- Email: [email protected]
Timing of Invasive Strategy in Acute Coronary Syndrome Without ST Segment Elevation in Groups of Patients with Different Ischemic Risk
APRIL 23e26, 2013
Unstable angina and NSTEMI Acute Myocardiac Infarction/Acute Coronary Syndrome I Wednesday, April 24, 2013 2:00 PM w 3:00 PM (Abstract nos. AS-116, AS-212)
- AS-116 Timing of Invasive Strategy in Acute Coronary Syndrome Without ST Segment Elevation in Groups of Patients with Different Ischemic Risk. Nikolay Dimitrov1, Iana Simova2, Hristo Mateev2, Maria Radkova3, Pavlin Pavlov2, Iveta Tasheva4. 1University Hospital “St. Ekaterina”, Sofia, Bulgaria; 2National Cardiology Hosptital, Sofia, Bulgaria; 3Hospital Losenets, Sofia, Bulgaria; 4Tokuda Hospital, Sofia, Bulgaria. Background: Acute coronary syndrome (ACS) without ST segment elevation comprises a heterogeneous group of patients with different risk level for the occurrence of major adverse cardiac events (MACE). The purpose of the present study is to evaluate the prognostic significance of early invasive strategy versus selective invasive strategy in groups of patients with different risk profile. Methods: We studied 178 patients with unstable angina or non-ST elevation myocardial infarction (UA/NSTEMI), 28(15.7%) of whom had a high risk-GRACE 140. Patients were randomly allocated to an early invasive strategy (coronary angiography-SCAG and percutaneous intervention-PCI in the first 24 hours after admission) or to a selective invasive strategy (attempt for medical stabilization and proceeding to SCAG only in case of angina recurrence and/or evidence of inducible myocardial ischemia). We followed the patients for a mean period of 22.8 14 months. Results: During the follow-up patients with high risk allocated to an early invasive strategy showed a significant reduction in the incidence of angina pectoris recurrence (p<0.001), repeat hospitalization (p<0.001), SCAG (p¼0.001) and PCI (p¼0.001) and the cumulative incidence of MACE (p¼0.006) compared to those in whom selective invasive strategy was chosen. Kaplan-Mayer survival curves showed that the time to occurrence of untoward cardiac events was significantly longer when early instead of selective invasive strategy was undertaken in this subgroup.
In the absence of high risk features there was not a significant difference in the rate of MACE occurrence during the follow-up regardless of the accepted strategy (excluding MI, which frequency was higher with selective invasive strategy). Early invasive strategy, however, showed some advantage over the selective one in this subgroup-the time to occurrence of MACE was prolonged also in nonhigh risk patients. Conclusion: Choice of an early invasive strategy in patients with acute coronary syndrome without ST elevation in the presence of high risk features is associated with a reduced incidence of MACE compared to a selective invasive strategy. Early invasive strategy in high risk patients is also associated with longer time to occurrence of MACE. In the subgroup of patients without high risk characteristics the advantages of early versus selective invasive strategy are not so clear.
- AS-212 No Difference in Short Term Outcomes of ST Elevation MI (STEMI) Patients Undergoing Primary Percutaneous Coronary Interevntion (PPCI) Performed During "Off-hour" Versus "On-hour". Anoop Mathew, Louie Fischer, Jebby Kuriakose, Susan Kurian, Eapen Punnose. MOSC Medical College Hospital, Kolenchery, India. Background: Relationship between time of the day and day of the week whenpatients with STEMI present to the hospital and outcomes from PPCI is controversial especially with availability of improved hardware like thrombus aspiration catheter, covered stents and better pharmacotherapeutic agents.This study was aimed to compare the 30 day Major Adverse Cardiac Events (Death/Q wave Myocardial Infarction/Target Vessel Revascularisation) of such patients presenting to a tertiary level cardiac centre with 24/7 PPCI services delivered by experienced operators. Methods: All patients admitted and underwent PPCI from June 2011 to July 2012 were included. Patients were divided into two groups according to the time and day of admission as "On Hour": 8am to 6 pm Monday to Saturday and "Off hour": 6 01 pm to 7 59am Monday to Saturday and all patients admitted on holidays. Results: Of the total of 198 patients admitted and underwent PPCI in our centre during the study period, 121 were in the on hour group and 77 were in the off hour group. Baseline characteristics were similar in both groups except for a significantly prolonged total ischemic time (time from the onset of index symptom to balloon time) in the off hour group (8.1 hr vs 11.2 hrs p¼.004). There was no difference in door to balloon (DTB) time (65.4 mnts vs 70.5 mnts p¼ns), in hospital mortality (0.8% vs 0 p¼ns) or 30 day MACE (1.7% vs 1.2 p¼ns). Incidence of stent thrombosis was also similar in the two groups (0.8% vs 1.2% p¼ns). Conclusion: In this consecutive series of a tertiary level cardiac care centre where experienced operators are available to perform PPCI round the clock there is no difference in short term outcomes of STEMI patients undergoing PPCI.
