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TCTAP A-079 Clinical Outcomes of Incomplete Revascularization in Octogenarians Hospitalized for Acute Coronary Syndrome
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
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patients were divided into 2 groups: those with a favorable (Group 1 35 patients -70% without DM) and unfavorable (group 2 patients 30% 15 with DM) outcome (sudden death, fatal and nonfatal cardiac arrhythmias, heart failure decompensation) during the observation period. RESULTS According to the analysis of the basic parameters, the greatest contribution to the formation of an unfavorable outcome HF provided the combined attributes: III-IV FC by NYHA þ PICS þ DM; HF þ AF DM. According to the study echocardiography at rest on the 1st day of the disease marked by a moderate dilatation of the LV cavity: LV ESS - 4,5 0,1 cm, the LV EDS - 6,0 0,1 cm and LV ESV 95,5 4.1 ml of LVEDV - 168,5 5,8 ml. After 6 months in the first group there was a significant increase in the value of SF and FEV to 25,5 0,6% and 46,4 0,6% (on the 1st day amounted to 22,5 0,6 and 43,1 0.9 respectively). LV ESS was - 4,35 0,2 cm, the LV EDV 5,8 0,1 cm. It is also noted a significant decrease in left ventricular ESV 15% of LV EDV by 11.2%. In patients with concomitant diabetes in addition to the above factors, a large contribution to the adverse outcomes of the HF did the level of fasting blood glucose (13 mM/L) and postprandial “drop” of blood glucose levels > 54% recorded at the time of admission. CONCLUSION The most powerful marker of adverse outcome of the HF, controlled by medication are resting ECG data from clinic anamnestic greatest contribution have combined features (AF, DM, PICS), the high value of the size of the heart makes a further contribution to the formation of forward-looking conclusions. TCTAP A-077 Degree of Left Ventricular Dysfunction and Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction Sunki Lee,1 Seung-Woon Rha,1 Byoung Geol Choi,1 Se Yeon Choi,1 Jae Kyeong Byun,1 Min Shim,1 Sung Hun Park,1 Eun Jin Park,1 Jah Yeon Choi,1 Jae Joong Lee,1 Li Hu,1 Jin Oh Na,1 Cheolung Choi,1 Hong Euy Lim,1 Jin Won Kim,1 Eung Ju Kim,1 Chang Gyu Park,1 Hong Seog Seo,1 Dong Joo Oh1 1 Korea University Guro Hospital, Korea (Republic of) BACKGROUND Although previous studies demonstrated the prognostic value of left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI), a study assessing long-term clinical outcomes after AMI according to LVEF status is limited and has not been evaluated in larger study populations. METHODS We analyzed the data from Korea Acute Myocardial Infarction Registry (KAMIR) enrolled from 2011 to 2015. A total of 12,431 AMI patients (pts) were grouped into preserved EF(LVEF 50%), borderline EF (40% EF < 50%), and reduced EF (EF < 40%) at baseline and 12 months after AMI. We evaluated the prognostic impact of baseline left ventricular function on 3-year cumulative clinical outcomes after AMI presentation. Moreover, we compared baseline LVEF and 12 months after AMI presentation to investigate the effect of LVEF change (recovered, deteriorated, and unchanged) on clinical outcomes. RESULTS Compared to pts with pre served and borderline LV function, those with reduced LVEF at baseline had higher 3-year cumulative rates of major adverse cardiovascular events (MACE, 5.1 vs. 5.9 vs. 9.8%, p<0.0001, Figure), non-cardiac death (1.1 vs. 1.7 vs. 2.2%, p¼0.0006), and re-hospitalization (1.6 vs.2.5 vs. 6.5%, p<0.0001), differences which persisted after adjustment for baseline characteristics. However, there was no significant difference in the 3- year cerebrovascular events among the groups (0.1 vs. 0.1 vs. 0.2%, p¼0.639). Intriguingly, pts who had shown deteriorated LVEF at 12 months revealed poor clinical outcomes as compared to pts whose LVEF recovered or unchanged (MACE; 10.2 vs. 11.3vs. 18.4%, p¼0.026). CONCLUSION Among pts with reduced LVEF (< 40%) at baseline after AMI, adverse events including MACE, non-cardiac death, and rehospitalization were markedly increased. Conversely, borderline systolic dysfunction (40% EF < 50%) showed a similar prognosis to preserved EF. In AMI pts whose follow-up LVEF deteriorated at 12 months showed poor clinical outcome.
