Revascularization In Acute Coronary Syndrome Research Articles

Incidence and pattern of urgent revascularization in acute coronary syndromes treated with ticagrelor or prasugrel

BackgroundThe ISAR-REACT 5 trial compared the efficacy and safety of ticagrelor and prasugrel in patients with ACS managed invasively. The present study sought to investigate the impact of ticagrelor and prasugrel on the incidence and pattern of urgent revascularization in acute coronary syndromes (ACS) patients undergoing percutaneous coronary intervention (PCI).Methods and resultsThis post-hoc analysis of the ISAR-REACT 5 trial included all ACS patients who underwent PCI. The primary endpoint for this analysis was the incidence of urgent revascularization at 12-month follow-up. Secondary outcome was the pattern of urgent revascularization procedures (namely, urgent target vessel/non-target vessel revascularization – TVR/NTVR). Among 3,377 ACS patients who underwent PCI, 1,676 were assigned to ticagrelor and 1,701 to prasugrel before PCI. After 12 months, the incidence of urgent revascularization was higher among patients assigned to ticagrelor as compared to prasugrel (6.8% vs. 5.2%; hazard ratio [HR] = 1.32, 95% confidence interval [CI] 1.00–1.75; p = 0.051), mostly attributable to significantly more urgent NTVR in the ticagrelor group (3.8% vs. 2.4%; HR = 1.62 [1.09–2.41]; p = 0.017). The risk of urgent TVR did not differ between treatment groups (3.3% vs. 3.0%; HR = 1.13 [0.77–1.65]; p = 0.546).ConclusionsIn ACS patients treated with PCI, the cumulative rate of urgent revascularizations after 12 months is higher with ticagrelor compared to prasugrel, due to a significant increase in urgent revascularizations involving remote coronary vessels.Graphic abstract

C-58 | Kidney Outcomes with Sodium-Glucose Co-transporter-2 Inhibitors use in patients undergoing Revascularization for Acute Coronary Syndromes: A Propensity-Matched Analysis

C-58 | Kidney Outcomes with Sodium-Glucose Co-transporter-2 Inhibitors use in patients undergoing Revascularization for Acute Coronary Syndromes: A Propensity-Matched Analysis

Effects of different rehabilitation modality on cardiopulmonary function in patients with acute coronary syndrome after revascularization.

To investigate the effects of different rehabilitation modalities on cardiopulmonary function in patients with acute coronary syndrome after revascularization. Two randomized controlled trials were conducted. All patients were stable for more than 48 h and less than 1 week after revascularization for acute coronary syndrome and were randomly assigned to Group A (home-based rehabilitation group) or Group B (center guided home-based rehabilitation group). The cardiopulmonary exercise test was mainly performed before and 3 months after cardiac rehabilitation (at the end of intervention). The primary endpoints of the study were peak oxygen uptake (VO2peak), and the secondary endpoints were maximum metabolic equivalents (METs), anaerobic threshold exercise load (Load AT), maximal workload (Load max), and anaerobic threshold oxygen uptake (VO2 AT). A total of 106 patients were included in the study, with 47 patients in Group A (with 6 losses) and 50 patients in Group B (with 3 losses). There were no significant difference between the two groups in terms of age, gender, body mass index (BMI), left ventricular ejection fraction(LVEF), low-density lipoprotein cholesterol(LDL-C),cardiovascular risk factors. In Group A, no significant differences in CPET indices were observed before and after the intervention. In Group B, values of maximum metabolic equivalents (METs), peak heart rate (PHR), anaerobic threshold exercise load (Load AT), maximal workload (Load max), maximum ventilation per minute (VE max), peak oxygen uptake (VO2peak), anaerobic threshold oxygen uptake (VO2 AT) and maximum oxygen pulse (VO2/HRmax) were higher than those before the intervention (P < 0.05). In addition, METs (max), Load AT, Load max, VO2 AT, and VO2peak in Group B were higher than those in group A (P < 0.05). The change rates of VO2peak, METs(max), PHR, Load max, VO2 AT, VE max, VO2/HR(max) in the two groups were significantly different before and after intervention (P < 0.05). Cardiac exercise rehabilitation is helpful for improving patients' cardiopulmonary endurance and quality of life. Moreover, rehabilitation modalities with regular hospital guidance can improve cardiopulmonary function in a shorter period,which seems to be more effective than a complete home-based rehabilitation model. http://www.chictr.org.cn, identifier (ChiCTR2400081034).

