- Email: [email protected]
TCTAP A-012 Abstract Withdrawn
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
TCTAP A-010 Combined Contrast-Induced Acute Kidney Injury and Hypoxic Liver Injury Is Associated with Worse Outcome in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Results from INTERSTELLAR Registry Sung Woo Kwon,1 Jeonggeun Moon,2 Tae-Hoon Kim,3 Hojun Jang,5 Jon Suh,4 Hyun Woo Park,4 Pyung Chun Oh,2 Sang-Don Park,1 Woong Chol Kang2 1 InHa University Hospital, Korea (Republic of); 2Gachon University Gil Medical Center, Korea (Republic of); 3Sejong General Hospital, Korea (Republic of); 4Soon Chun Hyang University Bucheon Hospital, Korea (Republic of); 5Sejong General Hospital, Korea (Republic of) BACKGROUND We sought to evaluate the prognostic impact of combined contrast-induced acute kidney injury (CI-AKI) and hypoxic liver injury (HLI) in patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). METHODS A total of 668 consecutive patients (77.2% male, mean age 61.313.3 years) with STEMI underwent primary PCI were analyzed. CI-AKI was defined as increase in serum creatinine of 0.5 mg/dl or 25% relative rise, within 48h after index procedure. HLI was defined as 2-fold increase of serum aspartate transaminase above upper normal limit at admission. Patients were divided into four groups according to their CI-AKI and HLI states. Major adverse cardiovascular and cerebrovascular events (MACCE) defined as composite of allcause mortality, non-fatal MI, non-fatal stroke, ischemia-driven target lesion revascularization (TLR) and target vessel revascularization (TVR) were recorded. RESULTS Over a mean follow-up period of 2.21.6 years, there were 94 MACCEs (66 all-cause mortality, 15 non-fatal MI, 7 non-fatal stroke, and 6 ischemia-driven TLR/TVR) with an event rate of 14.1%. The rate of MACCE and all-cause mortality were 9.7% and 5.2% in no organ damage group, 21.3% and 21.3% in CI-AKI group, 18.5% and 14.6% in HLI group, and 57.7% and 50.0% in combined CI-AKI and HLI group, respectively. Survival probability plots of composite MACCE and all-cause mortality revealed that combined CI-AKI and HLI is associated with worst prognosis (p<0.0001 for both).
S5
sub-acute phase of ST-segment elevation myocardial infarction (STEMI). METHODS 121 STEMI patients who received primary PCI were included. Thrombolysis in myocardial infarction (TIMI) Myocardial Perfusion Frame Count (TMPFC), a novel angiographic method to assess myocardial perfusion, was applied to evaluate MD after PCI and TMPFC > 95 frames was defined as MD. Two-dimensional speckletracking echocardiography was performed at 3-7 days after reperfusion. The infarction related regional longitudinal (RLS) strains as well as circumferential (RCS) and radial (RRS) ones, along with global longitudinal (GLS), circumferential (GCS), and radial (GRS) strains were measured. RESULTS Patients with MD had decreased peak amplitude of RLS (-11.0 5.6 vs. -13.7 5.0%,p¼0.012), RCS (-11.8 5.7 vs. -16.2 5.6%, p<0.001), RRS (23.5 11.3 vs. 30.3 16.7%, p¼0.012) on the regional level and decreased peak amplitude of GCS (-14.2 4.5 vs. -16.8 4.2%, p¼0.005), GRS (27.5 9.9 vs. 33.7 15.7%, p¼0.012) on the global level. The RCS to RLS ratio and RCS to RRS ratio were significantly different between patients without MD and patients with MD (1.28 0.31 vs 1.07 0.47, p¼ 0.027 and 0.69 0.33 vs 0.56 0.28, p¼ 0.047). Receiver operator characteristics curves identified a cut off value of 94 frames for TMPFC to differentiate between normal and abnormal wall motion score index in sub-acute phase of STEMI (AUC¼0.72; p<0.001). CONCLUSION In the sub-acute phase of STEMI, the presence of MD in infarcted tissue relates to reduced global and regional myocardial deformation. RCS alterations were more significant than RLS and RRS between patients with or without MD. TMPFC was useful to predict left ventricular systolic dysfunction in the sub-acute phase of STEMI.
TCTAP A-012 Abstract Withdrawn TCTAP A-013 Long-Term Clinical Impact of Complete Revascularization in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease Min Chul Kim,1 Myung-Ho Jeong,1 Doo Sun Sim,1 Young Joon Hong,1 Ju Han Kim,1 Youngkeun Ahn1 1 Chonnam National University Hospital, Korea (Republic of) BACKGROUND Optimal interventional strategy for ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) is still controversial. We analyzed the longterm clinical outcome of complete revascularization (CR) compared to incomplete revascularization (IR) in patients with STEMI and MVD.
