Acute Coronary Syndromes & Interventional Cardiology最新文献

{"title":"19 The mechanism of supply-demand imbalance and clinical outcomes in patients with type 2 myocardial infarction","authors":"A. Bularga, A. Anand, F. Strachan, Ken K. Lee, S. Stewart, A. Ferry, L. Marshall, D. McAllister, Anoop S. V. Shah, D. Newby, N. Mills, A. Chapman","doi":"10.1136/HEARTJNL-2020-BCS.19","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.19","url":null,"abstract":"Background Type 2 myocardial infarction is common and associated with substantial risk of adverse clinical outcomes, worse than type 1 myocardial infarction, with as few as 30% of patients still alive at five years. However, this broad diagnostic term encompasses multiple mechanisms of supply-demand imbalance, which may be associated with different risks of adverse outcomes. Purpose We aimed to assess the prevalence and clinical outcomes of different mechanisms of supply-demand imbalance related to survival in the High-STEACS (High-Sensitivity Troponin in the Evaluation of patients with Acute Coronary Syndrome) randomised controlled trial. Methods The High-STEACS trial was a stepped wedge cluster randomised controlled trial in ten hospitals across Scotland, including 48,282 consecutive patients with suspected acute coronary syndrome. The diagnosis was adjudicated according to the Fourth Universal Definition of Myocardial Infarction. In patients with type 2 myocardial infarction, we prospectively adjudicated the cause for supply demand imbalance. Linkage of electronic healthcare records was used to track investigation, treatments and clinical outcomes. We used the Kaplan-Meier method, the log rank test and cox regression models adjusted for age, sex, renal function and co-morbidities to evaluate the risk of future all-cause mortality between categories. Results We identified 1,121 patients with type 2 myocardial infarction (age 74¬ ± 14, 55% female). At one year, death from any cause occurred in 23% (258/1,121) of patients. The most common reason for supply-demand imbalance was tachyarrhythmia in 55% (616/1,121), followed by hypoxaemia in 20% (219/1,121) of patients. Tachyarrhythmia was associated with reduced future risk of all-cause mortality (adjusted HR 0.69, 95%CI 0.43-1.09), similar to those with type 1 myocardial infarction. Comparatively, patients with hypoxaemia appeared at highest risk (adjusted HR 1.75, 95%CI 1.09-2.80). Conclusion The mechanism of myocardial oxygen supply-demand imbalance is associated with future prognosis, and should be considered when risk stratifying patients with type 2 myocardial infarction. Conflict of Interest No conflict of interest","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130233485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"43 The role of mechanically-supported emergency percutaneous coronary intervention in cardiogenic shock","authors":"Kristina Frain, P. Rees","doi":"10.1136/HEARTJNL-2020-BCS.43","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.43","url":null,"abstract":"Background Historically, the intra-aortic balloon pump (IABP) has been the primary means of providing rapid mechanical circulatory support (MCS) in patients undergoing emergency revascularisation for acute myocardial infarction complicated by cardiogenic shock (AMI-CS). Despite the availability of alternative devices such as the percutaneous Impella 2.5/CP® which have displayed superior haemodynamic support in animal models, evidence in support of their use in humans is limited and international guidelines do not currently recommend their use. This review aims to examine the existing literature in order to compare survival outcomes in AMI-CS patients undergoing emergent revascularisation supported by percutaneous MCS devices; IABP and Impella 2.5/CP, to discuss the implications of the findings on clinical practice. Method A review of the literature was conducted through the application of search terms ‘Intra-aortic balloon pump’, ‘Impella’, ‘Cardiogenic shock’ and ‘Mortality’ to four databases: Ovid Medline, Ovid Embase, Cochrane and Web of Science. This resulted in 1,823 studies which were then screened based on title and abstract before full text analysis to identify studies that met pre-defined inclusion and exclusion criteria. Results 12 studies met the eligibility criteria: 2 randomised controlled trials (RCTs) and 10 observational studies. In total 28,104 patients were included. 10 studies compared outcomes in patients treated with IABP compared to control. Only 2 studies directly compared outcomes in patients supported by the IABP vs Impella®. The results were inconsistent. 10/12 studies found no difference in mortality between intervention and control arms. Notably, one study claimed reduced mortality with IABP vs control, and one study concluded that Impella® improved survival rates when compared to IABP. The average 30-day all-cause mortality in patients treated with IABP was 42.5% vs 37% in patients treated with Impella® which is consistent with historical studies. Conclusion AMI-CS represents an important cohort of patients in whom conducting RCTs is difficult. As a result, the literature is limited. Analysis of the studies available suggests that there is insufficient evidence to support superior survival in those supported by IABP or Impella® when compared to control. Despite noting positive findings in terms of demonstratable haemodynamic support associated with the Impella® in porcine models these benefits have not been observed in human studies. This literature review failed to establish superior survival associated with the use of IABP or the Impella®, however limitations of the studies have been discussed to outline suggestions for future research. Conflict of Interest None","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125370732","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"21 High-sensitivity cardiac troponin concentrations at presentation in patients with