TCTAP A-078 The Effect of Admission Blood Glucose and Hemoglobin A1C on Prognosis of Diabetic Patients with Acute Myocardial Infarction: From KorMI Registry KangUn Choi,1 Byung-Jun Kim,1 Jong-Ho Nam,1 Kyu-Hwan Park,1 Chan-Hee Lee,1 Jang-Won Son,1 Ung Kim,1 Jong-Seon Park,1 Dong-Gu Shin,1 Young-Jo Kim,1 Jun-Ho Bae,2 Deuk-Young Nah,2 Jeong-Hwan Cho,3 Sang-Wook Kang3 1 Yeungnam University Medical Center, Korea (Republic of); 2Dongguk University Gyeongju Hospital, Korea (Republic of); 3Daegu Veterans Hospital, Korea (Republic of) BACKGROUND Hyperglycemia is a well established predictor of mortality in patients with acute myocardial infarction (AMI) with or without diabetes. However, it remains unclear how admission blood glucose and hemoglobin A1C affect outcomes in diabetic patients with AMI. METHODS We assessed the prognostic impact of admission blood glucose and HbA1C level in diabetic patients with AMI. We evaluated 2,493 diabetic patients with AMI from the Korea Working Group on Myocardial Infarction (KorMI). Patients were divided into 2 groups according to blood glucose (< 200mg/dL; and 200mg/dL) and 3 groups according to HbA1C levels (<6%; 6 w 8%; and 8%). 1, 6 and 12-month major adverse cardiac event (MACE) was defined as either all cause of death, MI and any type of revascularization. RESULTS There were significant differences in 1, 6 and 12-month MACE rates according to admission glucose (12-month MACE: 189 (13.6%) in group 200 mg/dL vs 105 (9.5 %) < 200 mg/dL, p ¼ 0.002), but not according to HbA1C level. Then, we divided the group 200 mg/dL into 3 groups by HbA1C level, as mentioned above. There was a graded decrease in 12-month MACE rates (10 (18.9 %) in <6 % group; 96 (15.1 %) in 6w8 % group; and 83 (11.8 %) in 8 % group, p ¼ 0.035) and tendency to increase 12-month MACE free survival rates (87.8 % in < 6 % group; 86.8 % in 6 w 8 % group; and 89.9 %in 8 % group) according to HbA1C level, both. CONCLUSION Blood glucose level above 200 mg/dL and Less than 6.0 % HbA1C on admission may affect poor clinical outcomes in diabetic patients with acute myocardial infarction. TCTAP A-079 Clinical Outcomes of Incomplete Revascularization in Octogenarians Hospitalized for Acute Coronary Syndrome Mohammad Arifur Rahman,1 Afzalur Rahman,1 Farhana Ahmed1 1 National Institute of Cardiovascular Diseases, Bangladesh BACKGROUND Octogenarians (aged 80 years) are high risk patients and largely under-represented in clinical trials. They have higher prevalence of co morbidities and often experience complications during PCI. There is increasing number of PCI in the elderly, but this is troubled by increased short and long term morbidity and mortality. A simplified approach with incomplete or “culprit-lesion” only PCI may be an option even in Multivessel disease, to minimize periprocedural complications while still allowing a meaningful clinical recovery in patients with inherent functional limitations related to age itself.
