Independent Predictors Of MACE Research Articles

P69 LONG–TERM OUTCOMES WITH DRUG–ELUTING BALLOONS FOR THE TREATMENT OF IN–STENT RESTENOSIS AND DE NOVO LESIONS

Abstract Introduction Drug coated balloons (DCB) have emerged for percutaneous coronary interventions (PCI) and mainly for in–stent restenosis or particular anatomies. However, the indications and the predictors of long–term failure of DCB have been poorly evaluated besides small–sized randomized clinical trials. Therefore, the aim of the present study was to provide a real–world analysis of the prognostic determinants and long–term outcomes among patients treated with DCB for any type of lesion and included in a comprehensive multicenter registry. Methods We included patients undergoing coronary angiography and PCI with DCB for in–stent restenosis or de novo lesions in 3 centers. Quantitative parameters for coronary lesions were calculated by an automatic edge–detection system. The primary study endpoint was the occurrence of major cardiovascular events (a composite of death, MI and target vessel revascularization) at the longest available follow–up. Secondary endpoints were the individual components of the primary endpoint, target lesion failure (TLF) or any acute coronary syndrome. Results Out of 281 patients treated with DCB, the 267 displaying a follow–up > 12 months were included, of whom 196 treated for in–stent restenosis and 71 with de novo lesions. At a median follow–up of 616 [368–1025] days, MACE occurred in 70 (26.2%) of the patients. No difference in clinical, demographic of angiographic features was observed between patients with or without an event, with the exception of a higher rate of in–stent restenosis (p = 0.04), longer and more type C lesions (p = 0.05 and p = 0.04) related with MACE. At multivariate Cox–regression, type C lesions emerged as the only independent predictor of MACE (adjusted OR[95%CI]= 1.83[1.13–2.97], p = 0.014), mainly driven by target vessel revascularization (adjusted OR[95%CI]= 1.78[1.05–2.95], p = 0.03) although not conditioning survival. However, in–stent restenosis emerged as a major determinant of TLF (adjusted OR[95%CI]= 2.59[1.17–5.75], p = 0.02). Conclusion The present registry shows that drug–coated balloons represent a potential treatment strategy even for de–novo lesions, especially in less complex cases. In fact, we observed an increased risk of MACE and target lesion failure in case of type C and restenotic lesions.

Nursing Analysis Based on Medical Imaging Technology before and after Coronary Angiography in Cardiovascular Medicine.

With the advancement of technology, medical imaging technology has been greatly improved. This article mainly studies the nursing before and after coronary angiography in cardiovascular medicine based on medical imaging technology. This paper proposes a multimodal medical image fusion algorithm based on multiscale decomposition and convolution sparse representation. The algorithm first decomposes the preregistered source medical image by NSST, takes the subimages of different scales as training images, and optimizes the subdictionaries of different scales; then convolution and sparse the subimages on each scale encoding to obtain the sparse coefficients of different subimages; secondly, the combination of improved L1 norm and improved spatial frequency (novel sum-modified SF (NMSF)) is used for high-frequency subimage coefficients, and the fusion of low-frequency subimages improved the rule of combining the L1 norm and the regional energy; finally, the final fused image is obtained by inverse NSST of the fused low-frequency subband and high-frequency subband. Experimental analysis found that the bifurcation angle has nothing to do with the damage of the branch vessels after the main branch stent is placed. The bifurcation angle greater than 50° is an independent predictor of MACE after stent extrusion for bifurcation lesions. Experimental results show that the proposed method has good performance in contrast enhancement, detail extraction, and information retention, and it improves the quality of the fusion image.

Overlapping versus single long stents in long chronic total occlusions: insights of the Iberian CTO Registry.

It is unknown whether the availability of long drug-eluting stents modify the PCI strategy of long CTO. To describe the contemporary PCI strategy of long chronic total occlusions (CTO) using overlapping (OS) or single long stents (SS) and to analyze its results. 2842 consecutive CTO PCIs were included. Those with an occlusion length ≥20 mm in which ≥1 drug eluting stent (DES) was implanted were analyzed. We compared procedural characteristics and clinical outcomes of CTO treated with OS or SS. 1088 CTO PCIs were analyzed (79.9% males; 64.7±10.6 years). Mean J-score was 2.8±0.9. A SS was used in 38.5% of cases and OS in 61.5%. Total stent length was 64.1±29.9 mm; it was higher in the OS group (OS: 79.9±25.5 mm vs. SS: 38.3±14.7 mm; P<0.0001). Mean number of stents in the OS group was 2.3±1. Very long stents (≥40 mm) were used in 27.4% of cases, more frequently in the OS group (OS:32.4% vs. SS:19.3%; P<0.0001). After a mean follow-up of 19±15.9 months, the rate of adverse events (MACE) was 2% (cardiac death: 1.6%, myocardial infarction: 1.6%, target lesion revascularization: 1.9% and stent thrombosis: 0.18%) with no significant differences between both groups. Overlapping was not an independent predictor of MACE. In long CTO PCIs, OS is more frequently used than single stenting, especially in more complex procedures. Clinical outcomes at a mid-term follow-up are favorable. Using newer generation DES, overlapping was not an independent predictor of MACE; however, a trend toward a higher event rate was observed in the OS group.

