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TCTAP A-036 Characteristics of Coronary Angiography in Young Patients with Acute Coronary Syndrome
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
TCTAP A-035 Invasive Versus Conservative Strategy in Non-ST-elevation Myocardial Infarction – Patient Characteristics, Outcomes and Reasons for Conservative Therapy: Data from a Single Tertiary Center Billy Yonathan Wijaya,1 Nurun Nisa De Souza,2 Khung Keong Yeo3 1 Duke-NUS Medical School, Singapore; 2Singapore Clinical Research Institute, Singapore; 3National Heart Centre Singapore, Singapore BACKGROUND Treatment of non-ST-Elevation Myocardial Infarction (NSTEMI) includes an initial invasive strategy (angiography followed by revascularization if appropriate) and an initial conservative strategy. The meta-analysis comparing the two pathways shows the benefit of invasive strategy over conservative strategy. Our objective is to compare patient characteristics and outcomes for invasive versus conservative strategy and to identify commonly documented reasons for undergoing conservative strategy. METHODS We performed a retrospective-cohort-study of NSTEMI patients in a tertiary medical center in Asia using the cardiac catheterization database, electronic medical records, and case notes review. RESULTS Angiography was performed in 70.8% of NSTEMI patients. An invasive strategy was significantly associated with younger age, male gender, no past medical history of angiography, hypertension, diabetes mellitus, hyperlipidemia, acute myocardial infarction (AMI), chronic kidney disease, heart failure (HF), acute renal failure (ARF), cerebrovascular accident (CVA) and arrhythmia. After multivariate analysis, younger age (AOR¼0.94, 95% CI 0.93-0.95), Malay ethnicity (AOR¼0.49, 95% CI 0.33-0.73), past medical history of AMI (AOR¼0.65, 95% CI 0.45-0.92), HF (AOR¼0.50, 95% CI 0.35-0.72) and ARF (AOR¼0.66, 95% CI 0.44-0.99) remained as independent predictors of invasive strategy. The invasive strategy was significantly associated with lower adverse in-hospital events such as in-patient death, HF, ARF, CVA and shorter length of stay with p-values of p<0.001, p¼0.003 and p¼0.001 respectively. The medical related reason was the top documented reasons for conservative strategy. Those who had a conservative strategy and was not offered angiography was significantly associated with a documented medical related reason. Whereas those who had conservative management and was offered angiography was significantly associated with a documented social or financial reason. CONCLUSION Angiography was associated with lower adverse inhospital events. There is a prominent physician influence in those who undergo conservative strategy as suggested by medical related reason’s (top documented reason) significant association with having not been offered angiography. TCTAP A-036 Characteristics of Coronary Angiography in Young Patients with Acute Coronary Syndrome Rahmad Isnanta1 Adam Malik hospital, Indonesia
1
BACKGROUND Incidence of acute coronary syndrome has been increasing at young age (45 years). There are many of Indonesian people who do not believe that heart attack can occur at the young age. METHODS The severity of coronary stenosis was determined by vessel score and coronary score. A significant vessel score was defined as a stenosis of coronary vessel of >70%. Patients were divided into two groups: those aged 45 years (72 cases) and those aged >45 years (250 cases). RESULTS The highest distribution of 1-VD (Single-Vessel Disease) patients was found the group of patients aged 45 years (43.1% vs 26.0%); while for 3-VD (Triple Vessel Disease) patients, the highest distribution was noticed in the group of patients aged >45 years (31.6% vs 18.1%). The stenosis score was lower in patients aged 45 years compared those aged >45 years (median stenosis score 4 vs 8), p<0.001. Atherosclerosis was found most common for the left anterior descending artery in both age groups (65.3% and 74.0%). However, there was less significant stenosis lesion for the Left Circumflex and Right Coronary Arteries in patients aged 45. The result was statistically significant (26.4% and 31.9% vs 46.4% and 57.2%, p¼0.002 and 0.001). CONCLUSION The number of coronary artery diseases (vessel score) and stenosis score is lower in patients aged 45 years compared to patients aged >45 years.