CONCLUSION Combined CI-AKI after index procedure and HLI at admission is associated with poor clinical outcomes in patients with ST elevation myocardial infarction who underwent primary PCI. TCTAP A-011 Influence of Microvascular Dysfunction on Regional Myocardial Deformation in the Sub-Acute Phase of Myocardial Infarction: A Pilot Study Comparing Angiographically Defined Microvascular Dysfunction with Speckle-Tracking Echocardiography Assessed Myocardial Deformation Song Ding,1 Zhiqing Qiao,1 Jun Pu,2 Ben He1 1 Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China; 2Renji Hospital/Shanghai Jiao Tong University, China BACKGROUND The impact of microvascular dysfunction (MD) assessed by angiography on myocardial deformation assessed by twodimensional speckle-tracking echocardiography was unclear in the
METHODS A total of 575 consecutive patients with STEMI and MVD who admitted at Chonnam National University Hospital between January 2006 and July 2009 were enrolled. Excluding patients with cardiogenic shock, who experienced initial cardiac arrest or inhospital death, a total of 453 patients were analyzed and divided into two groups according to interventional strategy; CR group (n¼240) vs. IR group (n¼213). Primary endpoint was a major adverse cardiac events (composite of all-cause mortality, myocardial infarction [MI], and any revascularization) during long-term follow-up period (median 6.3 years; interquartile range 3.7 to 7.7 years). We also examined the incidence of each component of MACE, cerebrovascular accident (CVA), stent thrombosis, and readmission due to acute heart failure (HF). RESULTS IR group was older (67.411.5 vs. 71.512.2 years, p < 0.001) and had a higher level of N-terminal pro B-natriuretic peptide (median 808 [179-1942] vs. 1275 [303-2963] pg/mL, p ¼ 0.042). The proportion of gender, prevalence of atherosclerotic risk factors, left ventricular ejection fraction (55.111.2 vs. 55.312.4%, p ¼ 0.103) and door-to-balloon time (76.923.8 vs. 75.028.9 min, p ¼ 0.425) were comparable between two groups. Coronary stenting was done in 447 patients (98.7%; 99.2 vs. 98.1%, p ¼ 0.427) and peri-procedural complications occurred similarly in both groups (10.0 vs. 11.7%, p ¼ 0.650). Among 315 patients who underwent multivessel PCI, 251 patients (79.7%) received staged PCI. During follow-up period, MACE occurred in 158 patients (34.9%) and 57 patients (12.6%) died. CR significantly reduced MACE (27.1 vs.
TCTAP A-010 Combined Contrast-Induced Acute Kidney Injury and Hypoxic Liver Injury Is Associated with Worse Outcome in Patients with ST Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention: Results from INTERSTELLAR Registry Sung Woo Kwon,1 Jeonggeun Moon,2 Tae-Hoon Kim,3 Hojun Jang,5 Jon Suh,4 Hyun Woo Park,4 Pyung Chun Oh,2 Sang-Don Park,1 Woong Chol Kang2 1 InHa University Hospital, Korea (Republic of); 2Gachon University Gil Medical Center, Korea (Republic of); 3Sejong General Hospital, Korea (Republic of); 4Soon Chun Hyang University Bucheon Hospital, Korea (Republic of); 5Sejong General Hospital, Korea (Republic of) BACKGROUND We sought to evaluate the prognostic impact of combined contrast-induced acute kidney injury (CI-AKI) and hypoxic liver injury (HLI) in patients with ST-elevation myocardial infarction (STEMI) who underwent primary percutaneous coronary intervention (PCI). METHODS A total of 668 consecutive patients (77.2% male, mean age 61.313.3 years) with STEMI underwent primary PCI were analyzed. CI-AKI was defined as increase in serum creatinine of 0.5 mg/dl or 25% relative rise, within 48h after index procedure. HLI was defined as 2-fold increase of serum aspartate transaminase above upper normal limit at admission. Patients were divided into four groups according to their CI-AKI and HLI states. Major adverse cardiovascular and cerebrovascular events (MACCE) defined as composite of allcause mortality, non-fatal MI, non-fatal stroke, ischemia-driven target lesion revascularization (TLR) and target vessel revascularization (TVR) were recorded. RESULTS Over a mean follow-up period of 2.21.6 years, there were 94 MACCEs (66 all-cause mortality, 15 non-fatal MI, 7 non-fatal stroke, and 6 ischemia-driven TLR/TVR) with an event rate of 14.1%. The rate of MACCE and all-cause mortality were 9.7% and 5.2% in no organ damage group, 21.3% and 21.3% in CI-AKI group, 18.5% and 14.6% in HLI group, and 57.7% and 50.0% in combined CI-AKI and HLI group, respectively. Survival probability plots of composite MACCE and all-cause mortality revealed that combined CI-AKI and HLI is associated with worst prognosis (p<0.0001 for both).