Updated Strategies in Non-Culprit Stenosis Management of Multivessel Coronary Disease-A Contemporary Review.

The prevalence of multivessel coronary artery disease (CAD) in acute coronary syndrome (ACS) patients underscores the need for optimal revascularization strategies. The ongoing debate surrounding percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), hybrid interventions, or medical-only management adds complexity to decision-making, particularly in specific angiographic scenarios. The article critically reviews existing literature, providing evidence-based perspectives on non-culprit lesion revascularization in ACS. Emphasis is placed on nuances such as the selection of revascularization methods, optimal timing for interventions, and the importance of achieving completeness in revascularization. The debate between culprit-only revascularization and complete revascularization is explored in detail, focusing on ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI), including patients with cardiogenic shock. Myocardial revascularization guidelines and recent clinical trials support complete revascularization strategies, either during the index primary PCI or within a short timeframe following the culprit lesion PCI (in both STEMI and NSTEMI). The article also addresses the complexities of decision-making in NSTEMI patients with multivessel CAD, advocating for immediate multivessel PCI unless complex coronary lesions require a staged revascularization approach. Finally, the article provided contemporary data on chronic total occlusion revascularization in ACS patients, highlighting the prognostic impact. In conclusion, the article addresses the evolving challenges of managing multivessel CAD in ACS patients, enhancing thoughtful integration into the clinical practice of recent data. We provided evidence-based, individualized approaches to optimize short- and long-term outcomes. The ongoing refinement of clinical and interventional strategies for non-culprit lesion management remains dynamic, necessitating careful consideration of patient characteristics, coronary stenosis complexity, and clinical context.

Critical Endpoints In Dynamic Follow-Up Of Anemia Patients With Percutaneous Coronary Intervention For Acute Coronary Syndrome

Introduction — Identifying critical endpoints during long-term follow-up of patients with coronary artery disease (CAD) and anemia after percutaneous coronary intervention (PCI) would allow optimizing management tactics for this group of patients. Objective — To investigate the risks of developing adverse cardiovascular complications in patients with anemia who underwent revascularization for acute coronary syndrome (ACS) and to assess the most significant factors affecting outcomes. Material and Methods — The study included 298 patients with CAD who had undergone PCI at least two years before enrollment. A survey of patients and a retrospective analysis of their medical records were conducted. The outcome was a composite endpoint (death, myocardial infarction, stroke, transient ischemic attack). Kaplan-Meier curves were constructed to assess the effect of anemia on outcomes. To identify predictors of an adverse outcome, a Cox regression model was built. Results — In the group of patients with ACS who underwent PCI, the incidence of anemia was 8.4%. The incidence of the composite endpoint in patients with anemia was 51.6%, which was significantly different from its value in patients without anemia after 400 days of follow-up (logrank test, p&lt;0.008). After day 1,200, both groups exhibited similar dynamics of adverse outcomes. The following factors were statistically significantly linked to the risk of death within 24 months after PCI: left ventricular ejection fraction (p=0.002), anemia (p=0.009), and chronic kidney disease (p=0.02). Conclusion — We demonstrated that anemia influenced the development of adverse outcomes from day 400 to day 1,200 of a follow-up. Some factors, such as left ventricular ejection fraction and the presence of chronic kidney disease, also had a high predictive power for adverse events.

Complete revascularization for acute coronary syndrome, one step at a time.