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TCTAP A-037 Aortic Arch Calcification Associated with Cardiovascular Events and Death Among Patients with Acute Coronary Syndrome Tsung Lin Yang,1 Shao-Sung Huang,2 Hsin-Bang Leu,2 Shing-Jong Lin,2 Chun-Chih Chiu2 1 Taipei Medical University Hospital, Taiwan; 2Taipei Veterans General Hospital, Taiwan BACKGROUND The relationship between aortic calcification and hard outcomes suggests that chest x-ray examination may be a good candidate for risk stratification for ACS patients due to its widespread availability, ready feasibility, and easy interpretability. Furthermore, calcification in aortic arch is more reliably detected than aorta in a thoracic or abdominal portion in chest x-ray examination, which was often obscured by other intrathoracic and intra-abdominal organs. The connection between AAC and clinical outcomes in ACS patients was incompletely investigated. Our study aimed to examine the epidemiology, coronary characteristics as well as clinical outcomes of ACS patients with AAC and clarify whether AAC plays a prognostic role in ACS patients. METHODS Patients admitted to the coronary care unit of Taipei Veterans General Hospital under the impression of acute coronary syndrome, including STEMI, NSTEMI, and UA, were recruited retrospectively between January 1 and December 31, 2013. The definitions of STEMI, NSTEMI, and UA followed the ACCF/AHA guidelines. The data collection, processing, analysis, and interpretation were approved by the committee of the Institutional Review Board of Taipei Veterans General Hospital (IRB number 2014-11-003 AC). The underlying systemic disorders, anginal symptoms, electrocardiography, chest plain film, laboratory investigations, coronary artery angiography, the course of hospitalization, in-hospital events, and discharge follow-up (if available) of each patient were thoroughly scrutinized. The image interpretation, including electrocardiography, chest plain film (Figure 1), coronary artery angiography, were separately performed twice by two experienced cardiologists blinded to clinical conditions. If discrepancy existed between two cardiologists in the same patient, a third experienced cardiologist would join reviewing examinations. The primary outcome was the composite endpoint of long-term major adverse cardiovascular events (MACE) comprising of non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death, the definition of which followed the universal agreement of consensus. The secondary outcomes were 30-day and long-term all-cause mortality. The baseline characteristics were shown in Table 1.
TCTAP A-035 Invasive Versus Conservative Strategy in Non-ST-elevation Myocardial Infarction – Patient Characteristics, Outcomes and Reasons for Conservative Therapy: Data from a Single Tertiary Center Billy Yonathan Wijaya,1 Nurun Nisa De Souza,2 Khung Keong Yeo3 1 Duke-NUS Medical School, Singapore; 2Singapore Clinical Research Institute, Singapore; 3National Heart Centre Singapore, Singapore BACKGROUND Treatment of non-ST-Elevation Myocardial Infarction (NSTEMI) includes an initial invasive strategy (angiography followed by revascularization if appropriate) and an initial conservative strategy. The meta-analysis comparing the two pathways shows the benefit of invasive strategy over conservative strategy. Our objective is to compare patient characteristics and outcomes for invasive versus conservative strategy and to identify commonly documented reasons for undergoing conservative strategy. METHODS We performed a retrospective-cohort-study of NSTEMI patients in a tertiary medical center in Asia using the cardiac catheterization database, electronic medical records, and case notes review. RESULTS Angiography was performed in 70.8% of NSTEMI patients. An invasive strategy was significantly associated with younger age, male gender, no past medical history of angiography, hypertension, diabetes mellitus, hyperlipidemia, acute myocardial infarction (AMI), chronic kidney disease, heart failure (HF), acute renal failure (ARF), cerebrovascular accident (CVA) and arrhythmia. After multivariate analysis, younger age (AOR¼0.94, 95% CI 0.93-0.95), Malay ethnicity (AOR¼0.49, 95% CI 0.33-0.73), past medical history of AMI (AOR¼0.65, 95% CI 0.45-0.92), HF (AOR¼0.50, 95% CI 0.35-0.72) and ARF (AOR¼0.66, 95% CI 0.44-0.99) remained as independent predictors of invasive strategy. The invasive strategy was significantly associated with lower adverse in-hospital events such as in-patient death, HF, ARF, CVA and shorter length of stay with p-values of p<0.001, p¼0.003 and p¼0.001 respectively. The medical related reason was the top documented reasons for conservative strategy. Those who had