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TCTAP A-010 Prognostic Value of Clinical SYNTAX Score on 2-year Outcomes in Patients with Acute Coronary Syndrome After Percutaneous Coronary Intervention
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
METHODS From April 2013 to October 2016, 899 patients underwent high-pitch aortic CTA for suspected aortic dissection at ER. Thirtyeight patients who were finally diagnosed as acute coronary syndrome (ACS) and received subsequent coronary catheterization within one month were recruited. The study subjects were grouped into STelevation myocardial infarct (STEMI) in 9, Non-ST-elevation myocardial infarct (NSTEMI) in 18, and unstable angina (UA) in 11, based on the clinical diagnosis. Visual patterns of PDs were classified to transmural, non-transmural, and subendocardial. Quantitative categorizations of PD based on thickness were grouped to more or less than 50% involvement. The infarct/ischemia related artery (IRA) was confirmed via coronary angiography. The PD severity score was calculated by diseased segment (17 segments adapted from AHA) multiplying the severity (PD thickness: 3 for transmural, 2 for >50%, 1 for <50% and 0 for normal). RESULTS PD was identified in 32 of the 38 patients with ACS. The predominant pattern of PDs was transmural in STEMI (89%), nontransmural in NSTEMI (61%), and subendocardial in UA (45%). The sensitivity and specificity of PD for predicting IRA were 91% and 100%. Besides, the sensitivity and specificity of more than 50% thickness of PD involvement for detecting MI were 85% and 91%. A significant difference exists in waiting time for catheterization (p<0.00001) and PD severity score (p<0.001) between these three groups. CONCLUSION In patients with ACS, myocardial PDs detected on nongated high-pitch aortic CTA provides high sensitivity and specificity with IRA related territory. Furthermore, PD with more than 50% thickness involvement contributes well sensitivity and specificity for myocardial infarct detection especially in patients with ACS.
TCTAP A-010 Prognostic Value of Clinical SYNTAX Score on 2-year Outcomes in Patients with Acute Coronary Syndrome After Percutaneous Coronary Intervention Chen He,1 Jinqing Yuan,2 Bo Xu2 1 Fuwai Hospital, CAMS&PUMC, China; 2Fuwai Hospital, China BACKGROUND The anatomical SYNTAX score is a scoring system based on the complexity and severity of coronary lesions and is thought to be a prognostic tool to predict long-term outcomes. One of the major limitations of using the SYNTAX score in clinical practice was SYNTAX score don’t contain the clinical characteristics. There are few researches about the prognostic value of clinical SYNTAX score in patients with acute coronary syndrome after percutaneous coronary intervention. This prospective, single-central, observational study evaluated the prognostic value of clinical SYNTAX score on 2-year outcomes in patients with acute coronary syndrome after percutaneous coronary intervention. METHODS Between January 2013 and December 2013, 6,099 consecutive acute coronary syndrome patients admitted to Fuwai hospital and underwent PCI were enrolled in this study. Accordingly with clinical syntax score, patients were divided in low CSS group (CSS6.5, 2,012 patients), mid CSS group (6.5＜CSS＜13.8, 2,056 patients) and high CSS group (CSS13.8, 2031 patients). RESULTS At 2-years follow-up, rates of cardiac death and MACCE were significantly higher in the high CSS group. CSS was superior to the baseline SS in predicting 2-years cardiac death (AUC 0.738 vs 0.615, P<0.001), but wasn’t superior in predicting 2-years MACE (AUC 0.597 vs 0.592, P¼0.285). On Cox regression analysis, CSS (p¼0.000), PCI history (p ¼0.002), and hypertension (p<0.000) were independent predictors of cardiac death. CSS (p¼0.000), IABP support (p¼0.000), diabetes mellitus (p¼0.004), and successful PCI (p¼0.000) were independent predictors of MACE.
