Transradial Coronary Angiography and Intervention are Safe and May Have a Short Learning Curve

Conclusion: Low LDL-C levels are crucial in all ACS pts receiving CABG surgery. Even in 2010, these very high risk pts do not receive optimal management of their LDL-C; lower MACE may be observed if target LDL-C levels were achieved. Conflict of interest: None. doi:10.1016/j.hlc.2010.04.042 42 TRANSRADIAL CORONARY ANGIOGRAPHY AND INTERVENTION ARE SAFE AND MAY HAVE A SHORT LEARNING CURVE JL Looi ∗ , A Cave, S El-Jack North Shore Hospital, Auckland, New Zealand Background: Transradial cardiac catheterization is underutilised possibly because of perceived technical difficulty and increased radiation exposure. We sought to compare radial and femoral angiography and intervention procedural parameters as performed by experienced angiographers with varying radial access skills. Methods: We separately analysed data on patients undergoing diagnostic angiography with or without ad hoc intervention over a period of 12 months. Radial and femoral procedures were compared using procedural/fluoroscopy time, radiation dose, contrast volume and complications. They were further compared by operator experience. Results: Angiography only was performed in 1001 patients and 189 had ad hoc intervention (PCI). All femoral procedures were successful with 93% and 92% success rate with radial angiography and PCI respectively; vascular complications were similar. Fluoroscopy times were longer in the radial group both for angiography and PCI (5.3 min vs. 4.0 min, p < 0.01 and 17.3 min vs. 13.3 min, p = 0.01 respectively). Total procedural times were however similar for radial and femoral angiography (24 min vs. 22 min, p = 0.19), with borderline longer PCI times for radial patients (57 min vs. 48.5 min, p = 0.01). Less contrast was used for radial angiography (111.5 ml vs. 138.5 ml, p < 0.01), but not for PCI (256 ml vs. 271 ml, p = 0.79). Failure rates did not differ by technical expertise. In the 1st 3 months, procedural times were longer for non-radial-experts performing angiography (25.5 min vs. 21 min, p < 0.01 respectively), however the times became equivalent in the final 3 months of analysis (24.5 vs. 20.5, p = 0.10). Conclusion: The radial approach for coronary procedures appears as a safe alternative to femoral access, with a relatively short technical learning curve. doi:10.1016/j.hlc.2010.04.043

Abstracts

S21

43 HIGH MORTALITY AND MORBIDITY IN ACUTE CORONARY SYNDROME PATIENTS WHO RECEIVED MEDICAL (NON-REVASCULARISATION) MANAGEMENT JL Looi 1,∗ , KL Looi 1 , KL Chow 1 , S Haliday 1 , M Lee 1 , G Gamble 2 , HD White 1 , CJ Ellis 1 1 Auckland

City Hospital, Auckland, New Zealand of Medicine, Auckland University, Auckland, New Zealand

2 Department

Background: Revascularisation with percutaneous coronary interventions (PCI) or coronary artery bypass grafting (CABG) is effective in reducing morbidity and mortality in patients (pts) with acute coronary syndrome (ACS). However, some pts are managed medically only. Methods: We used a prospective database of 1580 admissions to Auckland City Hospital (ACH) Coronary Care Unit between 1 June 2006 and 31 July 2007 from 1474 pts. 901 pts presented with ACS, of whom 274 pts transferred from another hospital were excluded. We analysed 628 ACS admissions from the ACH catchment area. Results: 260 pts were medically managed after an ACS. 179 patients underwent coronary angiography. Of those, 109 had normal, mild/single vessel disease. 70 patients (mean age 70.4 ± 11.5 years) had severe disease (≥75% in ≥2 vessels). Pts without angiogram were older (mean age 79.7 years, p < 0.001). Renal dysfunction was common in both groups (baseline creatinine 158 umol/L and 185 umol/L respectively). For patients not receiving angiography (81) or with severe disease (70) not receiving revascularisation (total, n = 151), outcomes were poor at median follow-up 1.73 (0.26–2.83) years with 205 major adverse cardiac events (MACE): 30 cardiac deaths, 32 heart failure admission, 66 cardiac chest pain admission and 40 subsequent ACS (see figure). 14 later had revascularisation (9PCI and 5 CABG).

Conclusion: ACS pts treated medically with either severe coronary disease or not offered angiography have significant MACE at medium-term follow-up. Options for revascularisation in this group may be limited due

ABSTRACTS

Heart, Lung and Circulation 2010;19S:S1–S35