Prognostic value of ventricular mechanical dyssynchrony in patients with left ventricular aneurysm: A comparative study of medical and surgical treatment

BackgroundThe prognostic value of left ventricular (LV) mechanical dyssynchrony (MD) in patients with LV aneurysm (LVA) is unclear. This study aimed to investigate the long-term prognostic value of LVMD in LVA patients. Methods92 consecutive patients who underwent 99mTc-sestamibi-gated SPECT myocardial perfusion imaging (GSPECT) were retrospectively analyzed and followed-up for a median of 63 months (range, 1-73 months). LV function and histogram bandwidth (BW) were analyzed by QGS software. LVMD was defined by ROC analysis. Cardiac death was defined as the primary endpoint, and the composite of cardiac deaths and severe or acute heart failure (MACE) as the secondary endpoint. ResultsThe annual cardiac mortality rate of LVA patients with LVMD and treated by surgical therapy was significantly lower than those treated by medical therapy (2.40% vs. 6.40%, P < .05) but not annual MACE rate (6.61% vs. 10.06%, P > .05). In patients without LVMD, no significant difference in survival and MACE-free survival between medical and surgical treatment. In addition, the occurrence of LVMD is related to the worsen cardiac outcome in terms of MACE and cardiac death, independent of the treatment methods. BW was an independent predictor for MACE (HR 1.010, P < .01) and LVEF (HR .928, P < .05) was an independent predictor for cardiac death in all LVA patients. ConclusionsLVA patients with LVMD might be associated with high risk for cardiac death and surgical treatment might improve cardiac survival compared to medical therapy in these patients.

Left ventricular thrombus after acute ST-segment elevation myocardial infarction: multi-parametric cardiac magnetic resonance imaging with long-term outcomes.

Left ventricular thrombus (LVT) after acute ST-segment elevation myocardial infarction (STEMI) are generally associated with poorer outcomes for patients at long-term follow-up. We hypothesis that tissue characteristics and strain parameters by cardiac magnetic resonance (CMR) imaging may indicate the interactions of LVT with ventricular myocardium remodeling at both acute stage and chronic stages in STEMI patients. This retrospective study included 111 consecutive STEMI patients (38 with LVT and 73 without LVT). All patients underwent CMR during acute stage (within 7days) and chronic stage (after at least 2months) periods after percutaneous coronary intervention (PCI). Left ventricular native T1, extracellular volume (ECV), radial, circumferential, and longitudinal strain were analyzed in both phases. Major adverse cardiac events (MACE, including cardiovascular death, myocardial reinfarction, and hospitalization for heart failure), thromboembolic and bleeding events, were the clinical endpoints of the study. During the acute stage, left ventricular ejection fraction (LVEF) (OR 0.77, P value = 0.01) and longitudinal strain (OR 1.90, P value < 0.001) were correlated with LVT formation. Strain parameters were reduced, while the native T1 and ECV values of both the infarcted area and remote myocardium were elevated in LVT patients. During the chronic stage, LVT resolved in 29 of 38 patients (76%). LVT remaining patients had lower LVEF, a larger LV, and higher ECV in the acute stage than those of the LVT-resolved patients. In the long-term follow up of 678days, LVT (HR 2.45, P value = 0.02), aneurysm (HR 1.81, P value = 0.04), and native T1 (HR 2.44, P value = 0.01) were identified as three independent predictors of MACE, the incidence of thromboembolic events and bleeding events by a multivariable stepwise Cox proportional hazards regression. STEMI patients developing LVT had worse LV function, myocardial infarction extent, strain, and higher T1 and ECV values than STEMI patients without LVT. The LVT-remaining patients in the chronic stage had poorer functional and mapping parameters beginning in the first week. During the acute stage, LVEF and global longitudinal strain were independent correlated with LVT formation. During the long-term follow up, LVT, aneurysm and elevated myocardial T1 were associated with adverse outcomes in acute STEMI patients.

Clinical Usefulness of the Serial Examination of Three-Dimensional Global Longitudinal Strain After the Onset of ST-Elevation Acute Myocardial Infarction.