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
CONCLUSION Clinical SYNTAX score was a good prognostic tool of long-term outcomes in ACS patients undergoing PCI combing the SYNTAX score with several clinical risk characteristics including age, ejection fraction, and creatinine clearance. TCTAP A-011 Comparison of Timing of Non-culprit Lesion Percutaneous Coronary Intervention in Myocardial Infarction Patients Hyung Oh Kim,1 Weon Kim,1 Soo-Joong Kim,1 Jong Shin Woo,1 Hyemoon Chung,2 Jae Min Kim1 1 Kyung Hee University Medical Center, Korea (Republic of); 2Gangnam Severance Hospital, Korea (Republic of) BACKGROUND The percutaneous coronary intervention (PCI) of a non-infarct artery at the time of primary PCI for patients with acute myocardial infarction (AMI) is still debatable. The purpose was to evaluate the long-term outcomes according to the treatment strategy of non-culprit lesions among the AMI patients with multivessel disease who underwent primary PCI or early invasive PCI. METHODS Among 615 AMI patients, 333 patients with multivessel disease were analyzed retrospectively in a single center. Among them, 133 patients underwent culprit lesion only PCI (group 1), 120 patients underwent non-culprit lesion PCI at the time of primary culprit lesion PCI simultaneously (group 2), and 80 patients underwent second staged PCI for non-culprit lesion shortly after culprit lesion primary PCI (group 3). The clinical outcomes including all-cause mortality, non-fatal MI and repeated admission because of heart failure were assessed for 36 months.
accepted as a definition of ’elderly’ or older person. However, there was no guideline for the very elderly patients (80 years) with STsegment elevated myocardial infarction (STEMI) treated with PCI. Therefore, we investigated the impact of very old age (80 years) on long-term prognosis in elderly patients who were treated with PCI for STEMI. METHODS A total of 337 elderly patients who were treated with PCI due to STEMI were analyzed. Patients were divided into the two groups according to the age: 65-79 years patients (n¼269) vs over 80 years patients (n¼68). RESULTS Baseline clinical characteristics showed that past history of PCI (14.9% vs 4.4%, p¼0.024), diabetes mellitus (39.0%, vs 13.2%, p<0.001), and smoking (38.7% vs 20.6%, p¼0.007) were higher in elderly patients as compared with very elderly patients. Angiographic characteristics were similar between the two groups. Clinical outcomes showed that mortality up to 30 days were higher in very elderly patients, but total mortality up to 3 years were similar between the two groups. (Table 1) Multivariate regression showed that very old age (80 years, HR 3.5, CI 1.16-10.7, p¼0.026), past history of cerebrovascular events (HR 4.7, CI 1.4-15.4, p¼0.011), and past history of coronary bypass graft (HR 1.8, CI 1.0-3.2, p¼0.044) were independent risk factors for mortality up to 3 years.
RESULTS Patients with group 1 showed older and had more non-ST elevation AMI. During 36-month follow-up, there were higher incidences of major adverse cardiac event (MACE) in group 1 [28 (21%) in group 1, 16 (13%) patients in group 2, 9 (12%) patients with group 3, p¼0.02, Figure]. During 6-month follow-up, staged PCI showed the better tendency, but there was no significant difference of event occurrence between staged and simultaneously PCI of a non-culprit lesion. Similarly, ST-segment elevation myocardial infarction (STEMI) patients (n¼127) also showed significant better MACE-free survivals who performed Non-culprit PCI (simultaneously and staged) compared to culprit-only PCI (p¼0.02). CONCLUSION Very old age was associated with short-term mortality and was an independent risk factor for mortality up to 3 years. Therefore, more intensive and careful therapies will be needed for very elderly patients with STEMI treated with PCI.
TCTAP A-013 The Prognostic Comparison of the Estimations of Renal Function in Patients with Acute Coronary Syndrome Yu-Lun Cheng,1 Shih-Hsien Sung1 1 Taipei Veterans General Hospital, Taiwan BACKGROUND Renal function is a major prognostic determinant in patients with acute coronary syndrome (ACS). This study seeks to compare the clinical significance of two different estimated glomerular filtration rate (eGFR) equations, one of which is calculated by using the four-level race Chronic Kidney Disease Epidemiology Collaboration study equation (eGFREPI_4R) and the other is by using the Chinese modified Modification of Diet in Renal Disease study equation (eGFRcMDRD),in patients with ACS.
