In-hospital MACE Research Articles

Effect of prior statin treatment on the achievement of <55 mg/dL LDL cholesterol threshold in acute coronary syndrome patients undergoing percutaneous coronary intervention

Abstract Funding Acknowledgements Type of funding sources: None. Background Acute coronary syndrome (ACS) patients are associated with a higher risk of adverse cardiac events after percutaneous coronary intervention (PCI). A lower threshold level of low density cholesterol (LDL), less than 50 mg/dL, as recommended by most recent guidelines, has been associated with a lower risk of such events. An early and more pronounced achievement of such target LDL level could confer benefit to this high risk patient category. It is not known whether prior treatment with statins might have such beneficial effect in patients admitted with acute coronary syndromes undergoing PCI. Purpose To study the role of prior statin use in patients admitted with ACS and treated with PCI regarding the achievement of target LDL threshold. Methods We prospectively enrolled 400 consecutive ACS patients who underwent PCI treatment in our hospital. We collected peri- and postprocedural clinical and laboratory data; all patients were followed up and were asked to have their lipid profile measured at 1 month after discharge. Patients were divided in 2 groups: patients who were already on statin treatment on admission (group 1) and those who were not (group 2). Primary endpoint was achievement of target LDL threshold in accordance with current ESC guidelines 1 month after discharge, and secondary endpoint was in-hospital and 30-day occurrence of major adverse events (death, nonfatal myocardial infarction and re-hospitalization). Results Out of 400 patients, 105 of them composed group 1 and 295 patients composed group 2. Mean age was 64.96 +/- 10.26 years. 74.8% were males. 94.8% suffered from arterial hypertension, 41% from diabetes and 56.3% were active smokers. On admission, mean LDL level was 118.15 +/- 42.67 mg/dL in group 1 and 141.66 +/- 44.14 mg/dL in group (p=<0.05). 399 (99.7%) of the patients were discharged on a high intensity dose statin. 30 day clinical follow up was completed in all (n=400) patients and lipid profile was acquired from 379 (94%) patients. Mean LDL level was 83.2 +/- 31.2 mg/dL in group 1 and 86.56 +/- 86.56 mg/dL in group 2. The threshold of <55 mg/dL of target LDL, was achieved in 16.2% of the patients in group 1 and in 10.2% in group 2 (p=0.1). There was no in-hospital death in both groups. 1 patient in each group suffered periprocedural myocardial infarction. At 30-day follow up, secondary endpoint occurred in 15 patients (3.8%) in total cohort. 5 (4.8%) in first group (a composite of 2 deaths and 3 rehospitalizations) and in 10 (3.4%) in second group (a composite of 4 deaths and 6 rehospitalizations). Conclusion In patients with acute coronary syndrome who are treated with PCI, prior treatment with statin, despite a numerically more favorable outcome, has no statistically significant impact on achievement of LDL target threshold in accordance with current guidelines or in in-hospital and 30-day MACE occurrence.

B-43 | TAVR in End-Stage Renal Disease Patients: Long-Term Outcomes, Structural Valve Degeneration and Need for Aortic Valve Reintervention

ESRD patients are predisposed to the development of calcific aortic valve disease. Patients with ESRD were excluded from the clinical trials of TAVR, and hence long-term outcomes are not well established. We sought to describe the long-term outcomes, including incidence of structural valve degeneration (SVD) and re-intervention, in patients with ESRD undergoing TAVR at our institution. Retrospective registry of consecutive patients with ESRD who underwent TAVR for aortic stenosis at our institution (2012-present). Variables of interest included patient demographics, clinical and procedural characteristics. Outcomes assessed were in-hospital events, SVD, aortic re-intervention procedures, and standard MACE incidence at 30-days, 6-months, 1-year, and at annual follow-ups. Our study included 95 patients with ESRD who underwent TAVR. In-hospital events were notable for new permanent pacemaker placement (12.6%), cardiac arrest (5.3%), and mortality (6.3%). The long-term all-cause mortality was 47.4%, with survival time after TAVR of 596 days. The most common long-term MACE was MI (7.4%). Long-term SVD occurred in 25 cases (26.3%). Long-term re-intervention occurred in 3 cases (3.2%). In-hospital and long-term MACE were high; however, when looking at baseline STS scores, these rates were close to expected. SVD was elevated with over one-fourth of patients demonstrating some degree for degeneration; however, only 3.2% of patients required re-intervention. To the best of our knowledge, this is the only study characterizing long-term SVD and re-intervention rates in this population.

Safety and efficacy of the expressman extension system for complex coronary lesions during percutaneous coronary intervention.

Safety and efficacy of the expressman extension system for complex coronary lesions during percutaneous coronary intervention.

Evaluation of Coronary Flow Level with Mots-C in Patients with STEMI Undergoing Primary PCI.