Two-dimensional (2D) and three-dimensional (3D) speckle tracking echocardiography (STE) after ST-elevation acute myocardial infarction (STEMI) can predict the prognosis. This study investigated the clinical significance of a serial 3D-STE can predict the prognosis after onset of STEMI. This study enrolled 272 patients (mean age, 65 years) with first-time STEMI treated with reperfusion therapy. At 24 h after admission, standard 2D echocardiography and 3D full-volume imaging were performed, and 2D-STE and 3D-STE were calculated. Within 1 year, 19 patients who experienced major adverse cardiac events (MACE; cardiac death, heart failure requiring hospitalization) were excluded. Among the 253 patients, 248 were examined with follow-up echocardiography. The patients were followed up for a median of 108 months (interquartile range: 96-129 months). The primary endpoint was the occurrence of a MACE; 45 patients experienced MACEs. Receiver operating characteristic curves and Cox hazard multivariate analysis showed that the 2D-global longitudinal strain (GLS) and 3D-GLS at 1-year indices were significant predictors of MACE. The Kaplan-Meier curve demonstrated that a 3D-GLS of >-13.1 was an independent predictor for MACE (log-rank χ2=165.5, P<0.0001). The deterioration of 3D-GLS at 1 year was a significant prognosticator (log-rank χ2=36.7, P<0.0001). The deterioration of 3D-GLS measured by STE at 1 year after the onset of STEMI is the strongest predictor of long-term prognosis.

Late Percutaneous Coronary Intervention is Associated with Better Prognosis of Patients with Acute Myocardial Infarction.

BackgroundThe optimal timing of invasive coronary revascularization in patients with late presentation of acute myocardial infarction (AMI) remains unclear.ObjectiveThis study aimed to investigate whether late percutaneous coronary intervention (PCI) is associated with the prognosis of AMI patients with HFpEF presenting >24h after symptom onset.MethodsWe enrolled 680 AMI patients with HFpEF. Patients were divided into 3 groups: early-PCI strategy (defined as the time to open IRA from symptom onset <24 h), late-PCI strategy (defined as the time of PCI-mediated reperfusion was >24 h) and non-revascularization group.ResultsA total of 144 (21.2%) experienced a MACE, including 118 (17.4%) all-cause deaths and 26 (3.8%) re-hospitalization for HF during a follow-up period of 30.20±15.62 months. After adjusting for gender, age, smoking, diabetes mellitus, NT-proBNP and eGFR, late-PCI was a significant and independent predictor of MACE (hazard ratio 0.367; 95% confidence interval 0.202–0.665; p<0.001). Kaplan–Meier analysis showed that late-PCI decreased cumulative risk of MACE (p< 0.001).ConclusionLate-PCI and early-PCI strategies are associated with a reduced risk of MACE in AMI patients with HFpEF presenting >24 h after symptom onset, compared to conservative strategies.

Long-term follow-up of percutaneous balloon mitral valvuloplasty for mitral stenosis: an old but needed player

Abstract Funding Acknowledgements Type of funding sources: None. Background In the era of innovative transcatheter valve interventions, percutaneous balloon mitral valvuloplasty (PBMV) remains the primary treatment option in anatomic suitable patients. Purpose This study aimed to evaluate longterm follow-up (FU) of PBMV and to determine predictors of MACE. Methods Between 1991 and June 2021, 202 consecutive patients underwent PBMV in a single tertiary centre. Clinical data, echocardiographic parameters, and MACE (cardiovascular mortality, need for percutaneous or surgical mitral reintervention and hospitalization for heart failure) were analysed. Predictors of MACE were determined by Cox regression analysis. Results Mean age was 47.3 ± 13.6 years, 89.6% female, 47.3% patients presenting atrial fibrillation. Mean Wilkins score was 7.6 ± 1.4, 51.5% had mild or moderate mitral regurgitation and mean pulmonary artery systolic pressure (PASP) of 46.7 ± 17.1 mmHg. Mean pre MVA and mean mitral valve (MV) gradient were 1.1 ± 0.2 cm2 and 10.8 ± 5.6 mmHg, respectively. Successful PMBV was achieved in 89.1%. During a mean FU of 12.0 ± 8.8 years, there were 25 deaths (12.4%) and 33.3% needed MV reintervention (6.5% underwent PBMV and 29.7% needed MV surgery). At univariate analysis, previous MV intervention [HR = 1.95 (1.02–3.72), p &amp;lt; 0.05], Wilkins score [HR = 1.22 (1.01–1.47), p &amp;lt; 0.05], pre mean MV gradient≥8 [HR = 0.62 (0.38–1.00), p &amp;lt; 0.05], mean MV gradient after procedure [HR = 1.37 (1.19–1.58), p &amp;lt; 0.05] and PASP &amp;gt;45 mmHg [HR = 3.29 (1.13–9.55), p &amp;lt; 0.05] were predictors of MV reintervention. At multivariate analysis, pre mean MV gradient≥8 [HR = 0.17 (0.037–0.81), p &amp;lt; 0.05] and mean MV gradient after procedure were independent predictors of MV reintervention [HR = 1.74 (1.21–2.49), p &amp;lt; 0.05]. Wilkins score [HR = 1.29 (1.06–1.57), p &amp;lt; 0.05] and mean MV gradient after procedure [HR = 1.41 (1-21–1.63), p &amp;lt; 0.05] were independent predictors of MACE. Cumulative event-free survival at 10 and 20 years were 72.0 and 46.0%, respectively. Conclusions PBMV remains a reliable and efficient therapeutic option of mitral stenosis, warranting event-free survival at 10 years in most patients selected for the procedure. Mean MV gradient after procedure was independent predictor of MV reintervention and MACE during follow-up. Abstract Figure. Abstract Figure.