CONCLUSION In AMI patients with multivessel diseases, complete revascularization was not harmful. The strategy of staged PCI for nonculprit lesion PCI after culprit lesion primary PCI might be encouraged for both STEMI and non-ST-segment elevation myocardial infarction (NSTEMI) patients. TCTAP A-012 Impact of Very Old Age on Long Term Prognosis in Elderly Patients with ST Segment Elevated Myocardial Infarction Treated with Primary Coronary Intervention Ji Young Park,1 Jae Woong Choi,1 Sung Kee Ryu1 1 Eulji Medical Center, Korea (Republic of) BACKGROUND Age was reported as a significant risk factor for coronary artery disease. The World widely, the age of 65 years was
METHODS The patients admitted for ACS with elevated cardiac enzyme (Troponin-I) composed of this study. The equations of EPI_4R and cMDRD were used to calculate eGFR. National Death Registry was linked to identify the clinical outcomes of all-cause mortality within a 5-year follow-up. RESULTS Among a total of 2750 patients (age 71 13 years, 78% men) in this study, 1175 patients (43%) received percutaneous coronary intervention (PCI) during admission. The calculations were generally higher by cMDRD than EPI_4R, especially in the patients with preserved renal function. During a median follow-up duration of 29 months, both eGFREPI_4R and eGFRcMDRD were independently predictive of mortality in the study population, after accounting for age, gender, systolic blood pressure, heart rate, peak Troponin-I level, shock status and intubation status (hazard ratio and 95% confidence intervals per-1SD: 0.528, 0.457-0.609 and 0.537, 0.463-0.623, respectively). The associations of eGFREPI_4R, eGFRcMDRD and clinical outcomes remained true whether or not the patients received PCI during admission. With reference to an eGFR of 90 ml/min/1.73 m2, advanced CKD stages
METHODS From April 2013 to October 2016, 899 patients underwent high-pitch aortic CTA for suspected aortic dissection at ER. Thirtyeight patients who were finally diagnosed as acute coronary syndrome (ACS) and received subsequent coronary catheterization within one month were recruited. The study subjects were grouped into STelevation myocardial infarct (STEMI) in 9, Non-ST-elevation myocardial infarct (NSTEMI) in 18, and unstable angina (UA) in 11, based on the clinical diagnosis. Visual patterns of PDs were classified to transmural, non-transmural, and subendocardial. Quantitative categorizations of PD based on thickness were grouped to more or less than 50% involvement. The infarct/ischemia related artery (IRA) was confirmed via coronary angiography. The PD severity score was calculated by diseased segment (17 segments adapted from AHA) multiplying the severity (PD thickness: 3 for transmural, 2 for >50%, 1 for <50% and 0 for normal). RESULTS PD was identified in 32 of the 38 patients with ACS. The predominant pattern of PDs was transmural in STEMI (89%), nontransmural in NSTEMI (61%), and subendocardial in UA (45%). The sensitivity and specificity of PD for predicting IRA were 91% and 100%. Besides, the sensitivity and specificity of more than 50% thickness of PD involvement for detecting MI were 85% and 91%. A significant difference exists in waiting time for catheterization (p<0.00001) and PD severity score (p<0.001) between these three groups. CONCLUSION In patients with ACS, myocardial PDs detected on nongated high-pitch aortic CTA provides high sensitivity and specificity with IRA related territory. Furthermore, PD with more than 50% thickness involvement contributes well sensitivity and specificity for myocardial infarct detection especially in patients with ACS.
