- Email: [email protected]
TRAIL is Reduced in the Circulation of Patients with CVD, and in Monocytes of Unstable CAD Patients
Abstracts
Conclusion: TAR has a lower MACCE compared to SIMA+SVG. http://dx.doi.org/10.1016/j.hlc.2016.06.156 156 TRAIL is Reduced in the Circulation of Patients with CVD, and in Monocytes of Unstable CAD Patients S. Cartland 1,2,∗ , S. Robertson 1,2 , G. Martinez 3 , S. Patel 1,3,1 , M. Kavurma 1,2,1 1 Heart
Research Institute, Sydney, Australia University of Sydney, Australia 3 Department of Cardiology, Royal Prince Alfred Hospital Sydney, Australia 2 The
Introduction: Tumour-necrosis factor (TNF) -␣ and TNFrelated apoptosis inducing ligand (TRAIL) have been implicated in cardiovascular disease, with recent data demonstrating TRAIL may be athero-protective. Here, we aimed to assess levels of these proteins in patients with coronary artery disease, both systemically and at local coronary level. Method: Patients with a clinical indication for cardiac catheterisation at Royal Prince Alfred Hospital were divided into 3 groups: no/minor coronary artery disease (CAD) (n=9, age 61.3 ± 6.7); stable CAD (n=20, age 61.8 ± 10.0); and unstable CAD (n=15, age 63.9 ± 11.7). Blood samples from the coronary sinus (CS), aortic root (arterial; A) and lower right atrium (venous) were collected and assayed for TNF-␣ and TRAIL. On a subset of unstable CAD patients, monocytes were isolated and TRAIL gene expression was assessed. Results: TNF-␣ levels were comparable in all groups, irrespective of sampling site. There was a significant relationship between coronary disease activity and venous TRAIL levels, with lowest levels found in unstable patients (p<0.05), and highest in no CAD patients. In monocytes from unstable CAD patients, TRAIL mRNA expression was also significantly reduced (p<0.0001). Trans-coronary CS-A TRAIL gradients were comparable in all groups, indicating that intra-cardiac production does not contribute to these changes. Conclusion: These data demonstrate that systemic TRAILgene expression and protein secretion is markedly suppressed in active coronary artery disease. Further studies are required to elucidate mechanisms of suppression and whether TRAIL might represent a therapeutic target in CAD patients. 1 Equal
Contribution.
http://dx.doi.org/10.1016/j.hlc.2016.06.157 157 Transferred Patients with Suspected ACS for Coronary Angiography: How Accurate is the Initial Diagnosis? S. Soh ∗ , I. Tsay, V. Malik, S. Wood, V. Bhushan, K. Simpson, R. Tan The Canberra Hospital, Australia
S69
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .
Introduction: The early recognition of acute coronary syndrome expedites patient management and improves outcomes. However, the diagnosis of patients with suspected ACS can remain unclear when assessed over an off-site phone referral, despite a combination of history and examination, ECG and troponin assay. We sought to assess the accuracy of this strategy in predicting the final diagnosis. Methods: All patient transfers to The Canberra Hospital with suspected ACS was prospectively audited between October and December 2015. Initial and final diagnoses were compared to assess the accuracy of the initial assessment. Results: 83 patients were included. Initial diagnoses include: ST-elevation myocardial infarction (STEMI) (n=16), non-STEMI (n=50), unstable angina (n=14) and chest pain requiring further investigation (n=3). 63 out of 83 (76%) transferred patients received a final diagnosis of ACS. The correct initial diagnosis was made in 55 (69%) patients, including 14 STEMI (88%), 34 non-STEMI (68%) and 7 unstable angina (50%) patients. 2 STEMI patients at initial assessment were subsequently diagnosed individually as myopericarditis and non-STEMI. 2 NSTEMI patients were subsequently diagnosed as STEMI. 13 patients (16%) were found to be non-ACS (arrhythmia, aortic stenosis, pneumonia, cardiomyopathy, gastro-oesophageal reflux disease) and 7 patients (8%) had undiagnosed chest pain. Conclusion: 76% of transferred patients had confirmed ACS at discharge. The correct diagnosis was made in the majority of cases at initial assessment, and accuracy was highest for STEMI. Improving our present approach in accepting appropriate patients and triaging patients with suspected ACS for transfer from regional and rural centres remains a challenge. http://dx.doi.org/10.1016/j.hlc.2016.06.158 158 Trends in the Procedural Characteristics and Clinical Outcomes in Patients Undergoing Percutaneous Revascularisation for the Treatment of ST Elevation Myocardial Infection. A Single Centre Experience L. Dawson 1,∗ , A. Broughton 1 , A. Taylor 1,2 , J. Shaw 1,2 1 Alfred
Hospital, Melbourne, Australia IDI and Heart Centre, Melbourne, Australia
2 Baker
Introduction: Recently guidelines have changed regarding primary angioplasty/stenting (PPCI) for ST elevation myocardial infarction (STEMI), including preferred access site and use of adjunctive therapies. We retrospectively reviewed all patients undergoing PPCI over a 5 year period to look for changes in procedural characteristics and 30-day clinical outcomes. Methods and Results: All patients presenting to the Alfred hospital between 1/1/2010 and 31/12/2015 undergoing PPCI for STEMI were identified. Procedure reports were reviewed and 30-day clinical outcomes were recorded including major adverse cardiac events (MACE). There was a total of 445 patients mean age 60.6 ± 12.4 with 369 (82.9%) male.