Characteristics and outcomes of patients with coronary artery ectasia presenting with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

BackgroundThe clinical significance of coronary artery ectasia (CAE) is not yet fully understood. We aimed to examine differences in clinical and procedural characteristics, clinical management, and outcomes in patients with CAE undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). MethodsThis was a retrospective analysis of consecutive patients presenting with STEMI with a culprit native coronary artery from July 2015 to June 2019. Patients were divided into CAE and Non-CAE groups as detected on coronary angiography during PPCI. Comparison between groups was made for baseline clinical and procedural characteristics, as well as complications, pharmacological treatment, and follow-up outcomes. Results36/1780 (2.0%) patients were found to have CAE. Patients with CAE had a median age of 57.1 ± 11.7 years and were more likely to be male 33/36 (91.7%). Diabetes was less commonly seen in the CAE group (11.1% vs 31.4%, p = 0.010), and there were no differences in the proportion of patients with hypertension and hyperlipidemia. Patients with CAE had more involvement of right coronary artery (RCA) culprit vessel (63.9% vs. 38.4%, p = 0.026), less coronary stenting (25.0% vs 87.2%, p < 0.001) and post-PPCI TIMI 3 flow (69.4% vs 95.5%, P < 0.001), and were more likely to be discharged with oral anticoagulants (36.1% vs 7.6%, p < 0.001). At 3-year follow-up, all-cause mortality rates were higher in the non-CAE group (0.0% vs 11.5%, p < 0.028), suggesting that CAE was not associated with unfavorable long-term outcome. On multivariate analysis, CAE was not an independent predictor of MACE. ConclusionDespite lower rates of post-PPCI TIMI 3 flow, CAE was not associated with unfavorable long-term outcome.

Abstract 9820: WATCH-DM Risk Score is Associated with Functional Capacity and Prognosis in Diabetic Patients with Heart Failure with Preserved Ejection Fraction

Introduction: The coexistence of type 2 diabetes mellitus (T2DM) and heart failure (HF) is frequent and associated with a higher mortality. WATCH-DM risk score is recently developed to predict the risk of HF among patients with T2DM using a machine learning approach (Segar et al, Diabetes Care 2019). Hypothesis: We hypothesized that WATCH-DM risk score would be associated with functional capacity and clinical outcomes in diabetic patients with HF with preserved ejection fraction (HFpEF). Methods: The PURSUIT-HFpEF (Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction) study is a multicenter registration of patients hospitalized for acute decompensated HFpEF. Among 1095 patients registered between 2016 and 2020, 418 patients (38.2%) had T2DM (male gender 49.5%, age 80±9 years, HbA1c 6.8±1.0%). WATCH-DM risk score was calculated in each patient, using BMI, age, systolic/diastolic blood pressure, serum creatinine, HDL-C, fasting plasma glucose, QRS duration, history of myocardial infarction or coronary bypass graft, and patients were divided as the low to average (≤10 points), high (11-13 points) and very high (≥14 points) risk groups. We measured 6 minute walk distance (6MWD) and NT-proBNP before discharge. We followed the study patients for median of 386 days (IQR 221 to 729 days) to observe the major adverse cardiovascular events (MACE; composite of death, heart failure hospitalization and stroke). Results: The WATCH-DM score in the study patients were 12.8±3.1 points, and 108 patients (25.8 %) had low-average, 147 patients (35.2%) high, and 163 patients (39.0%) very high HF risk. There was significant difference in 6MWD (p=0.004) among the groups, and the low-average risk group had significantly longer 6MWD than the high risk group (p=0.049). NT-proBNP was lower in the low-average risk group than in other 2 groups. Cox proportional hazard model selected the WATCH-DM score as an independent predictor for MACE (p=0.006). Kaplan-Meier curve demonstrated that patients with the low-average risk had significantly lower incidence of MACE than the others (p=0.049). Conclusions: The WATCH-DM risk score predicted functional capacity and prognosis in diabetic patients with HFpEF.