TCTAP A-010 Prognostic Value of Clinical SYNTAX Score on 2-year Outcomes in Patients with Acute Coronary Syndrome After Percutaneous Coronary Intervention Chen He,1 Jinqing Yuan,2 Bo Xu2 1 Fuwai Hospital, CAMS&PUMC, China; 2Fuwai Hospital, China BACKGROUND The anatomical SYNTAX score is a scoring system based on the complexity and severity of coronary lesions and is thought to be a prognostic tool to predict long-term outcomes. One of the major limitations of using the SYNTAX score in clinical practice was SYNTAX score don’t contain the clinical characteristics. There are few researches about the prognostic value of clinical SYNTAX score in patients with acute coronary syndrome after percutaneous coronary intervention. This prospective, single-central, observational study evaluated the prognostic value of clinical SYNTAX score on 2-year outcomes in patients with acute coronary syndrome after percutaneous coronary intervention. METHODS Between January 2013 and December 2013, 6,099 consecutive acute coronary syndrome patients admitted to Fuwai hospital and underwent PCI were enrolled in this study. Accordingly with clinical syntax score, patients were divided in low CSS group (CSS6.5, 2,012 patients), mid CSS group (6.5＜CSS＜13.8, 2,056 patients) and high CSS group (CSS13.8, 2031 patients). RESULTS At 2-years follow-up, rates of cardiac death and MACCE were significantly higher in the high CSS group. CSS was superior to the baseline SS in predicting 2-years cardiac death (AUC 0.738 vs 0.615, P<0.001), but wasn’t superior in predicting 2-years MACE (AUC 0.597 vs 0.592, P¼0.285). On Cox regression analysis, CSS (p¼0.000), PCI history (p ¼0.002), and hypertension (p<0.000) were independent predictors of cardiac death. CSS (p¼0.000), IABP support (p¼0.000), diabetes mellitus (p¼0.004), and successful PCI (p¼0.000) were independent predictors of MACE.
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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
CONCLUSION Clinical SYNTAX score was a good prognostic tool of long-term outcomes in ACS patients undergoing PCI combing the SYNTAX score with several clinical risk characteristics including age, ejection fraction, and creatinine clearance. TCTAP A-011 Comparison of Timing of Non-culprit Lesion Percutaneous Coronary Intervention in Myocardial Infarction Patients Hyung Oh Kim,1 Weon Kim,1 Soo-Joong Kim,1 Jong Shin Woo,1 Hyemoon Chung,2 Jae Min Kim1 1 Kyung Hee University Medical Center, Korea (Republic of); 2Gangnam Severance Hospital, Korea (Republic of) BACKGROUND The percutaneous coronary intervention (PCI) of a non-infarct artery at the time of primary PCI for patients with acute myocardial infarction (AMI) is still debatable. The purpose was to evaluate the long-term outcomes according to the treatment strategy of non-culprit lesions among the AMI patients with multivessel disease who underwent primary PCI or early invasive PCI. METHODS Among 615 AMI patients, 333 patients with multivessel disease were analyzed retrospectively in a single center. Among them, 133 patients underwent culprit lesion only PCI (group 1), 120 patients underwent non-culprit lesion PCI at the time of primary culprit lesion PCI simultaneously (group 2), and 80 patients underwent second staged PCI for non-culprit lesion shortly after culprit lesion primary PCI (group 3). The clinical outcomes including all-cause mortality, non-fatal MI and repeated admission because of heart failure were assessed for 36 months.
accepted as a definition of ’elderly’ or older person. However, there was no guideline for the very elderly patients (80 years) with STsegment elevated myocardial infarction (STEMI) treated with PCI. Therefore, we investigated the impact of very old age (80 years) on long-term prognosis in elderly patients who were treated with PCI for STEMI. METHODS A total of 337 elderly patients who were treated with PCI due to STEMI were analyzed. Patients were divided into the two groups according to the age: 65-79 years patients (n¼269) vs over 80 years patients (n¼68). RESULTS Baseline clinical characteristics showed that past history of PCI (14.9% vs 4.4%, p¼0.024), diabetes mellitus (39.0%, vs 13.2%, p<0.001), and smoking (38.7% vs 20.6%, p¼0.007) were higher in elderly patients as compared with very elderly patients. Angiographic characteristics were similar between the two groups. Clinical outcomes showed that mortality up to 30 days were higher in very elderly patients, but total mortality up to 3 years were similar between the two groups. (Table 1) Multivariate regression showed that very old age (80 years, HR 3.5, CI 1.16-10.7, p¼0.026), past history of cerebrovascular events (HR 4.7, CI 1.4-15.4, p¼0.011), and past history of coronary bypass graft (HR 1.8, CI 1.0-3.2, p¼0.044) were independent risk factors for mortality up to 3 years.