Complete revascularization for acute coronary syndrome, one step at a time.

Abstract 18019: Gender Differences Among Elderly Patients Hospitalized With Acute Coronary Syndrome in the United States Between 2011-2019

Introduction: Acute coronary syndrome (ACS) is one of the main causes of morbidity and mortality in the elderly. Women in general are less likely to be referred for coronary catheterization, percutaneous coronary intervention, and fibrinolysis. Hypothesis: We tested the hypothesis that elderly females were less likely to undergo catheterization and revascularization for ACS as compared to elderly men. Methods: We identified hospitalizations for patients aged 75 years old or older admitted with a primary admitting diagnosis of NSTEMI or STEMI between 2016 and 2019 using the National Inpatient Sample Database. Baseline characteristics, in-hospital complications, mortality, and length of stay were compared between male and female patients. A p-value &lt;0.001 was considered significant. Results: We identified a total of 776,485 hospitalizations. See Table 1 for baseline characteristics and in-hospital outcomes. Male patients exhibited a higher prevalence of comorbidities. Furthermore, female patients were more prone to conditions such as hypertension, obesity, dementia, and stroke. In terms of in-hospital complications, male patients had the highest percentage of all complications. Male patients had a statistically significantly higher number of interventions compared to females, including cardiac catheterization (59.7 vs 51.4, p &lt;0.001), percutaneous coronary intervention (39.7 vs 32.8, p &lt;0.001), and CABG (0.8 vs 0.4, p &lt;0.001). Male patients also had the highest length of stay compared to females (4.9 vs 4.6 days, p &lt;0.001). Alternatively, Females were found to have the highest mortality compared to males (7.8 vs 7.5, p &lt;0.001). Conclusions: Our results on ACS outcomes in elderly females are consistent with literature demonstrating that females are less likely to undergo catheterization or revascularization and have higher mortality. More research is needed to address these gender disparities.

Abstract 15300: Short-Term Outcomes in Different Revascularization for Acute Coronary Syndrome With Cardiogenic Shock Supported by Impella -Report From Japanese Registry for Percutaneous Ventricular Assist Device (J-PVAD Registry)

Introduction and Hypothesis: Percutaneous coronary intervention (PCI) has tended to be selected for the treatment of acute coronary syndrome with cardiogenic shock because of its ability of earlier and less-invasive therapy, though coronary artery bypass grafting (CABG) can perform complete revascularization. We hypothesized that Impella® support has the potential to make surgical treatment much safer because Impella® can improve hemodynamic state and could have the possibility to mitigate myocardial ischemia by unloading the left ventricle. Methods: The aim of study is to investigate if surgical revascularization is safe and effective treatment by comparing short-term outcome with different revascularization including PCI, CABG, and hybrid therapy (PCI followed by CABG). Of 1102 cardiogenic shock cases with Impella (994 cases in PCI, 48 cases in CABG, and 63 cases in Hybrid therapy) between February 2020 and December 2021 enrolled in the J-PVAD registry, short-term outcomes were compared between 62 propensity-matched cases between PCI (n=31) and CABG (n=31), as well as 68 matched cases between PCI (n=34) and hybrid therapy (n=34). Results: There was no difference in all-cause mortality between the PCI and CABG group as well as PCI and hybrid therapy group. The PCI group had a greater number of NYHA class≦2 at discharge than the CABG group (17 (54.8%) in the PCI group vs 10 (32.2%) in the CABG group, p=0.012). There was no difference in the number of NYHA class≦2 at discharge between the PCI and hybrid therapy group (18 (52.9%) in the PCI group vs 15 (44.1%) in the hybrid therapy group, p=0.12). Conclusions: CABG and hybrid therapy showed acceptable short-term outcome compared to PCI.