The American Journal of Cardiologyâ APRIL 23e26, 2013 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
55B
O R A L A B S T R A C T S
Unstable angina and NSTEMI Acute Myocardiac Infarction/Acute Coronary Syndrome I Wednesday, April 24, 2013 2:00 PM w 3:00 PM (Abstract nos. AS-116, AS-212)
- AS-116 Timing of Invasive Strategy in Acute Coronary Syndrome Without ST Segment Elevation in Groups of Patients with Different Ischemic Risk. Nikolay Dimitrov1, Iana Simova2, Hristo Mateev2, Maria Radkova3, Pavlin Pavlov2, Iveta Tasheva4. 1University Hospital “St. Ekaterina”, Sofia, Bulgaria; 2National Cardiology Hosptital, Sofia, Bulgaria; 3Hospital Losenets, Sofia, Bulgaria; 4Tokuda Hospital, Sofia, Bulgaria. Background: Acute coronary syndrome (ACS) without ST segment elevation comprises a heterogeneous group of patients with different risk level for the occurrence of major adverse cardiac events (MACE). The purpose of the present study is to evaluate the prognostic significance of early invasive strategy versus selective invasive strategy in groups of patients with different risk profile. Methods: We studied 178 patients with unstable angina or non-ST elevation myocardial infarction (UA/NSTEMI), 28(15.7%) of whom had a high risk-GRACE 140. Patients were randomly allocated to an early invasive strategy (coronary angiography-SCAG and percutaneous intervention-PCI in the first 24 hours after admission) or to a selective invasive strategy (attempt for medical stabilization and proceeding to SCAG only in case of angina recurrence and/or evidence of inducible myocardial ischemia). We followed the patients for a mean period of 22.8 14 months. Results: During the follow-up patients with high risk allocated to an early invasive strategy showed a significant reduction in the incidence of angina pectoris recurrence (p<0.001), repeat hospitalization (p<0.001), SCAG (p¼0.001) and PCI (p¼0.001) and the cumulative incidence of MACE (p¼0.006) compared to those in whom selective invasive strategy was chosen. Kaplan-Mayer survival curves showed that the time to occurrence of untoward cardiac events was significantly longer when early instead of selective invasive strategy was undertaken in this subgroup.
In the absence of high risk features there was not a significant difference in the rate of MACE occurrence during the follow-up regardless of the accepted strategy (excluding MI, which frequency was higher with selective invasive strategy). Early invasive strategy, however, showed some advantage over the selective one in this subgroup-the time to occurrence of MACE was prolonged also in nonhigh risk patients. Conclusion: Choice of an early invasive strategy in patients with acute coronary syndrome without ST elevation in the presence of high risk features is associated with a reduced incidence of MACE compared to a selective invasive strategy. Early invasive strategy in high risk patients is also associated with longer time to occurrence of MACE. In the subgroup of patients without high risk characteristics the advantages of early versus selective invasive strategy are not so clear.
- AS-212 No Difference in Short Term Outcomes of ST Elevation MI (STEMI) Patients Undergoing Primary Percutaneous Coronary Interevntion (PPCI) Performed During "Off-hour" Versus "On-hour". Anoop Mathew, Louie Fischer, Jebby Kuriakose, Susan Kurian, Eapen Punnose. MOSC Medical College Hospital, Kolenchery, India. Background: Relationship between time of the day and day of the week whenpatients with STEMI present to the hospital and outcomes from PPCI is controversial especially with availability of improved hardware like thrombus aspiration catheter, covered stents and better pharmacotherapeutic agents.This study was aimed to compare the 30 day Major Adverse Cardiac Events (Death/Q wave Myocardial Infarction/Target Vessel Revascularisation) of such patients presenting to a tertiary level cardiac centre with 24/7 PPCI services delivered by experienced operators. Methods: All patients admitted and underwent PPCI from June 2011 to July 2012 were included. Patients were divided into two groups according to the time and day of admission as "On Hour": 8am to 6 pm Monday to Saturday and "Off hour": 6 01 pm to 7 59am Monday to Saturday and all patients admitted on holidays. Results: Of the total of 198 patients admitted and underwent PPCI in our centre during the study period, 121 were in the on hour group and 77 were in the off hour group. Baseline characteristics were similar in both groups except for a significantly prolonged total ischemic time (time from the onset of index symptom to balloon time) in the off hour group (8.1 hr vs 11.2 hrs p¼.004). There was no difference in door to balloon (DTB) time (65.4 mnts vs 70.5 mnts p¼ns), in hospital mortality (0.8% vs 0 p¼ns) or 30 day MACE (1.7% vs 1.2 p¼ns). Incidence of stent thrombosis was also similar in the two groups (0.8% vs 1.2% p¼ns). Conclusion: In this consecutive series of a tertiary level cardiac care centre where experienced operators are available to perform PPCI round the clock there is no difference in short term outcomes of STEMI patients undergoing PPCI.
The American Journal of Cardiologyâ APRIL 23e26, 2013 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
55B
O R A L A B S T R A C T S