RESULTS Patients with group 1 showed older and had more non-ST elevation AMI. During 36-month follow-up, there were higher incidences of major adverse cardiac event (MACE) in group 1 [28 (21%) in group 1, 16 (13%) patients in group 2, 9 (12%) patients with group 3, p¼0.02, Figure]. During 6-month follow-up, staged PCI showed the better tendency, but there was no significant difference of event occurrence between staged and simultaneously PCI of a non-culprit lesion. Similarly, ST-segment elevation myocardial infarction (STEMI) patients (n¼127) also showed significant better MACE-free survivals who performed Non-culprit PCI (simultaneously and staged) compared to culprit-only PCI (p¼0.02). CONCLUSION Very old age was associated with short-term mortality and was an independent risk factor for mortality up to 3 years. Therefore, more intensive and careful therapies will be needed for very elderly patients with STEMI treated with PCI.
TCTAP A-013 The Prognostic Comparison of the Estimations of Renal Function in Patients with Acute Coronary Syndrome Yu-Lun Cheng,1 Shih-Hsien Sung1 1 Taipei Veterans General Hospital, Taiwan BACKGROUND Renal function is a major prognostic determinant in patients with acute coronary syndrome (ACS). This study seeks to compare the clinical significance of two different estimated glomerular filtration rate (eGFR) equations, one of which is calculated by using the four-level race Chronic Kidney Disease Epidemiology Collaboration study equation (eGFREPI_4R) and the other is by using the Chinese modified Modification of Diet in Renal Disease study equation (eGFRcMDRD),in patients with ACS.
CONCLUSION In AMI patients with multivessel diseases, complete revascularization was not harmful. The strategy of staged PCI for nonculprit lesion PCI after culprit lesion primary PCI might be encouraged for both STEMI and non-ST-segment elevation myocardial infarction (NSTEMI) patients. TCTAP A-012 Impact of Very Old Age on Long Term Prognosis in Elderly Patients with ST Segment Elevated Myocardial Infarction Treated with Primary Coronary Intervention Ji Young Park,1 Jae Woong Choi,1 Sung Kee Ryu1 1 Eulji Medical Center, Korea (Republic of) BACKGROUND Age was reported as a significant risk factor for coronary artery disease. The World widely, the age of 65 years was
METHODS The patients admitted for ACS with elevated cardiac enzyme (Troponin-I) composed of this study. The equations of EPI_4R and cMDRD were used to calculate eGFR. National Death Registry was linked to identify the clinical outcomes of all-cause mortality within a 5-year follow-up. RESULTS Among a total of 2750 patients (age 71 13 years, 78% men) in this study, 1175 patients (43%) received percutaneous coronary intervention (PCI) during admission. The calculations were generally higher by cMDRD than EPI_4R, especially in the patients with preserved renal function. During a median follow-up duration of 29 months, both eGFREPI_4R and eGFRcMDRD were independently predictive of mortality in the study population, after accounting for age, gender, systolic blood pressure, heart rate, peak Troponin-I level, shock status and intubation status (hazard ratio and 95% confidence intervals per-1SD: 0.528, 0.457-0.609 and 0.537, 0.463-0.623, respectively). The associations of eGFREPI_4R, eGFRcMDRD and clinical outcomes remained true whether or not the patients received PCI during admission. With reference to an eGFR of 90 ml/min/1.73 m2, advanced CKD stages