findings in patients with Cx occlusion were the combination “ST depression in V1-V4 leads and ST elevation in inferior leads” (26%). Mean time from symtoms onset to emergency unit was 310, 790 and 658 minutes in LAD, Cx and RCA respectively (p¼0.007). We detected a higher rate of non-sustained ventricular tachycardia in Cx occlusions (3.2%, 28.6% and 17.9% respectively, p¼0.017). CONCLUSION Cx occlusion was only responsible for 5.5% acute coronary syndromes (and 10.7% STEMI). The most frequent ECG abnormalities were ST depression of V1-V4 leads with ST elevation in inferior leads. Cx occlusions were initially diagnosed as NSTEMI in 26% of cases and these patients presented higher levels of CPK, longer delay from symptoms onset to arrival at the emergency department and a higher rate of non-sustained ventricular tachycardia. CATEGORIES CORONARY: Acute Coronary Syndromes TCT-628 Causes and Predictors for Short-Term Readmission and Recurrence after Primary Takotsubo Syndrome-Insight from Nationwide Readmission Database in the United States Soichiro Hiramatsu,1 Yoshihiro Akashi,2 Masaharu Ishihara3 1 Chiba-NIshi General Hospital, Matsudo, Japan; 2St. Marianna University School of Medicine, Kawasaki, Japan; 3Hyogo College of Medicine, Nishinomiya, Japan BACKGROUND Little is known about etiology and clinical outcomes in primary takotsubo syndrome. METHODS Patients with primary takotsubo syndrome were identified with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code 429.83 in Nationwide Readmission Databases (NRD). The primary outcome is all-cause readmission within 30 days after initial hospital. The secondary outcomes are readmissions for cardiac, heart failure and recurrence within 30 days after discharge. Univariate and multivariate logistic regression were performed to identify predictors of all-cause, cardiac, heart failure and recurrence readmission within 30 days after discharge. RESULTS 10599 (national estimate¼25553) patients were diagnosed with takotsubo syndrome as primary diagnosis from 2010 to 2014 in the United States. 105 patients were died during the initial hospitalization (in-hospital mortality¼1.0%). Of the remaining (n¼10494), 978 patients experienced all-cause readmission within 30-days after discharge (30-day all-cause readmission rate¼9.3%). The most frequent cardiac cause of 30-day readmission was heart failure (9.9%),
CONCLUSION In-hospital mortality and thirty-day readmission rates were relatively low in primary takotsubo syndrome. Recognition of risk factors for short-term readmissions may lead to even better clinical management and outcomes. CATEGORIES CORONARY: Acute Coronary Syndromes TCT-629 The Association Between HsTrop and Tachyarrhythmias: Type 1 or Type 2 MI? The STRIPE-MI Study Mark Mariathas,1 Cameron Gemmell,2 Bartosz Olechowski,1 Zoe Nicholas,3 Michael Mahmoudi,1 Nick Curzen4 1 University Hospitals Southampton, Southampton, United Kingdom; 2 University of Southampton, Southampton, United Kingdom; 3 Southampton General Hospital, Southampton, United Kingdom; 4 University Hospital Southampton, Southampton, United Kingdom BACKGROUND The introduction of highly sensitive troponin (HsTrop) assays into clinical practice has resulted in a significant increase in the frequency of type 1 (T1MI) & type 2 (T2MI) myocardial infarction (MI) diagnoses in clinical practice. The accurate differential diagnosis of T1MI & T2MI is essential in order to avoid inappropriate percutaneous revascularisation. The aims of this study were: (a) to describe the relative frequency of T2MI; (b) to describe the medium term mortality of T1 & T2MI in order to compare prognosis. METHODS A retrospective analysis of consecutive patients with a primary discharge diagnosis of either tachyarrhythmia or non-ST elevated myocardial infarction (NSTEMI). Patients were classified as either T1MI or T2MI based on a review of their clinical records including ECG & troponin series. Statistical analysis was undertaken to compare the two groups. RESULTS A total of 704 patients were recruited (n¼264 NSTEMI, n¼440 arrhythmia). Forty-seven percent of tachyarrhythmia patients presented with elevated troponin above the 99th percentile (>40ng/L). There was no statistically significant difference in moratlity between NSTEMI and tachyarrhythmia troponin positive patients (Log rank p¼.583). Of the total 704 cases, 470 were troponin positive. Of the latter, 240 (51%) patients were classified as T1MI and 230 (49%) as T2MI. T1MI patients had higher peak troponin values (4636ng/L Vs 899ng/L, p<.001), more coronary angiography (161(67%) Vs 32(14%), p<.001) and more revascularisation (91(57%) Vs 0(0%), p<.001). Patients were followed up for a median of 523 days and up to a maximum of 825 days. Kaplan Meier analysis showed mortality in T2MI patients was significantly worse (Log rank p¼.011). Patients with T2MI driven by other illnesses had significantly higher mortality compared to patients with T2MI driven by arrhythmia (Log rank p<.001).