The protective effects of mitochondrial open reading frame of the 12S rRNA-c (MOTS-C) on cardiovascular diseases have been shown in numerous studies. However, there is little documentation of the relationship between MOTS-C and coronary blood flow in ST-segment elevation myocardial infarction (STEMI). We aimed to investigate the role of MOTS-C, which is known to have cytoprotective properties in the pathogenesis of the no-reflow phenomenon, by comparing the coronary flow rate and MOTS-C levels in patients with STEMI submitted to primary PCI. 52 patients with STEMI and 42 patients without stenosis >50% in the coronary arteries were included in the study. The STEMI group was divided into two groups according to post-PCI TIMI (Thrombolysis In Myocardial Infarction) flow grade:(i) No-reflow: grade 0, 1, and 2 and (ii) grade 3(angiographic success). A p value of <0.05 was considered significant. MOTS-C levels were significantly lower in the STEMI group compared to the control group (91.9 ± 8.9 pg/mL vs. 171.8±12.5 pg/mL, p<0.001). In addition, the Receiver Operating Characteristics (ROC) curve analysis indicated that serum MOTS-C levels had a diagnostic value in predicting no-reflow (Area Under the ROC curve [AUC]:0.95, 95% CI:0.856-0.993, p<0.001). A MOTS-C ≥84.15 pg/mL measured at admission was shown to have 95.3% sensitivity and 88.9% specificity in predicting no-reflow. MOTS-C is a strong and independent predictor of no-reflow and in-hospital MACE in patients with STEMI. It was also noted that low MOTS-C levels may be an important prognostic marker of and may have a role in the pathogenesis of STEMI.

479 ECHOCARDIOGRAPHIC ESTIMQTION OF CQRDIQC POWER IN CARDIOGENIC SHOCK: CORRELATION WITH INVASIVE HEMODYNAMICS AND PROGNOSTIC IMPLICATIONS.

Abstract Background Cardiac power output (CPO) is currently used for cardiogenic shock patient's evaluation including shock phenotyping, mechanical circulatory support selection and weaning algorithms. Despite its remarkable prognostic role, CPO use is limited by the need for a Swan-Ganz catheter. Aim of this study was to evaluate the feasibility and accuracy of echocardiographic estimation of CPO compared to RHC-derived measurement. We also aimed to investigate the prognostic role of non-invasive CPO in the specific setting of cardiogenic shock. Methods We performed blinded echocardiography in all consecutive heart failure (HF) patients undergoing RHC as a part of their evaluation at Cardiology Department of Città della Salute e della Scienza University hospital in Turin. Echocardiographic CPO was calculated as: (cardiac output * mean arterial pressure)/451. eCPO was subsequently assessed in 80 patients admitted for cardiogenic shock in cardiac ICU of centers participating at the Altshock registry during the first 24 hours from shock onset. Primary endpoint was in-hospital MACE (death, heart transplantation or LVAD implantation during the index hospitalization). Results 103 HF patients (57.6 ± 11.3 years, 63% males, median left ventricle ejection fraction 25% [IQR 20-51%]) were included in the derivation cohort. Mean invasive CPO was 0.72 ± 0.27 W, while eCPO was 0.74 ± 0.27 W. eCPO showed a good correlation with invasive CPO (Pearson r: 0.96, p&amp;lt;0.001). In the Altshock registry cohort (80 patients, 81% males, mean age 62.5 ± 14.4 years, in-hospital mortality 31.4%) eCPO &amp;lt;0.6 (HR 2,48 [95% CI 1,06 - 5,85], p=0,04), hemoglobin (p=0.005), systolic blood pressure (p=0.05) and SCAI class (p=0.02) were associated with increased risk of in-hospital MACE at univariate analysis. Echocardiographic CPO &amp;lt;0.6 remained significantly associated with MACE also after adjustment at multivariate Cox analysis (HR 2,87 [95% CI 1,03 - 7,96] p=0,043). Conclusion Echocardiographic estimation of CPO (eCPO) is feasible and showed a good agreement with invasive CPO. Reduced eCPO during the first 24 hours was associated with increased in-hospital MACE in cardiogenic shock patients.

Age-Related Mortality in STEMI Patients: Insight from One Year of HUB Centre Experience during the Pandemic.

