PW147 Bioabsorb Vascular Scaffold (BVS) thrombosis
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Results: First phase comprised 120 subjects, second phase 80 and third phase 56 subjects. Mean age was 53 (45-61) years. Mean BMI was 28.353.59 kg/m 2 . After one month 22 (27.5%) of the subjects had acute stress disorder (ASD) and 13.8% had major depressive disorder (MDD). After six months 15 (37.5%) subjects had PTSD and 12 (27.3%) had MDD. Alcohol consumption showed to be predictive for development of MDD in the second phase (P¼0.002, OR¼2.48), while physical inactivity showed to be predictive for the development of comorbidity of MDD and ASD in the second phase (P¼0.036, OR¼100.00). Conclusion: Our results showed that cardiovascular disorders can cause anxious and depressive disorders among frequent alcohol consumers and physically inactive in- dividuals. So, depression, anxiety, physical inactivity, and alcohol consumption cannot only be considered as risk factors for cardiovascular disorders, but should also be regarded as a consequence of cardiovascular disorders. Disclosure of Interest: None Declared PW146 Out-of-hours Primary Percutaneous Coronary Intervention for ST-elevation Myocardial Infarction Does Not Portend Worse Outcomes Angela L. Brennan* 1 , Nick Andrianopoulos 1 , Chris Reid 1 , Andrew E. Ajani 2 , Melanie Freeman 3 , Jess O’Brien 4 , Martin Sebastian 5 , Bryan P. Yan 6 , Antony Walton 4 , Stephen J. Duffy 4 1 School of Public Health & Preventive Medicine, Monash University, 2 Cardiology, Royal Melbourne Hospital, 3 Cardiology, Box Hill Hospital, 4 Cardiology, Alfred Hospital, Melbourne, 5 Cardiology, Geelong Hospital, Geelong, Australia, 6 Department of Medicine and Therapeutics, Chinese University of Hong Kong, Shatin, NT, Hong Kong Introduction: Logistically, it is faster to mobilise catheterization laboratory staff during normal working hours, generally leading to shorter door-to-balloon times (DTBT’s) for patients with ST-elevation myocardial infarction (STEMI) treated with primary percuta- neous coronary intervention (PPCI). Prior studies have suggested that the outcomes of patients undergoing PPCI out-of-hours are worse than those treated in-hours, however more recent studies have contradicted this finding. Objectives: To examine the effect of timing of hospital presentation (in-hours [IH] versus out-of-hours [OH]) on the outcomes of patients undergoing PPCI for STEMI in a contemporary setting. Methods: We analysed data from 2,193 patients presenting with STEMI undergoing PPCI from the Melbourne Interventional Group (MIG) registry. Transfer and rescue PCI’s were excluded.. IH refers to the usual operating hours of cardiac catheter laboratories; i.e. 8 a.m. – 6 p.m. Monday to Friday, with OH referring to 6 p.m. – 8 a.m. Monday to Friday, all weekends and public holidays. Results: Apart from IH patients being older (6413 vs. 6213 years, p<0.001), OH patients having increased BMI (27.24.7 vs. 27.85.0 kg/m 2 ,p¼0.009) and being more likely to be current smokers (31% vs. 38%, p¼0.03), the baseline demographics were similar. The OH patients presented to hospital quicker with median symptom-to-door time of 97 (IQR 65-150) vs. 90 minutes (IQR 62-138), p¼0.04. The IH group had a shorter DTBT (68 [IQR 48-94] vs. 93 [IQR 73-119] minutes, p<0.0001), and achieved a DTBT of 90 minutes in 71% of cases compared to 45% in the OH group, p<0.001. DES use was higher in the OH group (30%) compared to IH (26%), p¼0.02. Mortality and major adverse cardiac events (MACE; death, recurrent MI or target lesion revascu- larization) were similar at 30 days and 12 months. However, the OH group had a higher 12-month stroke rate (0.6% vs. 1.7%, p¼0.03), despite having similar baseline incidence of hypertension, cerebrovascular disease and atrial fibrillation. Multivariable analysis showed OH presentation was associated with a trend towards improved survival at 12 months (OR 0.63; 95% CI: 0.41-0.99, p<0.045) and lower MACE (0.78; 0.59-1.04, p¼0.088). Conclusion: In contrast to some earlier studies, out-of-hours presentation to hospital with STEMI is not associated with worse outcomes in patients undergoing PPCI, despite longer DTBTs. There remains room for improvement in achieving better DTBTs in this group. Disclosure of Interest: None Declared PW147 Bioabsorb Vascular Scaffold (BVS) thrombosis Gohar Jamil* 1 , Abbas Ahmed 1 , Mujgan Jamil 2 , Mohammad Nour 1 , Husam Ouda 1 1 Cardiology, 2 medicine, Tawam Hospital, Al Ain, United Arab Emirates Introduction: Bioabsorabable