STEMI
treated with primary percutaneous coronary intervention (PPCI). This study compared the effectiveness of eptifibatide relative to abciximab in patients with STEMI
treated with PPCI as there are only a few studies directly comparing these 2
agents.
Methods: This was an observational cohort study of 2083 patients who received
a GPIIb/IIIa inhibitor whilst undergoing PPCI from 2006 to 2012. Patients who did
not receive a GPIIb/IIIa inhibitor were excluded. The primary end-point was the
first major adverse cardiac event (MACE) defined as death, non-fatal myocardial
infarction, stroke or target vessel revascularisation.
Results: 1522 patients received abciximab with 561 receiving eptifibatide. Patients who received eptifibatide had higher rates of previous PCI and hypercholesterolaemia and were more likely to undergo a procedure from the radial route.
Unadjusted Kaplan-Meier analysis revealed no significant difference in the 1-year
event rates between patients given eptifibatide versus abciximab (Figure 1). Ageadjusted Cox analysis demonstrated no difference in 1 year outcome between
abciximab and eptifibatide (HR 1.01 [95% CI 0.73-1.39)), which persisted after
multivariate adjustment ((HR 1.37 [95% CI 0.93-1.96)). In addition, after regression adjustment incorporating a propensity score (age, gender, ethnicity, previous
MI, PCI or CABG, diabetes, hypertension, hypercholesterolaemia, smoking status, presence or absence of shock, and ejection fraction) into the hazards model
as a covariate, no difference in outcome emerged (HR 1.21 [95% CI 0.83-1.54)).
1025
P5553 | BEDSIDE
Determinants of angiographic thrombus burden in patients with
ST-elevation myocardial infarction
I.H. Tanboga, S. Topcu, E. Aksakal, K. Kalkan, S. Sevimli, M. Acikel. Ataturk
University, Faculty of Medicine, Erzurum, Turkey
Aims: We aimed to investigate the determinants of angiographic thrombus burden in patients with ST elevation myocardial infarction (STEMI) who underwent to
primary Percutaneous coronary intervention (PCI).
Methods: The study population consisted of 662 patients with non-anemic
STEMI who underwent to primary PCI. Clinical, laboratory and demographic properties of the patients were recorded Baseline hematologic indices were measured
at time of admission. Angiographic coronary thrombus burden was scored based
on TIMI thrombus grades. After wiring and/or small balloon dilation, patients with
thrombus burden grade 4 and 5 was defined as high thrombus burden, patients
with thrombus burden < grade 4 was defined as low thrombus burden.
Results: Patients with high thrombus burden had more family history of coronary artery disease, longer pain-balloon time, higher Killip class (≥II), higher
neutrophil-to-lymphocyte ratio (NLR), red cell distribution width (RDW), baseline
creatine kinase musclebrain fraction (CK-MB) and baseline troponin, higher peak
CK-MB and peak troponin; however, lower triglycerides. As an angiographically,
Patients with high thrombus burden had longer lesion in the infarct-related artery,
less frequent direct stenting, lower epicardial and myocardial perfusion, more frequent distal embolization, more frequent electrocardiographic and angiographic
no-reflow. In multivariate logistic regression analysis only RDW (OR:1.29,
95% CI 1.19 – 1.39, p<0.001) was determined as independent predictors in the
analysis. The area under the ROC curve of the RDW was 0.733 (0.690 – 0.776,
P<0.001) to predict high TIMI thrombus burden.
Conclusion: Present study results demonstrated that high thrombus burden in
patients with STEMI were associated with impaired postprocedural epicardial and
myocardial perfusion and higher no-reflow and distal embolization; and increased
RDW values was independent predictors of coronary thrombus burden.
Figure 1. KM curve showing MACE
Conclusion: This observational data suggests that eptifibatide is associated with
similar outcomes to abciximab in patients with STEMI undergoing primary PCI.
P5552 | BEDSIDE
Primary versus secondary transport of STEMI patients: impact on
transport times and mortality
A. Al Mawiri 1 , J.F. Vojacek 2 , J. Bis 2 , M. Sitina 1 , J. Stasek 2 . 1 Emergency Medical
Service, Hradec Kralove, Czech Republic; 2 Charles University Prague, Faculty
of Medicine in Hradec Kralove, 1st Department of Medicine, Hradec Kralove,
Czech Republic
Background: The door-balloon time (DBT) is linked to morbidity and mortality of
patients with ST segment elevation myocardial infarction (STEMI). Despite preferable direct transport to catheterization laboratory (PT), still significant proportion
of STEMI patients is transported via non-PCI regional hospitals or Coronary Care
Units (ST) prior to percutaneous coronary intervention (PCI). This study assessed
to what extent PT vs ST affects the DBT and mortality.