Old patients have a poor prognosis when affected by ST elevation myocardial infarction (STEMI). The aim of our study was to evaluate the impact of age on acute and mid-term mortality in STEMI patients over one year in the pandemic period. we collected data on 283 STEMI patients divided into three groups according to age (not old, "Not-O", ≤74 y/o; old, "O", 75-84 y/o; very old, "Very-O", ≥85 y/o). the three groups did not differ in their clinical or procedural characteristics. The Very-O patients had a significantly increased incidence of in-hospital MACE (35%), mortality (30.0%), and percentage of cardiac death (25.0%). The only two independent predictors of in-hospital mortality were the ejection fraction (EF) [OR:0.902 (95% CI) 0.868-0.938; p &lt; 0.0001] and COVID-19 infection [OR:3.177 (95% CI) 1.212-8.331; p = 0.019]. At follow-up (430 +/- days), the survival rates were decreased significatively among the age groups (Not-O 2.9% vs. O 14.8% vs. Very-O 28.6%; p &lt; 0.0001), and the only two independent predictors of the follow-up mortality were the EF [OR:0.935 (95% CI) 0.891-0.982; p = 0.007] and age [OR:1.06 (95% CI) 1.018-1.110; p = 0.019]. in very old patients, all the accessory procedures that may be performed should be accurately and independently weighed up in terms of the risk-benefit balance and the real impact on the quality of life because of the poor mid-term prognosis.

Implications of new-onset atrial fibrillation on in-hospital and long-term prognosis of patients with acute myocardial infarction: A report from the CBD bank study.

An increase in the incidence of atrial fibrillation (AF) during the acute phase of myocardial infarction (AMI) has been observed. But it is still unclear whether the implications of new-onset AF on in-hospital and long-term prognosis are of similar magnitude. Using data from the CBD Bank study, 3,824 consecutive AMI patients, without prior AF, were analyzed. During the index hospitalization, all patients were monitored by continuous cardiac monitoring, twice daily performed 12- or 18-lead ECGs and timely ECG checks when cardiac symptoms occurred. Follow-up visits were routinely scheduled after discharge. Primary outcomes were all-cause death and cardiovascular death occurring during hospitalization and long-term follow-up. Secondary outcome was MACEs during hospitalization. During the median hospital stay of 9.0 (7.0, 11.0) days, new-onset AF was documented in 133 (3.48%) patients; 95 (71.43%) patients had AF attacks within 3 days following AMI. Independent risk factors associated with new-onset AF were older age, larger left atrial diameter, higher level of NT-proBNP, and primary PCI. New-onset AF was found to be significantly associated with in-hospital all-cause death (OR 4.33, 95%CI: 2.37-7.89, P < 0.001), cardiovascular death (OR 4.10, 95%CI: 2.18-7.73, P < 0.001), and MACEs (OR 2.51, 95%CI: 1.46-4.33, P = 0.001). A total of 112 new-onset AF and 3,338 non-AF patients were followed up for 1,090 (365, 1,694) days after discharge. There was no significant association between new-onset AF and long-term all-cause death (HR 1.21, 95%CI: 0.77-1.92, P = 0.406) or cardiovascular death (HR 1.09, 95%CI: 0.61-1.97, P = 0.764). New-onset AF following AMI is strongly associated with an increased risk of adverse in-hospital prognosis, but it does not affect prognosis in those who survive until hospital discharge.

Management of st-segment elevation myocardial infarction in comparison to european society of cardiology guidelines in alexandria university hospitals

Abstract Aim The aim of this study was to determine the major contributors to reperfusion delay in ST- elevation myocardial infarction (STEMI) patients in Alexandria University hospitals and the adherence to ESC clinical practice guidelines. Methods and results Prospective cohort of all patients presented with ST-elevation myocardial infarction (STEMI) with chest pain or discomfort between March 2020 and February 2021 in Alexandria university hospitals. A total of 436 patients were enrolled, 280 patients (64.2%) underwent PPCI, 32 patients (7.3%) had thrombolytic therapy and 124 patients (28.4%) had conservative strategy. In regard to the demographics and risk factors, the mean age of our cohort was 55.2 years. The majority were males (80.9%) and smokers (72.2%). Hypertension was a risk factor in 41.5% of our population, diabetes in 33.5%, and a family history was present in 14.2%, while 7.3% had renal impairment. The median pre-hospital delay was 360 minutes; mainly due to delay in seeking medical care which was the cause in 45.6%, whereas the mean ER time delay was 48.24 ± 89.30 minutes. The median time from CCU admission to wire crossing was 40.0 minutes with a mean value 53.86 ±49.0 minutes. The total ischemic time was 372 minutes (6.2 hours) with a mean ischemic time of 408 minutes (6.8 hours). The rate of reperfusion therapy (PPCI or thrombolysis) was 71.5 percent among all STEMI patients who presented within 12 hours, with achievement of timely reperfusion according to ESC guidelines for management of STEMI in 35.0%. The majority of our patients (70.7%) had door to wire crossing time of less than 90 minutes. In-hospital overall mortality was 5.5%. The PPCI group had a mortality rate of 2.9 percent, whereas the conservative management group had a mortality rate of 12.9 percent, with a statistically significant difference (P&amp;lt;0.001) between the two groups. In-hospital overall MACE was 27.3%. The PPCI group had MACE rate of 15%, the thrombolytic group had MACE rate of 28.1%, and the conservative management group had MACE rate of 54.8%, with a statistically significant difference (P&amp;lt;0.001) between the three groups. Conclusions Regardless of the financial and technical limitations in our center, timely reperfusion rate and performance are not far from meeting ESC 2017 guidelines for the management of STEMI. Primary PCI was the most frequently used treatment modality, and the associated total in- hospital mortality was below 5%. An enormous increase in the total ischemic time is a major concern due. Additional Content An author video to accompany this abstract is available on https://academic.oup.com/eurheartjsupp. Please click on the arrow next to ‘More Content’ and then click on ‘Author videos’.