vascular scaffold (BSV) has emerged with the idea of less permanence and possibly less short and long term complications. Worldwide there is very limited clinical experience of the BVS. Objectives: To look at the incidence of scaffold thrombosis. Methods: Retrospective analysis of patient’s outcome from tertiary care facility, in which BSV was used. Over 10 month period 29 BVS were deployed in 20 patients. In two patients the scaffold could not be delivered or deployed to the target site. These patients were excluded from our analysis. Results: A total of x BVS were deployed in the LAD, x in the LCx and x in the RCA. Indications for BVS deployment were STEMI in 5, NSTEMI in 10 and angina in 5 patients. The average deployment pressure was 14 ATMs and average duration of BVS inflation was 14 seconds. TIMI 3 flow was noted in all arteries after scaffold deployment. The size of BVS ranged from 2.5 to 4.0 mm diameter. BVS thrombosis was seen in 4 patients, 2 in the LAD and 2 in the RCA. Thrombosis was noted within 2 days in two patients, after 5 months in two patients who were non compliant with dual antiplatelet therapy. In all these four patients, TIMI 3 flow was suc- cessfully restored with DES deployed inside the scaffold. Conclusion: Such a high incidence of BVS thrombosis seen in our patients is not previ- ously reported. This occurrence may be due to technical issues, inherent issues with the BVS, aspirin or clopidogrel non compliance or resistance. IVUS or OCT would have been helpful in knowing the etiology. Disclosure of Interest: None Declared PW148 Modified Pot technique (Proximal Optimization Technique) to avoid complex bifurcation stenting Leong Weng San* 1 , Tieh Siaw Cheng 2 , Kong Poi Keong 2 1 Cardiology, Hospital Raja Permaisuri Bainun, Ipoh, 2 Cardiology, Penang Hospital, Goergetown, Malaysia Introduction: Benefit of bifurcation stenting has been controversial. Single stent of main vessel strategy alone may be preferred to dual stents for both the main and the side branch. However, there is risk of side branch closure following main branch stenting and high pressure post dilatation. Pot technique has been used to facilitate side branch rewiring and stent placement. Objectives: We postulate that a modified method of Pot technique to open up the side branch carina would help reduce side branch closure during predilatation, stent deploy- ment and postdilatation of the main branch. Methods: We performed prospective study on 5 patients with LAD bifurcation lesions. Side branches (diagonal arteries) of all patients were considered need to be protected if vessel diameter was more than 2.0mm. Both LAD/ Diagonal were wired with 0.014” PCI wires. Point A (proximal to side branch) was predilated at higher pressure as compared to Point B (at level of side branch) and Point C (distal to side branch). Main vessel lesion was stented, followed by guidewire exchange. Point A was postdilated to bigger diameter as compared to point B and point C. Primary end point was side branch closure, worsening TIMI flow, narrowing of ostial side branch diameter and need for kissing balloon or side branch stenting. Results: Our 5 patients had mid LAD bifurcation lesions with different variations of Madina classes. All 5 patients were admitted for acute coronary syndromes. Predicted main vessel diameters for all 5 patients were 2.75mm. LAD was predilated with compliant balloon diameter 2.0-2.5mm. All patients have successful LAD stenting and postdilatation of LAD stents. There was no observed side branch closure, dissection, narrowing of ostial side branch or poorer TIMI flow. All patient has final TIMI 3 flow in their respective side branch. There is no need for kissing balloon or side branch stenting. Conclusion: Though Pot technique was earlier described to facilitate bifurcation stenting, our step by step modified method of Pot technique may be used to open up the carina of the side branch, and thus avoid complicated bifurcation stenting with good immediate result. Further study would be needed to recruit more patients and other non-LAD cor- onary arteries. Disclosure of Interest: None Declared No % stenosis pre dilation Balloon Scaffold size ATM second vessel thrombosis BVS thrombosis duration 1 LAD 90% OM 90% 3.5 x12 3.5x12 3.5 18 14 8 2 days RCA 90% 3x18 3x18 14 12 RCA 2 LAD 99% 3x 20 3 x 18 3x28 16 60 LAD 5 months Lcx 90% 2.5 x12 3.5x12 16 60 3 RCA 70% 2.5x12 3 x18 14 12 RCA 5 months 4 LAD100% 2.5 x12 3 x18 16 20 LAD 2 days Lcx 99% 2.5x12 3 x 18 16 20 GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters e289 POSTER ABSTRACTS
