Trends, clinical characteristics and outcomes of patients undergoing FFR-guided management in a real world cohort

Abstract

465 Trans-radial versus femoral artery access for percutaneous coronary intervention in acute coronary syndrome: A reflection from a five-year experience in the MIG cohort K. Rankin 1,∗ , C. Machado 1 , N. Andrianopoulos 2 , T. Yip 1 , E. Oqueli 6 , C. Jaworski 1 , D. Clark 3 , G. New 4 , M. Mok 1 , A. Ajani 5 , C. Hiew 1 , M. Sebastian 1 1 University

Hospital, Geelong, VIC, Australia University CCRET - Centre of Cardiovascular Research & Education in Therapeutics, Melbourne, VIC, Australia 3 Austin Hospital, Heidelberg, VIC, Australia 4 Box Hill Hospital, Box Hill, VIC, Australia 5 Royal Melbourne Hospital, VIC, Australia 6 Ballarat Base Hospital, VIC, Australia 2 Monash

Background: Recent studies demonstrate superior outcomes in regards to mortality, bleeding and vascular complications with trans-radial (TRA) compared to femoral approach (FA) particularly in the ST-elevation myocardial infarction (STEMI) population. We investigated the temporal trends in TRA utilisation over a five-year period in a contemporaneous Victorian cohort, and compared outcomes with FA cases. Method: Utilising prospectively collected data from patients with ACS managed with PCI in the Melbourne Interventional Group (MIG) registry centres between 2009 and 2013, TRA cases were compared to FA cases for patient characteristics, procedural variables and clinical outcomes. Results: The use of TRA increased significantly over the five-year period from 5.2% in 2009 to 37.0% in 2013 (p <0.001). TRA was used more frequently in males, and patients with peripheral vascular disease (p=0.02). TRA was more likely to be used in patients who had received thrombolysis or lowmolecular weight heparin prior to PCI (p<0.001), although was less likely to be utilised in patients presenting with ST elevation myocardial infarction, out-of-hospital cardiac arrest or cardiogenic shock (p<0.001). TRA was associated with less post-procedural bleeding (p<0.001) and renal impairment (p=0.006). Multivariate logistic regression analysis demonstrated no difference in 12-month major adverse cardiovascular outcomes (MACE) or mortality between the TRA and FA groups. Conclusion: Across a five-year period there has been a marked increase in trans-radial PCI for ACS management, although TRA remains underutilised in STEMI patients. TRA is associated with reduced post-procedural bleeding and renal impairment with no compromise in cardiovascular outcomes. http://dx.doi.org/10.1016/j.hlc.2015.06.466

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466 Trans-radial vs.trans-femoral radiation exposure and screening times for diagnostic coronary angiography at Sydney Southwest Private Hospital M. De Raya ∗ , J. Holden, O. Wayman, D. Taylor Sydney Southwest Private Hospital, NSW, Australia Background and Aim: The use of radial approach for diagnostic coronary angiography is known to improve short-term outcomes. However, it is uncommonly used due to technical difficulties and concern that it may be associated with increased patient radiation exposure. This study compares the radiation exposure and screening times of radial and femoral diagnostic coronary angiography at SSWPH in 2013. The femoral artery is the traditional and preferred access site for coronary procedures because of ease of arterial cannulation and catheter manipulation, but this approach has several limitations. On the other hand, the radial artery is a safer entry site for some reasons. Studies have shown that this approach has a lower complication rate in terms of bleeding, haematoma and other vascular complications. Methods: A retrospective review of 417 patients (mean age 66 years, 66% males) who underwent diagnostic coronary angiography in 2013 was analysed. We divided the patients into 2 groups, trans-radial vs. trans-femoral. We then compared the dose area product (DAP) and the fluoroscopy time (FT) within the 2 groups. Fractional flow reserve and graft studies were excluded from the analysis. Results: Median DAP was 47.45 mGy cm2 for trans- radial and 36.42 mGy cm2 for trans- femoral. The fluoroscopy times for trans-radial and trans-femoral approach were 6.59 mins vs. 7.85 mins respectively. Conclusion: The radiation exposure was higher in the trans-radial group compared to the trans-femoral group (47.45 vs 36.42). But the fluoroscopy time was lower in the trans-radial group than the trans-femoral group (6.59 minutes vs 7.85 minutes). http://dx.doi.org/10.1016/j.hlc.2015.06.467 467 Trends, clinical characteristics and outcomes of patients undergoing FFR-guided management in a real world cohort O. Wahbi-Izzettin 1 , M. Yudi 1,2,∗ , D. Russell 1 , P. MacIntyre 1 , L. Galligan 1 , P. Roberts-Thomson 1 , N. Dwyer 1 , A. Black 1 1 Royal

Hobart Hospital, TAS, Australia Health, Melbourne, VIC, Australia

2 Austin

Background: Coronary angiography has well recognised limitations in quantifying lesion severity. Consequently, FFR is recommended to assess the severity of intermediate