st-segment elevation myocardial infarction","authors":"R. Wereski, K. Lee, Stephen W. Smith, A. Chapman, D. Lowe, A. Gray, N. Mills","doi":"10.1136/HEARTJNL-2020-BCS.21","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.21","url":null,"abstract":"Background The widespread adoption of high-sensitivity cardiac troponin testing has encouraged the use of pathways to accelerate the rule-out and rule-in myocardial infarction in the Emergency Department. These pathways are not recommended for patients with ST-segment elevation, but there is a risk they may be applied incorrectly given that interpretation of the electrocardiogram is subjective, dependent on experience, and signs may be masked in those with posterior myocardial infarction. Methods Consecutive patients with suspected acute coronary syndrome were enrolled in a stepped-wedge cluster randomized controlled trial across ten hospitals in Scotland. The index diagnosis was adjudicated two clinicians independently in all patients with high-sensitivity cardiac troponin I concentrations above the sex-specific 99th centile on serial testing and abnormalities on the electrocardiogram recorded. The proportion of patients with ST-segment elevation myocardial infarction and concentrations below the rule-out threshold ( at presentation were determined. Secondary analysis determined the effect of symptom duration, and culprit vessel location, on troponin concentrations. Results In total, we enrolled 48,282 consecutive patients with suspected myocardial infarction were enrolled, with 925 having an index diagnosis of STEMI. The majority (83.5%, 772/925) of patients had a troponin concentration above the 99th-centile on presentation. The median troponin concentration on presentation was 196 ng/L [46.0, 21611.], with 2.2% (20/925) and 14.4% (133/925) under the 5ng/L rule-out threshold, and Discussion In patients with suspected acute coronary syndrome who have a final diagnosis of ST-segment elevation myocardial infarction, high-sensitivity cardiac troponin concentrations are below the rule-out and rule-in threshold at presentation in more than 1 in 50 and 1 in 4 patients, respectively. Clinicians should not rely on cardiac troponin concentrations to guide initial treatment decisions in patients with possible ST-segment elevation myocardial infarction. Conflict of Interest None","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"157 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130507875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"42 An observation of the predictors of patient adherence and performance in a multidisciplinary regional cardiac rehabilitation programme","authors":"R. Griffiths, Aled Jones, Hannah Davies, R. Mitra","doi":"10.1136/HEARTJNL-2020-BCS.42","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.42","url":null,"abstract":"Introduction Cardiac Rehabilitation (CR) comprises physical, psychological and medical interventions which together aim to reduce and reverse underlying cardiac disease, improve symptoms of cardiac disease and enhance functional status of participants. It is recommended internationally after acute coronary syndromes and reperfusion therapies as well as for patients with stable coronary artery disease. Despite clear evidence in favour of CR, participation remains low. We retrospectively analysed 7 years of demographic data from a regional multidisciplinary exercise-based CR programme in South Wales between 2011 and 2018. Factors that may predict compliance and improvement with CR were investigated. Methods Standard UK criteria were used to recruit patients to the CR programme. Patients’ perceived fitness level, resting heart rate (HR), resting blood pressure and walking distance were recorded before and after CR. Exercise prescription was based on functional capacity test findings (performed prior to commencing CR), British Association for Cardiovascular Prevention and Rehabilitation risk stratification and functional ability. Patients worked at a moderate intensity, determined by observing their HR (40-70% HR reserve) and their rate of perceived exertion (12-14 on the Borg 6-20 scale). Aerobic exercise time was increased, and active recovery time reduced, as patients progressed through the CR programme. Results 1288 patients were included in the analysis. 91.7% of the study population (n=1181) started the CR programme. Males were more likely to engage with the CR programme than females (p=0.02) although the proportion of patients starting CR was high in both groups (93% male, 88% female). Patients with atrial fibrillation (AF) were less likely to engage with CR (p Linear regression modelling found that increasing age (p Conclusions Fewer females were referred and started CR than males in our programme. Although this discrepancy could represent a true gender difference in CR requirement, it may also represent under-referral of females to CR or indicate barriers to uptake of CR for females. Targeted work to encourage female participation in CR is clearly required to address this gender gap. Younger patients were more likely to drop-out of our CR programme than older patients. Retention of younger patients needs to be encouraged in future CR programmes as these patients have been shown to benefit from CR over a wide range of areas (1). Increasing age and presence AF, but not presence of severely impaired LV function, predicted poorer performance in CR. Reference Rodrigues P, et al. Cardiac rehabilitation: does age matter? European Heart Journal 1 August 2013;34(suppl_1):P5792. Conflict of Interest Nil","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131599244","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"29 The use of residual syntax score for prognostication in elderly patients undergoing percutaneous coronary intervention","authors":"J. Abramik, N. Kontogiannis, R. Scarsini, G. L. Maria, T. Raina, G. Kassimis","doi":"10.1136/HEARTJNL-2020-BCS.29","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.29","url":null,"abstract":"Introduction