S34
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Our aim was to evaluate clinical outcomes of incomplete revascularization in patients older than 80 years. METHODS From January 2012 to January 2014, 62 octogenarians with acute coronary syndrome were included in the study who underwent Incomplete revascularization due to variety of causes. Baseline clinical characteristics, indications for coronary intervention, in hospital outcomes and 1 year outcome were observed. Study endpoint was in hospital outcomes (Bleeding, Renal impairment, MI, LVF, emergency revascularization, stroke and death) and 1 year follow up for MI, repeat revascularization and death.
operators to take decision in favor of Incomplete revascularization. Proper patients selection, preplanning, use of appropriate hardwires and DES by an expert operators may bring success to deal with such group of vulnerable patients for whom the palliative goal is to reducing symptoms. Further studies into the optimal ACS management strategy in octogenarians are warranted.
RESULTS Elderly patients aged 80 years were mostly male 49(79%). Risk factors were smoking & chewable tobacco 24(56%), HTN 35(56%), DM 28(45%) and Dyslipidemia 38 (61%). Admission diagnoses were STEMI 10 (16%), NSTEMI 38(62%) and UA 14 (22%). CAG findings showed DVD 28 (45%) followed by SVD 17 (27%), TVD 13(21) and LM were 4(6%). Ostial lesions were 11 (11%) and calcified lesions were 18(29%). In hospital outcomes showed vascular site complication 5(8%), CIN4(6%), MI 6(9%), LVF 6(9%), CVD 2(3%) emergency CABG 3 (4%) & death were 3(4%). 26(45%) patients became asymptomatic, 22(38%) symptom improved and 8(16%) remain symptomatic. 1 year follow up showed MI 6(11%), repeat revascularization 8 (14%) and death were 5(9%).
TCTAP A-080 First and Second Generation Drug Eluting Stents Versus Bare Metal Stents in All Comer Population of Patients Undergoing PCI of Saphenous Vein Graft in 1-Year Follow-up Wojciech Wanha,1 Tomasz Roleder,1 Szymon Ladzinski,1 Sylwia Gladysz,1 Grzegorz Smolka,1 Andrzej Ochala,1 Michal Tendera,1 Wojciech Wojakowski1 1 Medical University of Silesia, Poland BACKGROUND The aim of this study was to assess device-specific outcomes after implantation bare-metal stents (BMS), first- (paclitaxel, sirolimus) or second-generation (everolimus, zotarolimus, biolimus A9) DES in all-comer population of patients undergoing PCI of saphenous vein graft SVG). METHODS The Registry included 378 consecutive patients after coronary artery bypass graft (CABG) undergoing PCI on SVG. Primary efficacy end-point was Major Adverse Cardiac and Cerebrovascular event (MACCE) defined as death, stroke or repeat-revascularization at 1-year follow-up.