Transcript of PW147 Bioabsorb Vascular Scaffold (BVS) thrombosis
No % stenosis
pre dilation
Balloon
Scaffold
size ATM second
vessel
thrombosis
BVS
thrombosis
duration
1 LAD 90%
OM 90%
3.5 x12
3.5x12
3.5 18 14 8 2 days
RCA 90% 3x18 3x18 14 12 RCA
2 LAD 99% 3x 20 3 x 18
3x28
16 60 LAD 5 months
Lcx 90% 2.5 x12 3.5x12 16 60
3 RCA 70% 2.5x12 3 x18 14 12 RCA 5 months
4 LAD100% 2.5 x12 3 x18 16 20 LAD 2 days
Lcx 99% 2.5x12 3 x 18 16 20
POST
ERABST
RACTS
Results: First phase comprised 120 subjects, second phase 80 and third phase 56 subjects.Mean age was 53 (45-61) years. Mean BMI was 28.35�3.59 kg/m2. After one month 22(27.5%) of the subjects had acute stress disorder (ASD) and 13.8% had major depressivedisorder (MDD). After six months 15 (37.5%) subjects had PTSD and 12 (27.3%) hadMDD. Alcohol consumption showed to be predictive for development of MDD in thesecond phase (P¼0.002, OR¼2.48), while physical inactivity showed to be predictive forthe development of comorbidity of MDD and ASD in the second phase (P¼0.036,OR¼100.00).Conclusion: Our results showed that cardiovascular disorders can cause anxious anddepressive disorders among frequent alcohol consumers and physically inactive in-dividuals. So, depression, anxiety, physical inactivity, and alcohol consumption cannotonly be considered as risk factors for cardiovascular disorders, but should also be regardedas a consequence of cardiovascular disorders.Disclosure of Interest: None Declared
PW146
Out-of-hours Primary Percutaneous Coronary Intervention for ST-elevationMyocardial Infarction Does Not Portend Worse Outcomes
Angela L. Brennan*1, Nick Andrianopoulos1, Chris Reid1, Andrew E. Ajani2, Melanie Freeman3,Jess O’Brien4, Martin Sebastian5, Bryan P. Yan6, Antony Walton4, Stephen J. Duffy41School of Public Health & Preventive Medicine, Monash University, 2Cardiology, RoyalMelbourne Hospital, 3Cardiology, Box Hill Hospital, 4Cardiology, Alfred Hospital, Melbourne,5Cardiology, Geelong Hospital, Geelong, Australia, 6Department of Medicine and Therapeutics,Chinese University of Hong Kong, Shatin, NT, Hong Kong
Introduction: Logistically, it is faster to mobilise catheterization laboratory staff duringnormal working hours, generally leading to shorter door-to-balloon times (DTBT’s) forpatients with ST-elevation myocardial infarction (STEMI) treated with primary percuta-neous coronary intervention (PPCI). Prior studies have suggested that the outcomes ofpatients undergoing PPCI out-of-hours are worse than those treated in-hours, howevermore recent studies have contradicted this finding.Objectives: To examine the effect of timing of hospital presentation (in-hours [IH] versusout-of-hours [OH]) on the outcomes of patients undergoing PPCI for STEMI in acontemporary setting.Methods: We analysed data from 2,193 patients presenting with STEMI undergoing PPCIfrom the Melbourne Interventional Group (MIG) registry. Transfer and rescue PCI’s wereexcluded.. IH refers to the usual operating hours of cardiac catheter laboratories; i.e.8 a.m. – 6 p.m. Monday to Friday, with OH referring to 6 p.m. – 8 a.m. Monday to Friday,all weekends and public holidays.Results: Apart from IH patients being older (64�13 vs. 62�13 years, p<0.001), OHpatients having increased BMI (27.2�4.7 vs. 27.8�5.0 kg/m2, p¼0.009) and being morelikely to be current smokers (31% vs. 38%, p¼0.03), the baseline demographics weresimilar. The OH patients presented to hospital quicker with median symptom-to-doortime of 97 (IQR 65-150) vs. 90 minutes (IQR 62-138), p¼0.04. The IH group had ashorter DTBT (68 [IQR 48-94] vs. 93 [IQR 73-119] minutes, p<0.0001), and achieved aDTBT of �90 minutes in 71% of cases compared to 45% in the OH group, p<0.001.DES use was higher in the OH group (30%) compared to IH (26%), p¼0.02. Mortalityand major adverse cardiac events (MACE; death, recurrent MI or target lesion revascu-larization) were similar at 30 days and 12 months. However, the OH group had a higher12-month stroke rate (0.6% vs. 1.7%, p¼0.03), despite having similar baseline incidenceof hypertension, cerebrovascular disease and atrial fibrillation. Multivariable analysisshowed OH presentation was associated with a trend towards improved survival at 12months (OR 0.63; 95% CI: 0.41-0.99, p<0.045) and lower MACE (0.78; 0.59-1.04,p¼0.088).Conclusion: In contrast to some earlier studies, out-of-hours presentation to hospital withSTEMI is not associated with worse outcomes in patients undergoing PPCI, despite longerDTBTs. There remains room for improvement in achieving better DTBTs in this group.Disclosure of Interest: None Declared