Abstract 9939: Admission Systolic Blood Pressure and Left Ventricular Structure/ Hemodynamics in Patients with Acute Decompensated Heart Failure with Preserved Ejection Fraction

Introduction: The blood pressure at hospital admission is associated with prognosis in patients with acute decompensated heart failure (ADHF). It is not well elucidated how admission blood pressure is determined and how it can affect clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Hypothesis: Difference in left ventricular (LV) structure and function could be associated with admission systolic blood pressure (sBP) in patients with decompensated HFpEF. Methods: The PURSUIT-HFpEF (Prospective, Multicenter, Observational Study of Patients with Heart Failure with Preserved Ejection Fraction) is a multicenter registration of patients hospitalized for acute decompensated HFpEF. We divided the registered patients based on “clinical scenario (CS)” in ADHF, as CS1;sBP&gt;140mmHg at admission, CS2; sBP 100-140mmHg, CS3; sBP &lt;100mmHg. Echocardiography was performed during hospital stay. We followed them to observe the major adverse cardiovascular events (MACE; composite of death, heart failure hospitalization and stroke) for median of 390 days (IQR 253 to 7272 days). Results: Among 893 patients (age 81±9 years, male gender 45.2%) who were enrolled for the present study, only 14 patients (1.6%) were categorized as CS3. Thus, we combined patients with CS2 and CS3 into the CS2/3 group (n=383). No difference was observed in age and risk factors except gender (CS1; 49.0% vs. CS2 40.2% of male, p=0.001). Cox proportional hazard model showed admission sBP was an independent predictor of MACE (p=0.0001) along with age and presence of chronic kidney disease, and the CS2/3 had higher incidence of MACE during follow-up period than CS1 (p=0.0001 by log-rank test). While there was no differences in LV ejection fraction, the CS2/3 group showed smaller LV dimension (45±6mm vs. 46±6mm, respectively, p=0.0004) and volume (78±31 ml vs. 86±36mm, p=0.008) at end-diastole, and lower cardiac output (3.9±1.4 ml/min vs. 4.1±1.4 ml/min, p=0.0001) than the CS 1. No difference was observed in diastolic parameters such as left atrial volume index or E/e’ ratio between two groups. Conclusions: Smaller LV volume and lower cardiac output was associated with lower admission sBP, which led to poorer prognosis, in patients with decompensated HFpEF.

Abstract 8943: Type 2 Diabetes and Risk of Major Cardiovascular Events in Peripheral Artery Disease versus Coronary Artery Disease Patients

Introduction: The prevalence of type 2 diabetes (T2DM) is higher in peripheral artery disease (PAD) than in coronary artery disease (CAD) patients, and PAD overall confers higher cardiovascular risk than CAD. Hypothesis: We hypothesize that the incidence of major cardiovascular events compares between PAD and CAD patients when analyses are stratified by the presence of type 2 diabetes (T2DM). Methods: We prospectively recorded major cardiovascular events and death over 10.0±4.7 years in 923 patients with stable CAD, of whom 26.7% had T2DM and in 292 patients with PAD, of whom 42.1% had T2DM. Four groups were analyzed: CAD patients without diabetes (CAD/T2DM-; n=677), CAD patients with T2DM (CAD/T2DM+; n=246), PAD patients without diabetes (PAD/T2DM-; n=169) and PAD patients with T2DM (PAD/T2DM+; n=123). Results: When compared to the incidence of MACE in CAD+/T2DM- patients (25.1%), it was significantly higher in CAD+/T2DM+ patients (35.4%; p&lt;0.001), in PAD+/T2DM- patients (30.2%; p=0.022) and in PAD+/T2DM+ patients (47.2%; p&lt;0.001). Patients with both PAD and T2DM in turn were at a higher risk than CAD+/T2DM+ or PAD+/T2DM- patients (p=0.001 and p&lt;0.001, respectively). The incidence of MACE did not differ significantly between PAD+/T2DM- and CAD+/T2DM+ patients (p=0.413). Compared to patients with CAD, Cox regression analyses after multivariate adjustment showed an adjusted hazard ratio of 1.46 [1.14-1.87], p=0.002 for the presence of PAD. Conversely, T2DM increased the risk of MACE after multivariate adjustment in CAD and PAD patients (adjusted HR 1.58 [1.27-1.98], p&lt;0.001). Conclusions: In conclusion, our data show that T2DM and the presence of PAD are mutually independent predictors of MACE. Patients with both PAD and T2DM are at an exceedingly high risk of MACE.

Type 2 diabetes and the risk of cardiovascular events in peripheral artery disease versus coronary artery disease

IntroductionThe prevalence of type 2 diabetes mellitus (T2DM) is higher in peripheral artery disease (PAD) than in coronary artery disease (CAD) patients, and PAD overall confers higher cardiovascular risk than...