CONCLUSION More often Octogenarians are poor surgical candidate. Most of them suffer from several comorbidities. Several factor such small caliber vessel, diffuse disease, calcified lesion may also satisfy
RESULTS Registry included stable CAD and ACS [SA 79(20.8%), UA 166(43.9%), NSTEMI 108(28.5%), STEMI 25(6.6%)] treated with BMS [n¼195 (51.5%)] and DES [n¼183(48.4%)]. The baseline and procedural characteristics of patients receiving BMS and BES were comparable including thrombus and use of thrombectomy but DES group had more often embolic protection devices. Use of BMS group was comparable to DES in terms of risk of death [15% vs. 7%; HR¼ 0.9(95%CI 0.40-2.30), p¼0.94)], myocardial infarction [13.8% vs. 7.6%; HR¼1.1(95%CI 0.58–2.19), p¼0.71], target vessel revascularization [34.8% vs. 25.6%; HR¼1.4(95%CI 0.99–2.11), p¼0.05], stroke [1.5% vs. 2.1%; HR¼1.0 (95%CI, 0.21–5.51), p¼0.90] and MACCE [43.5%
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patients were divided into 2 groups: those with a favorable (Group 1 35 patients -70% without DM) and unfavorable (group 2 patients 30% 15 with DM) outcome (sudden death, fatal and nonfatal cardiac arrhythmias, heart failure decompensation) during the observation period. RESULTS According to the analysis of the basic parameters, the greatest contribution to the formation of an unfavorable outcome HF provided the combined attributes: III-IV FC by NYHA þ PICS þ DM; HF þ AF DM. According to the study echocardiography at rest on the 1st day of the disease marked by a moderate dilatation of the LV cavity: LV ESS - 4,5 0,1 cm, the LV EDS - 6,0 0,1 cm and LV ESV 95,5 4.1 ml of LVEDV - 168,5 5,8 ml. After 6 months in the first group there was a significant increase in the value of SF and FEV to 25,5 0,6% and 46,4 0,6% (on the 1st day amounted to 22,5 0,6 and 43,1 0.9 respectively). LV ESS was - 4,35 0,2 cm, the LV EDV 5,8 0,1 cm. It is also noted a significant decrease in left ventricular ESV 15% of LV EDV by 11.2%. In patients with concomitant diabetes in addition to the above factors, a large contribution to the adverse outcomes of the HF did the level of fasting blood glucose (13 mM/L) and postprandial “drop” of blood glucose levels > 54% recorded at the time of admission. CONCLUSION The most powerful marker of adverse outcome of the HF, controlled by medication are resting ECG data from clinic anamnestic greatest contribution have combined features (AF, DM, PICS), the high value of the size of the heart makes a further contribution to the formation of forward-looking conclusions. TCTAP A-077 Degree of Left Ventricular Dysfunction and Long-Term Clinical Outcomes in Patients with Acute Myocardial Infarction Sunki Lee,1 Seung-Woon Rha,1 Byoung Geol Choi,1 Se Yeon Choi,1 Jae Kyeong Byun,1 Min Shim,1 Sung Hun Park,1 Eun Jin Park,1 Jah Yeon Choi,1 Jae Joong Lee,1 Li Hu,1 Jin Oh Na,1 Cheolung Choi,1 Hong Euy Lim,1 Jin Won Kim,1 Eung Ju Kim,1 Chang Gyu Park,1 Hong Seog Seo,1 Dong Joo Oh1 1 Korea University Guro Hospital, Korea (Republic of) BACKGROUND Although previous studies demonstrated the prognostic value of left ventricular ejection fraction (LVEF) after acute myocardial infarction (AMI), a study assessing long-term clinical outcomes after AMI according to LVEF status is limited and has not been evaluated in larger study populations. METHODS We analyzed the data from Korea Acute Myocardial Infarction Registry (KAMIR) enrolled from 2011 to 2015. A total of 12,431 AMI patients (pts) were grouped into preserved EF(LVEF 50%), borderline EF (40% EF < 50%), and reduced EF (EF < 40%) at baseline and 12 months after AMI. We evaluated the prognostic impact of baseline left ventricular function on 3-year cumulative clinical outcomes after AMI presentation. Moreover, we compared baseline LVEF and 12 months after AMI presentation to investigate the effect of LVEF change (recovered, deteriorated, and unchanged) on clinical outcomes. RESULTS Compared to pts with pre served and borderline LV function, those with reduced LVEF at baseline had higher 3-year cumulative rates of major adverse cardiovascular events (MACE, 5.1 vs. 5.9 vs. 9.8%, p<0.0001, Figure), non-cardiac death (1.1 vs. 1.7 vs. 2.2%, p¼0.0006), and re-hospitalization (1.6 vs.2.5 vs. 6.5%, p<0.0001), differences which persisted after adjustment for baseline characteristics. However, there was no significant difference in the 3- year cerebrovascular events among the groups (0.1 vs. 0.1 vs. 0.2%, p¼0.639). Intriguingly, pts who had shown deteriorated LVEF at 12 months revealed poor clinical outcomes as compared to pts whose LVEF recovered or unchanged (MACE; 10.2 vs. 11.3vs. 18.4%, p¼0.026). CONCLUSION Among pts with reduced LVEF (< 40%) at baseline after AMI, adverse events including MACE, non-cardiac death, and rehospitalization were markedly increased. Conversely, borderline systolic dysfunction (40% EF < 50%) showed a similar prognosis to preserved EF. In AMI pts whose follow-up LVEF deteriorated at 12 months showed poor clinical outcome.