Effect of complete revascularization in acute coronary syndrome after 75 years old: insights from the BleeMACS registry

Effect of complete revascularization in acute coronary syndrome after 75 years old: insights from the BleeMACS registry

Immediate versus staged complete revascularization in acute coronary syndrome: A meta-analysis of randomized controlled trials

BackgroundClinical guidelines recommend a complete revascularization (CR) in patients with acute coronary syndromes (ACS) and multivessel disease (MVD). However, its optimal timing is unclear. The aim of this meta-analysis was to compare the clinical outcomes following immediate versus staged CR in ACS. MethodsPubMed and Scopus were searched until March 2023 for randomized controlled trials (RCTs) comparing immediate versus staged CR. The primary endpoint was major adverse cardiovascular event (MACE) at the longest follow-up. Secondary outcomes were all-cause death, cardiovascular death, myocardial infarction (MI), any unplanned revascularization, target-vessel revascularization (TVR), and stent thrombosis. Safety outcomes were major bleeding, contrast volume, procedure duration, and length of hospitalization. ResultsEight RCTs were included (3559 patients, weighted mean follow-up 12.5 months). There were no differences in the primary endpoint (OR 0.74, 95%CI: 0.54–1.01) and in the secondary endpoints of death, and stent thrombosis between the two CR strategies. Immediate CR was associated with a lower risk of recurrent MI (OR 0.51, 95% CI 0.34–0.76), any unplanned revascularization (OR 0.59, 95%CI: 0.43–0.80), and TVR (OR 0.61, 95% CI 0.45–0.84) compared to staged CR. Immediate CR was also associated with lower total contrast volume and shorter total procedure duration and hospitalization length compared to staged CR without differences in major bleedings. ConclusionNo difference was found between immediate and staged CR regarding MACE, or deaths rates at one year. Immediate CR may be associated with a lower risk of recurrent MI and unplanned coronary revascularization than staged CR.

Review and Key Takeaways of the 2021 Percutaneous Coronary Intervention Guidelines.

The 2021 Percutaneous Coronary Intervention guidelines completed by American College of Cardiology/American Heart Association/Society for Cardiovascular Angiography and Interventions provide a set of guidelines regarding revascularization strategies. With emphasis on equity of care, multidisciplinary heart team use, revascularization for acute coronary syndrome, and stable ischemic heart disease, the guidelines create a thorough framework with recommendations regarding therapeutic strategies. In this comprehensive review, our aim is to summarize the 2021 revascularization guidelines and analyze key points regarding each recommendation.

It is not too late for ... percutaneous angiography in a 90-plus population

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Elderly people represent a vulnerable but increasing population presenting to percutaneous coronary intervention (PCI). The benefit of revascularization in acute coronary syndromes (ACS) is well-stablished. However, the benefit in elderly patients has been questioned, considering the patient’s expected survival, functional and cognitive status, comorbidities, procedure’s risk and need for extended anti-thrombotic therapy. Purpose To evaluate the effect of PCI on the prognosis of a group of very old patients with acute coronary syndrome (ACS). Methods We retrospectively analyzed all consecutive very old patients (≥90-year-old) admitted with ACS submitted to coronarography (CA) in one tertiary center, from January 2008 to December 2021. Clinical features were collected, including major adverse cardiac events (MACE), a defined composite endpoint of all-cause death, ischemic stroke, ACS, or hospitalization for acute heart failure, which were compared according if PCI was performed or not. Q-square, Cox regression and Log-rank tests were applied. Results A total of 79 patients were enrolled; 43 of them underwent PCI. Groups were comparable in basal characteristics, with similar median age at the event (92 years old, interquartile range IQR: 3), see picture 1. Most patients with ST-elevation (STE) ACS (n=45) had PCI (70% vs. 41%, p= 0,01), while in non ST-elevation (NSTE) ACS and unstable angina there was higher proportion of non-PCI (30% vs. 58%, p= 0,01). Individuals submitted to PCI were more likely to have single or double lesion vessel (76% vs 27%, p&amp;lt;001), while non-PCI patients presented more complex disease (23% vs 25%, p=0,5). Among the PCI-patients, the majority was singly revascularized (86%) and submitted to stent implantation (83%). Regarding in-hospital mortality, there was no difference between groups: 21% in the PCI group versus 33% in the non-PCI control group (p=0.2). During median follow-up time of 6 months (IQR: 27), mortality was similar in both groups (79% vs 67%; p=0.1). Nevertheless, overall MACE-free survival was significantly longer in PCI group than in the no-PCI group, and PCI treated patients had a risk of MACE 52% lower than the patients assigned to medical therapy (hazard ratio 0.508, p=0.007); see picture 2. Conclusion Very old patients presenting with ACS treated with either PCI presented longer MACE-free survival. These finding suggest that very old patients with ACS and single vessel disease may benefit systematically from PCI with stent. Efforts should be made to optimize care in this under-represented population in the clinical trials.