Impact of residual coronary lesions on outcomes of myocardial infarction patients with multi-vessel disease

Abstract Background Interest grew in residual disease burden after percutaneous coronary intervention (PCI). The residual SYNTAX score (rSS) is a strong prognostic factor of coronary events and all-cause death in patients who underwent PCI. Its derivative, the SYNTAX Revascularisation Index (SRI), has been used in determining the proportion of coronary artery disease (CAD) that has been treated and has been shown to have prognostic utility in PCI for patients with multi-vessel disease (MVD). Purpose We sought to assess the use of the rSS and the SRI as predictors for in-hospital outcomes and up to two-year follow-up outcomes in patients with MVD who underwent PCI in the setting of ST-Elevation Myocardial Infarction (STEMI) or Non-STEMI (NSTEMI). Methods We recruited 149 patients with either STEMI or NSTEMI in the setting of MVD who underwent PCI. We divided them into tertiles, based on their rSS and SRI values, respectively. We calculated bSS and rSS using the latest version of the web-based calculator, and from these scores we calculated SRI. The endpoints were: In-hospital composite MACE and its components, in-hospital mortality, follow-up MACE, and follow-up all-cause mortality up to 2-years. Results RSS and SRI were not significant predictors of in-hospital death or MACE, while hypertension, ST-segment resolution, LVEF, and significant left main coronary artery (LMCA) lesions were independent predictors of in-hospital MACE. At two-year follow-up, Kaplan-Meier analysis showed significantly increased incidence of death and MACE within the third rSS tertile (rSS &amp;gt;12) compared to the other tertiles (log rank p&amp;lt;0.001), while there was no significant difference between the three SRI tertiles. RSS and SRI were predictors of death and MACE on univariate Cox regression analysis. On multivariate Cox regression, rSS was an independent predictor for MACE (HR=1.0696, 95% CI: 1.0147–1.1275, p=0.0123) and all-cause mortality (HR=1.1114, 95% CI: 1.0430–1.1842, p=0.0011). Of notice, all patients with complete revascularisation survived throughout the entire follow-up period. Conclusions The rSS and SRI were poor predictors of in-hospital death and MACE, while they were good predictors of death and MACE at two-year follow-up, with better overall performance for rSS in comparison to SRI. Patients with rSS values &amp;gt;12 showed significantly higher incidence of MACE and all-cause mortality at two years. The best prognosis was achieved with complete revascularisation. Funding Acknowledgement Type of funding sources: None.

Impact of pre-existing vascular disease on clinical outcomes in patients with non-ST-segment myocardial infarction: a nationwide cohort study

Abstract Aims Little is known about the outcomes and processes of care of patients with non ST-segment myocardial infarction (NSTEMI) who present with “polyvascular” disease. Methods We analysed 287,279 NSTEMI patients using the Myocardial Infarction National Audit Project (MINAP) registry. Clinical characteristics and outcomes were analysed according to history of affected vascular bed; coronary artery disease (CAD), cerebrovascular disease (CeVD) and peripheral vascular disease (PVD), with comparison to a historically disease-free control group; comprising 167,947 patients (59%). Further analyses compared cumulative number of affected beds with our control. Results After adjusting for demographics and management, vascular bed disease was associated with increased likelihood of MACE (CAD OR: 1.06, 95% CI: 1.01–1.12, P=0.02) (CeVD OR: 1.19, 95% CI: 1.12–1.27, P&amp;lt;0.001) (PVD OR: 1.22, 95% CI: 1.13–1.33, P&amp;lt;0.001) and in-hospital mortality (CeVD OR: 1.24, 95% CI: 1.16–1.32, P&amp;lt;0.001) (PVD OR: 1.33, 95% CI: 1.21–1.46, P&amp;lt;0.001). Patients with no vascular disease were less likely to be discharged on statins (PVD 88%, CeVD 86%, CAD 90% and control 78%), and those with moderate (EF 30–49%) or severe left ventricular systolic dysfunction (LVSD) (EF&amp;lt;30%) were less likely to be discharged on ACE inhibitors (CAD 82%, CeVD 77%, PVD 77%, control 74%). Patients with polyvascular disease were less likely to be discharged on DAPT (PVD 78%, CeVD 77%, CAD 80%, control 87%). Conclusion Polyvascular disease patients had a higher adjusted incidence of in-hospital mortality and MACE. Patients with no history of vascular disease were less likely to receive statins or ACE inhibitors/ARBs, but more likely to receive DAPT. Funding Acknowledgement Type of funding sources: None.