S5
sub-acute phase of ST-segment elevation myocardial infarction (STEMI). METHODS 121 STEMI patients who received primary PCI were included. Thrombolysis in myocardial infarction (TIMI) Myocardial Perfusion Frame Count (TMPFC), a novel angiographic method to assess myocardial perfusion, was applied to evaluate MD after PCI and TMPFC > 95 frames was defined as MD. Two-dimensional speckletracking echocardiography was performed at 3-7 days after reperfusion. The infarction related regional longitudinal (RLS) strains as well as circumferential (RCS) and radial (RRS) ones, along with global longitudinal (GLS), circumferential (GCS), and radial (GRS) strains were measured. RESULTS Patients with MD had decreased peak amplitude of RLS (-11.0 5.6 vs. -13.7 5.0%,p¼0.012), RCS (-11.8 5.7 vs. -16.2 5.6%, p<0.001), RRS (23.5 11.3 vs. 30.3 16.7%, p¼0.012) on the regional level and decreased peak amplitude of GCS (-14.2 4.5 vs. -16.8 4.2%, p¼0.005), GRS (27.5 9.9 vs. 33.7 15.7%, p¼0.012) on the global level. The RCS to RLS ratio and RCS to RRS ratio were significantly different between patients without MD and patients with MD (1.28 0.31 vs 1.07 0.47, p¼ 0.027 and 0.69 0.33 vs 0.56 0.28, p¼ 0.047). Receiver operator characteristics curves identified a cut off value of 94 frames for TMPFC to differentiate between normal and abnormal wall motion score index in sub-acute phase of STEMI (AUC¼0.72; p<0.001). CONCLUSION In the sub-acute phase of STEMI, the presence of MD in infarcted tissue relates to reduced global and regional myocardial deformation. RCS alterations were more significant than RLS and RRS between patients with or without MD. TMPFC was useful to predict left ventricular systolic dysfunction in the sub-acute phase of STEMI.
TCTAP A-012 Abstract Withdrawn TCTAP A-013 Long-Term Clinical Impact of Complete Revascularization in Patients with ST-Segment Elevation Myocardial Infarction and Multivessel Coronary Artery Disease Min Chul Kim,1 Myung-Ho Jeong,1 Doo Sun Sim,1 Young Joon Hong,1 Ju Han Kim,1 Youngkeun Ahn1 1 Chonnam National University Hospital, Korea (Republic of) BACKGROUND Optimal interventional strategy for ST-segment elevation myocardial infarction (STEMI) and multivessel coronary artery disease (MVD) is still controversial. We analyzed the longterm clinical outcome of complete revascularization (CR) compared to incomplete revascularization (IR) in patients with STEMI and MVD.
CONCLUSION Combined CI-AKI after index procedure and HLI at admission is associated with poor clinical outcomes in patients with ST elevation myocardial infarction who underwent primary PCI. TCTAP A-011 Influence of Microvascular Dysfunction on Regional Myocardial Deformation in the Sub-Acute Phase of Myocardial Infarction: A Pilot Study Comparing Angiographically Defined Microvascular Dysfunction with Speckle-Tracking Echocardiography Assessed Myocardial Deformation Song Ding,1 Zhiqing Qiao,1 Jun Pu,2 Ben He1 1 Renji Hospital, School of Medicine, Shanghai Jiao Tong University, China; 2Renji Hospital/Shanghai Jiao Tong University, China BACKGROUND The impact of microvascular dysfunction (MD) assessed by angiography on myocardial deformation assessed by twodimensional speckle-tracking echocardiography was unclear in the
METHODS A total of 575 consecutive patients with STEMI and MVD who admitted at Chonnam National University Hospital between January 2006 and July 2009 were enrolled. Excluding patients with cardiogenic shock, who experienced initial cardiac arrest or inhospital death, a total of 453 patients were analyzed and divided into two groups according to interventional strategy; CR group (n¼240) vs. IR group (n¼213). Primary endpoint was a major adverse cardiac events (composite of all-cause mortality, myocardial infarction [MI], and any revascularization) during long-term follow-up period (median 6.3 years; interquartile range 3.7 to 7.7 years). We also examined the incidence of each component of MACE, cerebrovascular accident (CVA), stent thrombosis, and readmission due to acute heart failure (HF). RESULTS IR group was older (67.411.5 vs. 71.512.2 years, p < 0.001) and had a higher level of N-terminal pro B-natriuretic peptide (median 808 [179-1942] vs. 1275 [303-2963] pg/mL, p ¼ 0.042). The proportion of gender, prevalence of atherosclerotic risk factors, left ventricular ejection fraction (55.111.2 vs. 55.312.4%, p ¼ 0.103) and door-to-balloon time (76.923.8 vs. 75.028.9 min, p ¼ 0.425) were comparable between two groups. Coronary stenting was done in 447 patients (98.7%; 99.2 vs. 98.1%, p ¼ 0.427) and peri-procedural complications occurred similarly in both groups (10.0 vs. 11.7%, p ¼ 0.650). Among 315 patients who underwent multivessel PCI, 251 patients (79.7%) received staged PCI. During follow-up period, MACE occurred in 158 patients (34.9%) and 57 patients (12.6%) died. CR significantly reduced MACE (27.1 vs.