Percutaneous versus surgical revascularization of unprotected left main coronary artery: Data from the Portuguese Registry of Acute Coronary Syndromes (ProACS)

BackgroundIn acute coronary syndromes (ACS), the optimal revascularization strategy for unprotected left main coronary artery (ULMCA) culprit lesion has been under-investigated. Therefore, we compared clinical characteristics and short- and medium-term outcomes of percutaneous and surgical revascularization in ACS. Methods and resultsOf 31886 patients enrolled in a multicenter, national, prospective registry study between October 2010 and December 2020, 246 (0.8%) had ULMCA as a culprit lesion and underwent percutaneous coronary intervention (PCI) alone (n=133, 54%) or coronary artery bypass grafting (CABG) alone (n=113, 46%). Patients undergoing PCI presented more frequently ongoing chest pain (68% versus 41%, p<0.001) and cardiogenic shock (25% versus 1%, p<0.001). Time from admission to revascularization was higher in surgical group with a median time to CABG of 4.5 days compared to 0 days to PCI (p<0.001). Angiographic success rate was 93.2% in patients who underwent PCI. Primary endpoint (all-cause death, non-fatal reinfarction and/or non-fatal stroke during hospitalization) occurred in 15.9% of patients and was more frequent in the PCI group (p<0.001). After adjustment, surgical revascularization was associated with better in-hospital prognosis (odds ratio (OR) 0.164; 95% confidence interval (CI), 0.04–0.64; p=0.009). Similar results were achieved after propensity score matching. No difference was found at one-year all-cause death. ConclusionPercutaneous coronary intervention was the most common revascularization strategy in the ACS with ULMCA culprit lesion. PCI was preferred in unstable patients and presented a high angiographic success. CABG was often delayed and preferred in low-risk patients. At one-year follow-up, PCI and CABG conferred a similar prognosis. The two approaches appear complementary in this high risk cohort.

Staged Hybrid Coronary Revascularization in Acute Coronary Syndrome

BackgroundIn acute coronary syndrome (ACS) with non-ST elevation myocardial infarction, there is a subgroup of patients who are difficult to treat; these are patients with a complex left anterior descending artery (LAD) lesion or a non-LAD culprit lesion but who are not suitable for standard coronary artery bypass grafting (CABG). Staged hybrid coronary revascularization (HCR), combining primary percutaneous coronary intervention on the non-LAD culprit lesion with CABG, represents an attractive solution. MethodsWe conducted a retrospective observational study to compare effectiveness and safety of HCR vs CABG alone. From December 6, 2016, to December 21, 2021, at our institution, 339 patients underwent urgent CABG with or without previous primary percutaneous coronary intervention; 65 received HCR (study group) and 274 received CABG alone (control group). Primary outcomes were major adverse cardiac and cerebrovascular events at 30 days and at long-term follow-up. Secondary outcomes were in-hospital postoperative complications. ResultsSignificant preoperative differences were detected in the mean EuroSCORE II: 3.4 (1.5-7.8) in HCR vs 2.5 (1.1-4.5) in CABG (P < .05). Patients in the CABG group needed more blood transfusions than patients in the HCR group (P = .004). Conversely, no other significant differences were detected for in-hospital postoperative complications. Survival analysis did not show significant differences between HCR and CABG, either to 30 days (hazard ratio, 0.51 [95% CI, 0.03-4.04]; P = .52) or to longer follow-up (maximum 5 years; hazard ratio, 0.40 [95% CI, 0.09-1.68]; P = .21). ConclusionsOur data support the safety and effectiveness of staged HCR in the scenario of ACS.