Methods: Our region with 600 000 inhabitants uses well elaborated 24hours/365
days system of immediate transport of all patients with STEMI lasting less than
12 hours to referral catheterization laboratories in the tertiary University Hospital
Cardiac Center for more than 15 years. We prospectively recorded DBT of 677
consecutive patients with STEMI, treated by PCI in the years 2008-2009. Consequent follow-up was obtained in all patients.
Results: Median of DBT was 34±15.9 mins for PT patients (n=354) and
100±28.8 mins for patients with ST (n=323) (p<0.005). One-month mortality was
4% vs 9.5% (p=0.002) in the PT vs ST group, respectively. One-year mortality in
the PT and ST groups was 7.3 vs 20.5% (p<0.005), respectively.
P5554 | SPOTLIGHT 2013
Vitamin D status and clinical severity in ST segment elevation
myocardial infarction
O. Cagac 1 , I. Erdogu 2 , B. Hunuk 3 , O. Ozturk 2 , M. Sunbul 1 , D. Akaslan 1 ,
E. Durmus 1 , B. Mutlu 1 . 1 Marmara University, Faculty of Medicine, Department
of Cardiology, Istanbul, Turkey; 2 Samsun Education and Research Hospital,
Department of Cardiology, Samsun, Turkey; 3 Maltepe C.I.K. State Hospital,
Department of Cardiology, Istanbul, Turkey
Purpose: Emerging data revealed the significant role of vitamin D (vitD) in cardiovascular (CV) events. Clinical indices like Thrombolysis in Myocardial Infarction
(TIMI) risk score, corrected TIMI frame count (CTFC) and high sensitivity cardiac
troponin T (hs-cTnT) levels have short and long-term predictive values regarding
CV mortality and morbidity in ST-segment elevation acute myocardial infarction
(STEMI). The aim of this study was to determine the predictive value of vitD for
clinical severity parameters in STEMI.
Methods: Patients with STEMI admitted to our hospital were prospectively and
consecutively evaluated and proceeded to primary percutaneous coronary intervention (PCI). Patients with a previous history of coronary artery bypass graft
(CABG), renal/hepatic failure and patients in need for emergency CABG were excluded from the study. 102 subjects ([mean±SD]age, 57±11 years) were enrolled
in the study (female n [%]:18 [17,6%]). VitD levels were obtained on admission.
VitD < 20 ng/ml was defined as vitD deficiency. CTFC were calculated after PCI
for culprit lesion.
Results: VitD deficiency was detected in 63,4% (<30 ng/ml in 92,7%) of the study
population. In vitD deficient group, significantly higher hs-cTnT admission values
([median] 3598 ng/L vs 2576 ng/L, p=0,015), TIMI scores (25th-75th percentiles;
2-5 vs 1-3, p<0,001), LAD CTFC (Data±SEM; 18,4±2,3 vs 12,6±1,4 p=0,042)
and RCA CTFC (27,5,4±3,6 vs 19,6±1,6 p=0,044) were detected compared with
non vitD deficient group. VitD levels were inversely correlated with TIMI STEMI
scores (r:-0,438, p<0,001). In multivariate regression analyses, vitD levels was
found as an independent predictor of higher TIMI STEMI scores after adjusting
for age, gender, HT and DM (Table-1).
Table-1
Variables
Age (years)
Gender
HT
DM
VitD
β
p
Confidence Interval (95%)
0,327
0,139
0,059
0,082
−0,440
<0,04
0,44
0,78
0,66
0,01
(0,01 to 0,10)
(−1,29 to 2,91)
(−1,49 to 1,97)
(−1,45 to 2,26)
(−0,16 to −0,02)
Regression model for TIMI risk score.
One-year mortality (***p<0.05)
Conclusion: The admission of patients with STEMI to regional hospitals or Coronary Care Units instead of direct transport to catheterization laboratory significantly prolongs the DBT and increases mortality.
Conclusions: Our findings suggest that low vitD levels may play a role in disease
severity of STEMI patients by means of its independent associations with risk
algorithms.