TCTAP A-078 The Effect of Admission Blood Glucose and Hemoglobin A1C on Prognosis of Diabetic Patients with Acute Myocardial Infarction: From KorMI Registry KangUn Choi,1 Byung-Jun Kim,1 Jong-Ho Nam,1 Kyu-Hwan Park,1 Chan-Hee Lee,1 Jang-Won Son,1 Ung Kim,1 Jong-Seon Park,1 Dong-Gu Shin,1 Young-Jo Kim,1 Jun-Ho Bae,2 Deuk-Young Nah,2 Jeong-Hwan Cho,3 Sang-Wook Kang3 1 Yeungnam University Medical Center, Korea (Republic of); 2Dongguk University Gyeongju Hospital, Korea (Republic of); 3Daegu Veterans Hospital, Korea (Republic of) BACKGROUND Hyperglycemia is a well established predictor of mortality in patients with acute myocardial infarction (AMI) with or without diabetes. However, it remains unclear how admission blood glucose and hemoglobin A1C affect outcomes in diabetic patients with AMI. METHODS We assessed the prognostic impact of admission blood glucose and HbA1C level in diabetic patients with AMI. We evaluated 2,493 diabetic patients with AMI from the Korea Working Group on Myocardial Infarction (KorMI). Patients were divided into 2 groups according to blood glucose (< 200mg/dL; and 200mg/dL) and 3 groups according to HbA1C levels (<6%; 6 w 8%; and 8%). 1, 6 and 12-month major adverse cardiac event (MACE) was defined as either all cause of death, MI and any type of revascularization. RESULTS There were significant differences in 1, 6 and 12-month MACE rates according to admission glucose (12-month MACE: 189 (13.6%) in group 200 mg/dL vs 105 (9.5 %) < 200 mg/dL, p ¼ 0.002), but not according to HbA1C level. Then, we divided the group 200 mg/dL into 3 groups by HbA1C level, as mentioned above. There was a graded decrease in 12-month MACE rates (10 (18.9 %) in <6 % group; 96 (15.1 %) in 6w8 % group; and 83 (11.8 %) in 8 % group, p ¼ 0.035) and tendency to increase 12-month MACE free survival rates (87.8 % in < 6 % group; 86.8 % in 6 w 8 % group; and 89.9 %in 8 % group) according to HbA1C level, both. CONCLUSION Blood glucose level above 200 mg/dL and Less than 6.0 % HbA1C on admission may affect poor clinical outcomes in diabetic patients with acute myocardial infarction. TCTAP A-079 Clinical Outcomes of Incomplete Revascularization in Octogenarians Hospitalized for Acute Coronary Syndrome Mohammad Arifur Rahman,1 Afzalur Rahman,1 Farhana Ahmed1 1 National Institute of Cardiovascular Diseases, Bangladesh BACKGROUND Octogenarians (aged 80 years) are high risk patients and largely under-represented in clinical trials. They have higher prevalence of co morbidities and often experience complications during PCI. There is increasing number of PCI in the elderly, but this is troubled by increased short and long term morbidity and mortality. A simplified approach with incomplete or “culprit-lesion” only PCI may be an option even in Multivessel disease, to minimize periprocedural complications while still allowing a meaningful clinical recovery in patients with inherent functional limitations related to age itself.