Impact of the COVID-19 Pandemic on Myocardial Revascularization in Patients with Acute Coronary Syndrome in the Russian Federation

Aim. To compare and analyze the results of myocardial revascularization in the Russian Federation (RF) with acute coronary syndrome (ACS) before the onset (2018-2019) and during the novel coronavirus infection (COVID-19) pandemic (2020-2021).Material and methods. The analysis included the number of cases of ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation acute coronary syndrome (NSTE-ACS), the number of cases of myocardial revascularization in the above forms of ACS, the number of deaths depending on the form of ACS and the method performed revascularization. The period of time before the start of the coronavirus pandemic corresponded to the annual data received in the Russian Federation for 2018-2019. The period of the coronavirus disease pandemic corresponded to the annual data received in the country for 2020-2021. Absolute, relative, estimated values of patient hospitalization, myocardial revascularization procedures, and mortality in ACS were compared between time periods before and during the COVID-19 pandemic. The data for analysis were obtained from the monitoring of the Ministry of Health of Russia.Results. In 2018 and 2019 in the RF, 531,019 and 501,238 patients were hospitalized with a diagnosis of ACS, and during the pandemic (2020-2021) - 403,931 and 397,930 patients, respectively. Reduction in the number of patients diagnosed with ACS admitted to hospitals in Russia by 22.32% in 2020-2021 years was mainly due to a significant decrease in hospitalizations of patients with a diagnosis of NSTE-ACS (by 29.03%). At the same time, admission to clinics of patients with STEMI decreased only by 6.02%. During the COVID-19 pandemic, mortality increased significantly in PPCI (by 9.6%) and in the general STEMI group (by 12.3%); significantly increased mortality both in the general group (by 48%) and during PCI in patients with NSTE-ACS (by 28.6%); there was an increase in the average annual number of PPCI (by 12.6%), which was accompanied by an increased average annual number of PPCI per 1 million of population (up to 451 per 1 million of population); a slight increase in the average time "symptom-balloon" (by 2 minutes) was recorded; there was an absolute slight decrease and a relative increase in the number of PCIs in NSTE-ACS (by 2.7% and 37.1%, respectively). In 2021, in the Russian Federation, primary PCI was performed in 50.2%, thrombolytic therapy - in 23.1%, and 26.7% of patients remained without reperfusion. Pharmacoinphasive strategy was applied in 60%, and isolated thrombolysis - in 40% of patients.Conclusion. During the COVID-19 pandemic, revascularization in patients with ACS in Russia corresponded to the following trends recorded in the literature: increased hospital mortality in PPCI and in the general STEMI group; hospital mortality both in the general group and during PCI in patients with NSTE-ACS. The indicators of myocardial revascularization in ACS in the RF during the pandemic were fundamentally different from the data of Western countries: there was an increase in the average annual number of PPCI and the average annual number of PPCI per 1 million population; a slight increase in the average symptom-balloon time was recorded; revealed an absolute slight decrease and a relative increase in the number of PCIs in NSTE-ACS.

Evaluating the Utility of Colchicine in Acute Coronary Syndrome: A Systematic Review and Meta-Analysis.