Hyperacute postprocedural high platelet reactivity: a novel predictor for in-hospital adverse events in acute coronary syndrome with prasugrel loading

Abstract Introduction Postprocedural High platelet reactivity (HPR) seems to associate long term adverse cardiovascular events, mainly intrastent thrombosis. However, the relationship between hyper-acute postprocedural HPR with prasugrel loading and clinical outcomes in acute coronary syndrome (ACS) is still unclear. Moreover, factors contributing HPR in ACS with prasugrel loading are also unknown. Purpose This study aimed to assess the impact of hyper-acute postprocedural HPR with prasugrel loading on clinical outcomes in ACS during hospitalization, as well as to define appropriate cut-off values and identify contributing factors of HPR. Methods We performed a single-centre, retrospective observational study that enrolled 207 patients who underwent emergent PCI for ACS with prasugrel loading. The P2Y12reaction unit (PRU) value was measured immediately after PCI with the VerifyNow System. The primary endpoint was major adverse cardiac events (MACE, defined as the composite of death, myocardial infarction, stroke, heart failure, ventricular arrhythmia needing defibrillation). Results Mean patient age (standard deviation) was 70.5 (±13.0) years, 78.7% were male, and average time from prasugrel intake to PRU calculation was 98.3 (±49.1) min. During a mean hospital stay of 15.9 (±9.3) days, there were 34 in-hospital MACE (16.4%) and 10 deaths (4.8%). Thrombosis events, didn't stand out and mechanical complications, such as cardiac rupture and cardiac tamponade occupies most of cardiovascular death which occurred before 10 days on admission. PRU was significantly higher in MACE group than Non-MACE group (279±65 vs 227±72, p&amp;lt;0.001 respectively). The ROC curve analysis of PRU for discriminating significant in-hospital MACE showed the cut off value of 293 (sensitivity:52.9%, specificity:83.2% [AUC=0.709, p&amp;lt;0.0001]). 47patients (29.4%) were thus categorized as HPR (PRU&amp;gt;293) immediately after emergent PCI. Kaplan-Meyer curve showed MACE events occurred in HPR group than non-HPR group (38.2% vs 10.0%, p&amp;lt;0.001). Multiple cox analysis demonstrated that HPR was independent predictors of MACE in patients with ACS underwent PCI (OR 5.416, 95% CI 2.157–13.598, p&amp;lt;0.0001). Multiple logistic regression model showed female sex, low haemoglobin value, and large mean platelet volume were independent predictors of HPR. Conclusion PRU was significantly higher in MACE group, and appropriate cut-off value of HPR in this study was 293. HPR was independent predictor of MACE during hospitalization, however thrombosis event was not significant. Evidence of clinical impact with postprocedural HPR within 120 minutes after prasugrel loading is scarce. This study shows post-procedural HPR, even without sufficient time after prasugrel intake, can be a useful predictive marker of adverse events during hospitalization. Funding Acknowledgement Type of funding sources: None. PRU between Non-MACE and MACE groupKaplan-Meyer curve

Role of right ventricular free wall longitudinal strain in prediction outcome in patients with cardiac sarcoidosis

Abstract Introduction Right ventricular free wall longitudinal strain (RVFWLS) is a sensitive tool for right ventricular (RV) function assessment. Furthermore, it shows incremental prognostic role in various cardiac diseases. RV involvement is frequently observed along with left ventricular (LV) involvement in cardiac sarcoidosis (CS) patients, while its impact on outcome is unclear. Purpose The aim of this study is to investigate the association between RV dysfunction detected by RVFWLS and cardiovascular event in patients with CS. Methods We retrospectively evaluated 51 patients with CS who were treated with prednisone from 2012 through 2020. Diagnosis of CS was made according to the Japanese Circulation Society diagnostic criteria. We evaluated RVFWLS at baseline using vender-independent software. We considered major adverse cardiovascular event (MACE: ventricular arrhythmia, heart failure hospitalization) to be the primary outcome. Results Mean age of the study population was 63±11 years, and 61% were female. At baseline, 25 patients (49%) had reduced left ventricular (LV) ejection fraction (EF) (&amp;lt;50%) and 18 patients (35%) had impaired RVFWLS (&amp;lt;17%). Patients with impaired RVFWLS showed lower LVEF% (42±12% vs. 53±13%, P=0.005) and larger LV end-systolic volume index (54±33 vs. 37±23ml/m2, P=0.04) compared with those with preserved RVFWLS. Impaired RVFWLS patients also showed trend towards higher prevalence of basal interventricular thinning (50 vs. 28%, P=0.12). During a median follow-up of 548 days, eleven patients had MACE. In multivariable Cox-proportional hazards model analysis, RVFWLS was independently associated with MACE (HR 1.28, 95% CI: 1.07–1.10, P=0.009). Kaplan-Meier survival curves showed worse event-free survival in patients with impaired RVFWLS (log-rank test, P=0.001). Conclusions In patients with CS, RVFWLS is an independent predictor for MACE. RVFWLS may be valuable in improving risk stratification in CS. Funding Acknowledgement Type of funding sources: None. Kaplan-Meier survival curves

Type 2 diabetes and risk of major cardiovascular events in peripheral artery disease versus coronary artery disease patients