B277
METHODS This was a retrospective cohort study of 1499 patients with STEMI diagnosis who underwent primary PCI between January 2008 and December 2015. We performed a propensity score matched analysis to obtain two groups of 262 patients paired according to DES or BMS implantation and well balanced regarding: baseline characteristics, laboratory data, clinical data, anatomical and procedural data and medication at discharge (Table 1). RESULTS During follow-up (median 1015 days) DES patients had lower rates of all-cause mortality (6.5% vs 12.2%, p 0.049), MACE (16.4% vs 25.2%, p 0.049) and a patient-oriented combined endpoint (POCE) of all-cause death, any myocardial infarction and any revascularization (12.6% vs 22.5%, p 0.017). No differences in definitive stent thrombosis were observed. Total cohort BMS
Matched cohort BMS
(n[983) DES (n[374)
(n[262) DES (n P-Value
65 (14) 62 (12)
<0.001
Male sex
76.5% 81.6%
0.037
Diabetes
19.9% 28.6% 46.6%
Age (years)
Dyslipidemia GFR (mL/min) Hemoglobin (g/dL) CRUSADE score Infarct-related artery LAD CX RCA Stent lengh Stent diameter
0.001 0.012
54.3% 83 (37) 97 (38) 14.3 (1.8) 14.6 (2.9) 27 (18) 22 (14) 40.5% 42.8% 15.4%
<0.001 0.018 <0.001 0.033
26.0% 24.8% 51.1%
0.911 0.764 0.862
0.378
12.4 (1.6) 14.4(1.7)
0.860
21 (14) 22 (13)
0.581
40.8% 38.2% 17.2%
0.130
39.3% 0.003 <0.001
CONCLUSION Among survivors following AMI without HF or LVDS, the use of BB was associated with a lower risk of death and cardiovascular death at any time point up to 3 years. CATEGORIES CORONARY: Acute Coronary Syndromes
96 (44) 93 (35)
20.2% 42.0%
36.4%
3.2 (0.5) 3.1 (0.5)
80.9% 81.3%
P-Value 0.847
51.9%
18.5% 43.2%
25.6 (13.5) 28.3 (15.4)
[262) 62 (14) 63 (12)
26.2 (15.1) 26.5(13.9)
0.821
3.2 (0.5) 3.2 (0.5)
0.482
CONCLUSION In our real-world primary PCI registry the use of DES over BMS provides benefits to STEMI patients in terms of lower long term mortality, MACE and POCE. CATEGORIES CORONARY: Acute Coronary Syndromes TCT-625 Clinical impacts of Beta-blockers in patients following acute myocardial infarction without heart failure or left ventricular dysfunction(left ventricular ejection fraction>40%) Hanbit Park,1 Minsoo Kim,1 Sang Yong Om,1 Yong-Hoon Yoon,1 Sang-Cheol Cho,1 Osung Kwon,1 Ungjeong Do,1 Kyusup Lee,1 Do-yoon Kang,1 Cheol Hyun Lee,1 Pil Hyung Lee,1 Jung-Min Ahn,1 Duk-Woo Park,1 Soo-Jin Kang,1 Seung-Whan Lee,1 Young-Hak Kim,1 Cheol Whan Lee,1 Seong-Wook Park,1 Seung-Jung Park1 1 Asan Medical Center, Seoul, Korea, Republic of BACKGROUND For acute myocardial infarction(AMI) without heart failure(HF), it is unclear if beta blockers(BB) are associated with reduced mortality. OBJECTIVE To investigate the association between BB use and longterm mortality in patients with AMI without HF or left ventricular systolic dysfunction(LVDS, left ventricular ejection fraction > 40%). METHODS We prospective enrolled consecutive 16,254 patients who received DES between April, 2008 and December, 2013, using data from the Interventional Cardiology Research Incooperation SocietyDrug-Eluting Stents Registry. A Total of 2,459 patients were identified to receive BB following AMI without HF or LVDS. The primary end points were death and cardiovascular death. RESULTS Of 919 patients with ST-segment elevation myocardial infarction and 1,540 patients with non-ST-segment elevation myocardial infarction, 687(74.8%) and 1,084(70.4%) received BB, respectively. There were differences on 3-year overall mortality(11.7% vs. 3.3%, p<0.001) and 3-year cardiovascular mortality(3.7% vs. 0.5%, p<0.001) between BB group and non-BB group. And after multivariate adjustment, there were significant differences on 3-year overall mortality(Hazard ratio 0.566, 95% confidence interval 0.379-0.847, p¼0.006) and 3-year cardiovascular mortality(Hazard ratio 0.306, 95% confidence interval 0.126-0.748, p¼0.009) between BB group and non-BB group.