Colchicine has demonstrated promising effects in inhibiting local and systemic inflammation during acute coronary syndrome (ACS). However, the efficacy of colchicine in ACS is controversial. We performed a meta-analysis to assess the utility of colchicine in ACS by systematically searching randomized controlled trials. Recurrent myocardial infarction, coronary revascularization, and stroke were included as efficacy endpoint parameters whereas safety endpoints chosen were all-cause mortality, cardiovascular mortality, infectious events, and gastrointestinal (GI) adverse events. Nine identified studies were included (n = 7207 participants). Colchicine may reduce the risk of coronary revascularization by 54% [relative risk (RR) 0.46, 95% confidence interval (CI) 0.29-0.73; P &lt; 0.01] and stroke by 61% (RR 0.39, 95%CI 0.18-0.81; P = 0.01). We observed no significant difference in all-cause mortality (RR 1.25, 95%CI 0.70-2.24; P = 0.46), cardiovascular mortality (RR 0.99, 95%CI 0.58-1.69; P = 0.98), recurrent myocardial infarction (RR 0.75, 95%CI 0.49-1.14; P = 0.18), and infectious events (RR 0.67, 95%CI 0.08-5.52; P = 0.71). Colchicine increased the risk of GI adverse reactions (RR 1.89, 95%CI 1.25-2.84; P &lt; 0.01). Subgroup analysis of loading doses did not reveal significant differences in all endpoints (all P &gt; 0.05), whereas subgroup analysis of follow-up periods showed a lower risk of GI adverse reactions with longer follow-up ( P &lt; 0.01), which may be related to establishing tolerability. Trial sequential analysis suggested that further data are needed before definitive conclusions can be drawn. Colchicine may decrease the occurrence of stroke and revascularization in ACS, whereas slightly increasing the risk of GI reactions. The loading doses probably did not significantly improve the prognosis of patients.

English

Introduction: Functional physical capacity is indirectly associated with mortality, and may be compromised after a cardiovascular event, hence the importance of considering its prognostic factors during treatment in heart disease patients. Aim: To identify the prognostic factors of functional physical limitation in patients with myocardial revascularization for acute coronary syndrome. Material and method: A retrospective analysis was carried out of 29 medical records taken from patients submitted to a stress test (Bruce, modified Bruce) after myocardial revascularization during the months of January to December 2019. For the statistical analysis, a univariate and multivariate logistic regression (Odds Ratio-OR) was performed, as well as a simple linear regression analysis between the variables of interest. Results: the analyzed patients had a mean age of 60 ± 9,2 years, and 76% were men. The presence of systemic arterial hypertension (SAH), lower values of Maximum Heart Rate (HR) (ß = 0,112; CI: 0,074, 0,149; p &lt;0.001), high values of Systolic Arterial Pressure (SBP) (ß = - 0,083; CI 95%: -0,152, -0,014; p &lt;0.020), and a greater number of risk factors (ß = - 1,580; CI 95%: -2,456-0,868; p &lt;0.001), are considered predictors of functional limitation (&lt;7 METs). Conclusion: The presence of SAH, a greater number of risk factors, as well as high maximum SBP levels and lower maximum HR values reached during the stress test, were shown to be prognostic factors of functional limitation in subjects revascularized for ACS

OR8. Appropriateness of percutaneous coronary intervention procedure in Indonesia