Association of Raised BMI with MACE in patients of acute coronary syndrome undergoing percutaneous coronary intervention

BACKGROUND: Acute coronary syndrome (ACS) refers to a group of conditions. It is the leading cause of death in patients with coronary artery disease (CAD). Obesity is a major risk factor for coronary artery disease (CAD) and is closely linked to increased morbidity and death.&#x0D; AIMS AND OBJECTIVE: To determine the association of raised BMI with MACE in patients of Percutaneous coronary intervention is used to treat the acute coronary syndrome.&#x0D; METHODOLOGY: A Prospective cohort study was conducted at the Punjab Institute of Cardiology, Lahore from August 2020 to February 2021. 120 patients with ACS were enrolled by Non-probability consecutive sampling after the inclusion and exclusion criteria. MACE was recorded after 3 months of clinical follow-up.&#x0D; RESULTS: Among the exposed, the mean age was 37.9�9.3yearsr and 39.5�8.2 years among non-exposed. Among exposed, there were 32(53.3%) males and 28(46.7%) females, while 37(61.7%) males and 23(38.3%) females among non-exposed. The risk ratio of the obese participants was high as 35%.&#x0D; CONCLUSION: Raised BMI individuals are at risk of in-hospital complications and 3-month MACE and mortality after PCI.

Association of CHA2DS2-VASC Score with in-Hospital Cardiovascular Adverse Events in Patients with Acute ST-Segment Elevation Myocardial Infarction.

Background Acute ST-elevation myocardial infarction (STEMI) is a common clinical critical illness, and accurate, reliable, simple, and easy-to-remember tools are needed in clinical practice to quickly identify the risk of this condition in STEMI patients. This study investigates the predictive value of the admission CHA2DS2-VASc score for in-hospital MACE in STEMI patients. Methods A total of 210 STEMI patients who visited the Chest Pain Center of the Second People‘s Hospital of Hefei from December 2019 to December 2021 were retrospectively analyzed. They were divided into MACE and non-MACE groups. The receiver operating characteristic curve (ROC) was used to assess the predictive value of the CHA2DS2-VASc score for MACE events during hospitalization. Results The CHA2DS2-VASc score was higher in the MACE group than in the non-MACE group (P < 0.05), and multivariate logistic regression analysis showed that the CHA2DS2-VASc score was an independent risk factor for MACE events during hospitalization in STEMI patients (OR = 1.391, 95%CI 1.044–1.853, P=0.024); ROC curve analysis showed that the area under the curve (AUC) of the CHA2DS2-VASc score was 0.744, the sensitivity was 0.64, the specificity was 0.694, and the optimal cutoff value was 3.5 in predicting the risk of MACE events during hospitalization in STEMI patients. There were no significant differences between the GRACE score (0.744 VS.0.827) and TIMI score (0.744VS.0.745) (P > 0.05). Conclusion The CHA2DS2-VASc score can successfully predict the occurrence of in-hospital MACE events in STEMI patients.

Mid-term outcome of de novo lesions vs. in stent restenosis treated by intravascular lithotripsy procedures: Insights from the French Shock Initiative

BackgroundIntravascular lithotripsy (IVL) is a promising new technology for disrupting de-novo calcified coronary lesions (DNL) before percutaneous coronary intervention (PCI). We assessed 12-month outcomes of IVL in patients undergoing PCI for DNL or intra stent restenosis (ISR) lesions related to device underexpansion. MethodsProspective analysis of patients in the multicentre all-comers French Shock Initiative IVL registry. The primary safety endpoints in this analysis were in-hospital and 12-month major adverse cardiovascular events (MACE: cardiac death, myocardial infarction or target vessel revascularization). The primary effectiveness endpoint was procedural success, defined as <30% residual stenosis without severe angiographic complications. Event rates were analysed for the cohort and for DNL and ISR procedures separately. ResultsA total of 220 lesions were treated (76.7% DNL and 23.3% ISR) in 202 patients. Procedural success was achieved in 95.5% of patients (DNL group: 96.5%; ISR group: 92.0%). In-hospital MACE occurred in 6.4% of cases, mainly driven by periprocedural infarctions. The rate of MACE-free survival at 1 year was 86.6% in the overall cohort. Rates of target vessel (TVR) and lesion (TLR) revascularisation were 6.4% and 2.5%, respectively. The 1-year MACE rate was 91.5% in DNL group and 83.8% in ISR group. ConclusionsIn this large all-comers IVL cohort, rates of in-hospital and 1-year MACE were moderate. The safety and efficiency of IVL was comparable in DNL and ISR lesions. A comparative study of the impact of IVL on outcomes appears warranted.

Intravascular lithotripsy-assisted PCI for severely calcified coronary lesions: evaluating the impact on quality of life and outcomes.