Conclusion: TAR has a lower MACCE compared to SIMA+SVG. http://dx.doi.org/10.1016/j.hlc.2016.06.156 156 TRAIL is Reduced in the Circulation of Patients with CVD, and in Monocytes of Unstable CAD Patients S. Cartland 1,2,∗ , S. Robertson 1,2 , G. Martinez 3 , S. Patel 1,3,1 , M. Kavurma 1,2,1 1 Heart
Research Institute, Sydney, Australia University of Sydney, Australia 3 Department of Cardiology, Royal Prince Alfred Hospital Sydney, Australia 2 The
Introduction: Tumour-necrosis factor (TNF) -␣ and TNFrelated apoptosis inducing ligand (TRAIL) have been implicated in cardiovascular disease, with recent data demonstrating TRAIL may be athero-protective. Here, we aimed to assess levels of these proteins in patients with coronary artery disease, both systemically and at local coronary level. Method: Patients with a clinical indication for cardiac catheterisation at Royal Prince Alfred Hospital were divided into 3 groups: no/minor coronary artery disease (CAD) (n=9, age 61.3 ± 6.7); stable CAD (n=20, age 61.8 ± 10.0); and unstable CAD (n=15, age 63.9 ± 11.7). Blood samples from the coronary sinus (CS), aortic root (arterial; A) and lower right atrium (venous) were collected and assayed for TNF-␣ and TRAIL. On a subset of unstable CAD patients, monocytes were isolated and TRAIL gene expression was assessed. Results: TNF-␣ levels were comparable in all groups, irrespective of sampling site. There was a significant relationship between coronary disease activity and venous TRAIL levels, with lowest levels found in unstable patients (p<0.05), and highest in no CAD patients. In monocytes from unstable CAD patients, TRAIL mRNA expression was also significantly reduced (p<0.0001). Trans-coronary CS-A TRAIL gradients were comparable in all groups, indicating that intra-cardiac production does not contribute to these changes. Conclusion: These data demonstrate that systemic TRAILgene expression and protein secretion is markedly suppressed in active coronary artery disease. Further studies are required to elucidate mechanisms of suppression and whether TRAIL might represent a therapeutic target in CAD patients. 1 Equal
Contribution.
http://dx.doi.org/10.1016/j.hlc.2016.06.157 157 Transferred Patients with Suspected ACS for Coronary Angiography: How Accurate is the Initial Diagnosis? S. Soh ∗ , I. Tsay, V. Malik, S. Wood, V. Bhushan, K. Simpson, R. Tan The Canberra Hospital, Australia
S69
.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .
Introduction: The early recognition of acute coronary syndrome expedites patient management and improves outcomes. However, the diagnosis of patients with suspected ACS can remain unclear when assessed over an off-site phone referral, despite a combination of history and examination, ECG and troponin assay. We sought to assess the accuracy of this strategy in predicting the final diagnosis. Methods: All patient transfers to The Canberra Hospital with suspected ACS was prospectively audited between October and December 2015. Initial and final diagnoses were compared to assess the accuracy of the initial assessment. Results: 83 patients were included. Initial diagnoses include: ST-elevation myocardial infarction (STEMI) (n=16), non-STEMI (n=50), unstable angina (n=14) and chest pain requiring further investigation (n=3). 63 out of 83 (76%) transferred patients received a final diagnosis of ACS. The correct initial diagnosis was made in 55 (69%) patients, including 14 STEMI (88%), 34 non-STEMI (68%) and 7 unstable angina (50%) patients. 2 STEMI patients at initial assessment were subsequently diagnosed individually as myopericarditis and non-STEMI. 2 NSTEMI patients were subsequently diagnosed as STEMI. 13 patients (16%) were found to be non-ACS (arrhythmia, aortic stenosis, pneumonia, cardiomyopathy, gastro-oesophageal reflux disease) and 7 patients (8%) had undiagnosed chest pain. Conclusion: 76% of transferred patients had confirmed ACS at discharge. The correct diagnosis was made in the majority of cases at initial assessment, and accuracy was highest for STEMI. Improving our present approach in accepting appropriate patients and triaging patients with suspected ACS for transfer from regional and rural centres remains a challenge. http://dx.doi.org/10.1016/j.hlc.2016.06.158 158 Trends in the Procedural Characteristics and Clinical Outcomes in Patients Undergoing Percutaneous Revascularisation for the Treatment of ST Elevation Myocardial Infection. A Single Centre Experience L. Dawson 1,∗ , A. Broughton 1 , A. Taylor 1,2 , J. Shaw 1,2 1 Alfred
Hospital, Melbourne, Australia IDI and Heart Centre, Melbourne, Australia
2 Baker
Introduction: Recently guidelines have changed regarding primary angioplasty/stenting (PPCI) for ST elevation myocardial infarction (STEMI), including preferred access site and use of adjunctive therapies. We retrospectively reviewed all patients undergoing PPCI over a 5 year period to look for changes in procedural characteristics and 30-day clinical outcomes. Methods and Results: All patients presenting to the Alfred hospital between 1/1/2010 and 31/12/2015 undergoing PPCI for STEMI were identified. Procedure reports were reviewed and 30-day clinical outcomes were recorded including major adverse cardiac events (MACE). There was a total of 445 patients mean age 60.6 ± 12.4 with 369 (82.9%) male.