TCT-626 Long-term mortality of vasospastic angina with documented ST-segment depression during ergonovine provocation: Data form Asan Vasospastic Angina Registry Hanbit Park,1 Minsoo Kim,1 Sang Yong Om,1 Yong-Hoon Yoon,1 Sang-Cheol Cho,1 Osung Kwon,1 Ungjeong Do,1 Kyusup Lee,1 Do-yoon Kang,1 Cheol Hyun Lee,1 Pil Hyung Lee,1 Jung-Min Ahn,1 Duk-Woo Park,1 Soo-Jin Kang,1 Seung-Whan Lee,1 Young-Hak Kim,1 Cheol Whan Lee,1 Seong-Wook Park,1 Seung-Jung Park1 1 Asan Medical Center, Seoul, Korea, Republic of BACKGROUND Patients with vasospastic angina(VSA) were not always presented with ST-segment elevation(STE) on electrocardiogram(ECG). Some patients presented with ST-segment depression(STD) on ECG. Long-term prognosis of STD type VSA remains unknown. OBJECTIVES To investigate the long-term mortality of STD type VSA. METHODS Between March 1996 and September 2014, a total of 1779 VSA patients were enrolled in the ASAN VSA Registry from 13 heart centers in South Korea. The primary endpoint was defined as 5-year overall death. A median follow-up duration was 8.1 years (interquartile range: 4.3–11.6 years). RESULTS The VSAs were diagnosed by ergonovine stress coronary angiography(1036 [58.2%]) and ergonovine stress echocardiography(743 [41.8%]). Among the study patients, 503 patients(28.3%) showed STE on ECG, 234 patients(13.1%) showed STD, and 1042 patients(58.6%) showed no ST-segment deviation. Number of medications among STE, STD and No ST-segment change group was not shown difference (2.3 0.8 vs. 2.3 0.8 vs. 2.3 0.8, p ¼ 0.792). There was a difference on 5-year overall mortality among STE, STD, and No ST-segment change group(4.2% vs. 8.1% vs. 3.9%, p¼0.024). After multivariate adjustment, there was a significant difference on 5year overall mortality between STD group and non-STD group(Hazard ratio 2.26, 95% confidence interval 1.287-3.849, p¼0.004).
B278
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 70, NO. 18, SUPPL B, 2017
CONCLUSION STD type VSA was associated with a higher risk of 5-year overall death than Non-STD type VSA. CATEGORIES CORONARY: Acute Coronary Syndromes
while respiratory failure was the leading non-cardiac cause (14.3%). Several variables in socioeconomic status, comorbidities, in-hospital treatment were identified as independent predictors for 30-day readmissions.
TCT-627 Electrocardiographic parameters, peak of cardiac markers and diagnosis delay in patients with acute left circumflex occlusion Pedro Pérez-Díaz,1 Alfonso Jurado-Román,1 Ignacio Sanchez-Perez,1 María Thiscal López Lluva,1 Ramón Maseda Uriza,1 Jesus Piqueras-Flores,1 Fernando Lozano1 1 University General Hospital of Ciudad Real, Ciudad Real, Spain BACKGROUND Left circumflex occlusion is underdiagnosed in most of reperfusion studies about Myocardial Infarction, due to its poor electrocardiographic expressiveness and late diagnosis. This late diagnosis leads to higher infarct size and time to opening of the artery. METHODS Observational retrospective study including 628 coronary angiographies in a single university hospital between July 2016 and April 2017. We analyzed baseline and angiographic characteristics, clinical presentation, delay from diagnosis to emergency unit, cardiac biomarkers, electrocardiographic parameters and presentation of arrhythmias during admission. RESULTS 293 patients (70.1% male; 67.2 12.5 years) with acute coronary syndrome (ACS) were analyzed, of which left anterior descending (LAD), left circumflex (Cx) and right coronary artery (RCA) were occluded in 12.5%, 5.5% and 17.2% respectively. 73% of cases with left circumflex occlusion presented as ST Segment Elevation Myocardial Infarction (STEMI) and 26% were initially diagnosed as Non-ST Segment Elevation Myocardial Infarction (NSTEMI). We found no differences in baseline characteristics comparing patients with Cx as the culprit artery with the others. Peak creatine phosphokinase was significantly higher in Cx occlusion than in RCA (1604.7 þ- 909.6 UI/l vs 360.7 þ- 338.7 UI/l, p¼0.019) in NSTEMI. The most frequent ECG findings in patients with Cx occlusion were the combination “ST depression in V1-V4 leads and ST elevation in inferior leads” (26%). Mean time from symtoms onset to emergency unit was 310, 790 and 658 minutes in LAD, Cx and RCA respectively (p¼0.007). We detected a higher rate of non-sustained ventricular tachycardia in Cx occlusions (3.2%, 28.6% and 17.9% respectively, p¼0.017). CONCLUSION Cx occlusion was only responsible for 5.5% acute coronary syndromes (and 10.7% STEMI). The