Despite the increased uptake of intravascular lithotripsy (IVL) for treating severely calcified coronary lesions, there is limited patient-level data examining the effect of IVL on quality of life, symptomatology, and outcomes beyond 30days. We sought to assess demographics, procedural characteristics, outcomes, and impact of IVL on patient-reported angina after a minimum of 6months follow-up. A retrospective single-center study was conducted of patients treated with coronary IVL between January and October 2020. Baseline demographics were obtained from electronic patient records and SYNTAX scores were calculated from index coronary angiograms. Technical success and complications were assessed along with clinical outcomes, which included all-cause mortality, myocardial infarction (MI), target lesion revascularization (TLR), and MACE (composite of death, stroke, MI, and TLR). Canadian Cardiovascular Society (CCS) angina classification was assessed at virtual clinical follow-up. Forty-seven consecutive patients were included. At a mean follow-up of 306 ± 74days, the mean CCS angina score was reduced by 53% post-IVL-assisted PCI (2.9 vs 1.4, p < 0.001). Technical and procedural success were high (94% and 92%, respectively). One patient (2%) met the pre-specified criteria for in-hospital MACE and 4 (9%) met pre-specified MACE at follow-up, including 2 deaths and 2 TLR. Procedural complications included coronary dissection (11%) and coronary perforation (6%) and were managed either conservatively or with PCI. Coronary IVL is a safe and effective adjunctive therapy for treating heavily calcified coronary lesions. This cohort shows high procedural success and a significant reduction in CCS angina at follow-up.

GRACE score - is it good for all NSTEMI patients

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Patients (P) with a non-ST elevation myocardial infarction (NSTEMI) have a heterogenous prognosis and early risk stratification at admission is essential. GRACE score is validated to estimate in-hospital outcomes, as well as long term prognosis. Objective Evaluation of discriminatory capacity of GRACE score in P &amp;lt;65 years versus ≥65 presenting with NSTEMI. Methods Based on a single-center retrospective study, data collected from admissions between 1/01/2016 and 11/12/2019. Patients with cardiac arrest or hemodynamically unstable patients at admission were excluded. GRACE score was calculated using Killip-Kimball classification as a surrogate of heart failure. P were divided in 2 groups (G): G1 if &amp;lt;65 years old, G2 if ≥65 years. We evaluated the discriminatory capacity of GRACE score in predicting in-hospital MACE in both groups through ROC-curve analysis. Results We identified 405 patients with NSTEMI, 62.7% were males with an average age of 68.4±12.3 years old. Mean GRACE in global population was 118±28.3 points, lower in G1 P (G1 92.6±22.6, G2 130±21.2, p&amp;lt;0.001). At univariate analysis, GRACE score was predictor of MACE in G1 (p=0.05, OR 1.05) and G2 p=0.026, OR 1.03). Its discriminatory capacity was acceptable: for G1 the area under the curve (AUC) was 0.687 and in G2 AUC 0.785. Given the lower discriminatory capacity in G2, the authors determined other predictor factors (excluding GRACE) to accurate risk stratification in this G. At univariate analysis, predictor factors for MACE were diabetes (p=0.006, OR 5.4), left ventricle branch block (p=0.011, OR 2.2) and haemoglobin at admission (p=0.003, OR 0.63). At multivariate analysis, both diabetes (p=0.002) and haemoglobin (p=0.031) were independent predictor factors for MACE. Conclusion In our center, GRACE score was a better predictor for younger patients, while for other patients other factors, such as diabetes and haemoglobin at admission must be taken into account to assess risk stratification.

Can we predict the coronary angiography result?