Abstract The prevalence of type 2 diabetes (T2DM) is higher in peripheral artery disease (PAD) than in coronary artery disease (CAD) patients, and PAD overall confers higher cardiovascular risk than CAD. The purpose of this study was to investigate how the incidence of major cardiovascular events compares between PAD and CAD patients when analyses are stratified by the presence of type 2 diabetes (T2DM). We prospectively recorded major cardiovascular events and death over 10.0±4.7 years in 923 patients with stable CAD, of whom 26.7% had T2DM and in 292 patients with PAD, of whom 42.1% had T2DM. Four groups were analyzed: CAD patients without diabetes (CAD/T2DM-; n=677), CAD patients with T2DM (CAD/T2DM+; n=246), PAD patients without diabetes (PAD/T2DM-; n=169) and PAD patients with T2DM (PAD/T2DM+; n=123). When compared to the incidence of MACE in CAD+/T2DM- patients (25.1%), it was significantly higher in CAD+/T2DM+ patients (35.4%; p&amp;lt;0.001), in PAD+/T2DM- patients (30.2%; p=0.022) and in PAD+/T2DM+ patients (47.2%; p&amp;lt;0.001). Patients with both PAD and T2DM in turn were at a higher risk than CAD+/T2DM+ or PAD+/T2DM- patients (p=0.001 and p&amp;lt;0.001, respectively). The incidence of MACE did not differ significantly between PAD+/T2DM- and CAD+/T2DM+ patients (p=0.413). Compared to patients with CAD, Cox regression analyses after multivariate adjustment showed an adjusted hazard ratio of 1.46 [1.14–1.87], p=0.002 for the presence of PAD. Conversely, T2DM increased the risk of MACE after multivariate adjustment in CAD and PAD patients (adjusted HR 1.58 [1.27–1.98], p&amp;lt;0.001). In conclusion, our data show that T2DM and the presence of PAD are mutually independent predictors of MACE. Patients with both PAD and T2DM are at an exceedingly high risk of MACE. Funding Acknowledgement Type of funding sources: None.

The impact of J-CTO score on in-stent chronic total occlusion percutaneous coronary intervention.

The purpose of this study was to investigate the impact of J-CTO (Multicenter Chronic Total Occlusion Registry of Japan) score on in-stent chronic total occlusion (IS-CTO) percutaneous coronary intervention (PCI). A retrospective data collection was conducted on 474 patients undergoing a difficult IS-CTO PCI from January 2015 to December 2018. The primary endpoint (major adverse cardiovascular events [MACE]) consisted of target-vessel myocardial infarction (MI), cardiac death or ischemia-driven target-vessel revascularisation (TVR) at follow-up. The cut-off points were estimated by the Youden index. The overall procedural success rate was 77.6%. On multivariable analysis, factors including proximal bending (beta coefficient [β] = 3.465), tortuosity (β=3.064), stent under expansion (β=3.109) and poor distal landing zone (β=1.959) were associated with technical failure via antegrade approach but not the J-CTO score (OR = 0.632; 95% CI [0.352-1.134]; P=.124). After a median follow-up of 30months (interquartile range: 17-42months), multivariable analysis revealed that receiving >18months of dual antiplatelet therapy (DAPT) was an independent predictor of decreased risk of MACE (HR: 2.690; 95% CI: 1.346-5.347; P=.005). But the J-CTO score was not an independent predictor of MACE (HR: 1.018; 95% CI: 0.728-1.424; P=.917). J-CTO score system is not a helpful tool to predict the technical success of difficult IS-CTO PCI via antegrade approach, nor does it correlate with long-term outcomes in patients undergoing IS-CTO PCI. Nevertheless, factors associated with technical failure include proximal bending of ≥30 degrees, under expansion of ≥10mm, moderate or severe tortuosity (bending) ≥20 and poor distal target. Long-term DAPT therapy contributes significantly to decreased MACE.

Global Strain Measured by Three-Dimensional Speckle Tracking Echocardiography Is a Useful Predictor for 10-Year Prognosis After a First ST-Elevation Acute Myocardial Infarction.

Three-dimensional (3D) speckle tracking echocardiography (STE) after ST-elevation acute myocardial infarction (STEMI) is associated with left ventricular (LV) remodeling and 1-year prognosis. This study investigated the clinical significance of 3D-STE in predicting the long-term prognosis of patients with STEMI. A total of 270 patients (mean age 64.6 years) with first-time STEMI treated with reperfusion therapy were enrolled. At 24 h after admission, standard 2D echocardiography and 3D full-volume imaging were performed, and 2D-STE and 3D-STE were calculated. Patients were followed up for a median of 119 months (interquartile range: 96-129 months). The primary endpoint was occurrence of a major adverse cardiac event (MACE: cardiac death, heart failure with hospitalization), and 64 patients experienced MACEs. Receiver operating characteristic curves and Cox hazard multivariate analysis showed that the 3D-STE indices were stronger predictors of MACE compared with those of 2D-STE. Additionally, 3D-global longitudinal strain (GLS) was the strongest predictor for MACE followed by 3D-global circumferential strain (GCS). The Kaplan-Meier curve demonstrated that 3D-GLS >-11.0 was an independent predictor for MACE (log-rank χ2=132.2, P<0.0001). When combined with 3D-GCS >-18.3, patients with higher values of 3D-GLS and 3D-GCS were found to be at extremely high risk for MACE. Global strain measured by 3D-STE immediately after the onset of STEMI is a clinically significant predictor of 10-year prognosis.