S34
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 67, NO. 16, SUPPL S, 2016
Our aim was to evaluate clinical outcomes of incomplete revascularization in patients older than 80 years. METHODS From January 2012 to January 2014, 62 octogenarians with acute coronary syndrome were included in the study who underwent Incomplete revascularization due to variety of causes. Baseline clinical characteristics, indications for coronary intervention, in hospital outcomes and 1 year outcome were observed. Study endpoint was in hospital outcomes (Bleeding, Renal impairment, MI, LVF, emergency revascularization, stroke and death) and 1 year follow up for MI, repeat revascularization and death.
operators to take decision in favor of Incomplete revascularization. Proper patients selection, preplanning, use of appropriate hardwires and DES by an expert operators may bring success to deal with such group of vulnerable patients for whom the palliative goal is to reducing symptoms. Further studies into the optimal ACS management strategy in octogenarians are warranted.
RESULTS Elderly patients aged 80 years were mostly male 49(79%). Risk factors were smoking & chewable tobacco 24(56%), HTN 35(56%), DM 28(45%) and Dyslipidemia 38 (61%). Admission diagnoses were STEMI 10 (16%), NSTEMI 38(62%) and UA 14 (22%). CAG findings showed DVD 28 (45%) followed by SVD 17 (27%), TVD 13(21) and LM were 4(6%). Ostial lesions were 11 (11%) and calcified lesions were 18(29%). In hospital outcomes showed vascular site complication 5(8%), CIN4(6%), MI 6(9%), LVF 6(9%), CVD 2(3%) emergency CABG 3 (4%) & death were 3(4%). 26(45%) patients became asymptomatic, 22(38%) symptom improved and 8(16%) remain symptomatic. 1 year follow up showed MI 6(11%), repeat revascularization 8 (14%) and death were 5(9%).
TCTAP A-080 First and Second Generation Drug Eluting Stents Versus Bare Metal Stents in All Comer Population of Patients Undergoing PCI of Saphenous Vein Graft in 1-Year Follow-up Wojciech Wanha,1 Tomasz Roleder,1 Szymon Ladzinski,1 Sylwia Gladysz,1 Grzegorz Smolka,1 Andrzej Ochala,1 Michal Tendera,1 Wojciech Wojakowski1 1 Medical University of Silesia, Poland BACKGROUND The aim of this study was to assess device-specific outcomes after implantation bare-metal stents (BMS), first- (paclitaxel, sirolimus) or second-generation (everolimus, zotarolimus, biolimus A9) DES in all-comer population of patients undergoing PCI of saphenous vein graft SVG). METHODS The Registry included 378 consecutive patients after coronary artery bypass graft (CABG) undergoing PCI on SVG. Primary efficacy end-point was Major Adverse Cardiac and Cerebrovascular event (MACCE) defined as death, stroke or repeat-revascularization at 1-year follow-up.
CONCLUSION More often Octogenarians are poor surgical candidate. Most of them suffer from several comorbidities. Several factor such small caliber vessel, diffuse disease, calcified lesion may also satisfy
RESULTS Registry included stable CAD and ACS [SA 79(20.8%), UA 166(43.9%), NSTEMI 108(28.5%), STEMI 25(6.6%)] treated with BMS [n¼195 (51.5%)] and DES [n¼183(48.4%)]. The baseline and procedural characteristics of patients receiving BMS and BES were comparable including thrombus and use of thrombectomy but DES group had more often embolic protection devices. Use of BMS group was comparable to DES in terms of risk of death [15% vs. 7%; HR¼ 0.9(95%CI 0.40-2.30), p¼0.94)], myocardial infarction [13.8% vs. 7.6%; HR¼1.1(95%CI 0.58–2.19), p¼0.71], target vessel revascularization [34.8% vs. 25.6%; HR¼1.4(95%CI 0.99–2.11), p¼0.05], stroke [1.5% vs. 2.1%; HR¼1.0 (95%CI, 0.21–5.51), p¼0.90] and MACCE [43.5%