Abstract

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stenoses. Although FFR-guided management has been shown to reduce major adverse cardiac events, there is minimal data on its use in a contemporary Australian cohort. Aim: To describe the temporal trends, clinical and procedural characteristics, and outcomes of patients who underwent FFR-guided revascularisation (FFR-R) or FFRguided medical management (FFR-M). Methods: We analysed the use, clinical characteristics and outcomes of 245 consecutive patients who underwent FFR assessment from 2010 to 2014 at Royal Hobart Hospital. There were no exclusion criteria. Results: There has been a significant increase in the use of FFR with numbers increasing from 19 in 2010 to 82 in 2014. Following FFR assessment, 107 (44%) underwent revascularisation and 138 (54%) had medical therapy. In the revascularisation cohort, 27 (25%) had coronary artery bypass surgery. FFR was used in acute coronary syndromes (ACS) in 19 (8%) patients. Only 11% of patients had a previous noninvasive test. Patients with FFR-M were more likely to be female (42% vs. 27%, p=0.01), have atrial fibrillation (12% vs. 6%, p=0.04) and present with an ACS (10% vs. 5%, p=0.04). At mean follow-up of (1.6±1.2 years), there was no significant difference between FFR-R and FFR-M in mortality (2.8% vs. 0%, p=NS), myocardial infarction (2.8% vs. 2.1%, p=0.51) or unplanned revascularisation (8.4% vs 6.5%, p=0.31) Conclusion: The use of FFR is increasing in a real world cohort. Patients with FFR-M experienced low event rates supporting deferral of revascularisation if not indicated by FFR. This real world data reflects the data from randomised clinical trials. http://dx.doi.org/10.1016/j.hlc.2015.06.468 468 Use of fractional flow reserve (FFR) in the assessment of coronary artery disease leads to reduction of percutaneous coronary intervention (PCI) patients M. De Raya ∗ , J. Holden, O. Wayman, D. Taylor Sydney Southwest Private Hospital, NSW, Australia Objective: To assess the clinical course in patients with FFR ≥ 0.80 to be treated conservatively and to minimise the need for urgent revascularisation, therefore reducing the number of PCI patients. Background: At SSWPH, we began using FFR in June 2011. Since then, we have collected data to show that patients undergoing coronary angiography need not have any intervention to an insignificant lesion which is measured using FFR. Methods: A total of 51 lesions in 40 patients (28 M and 12 F) who underwent FFR were retrospectively identified at SSWPH between June 2011 and March 2014. Outcomes include medical therapy, revascularisation and surgery. All patients who had FFR were included in the study. Both coronary angiogram with or without ad hoc coronary angioplasty following FFR were performed on the patients in the cohort.

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Results: The mean patient age was 66 (47 - 83, 70% M). Lesions assessed were LM – 12%, LAD – 53%, LCx – 14%, RCA – 18% and OM – 5%. The mean FFR for the cohort was 0.81 (0.58 – 0.95). Of the 40 patients, 25 had insignificant lesions and were treated conservatively; 9 patients with an FFR of ≤ 0.80 underwent intervention on that vessel, while 3 patients had PCI to another culprit vessel; 3 of the patients in this group underwent CABG. There were no deaths reported for this study. Conclusion: The use of FFR to assess the severity of coronary artery disease is an effective tool leading to reduction of our patients undergoing revascularisation or PCI. http://dx.doi.org/10.1016/j.hlc.2015.06.469 469 Utility of a new regional cardiac catheterisation laboratory Y. Chacko ∗ , S. Hayman, A. Willson, S. Butterly, P. Larsen, R. Poulter, C. Thompson, D. Colburn, K. Lau, M. Johnson Cardiology Department, Sunshine Coast Hospital and Health Service, Queensland, Australia Background: The Sunshine Coast Hospital and Health Service (SCHHS) services approximately 400,000 people over a large geographic area. In April 2012, the Cardiac Catheterisation Laboratory (CCL) opened and a Primary PCI (PPCI) service commenced in December 2012. The local Queensland Ambulance Service and peripheral hospitals are being educated to shift to PPCI as first-line treatment for STEMI. Aim: To analyse the distribution of PPCI cases and time between onset of symptoms, first medical contact and PCI. Methods and Results: Data on all PPCI patients since commencement to January 2015 were collected prospectively (n=405, 76% male, mean age 64.1±13.6 years). Excluding visitors to the area, of those with known postcode, the majority (88%) were transferred from within 50km of the hospital (with 12% from >50km). Median [Inter-quartile Range] door-toballoon time was 48 [51] min. The median time to dispatch an ambulance was 1 [2] min and 34 [42] min until the patient arrived at NGH. Median first medical contact to balloon time was 119 [79] min over the entire cohort. Most patients received loading with a second anti-platelet (ticagrelor 60% or clopidogrel 35%) prior to arrival. Thirty-day mortality was 5% (22/405) including out-of-hospital cardiac arrest patients. Conclusion: The SCHHS Cardiac Catheter Laboratory is a heavily utilised, effective and efficient service. Despite its regional location, response times are comparable to established metropolitan services and within guideline recommendations. We continue to provide ongoing education to peripheral hospitals and the Queensland Ambulance Service aiming to optimise STEMI pre-transfer care. http://dx.doi.org/10.1016/j.hlc.2015.06.470