Impact of Three-Dimensional Strain on Major Adverse Cardiovascular Events after Acute Myocardial Infarction Managed by Primary Percutaneous Coronary Intervention-A Pilot Study.

Background: Three-dimensional speckle-tracking echocardiography (3D-STE) allows simultaneous assessment of multidirectional components of strain. However, there are few data on its usefulness to predict prognosis in patients with acute myocardial infarction (AMI). The objective of our pilot study was to evaluate the prognostic value of four different 3D-STE parameters (global longitudinal strain (GLS-3D), global circumferential strain (GCS-3D), global radial strain (GRS-3D), and global area strain (GAS)) in AMI, after successful revascularization by primary PCI. Methods: We enrolled 94 AMI patients (66 ± 13 years, 56% men) who underwent coronary angiography. All patients had been 3D-STE assessed and followed-up for 1 year for the occurrence of MACE. Results: A total of 25 MACE were recorded over follow-up. Cut-off values of −17% for GAS (HR = 3.1, 95% CI: 1.39–6.92, p = 0.005), −12% for GCS-3D (HR = 3.06, 95% CI: 1.36–6.8, p = 0.006), −10% for GLS-3D (HR = 3.04, 95% CI: 1.36–6.78, p = 0.006), and 25% for GRS-3D (HR = 2.89, 95% CI: 1.29–6.46, p = 0.009) showed moderate accuracy in MACE prediction. Multivariate regression showed that GAS (HR = 1.1, 95% CI: 1.03–1.16), GLS-3D (HR = 1.13, 95% CI: 1.03–1.26), and GCS-3D (HR = 1.13, 95% CI: 1.03–1.23) remained independent predictors of MACE (HR = 1.07, 95% CI: 1.01–1.14 for GAS, and HR = 1.1, 95% CI: 1.01–1.2 for GCS-3D). However, post hoc power analysis indicated adequate sample size (power of 80%) only for GAS and GCS-3D for the ROC curve analysis and for GAS, GCS-3D, and GRS-3D for the log-rank test. Conclusion: Patients with AMI might benefit from early risk stratification with the aid of 3D-STE measurements, particularly GAS and GCS-3D, but larger studies are necessary to determine the optimal cut-off values to predict MACE.

Long-term prognosis of zero coronary artery calcium score in symptomatic low to intermediate risk patients

Abstract Funding Acknowledgements Type of funding sources: None. Purpose/background Absence of coronary artery calcium (CAC) has shown an excellent long-term prognosis with a low number of events in asymptomatic patients. However, long-term prognosis in stable symptomatic patients undergoing SPECT MPI with a zero CAC score remains unknown. Methods We retrospectively analyzed 1600 low- to intermediate risk symptomatic patients referred for clinically indicated cardiac SPECT/CT imaging with a CAC score of zero. Long-term follow-up data were collected for the occurrence of all-cause mortality and major adverse cardiac events (MACE: any revascularization, non-fatal myocardial infarction or cardiac death). Results The mean age was 54.7 ± 11 years and 71% were female. More than half of the patients (51%) had 2 or more traditional risk factors, mainly a positive family history (55%) and/or hypertension (49%). Overall 12% had perfusion abnormalities, 98% of them were mild. During a mean follow-up of 8.6 ± 1.9 years MACE occurred in 42 patients (0.3% per year) and 85 patients died (0.6% per year). The predominant cause of death was cancer (40%). Cox proportional hazard model revealed that increasing age (HR: 1.05, 95% CI: 1.02-1.09) and current smoking status (HR: 3.58, 95% CI: 1.72-7.37) were independent predictors of MACE. Pre-test probability (HR: 1.52, 95% CI: 0.82-2.82) and abnormal SPECT result (HR: 1.72, 95% CI: 0.88-3.37) were not associated with an increased risk of MACE. Conclusion Overall, stable symptomatic patients with a low-to intermediate risk and a CAC score of 0 have a) low likelihood of abnormal SPECT, and b) excellent long-term prognosis of 0.3%/year irrespective of baseline pre-test probability and SPECT abnormalities. These findings support notion of CAC as gatekeeper for appropriate patient selection to avoid un-necessary downstream testing.