Abstract Funding Acknowledgements Type of funding sources: None. Introduction It is estimated that 5-15% of patients admitted with suspected acute myocardial infarction (AMI) have no significant lesions on coronary angiography (&amp;gt;50%), an entity called MINOCA. Objective To identify predictors of non-significant coronary lesions in patients admitted with AMI Methods Based on a multicenter retrospective study, data collected from admissions between 2013 and 2020. Patients (pts) without data on cardiovascular history or uncompleted clinical data were excluded. Pts were divided in 2 groups (G): GA – pts with significant coronary lesions; GB - pts with non-significant coronary lesions. Results MINOCA occurred in 1561 (20.6%) out of 6029 pts with AMI. There were no differences between G regarding age (p=0.745). GB pts were more frequently females (35.9% vs 24.9%, p&amp;lt;0.001), had lower rates of smoking habits (21.9% vs 26.9%, p&amp;lt;0.001), arterial hypertension (70.7% vs 73.4%, p=0.036), diabetes (31.1% vs 36.7%, p&amp;lt;0.001), past history of MI (13.9% vs 23.5%, p&amp;lt;0.001) and past history of stroke (5.0% vs 7.5%, p=0.002). There were no differences between G regarding symptoms at admission (p=0.359). At admission, GB had lower mean heart rate (76±18 vs 78±19, p=0.037), lower systolic arterial pressure (141±25 vs 144±28, p&amp;lt;0.001), lower rates of KK&amp;gt;1 (10% vs 12.2%, p=0.037), higher rates of atrial fibrillation (AF) (8.8% vs 6.8%, p=0.026), higher rates of normal ST-T segment (50.9% vs 29.6%, p&amp;lt;0.001), and lower BNP levels (99±36.9 vs 157±64, p&amp;lt;0.001). During hospitalization, GB pts used less diuretics (18.1% vs 26.1%, p&amp;lt;0.001) and inotropes (0.5% vs 1.8%, p=0.007). GB had a lower prevalence of left ventricle dysfunction (&amp;lt;50%) (20.4% vs 29.3%, p&amp;lt;0.001), and less need of mechanical ventilation (0.1% vs 1.0%, p&amp;lt;0.001), non-invasive ventilation (0.1% vs 1.6%, p&amp;lt;0.001) and provisory pacing (0.1% vs 0.5%, p=0.011). Logistic regression confirmed that being a female (p&amp;lt;0.001, OR 2.7), a non-smoker (p=0.002, OR 1.4), a non-diabetic (p=0.001, OR 1.45), AF (p=0.001, OR 1.8), normal QRS (p&amp;lt;0.001, OR 1.9) and normal LV function (p=0.009. OR 1.5) were predictors of MINOCA. The G were similar regarding in-hospital MACE outcomes (in-hospital death, stroke or MI) (p=0.658) and 1 year outcomes, namely 1 year mortality (p=0.709) and readmission of cardiovascular causa (p=0.290). Conclusion Several clinical factor may help us predicting which patients will have a coronary angiography without significant lesions. However, the absence of significant lesions is not predictive of better in-hospital and 1 year prognosis.

Primary Percutaneous Coronary Intervention with High-Bolus Dose Tirofiban: The FASTER (Favorite Approach to Safe and Effective Treatment for Early Reperfusion) Multicenter Registry.

Objectives To investigate the safety and clinical efficacy of tirofiban during primary percutaneous coronary interventions (pPCI). Background Gp IIb/IIIa inhibitors (GPI) use during pPCI has declined over years, mainly for the increased hemorrhagic risk associated to their use and for the availability of potent, fast-acting oral antiplatelet drugs. However, several pharmacodynamic studies showed suboptimal platelet inhibition with P2Y12-blockers, such as prasugrel or ticagrelor. Methods Patients with ST-segment elevation myocardial infarction (STEMI) undergoing pPCI were prospectively enrolled in a multicenter registry conducted in high-volume centers in Italy. All patients received intraprocedural tirofiban. The primary safety endpoint was the occurrence of in-hospital bleedings according to the Bleeding Academic Research Consortium definition. In-hospital major adverse coronary events (MACE, defined as death, reinfarction, stent thrombosis, and target vessel revascularization), final TIMI flow, myocardial blush grade, and ST-segment resolution were also evaluated. Results A total of 472 patients (mean age 61 ± 11 years, 83% males) were enrolled in 16 Italian centers from October 2015 to June 2018. Mean basal thrombus grade score was 3.47 ± 1.25. PCI was performed by transradial approach in 88% of patients. We observed a very low rate of 30 days BARC bleedings (2.1%) and MACE (0.8%). Complete (>70%) ST-segment resolution was observed in 67% of patients. Conclusions In the FASTER registry, the use of tirofiban during primary PCI, performed with a transradial approach in most cases, in patients with high thrombus burden was associated with high rates of complete ST-segment resolution and low rates of in-hospital bleeding and MACE.

The Procedural and Clinical Outcomes of Rotational Atherectomy in Patients Presenting With Acute Myocardial Infarction.

BackgroundRotational atherectomy (RA) is an indispensable tool used for calcified lesion preparation in percutaneous coronary intervention (PCI). However, use of RA in the setting of acute myocardial infarction (AMI) is challenged with limited clinical data.ObjectivesThis study aims to retrospectively investigate the procedural results, periprocedural complications, and clinical outcomes of RA in patients with AMI.MethodsAll possible consecutive patients who received RA in AMI from January 2009 to March 2018 in a single tertiary center were analyzed retrospectively. Patients without AMI during the study period were also enrolled for comparison.ResultsA total of 121 patients with AMI (76.0 ± 10.8 years, 63.6% males) and 290 patients without AMI were recruited. Among the AMI group, 81% of patients had non-ST-elevation myocardial infarction (NSTEMI) and 14% presented with cardiogenic shock. RA could be completed in 98.8% of patients in the AMI group and 98.3% in the non-AMI group (p = 1.00). The periprocedural complication rates were comparable between the AMI and non-AMI groups. The risks of in-hospital, 30-day, 90-day, and 1-year cardiovascular major adverse cardiac events (CV MACE) were significantly higher in the AMI group compared with the non-AMI group (in-hospital 13.2 vs. 2.8%, p < 0.001; 30-day 14.2 vs. 4.5%, p < 0.001; 90-day 20.8 vs. 6.9%, p < 0.001; 1-year 30.8 vs. 19.1%, p = 0.01). AMI at initial presentation and cardiogenic shock were predictors for both in-hospital CV MACE and 1-year CV MACE in multivariable binary logistic regression analysis. Other predictors for 1-year CV MACE included serum creatinine level and triple vessel disease.ConclusionRA in patients with AMI is feasible with a high procedural completion rate and acceptable periprocedural complications. Given unstable hemodynamics and complex coronary anatomy, the in-hospital and 1-year MACE rates remained higher in patients with AMI compared with patients without AMI.