most frequent ECG abnormalities were ST depression of V1-V4 leads with ST elevation in inferior leads. Cx occlusions were initially diagnosed as NSTEMI in 26% of cases and these patients presented higher levels of CPK, longer delay from symptoms onset to arrival at the emergency department and a higher rate of non-sustained ventricular tachycardia. CATEGORIES CORONARY: Acute Coronary Syndromes TCT-628 Causes and Predictors for Short-Term Readmission and Recurrence after Primary Takotsubo Syndrome-Insight from Nationwide Readmission Database in the United States Soichiro Hiramatsu,1 Yoshihiro Akashi,2 Masaharu Ishihara3 1 Chiba-NIshi General Hospital, Matsudo, Japan; 2St. Marianna University School of Medicine, Kawasaki, Japan; 3Hyogo College of Medicine, Nishinomiya, Japan BACKGROUND Little is known about etiology and clinical outcomes in primary takotsubo syndrome. METHODS Patients with primary takotsubo syndrome were identified with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis code 429.83 in Nationwide Readmission Databases (NRD). The primary outcome is all-cause readmission within 30 days after initial hospital. The secondary outcomes are readmissions for cardiac, heart failure and recurrence within 30 days after discharge. Univariate and multivariate logistic regression were performed to identify predictors of all-cause, cardiac, heart failure and recurrence readmission within 30 days after discharge. RESULTS 10599 (national estimate¼25553) patients were diagnosed with takotsubo syndrome as primary diagnosis from 2010 to 2014 in the United States. 105 patients were died during the initial hospitalization (in-hospital mortality¼1.0%). Of the remaining (n¼10494), 978 patients experienced all-cause readmission within 30-days after discharge (30-day all-cause readmission rate¼9.3%). The most frequent cardiac cause of 30-day readmission was heart failure (9.9%),
CONCLUSION In-hospital mortality and thirty-day readmission rates were relatively low in primary takotsubo syndrome. Recognition of risk factors for short-term readmissions may lead to even better clinical management and outcomes. CATEGORIES CORONARY: Acute Coronary Syndromes TCT-629 The Association Between HsTrop and Tachyarrhythmias: Type 1 or Type 2 MI? The STRIPE-MI Study Mark Mariathas,1 Cameron Gemmell,2 Bartosz Olechowski,1 Zoe Nicholas,3 Michael Mahmoudi,1 Nick Curzen4 1 University Hospitals Southampton, Southampton, United Kingdom; 2 University of Southampton, Southampton, United Kingdom; 3 Southampton General Hospital, Southampton, United Kingdom; 4 University Hospital Southampton, Southampton, United Kingdom BACKGROUND The introduction of highly sensitive troponin (HsTrop) assays into clinical practice has resulted in a significant increase in the frequency of type 1 (T1MI) & type 2 (T2MI) myocardial infarction (MI) diagnoses in clinical practice. The accurate differential diagnosis of T1MI & T2MI is essential in order to avoid inappropriate percutaneous revascularisation. The aims of this study were: (a) to describe the relative frequency of T2MI; (b) to describe the medium term mortality of T1 & T2MI in order to compare prognosis. METHODS A retrospective analysis of consecutive patients with a primary discharge diagnosis of either tachyarrhythmia or non-ST elevated myocardial infarction (NSTEMI). Patients were classified as either T1MI or T2MI based on a review of their clinical records including ECG & troponin series. Statistical analysis was undertaken to compare the two groups. RESULTS A total of 704 patients were recruited (n¼264 NSTEMI, n¼440 arrhythmia). Forty-seven percent of tachyarrhythmia patients presented with elevated troponin above the 99th percentile (>40ng/L). There was no statistically significant difference in moratlity between NSTEMI and tachyarrhythmia troponin positive patients (Log rank p¼.583). Of the total 704 cases, 470 were troponin positive. Of the latter, 240 (51%) patients were classified as T1MI and 230 (49%) as T2MI. T1MI patients had higher peak troponin values (4636ng/L Vs 899ng/L, p<.001), more coronary angiography (161(67%) Vs 32(14%), p<.001) and more revascularisation (91(57%) Vs 0(0%), p<.001). Patients were followed up for a median of 523 days and up to a maximum of 825 days. Kaplan Meier analysis showed mortality in T2MI patients was significantly worse (Log rank p¼.011). Patients with T2MI driven by other illnesses had significantly higher mortality compared to patients with T2MI driven by arrhythmia (Log rank p<.001).