a conservative strategy and was not offered angiography was significantly associated with a documented medical related reason. Whereas those who had conservative management and was offered angiography was significantly associated with a documented social or financial reason. CONCLUSION Angiography was associated with lower adverse inhospital events. There is a prominent physician influence in those who undergo conservative strategy as suggested by medical related reason’s (top documented reason) significant association with having not been offered angiography. TCTAP A-036 Characteristics of Coronary Angiography in Young Patients with Acute Coronary Syndrome Rahmad Isnanta1 Adam Malik hospital, Indonesia
1
BACKGROUND Incidence of acute coronary syndrome has been increasing at young age (45 years). There are many of Indonesian people who do not believe that heart attack can occur at the young age. METHODS The severity of coronary stenosis was determined by vessel score and coronary score. A significant vessel score was defined as a stenosis of coronary vessel of >70%. Patients were divided into two groups: those aged 45 years (72 cases) and those aged >45 years (250 cases). RESULTS The highest distribution of 1-VD (Single-Vessel Disease) patients was found the group of patients aged 45 years (43.1% vs 26.0%); while for 3-VD (Triple Vessel Disease) patients, the highest distribution was noticed in the group of patients aged >45 years (31.6% vs 18.1%). The stenosis score was lower in patients aged 45 years compared those aged >45 years (median stenosis score 4 vs 8), p<0.001. Atherosclerosis was found most common for the left anterior descending artery in both age groups (65.3% and 74.0%). However, there was less significant stenosis lesion for the Left Circumflex and Right Coronary Arteries in patients aged 45. The result was statistically significant (26.4% and 31.9% vs 46.4% and 57.2%, p¼0.002 and 0.001). CONCLUSION The number of coronary artery diseases (vessel score) and stenosis score is lower in patients aged 45 years compared to patients aged >45 years.
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TCTAP A-037 Aortic Arch Calcification Associated with Cardiovascular Events and Death Among Patients with Acute Coronary Syndrome Tsung Lin Yang,1 Shao-Sung Huang,2 Hsin-Bang Leu,2 Shing-Jong Lin,2 Chun-Chih Chiu2 1 Taipei Medical University Hospital, Taiwan; 2Taipei Veterans General Hospital, Taiwan BACKGROUND The relationship between aortic calcification and hard outcomes suggests that chest x-ray examination may be a good candidate for risk stratification for ACS patients due to its widespread availability, ready feasibility, and easy interpretability. Furthermore, calcification in aortic arch is more reliably detected than aorta in a thoracic or abdominal portion in chest x-ray examination, which was often obscured by other intrathoracic and intra-abdominal organs. The connection between AAC and clinical outcomes in ACS patients was incompletely investigated. Our study aimed to examine the epidemiology, coronary characteristics as well as clinical outcomes of ACS patients with AAC and clarify whether AAC plays a prognostic role in ACS patients. METHODS Patients admitted to the coronary care unit of Taipei Veterans General Hospital under the impression of acute coronary syndrome, including STEMI, NSTEMI, and UA, were recruited retrospectively between January 1 and December 31, 2013. The definitions of STEMI, NSTEMI, and UA followed the ACCF/AHA guidelines. The data collection, processing, analysis, and interpretation were approved by the committee of the Institutional Review Board of Taipei Veterans General Hospital (IRB number 2014-11-003 AC). The underlying systemic disorders, anginal symptoms, electrocardiography, chest plain film, laboratory investigations, coronary artery angiography, the course of hospitalization, in-hospital events, and discharge follow-up (if available) of each patient were thoroughly scrutinized. The image interpretation, including electrocardiography, chest plain film (Figure 1), coronary artery angiography, were separately performed twice by two experienced cardiologists blinded to clinical conditions. If discrepancy existed between two cardiologists in the same patient, a third experienced cardiologist would join reviewing examinations. The primary outcome was the composite endpoint of long-term major adverse cardiovascular events (MACE) comprising of non-fatal myocardial infarction, non-fatal stroke, and cardiovascular death, the definition of which followed the universal agreement of consensus. The secondary outcomes were 30-day and long-term all-cause mortality. The baseline characteristics were shown in Table 1.