Rotablation in Patients with Advanced Renal Insufficiency through End-Stage Renal Disease: Short- and Intermediate-Term Results.

Objective Patients with advanced renal insufficiency are at high risk of coronary artery disease (CAD) and complex lesions. Treating complex calcified lesion with rotational atherectomy (RA) in these patients might be associated with higher risks and poorer outcomes. This study was set to evaluate features and outcomes of RA in these patients. Method Consecutive patients who received coronary RA from April 2010 to April 2018 were queried from the Cath Lab database. The procedural details, angiography, and clinical information were reviewed in detail. Results A total of 411 patients were enrolled and divided into Group A (baseline serum creatinine <5 mg/dl, n = 338) and Group B (baseline serum creatinine ≥ 5 mg/dl through ESRD, n = 73). Most patients had high-risk features (65.7% of acute coronary syndrome (ACS), 14.1% of ischemic cardiomyopathy, and 5.1% of cardiogenic shock). Group B patients were significantly younger (66.8 ± 11.4 vs. 75.2 ± 10.7 years, p < 0.001) and had more RCA and LCX but less LAD treated with RA. No difference was found in lesion location, vessel tortuosity, bifurcation lesions, chronic total occlusion, total lesion length, or total lesion numbers between the two groups. Less patients in Group B obtained completion of RA (95.9% vs 99.1%, p=0.037). There was no difference in the incidence of procedural complication or acute contrast-induced nephropathy. Group B patients had more deaths and MACE while in the hospital. The MACE and CV MACE were also higher in Group B patients at 180 days and one year, mostly due to TLR and TVR. Multivariate regression analysis showed that ACS, age, peripheral artery disease (PAD), advanced renal insufficiency, ischemic cardiomyopathy/shock, and high residual SYNTAX score were independent risk factors for in-hospital MACE, whereas ACS, advanced renal insufficiency, ischemic cardiomyopathy/shock, triple-vessel disease, and PAD independently predicted MACE at 6 months. Conclusions Rotablation is feasible, safe, and could be carried out with very high success rate in very-high-risk patients with advanced renal dysfunction through ESRD without an increase in procedural complication.

Adverse 30-Day Clinical Outcomes and Long-Term Mortality Among Patients With Preprocedural Atrial Fibrillation Undergoing Percutaneous Coronary Intervention

Approximately 5-10% of patients presenting for percutaneous coronary intervention (PCI) have concurrent atrial fibrillation (AF). To what extent AF portends adverse long-term outcomes in these patients remains to be defined. We analysed data from the multicentre Melbourne Interventional Group Registry from 2014-2018. Patients were identified as being in AF or sinus rhythm (SR) at the commencement of PCI. The primary endpoint was long-term mortality, obtained via linkage with the National Death Index. 13,286 procedures were included, with 800 (6.0%) patients in AF and 12,486 (94.0%) in SR. Compared to SR, patients with AF were older (72.9±10.9 vs 64.1±12.0 p<0.001) and more likely to have comorbidities including diabetes mellitus (31.3% vs 25.0% p<0.001), hypertension (74.4% vs 65.1% p<0.001) and moderate to severe left ventricular systolic dysfunction (36.6% vs 19.5% p<0.001). Atrial fibrillation was associated with an increased risk of in-hospital mortality (11.0% vs 2.5% p<0.001) and MACE (composite of all-cause mortality, myocardial infarction, or target vessel revascularisation) (11.9% vs 4.2% p<0.001). In-hospital major bleeding was more common in the AF group (3.1% vs 1.0% p<0.001). On Cox proportional hazards modelling, AF was an independent predictor of long-term mortality (adjusted HR 1.38 95% CI 1.11-1.72 p<0.004) at a mean follow-up of 2.3±1.5 years. Preprocedural AF is common among patients presenting for PCI. Preprocedural AF is associated with high-rates of comorbid illnesses and portends higher risk of short- and long-term outcomes including mortality underscoring the need for careful evaluation of its risks prior to PCI.