PW147
Bioabsorb Vascular Scaffold (BVS) thrombosis
Gohar Jamil*1, Abbas Ahmed1, Mujgan Jamil2, Mohammad Nour1, Husam Ouda11Cardiology, 2medicine, Tawam Hospital, Al Ain, United Arab Emirates
Introduction: Bioabsorabable vascular scaffold (BSV) has emerged with the idea of lesspermanence and possibly less short and long term complications. Worldwide there is verylimited clinical experience of the BVS.Objectives: To look at the incidence of scaffold thrombosis.Methods: Retrospective analysis of patient’s outcome from tertiary care facility, in whichBSV was used. Over 10 month period 29 BVS were deployed in 20 patients. In two patientsthe scaffold could not be delivered or deployed to the target site. These patients wereexcluded from our analysis.Results: A total of x BVS were deployed in the LAD, x in the LCx and x in the RCA.Indications for BVS deployment were STEMI in 5, NSTEMI in 10 and angina in 5 patients.The average deployment pressure was 14 ATMs and average duration of BVS inflation was14 seconds. TIMI 3 flow was noted in all arteries after scaffold deployment. The size of BVSranged from 2.5 to 4.0 mm diameter.BVS thrombosis was seen in 4 patients, 2 in the LAD and 2 in the RCA. Thrombosis was
noted within 2 days in two patients, after 5 months in two patients who were noncompliant with dual antiplatelet therapy. In all these four patients, TIMI 3 flow was suc-cessfully restored with DES deployed inside the scaffold.
GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters
Conclusion: Such a high incidence of BVS thrombosis seen in our patients is not previ-ously reported. This occurrence may be due to technical issues, inherent issues with theBVS, aspirin or clopidogrel non compliance or resistance. IVUS or OCT would have beenhelpful in knowing the etiology.Disclosure of Interest: None Declared
PW148
Modified Pot technique (Proximal Optimization Technique) to avoid complexbifurcation stenting
Leong Weng San*1, Tieh Siaw Cheng2, Kong Poi Keong21Cardiology, Hospital Raja Permaisuri Bainun, Ipoh, 2Cardiology, Penang Hospital, Goergetown,Malaysia
Introduction: Benefit of bifurcation stenting has been controversial. Single stent of mainvessel strategy alone may be preferred to dual stents for both the main and the side branch.However, there is risk of side branch closure following main branch stenting and highpressure post dilatation. Pot technique has been used to facilitate side branch rewiring andstent placement.Objectives: We postulate that a modified method of Pot technique to open up the sidebranch carina would help reduce side branch closure during predilatation, stent deploy-ment and postdilatation of the main branch.Methods: We performed prospective study on 5 patients with LAD bifurcation lesions.Side branches (diagonal arteries) of all patients were considered need to be protected ifvessel diameter was more than 2.0mm. Both LAD/ Diagonal were wired with 0.014” PCIwires. Point A (proximal to side branch) was predilated at higher pressure as compared toPoint B (at level of side branch) and Point C (distal to side branch). Main vessel lesion wasstented, followed by guidewire exchange. Point A was postdilated to bigger diameter ascompared to point B and point C. Primary end point was side branch closure, worseningTIMI flow, narrowing of ostial side branch diameter and need for kissing balloon or sidebranch stenting.Results: Our 5 patients had mid LAD bifurcation lesions with different variations ofMadina classes. All 5 patients were admitted for acute coronary syndromes. Predictedmain vessel diameters for all 5 patients were 2.75mm. LAD was predilated withcompliant balloon diameter 2.0-2.5mm. All patients have successful LAD stenting andpostdilatation of LAD stents. There was no observed side branch closure, dissection,narrowing of ostial side branch or poorer TIMI flow. All patient has final TIMI 3 flowin their respective side branch. There is no need for kissing balloon or side branchstenting.
Conclusion: Though Pot technique was earlier described to facilitate bifurcation stenting,our step by step modified method of Pot technique may be used to open up the carina ofthe side branch, and thus avoid complicated bifurcation stenting with good immediateresult. Further study would be needed to recruit more patients and other non-LAD cor-onary arteries.Disclosure of Interest: None Declared
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