Abstract Background and Aims There is a possibility of the high variability of the appropriateness of PCI performed in Indonesia. It is assumed that appropriate PCI tends to have clinical outcomes than other categories. This study aimed to evaluate the appropriateness of the percutaneous coronary intervention (PCI) procedure in Indonesia. Method and Results We assigned appropriateness ratings to 214 acute coronary syndromes (ACS) and 191 stable ischemic heart disease (SIHD) records that underwent PCI in four hospitals from 2017 - 2018. The included hospitals consist of one public and three private hospitals, two cardiovascular centers, and two general hospitals with the most performed PCI procedures on 2016 - 2018 and accessible to the researchers. The PCI appropriateness was adjudicated using 2016/2017 ACC/AHA guidelines of the Appropriate Use of Care (AUC) for coronary revascularization in ACS and SIHD. The results were categorized into “appropriate”, “maybe appropriate”, and “rarely appropriate”. The result from this study demonstrated that in ACS patients, 76.0% and 24.0% of PCI were appropriate” and “maybe appropriate”. While, in SHID patients, 68.7%, 28.7%, and 2.6% of PCI were “appropriate”, “maybe appropriate”, and “rarely appropriate”. In ACS patients, “appropriate” PCI is more commonly found in ST-elevation myocardial infarction (STEMI) cases (62.6%). In SIHD patients, 54.0% and 46.0% of left-main diseases patients underwent “maybe appropriate” and “rarely appropriate” PCI. Conclusion The majority of PCI performed in ACS and SIHD patients from the studied hospitals are “appropriate”.

New Paradigm of Complete Revascularization in Acute Coronary Syndrome with Multivessel Coronary Artery Disease: Is it Reasonable in Clinical Practice?

Coronary artery disease is the leading cause of illness and death in older adults. Around 40% to 50% of patients with ST-segment elevation myocardial infarction (STEMI) have multiple coronary artery disease. Multiple vessel coronary disease has been shown to improve cardiac outcomes and survival in patients who have undergone complete revascularization (CR) versus patients who have undergone only incomplete revascularization (ICR). When coronary angiography and PCI of the source of the infarction are performed on patients with STEMI, the risk of adverse cardiac death or myocardial infarction is significantly reduced. Additional research is needed to determine the efficacy of PCI of non-critical lesions. However, following procedures such as CABG or PCI, these procedures may be impossible to perform due to a variety of personal, anatomical, technical, and logistical barriers. In this review, we discussed about benefit of complete revascularization in patient acute coronary syndrome (ACS) with multivessel disease and which patient can be performed aggressive revascularization to achieved CR in clinical practice.

Timing of Coronary Artery Bypass Grafting in Acute Coronary Syndrome: A National Analysis

BackgroundTiming of surgical revascularization for acute coronary syndrome remains debated. We assessed the impact of timing to coronary artery bypass grafting (CABG) on mortality and resource utilization in a national cohort. MethodsAdults admitted for acute coronary syndrome in the 2009-2018 National Inpatient Sample were grouped by time from coronary angiography to CABG (Δt): 0, 1-3, 4-7, and >7 days. Generalized linear models were fit to evaluate associations between Δt and in-hospital mortality and hospitalization costs. Timing and mortality of CABG for acute coronary syndrome were compared between high-performing hospitals (below the median risk adjusted mortality for all CABG and valve operations) and others. ResultsOf 444,065 patients, Δt = 0 days in 12.3%, Δt = 1-3 days in 57.3%, Δt = 4-7 days in 26.3%, and Δt > 7 days in 4.2%. Risk-adjusted mortality was greatest at Δt = 0 days (4.5%, 95% confidence interval [CI], 4.1%-4.9%) and Δt > 7 days (4.0%, 95% CI 3.4%-4.7%), but similar for operations performed at Δt = 1-3 days (1.8%, 95% CI 1.7%-1.9%) and Δt = 4-7 days (2.1%, 95% CI 1.9%-2.3%). Compared to Δt = 1-3 days, hospitalization costs were greater by $6,400 (95% CI $5,900-$6,900) for Δt = 4-7 days and $21,200 (95% CI $19,800-$22,600) for Δt > 7 days. High-performing hospitals had similar time to CABG as others (2 vs 2 days, P = .17), but lower mortality (0.9% vs 3.3%, P < .001). ConclusionsRevascularization on days 1-3 and 4-7 led to comparable in-hospital mortality, with greater rates on day 0 and after day 7. Costs were greater for revascularization at days 4-7 compared with days 1-3. These findings support the reduction of time to revascularization to 1-3 days when deemed clinically appropriate and feasible.