The residual Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) Score is an objective measure of the degree and complexity of residual stenosis after percutaneous coronary intervention (PCI). A raised residual SYNTAX score (rSYNTAX) has been shown to correlate with significantly increased mortality. Octogenarians are likely to pose the greatest technical challenges in terms of achieving complete revascularisation due to the complexity of their coronary artery disease, vascular calcification requiring the use of adjunctive therapies and limitations related to the use of radiographic contrast due to concomitant renal dysfunction. The aim of our study was to determine the association between incomplete revascularisation, as assessed by the rSYNTAX score, and one-year mortality in octogenarians undergoing PCI. Methods A retrospective analysis of 665 consecutive octogenarians who underwent emergency or elective PCI at a large non-surgical cardiac centre in the UK between January 2007 and December 2016 was performed. The SYNTAX scores before and after PCI were calculated. Patients were stratified according to terciles of baseline and rSYNTAX score. Furthermore, patients were classified as completely revascularized if the rSYNTAX was equal to 0, or incompletely revascularized otherwise. A residual (rSYNTAX) score of 0 was achieved in 291 (44%) of patients. In multivariate analysis, incomplete revascularisation was found to be an independent predictor of 1-year mortality (OR 1.02(1.01-1.04), p-value 0.014) (Table 1). Increasing rSYNTAX score was associated with reduced survival at 1 year (Figure 1). Other predictors of mortality included age, diabetes mellitus, peripheral vascular disease, raised serum creatinine and presence of cardiogenic shock on presentation. Incomplete revascularisation was also associated with an increased risk of in-hospital complications (p=0.003), including in-hospital death (p Conclusion The residual SYNTAX score is a useful tool in quantifying incomplete revascularisation in patients undergoing PCI for multivessel coronary artery disease. In the octogenarians studied in our cohort, incomplete revascularisation appears to confer a higher one-year mortality and increased risk of in-hospital complications. Conflict of Interest None","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133319210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"28 Probability of coronary disease and clinical outcomes in patients with type 2 myocardial infarction","authors":"R. Wereski, J. Hung, Anoop S. V. Shah, A. Anand, F. Strachan, N. Mills, A. Chapman","doi":"10.1136/HEARTJNL-2020-BCS.28","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.28","url":null,"abstract":"Background Type 2 myocardial infarction is common in clinical practice. However, despite these patients having a similar rate of major adverse cardiovascular events as those with atherothrombotic type 1 myocardial infarction, there is currently no consensus on how these patients should be evaluated or managed. Whether risk assessment for coronary artery disease can identify patients at increased risk of death is unclear. Methods The High-STEACS trial was a stepped wedge cluster randomised controlled trial in ten hospitals across Scotland, including 48,282 consecutive patients with suspected acute coronary syndrome. The index diagnosis was adjudicated in all patients and the likelihood of underlying coronary artery disease recorded as either low probability, high-probability, or known based on the clinical history, risk factors and comorbidities. The adjudicators were blinded to the primary and secondary outcomes including all-cause mortality at one year. Results High-sensitivity cardiac troponin I concentrations were above the sex-specific 99th centile in 22% (10,360/48,282) of patients. The adjudicated diagnosis was type 1 and type 2 myocardial infarction in 55% (4,981/9,115) and 12% (1,121/9,115), respectively. Compared to patients with type 1 myocardial infarction, those with type 2 myocardial infarction were older and more likely to be women. In patients with type 2 myocardial infarction, 20% were low-probability, 55% were high-probability and 25% had known coronary artery disease. All-cause mortality was highest in patients with known or suspected coronary artery disease (22.5% and 23.3%, respectively). Those with a low-probability of coronary artery disease had the lowest event rate (8.8%), even compared to those with type 1 myocardial infarction (figure 1). Discussion A simple clinical assessment of whether patients have a low- or high-probability of coronary artery disease is associated with future risk of death in patients with type 2 myocardial infarction. Whether incorporating this assessment into clinical practice to guide secondary prevention could improve outcomes requires prospective evaluation. Conflict of Interest None","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131953625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"50 Clinical outcomes following bailout stenting in patients treated with paclitaxel coated balloon versus sirolimus coated balloon; synergy or toxicity?","authors":"Boyang Liu, Sophia Khattak, M. Ishaq, S. Athukorala, R. Watkin, K. Lee, G. Pulikal, J. Ment, G. Bhatia, B. Freestone, M. Pitt, E. Viganò","doi":"10.1136/HEARTJNL-2020-BCS.50","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.50","url":null,"abstract":"Aims The bailout stenting post-drug coated balloon (DCB) is performed with second generation drug eluting stents (DES). For paclitaxel DCBs (PCB), it will result in delivery of 2 different drugs to the vessel wall (Paclitaxel from DCB + Limus from DES), on the contrary for sirolimus DCBs (SCB) it will result in double dose of a same drug (Limus from DCB + Limus from DES). In this study, we study the differences in the clinical outcomes between the two groups (PCB + Limus stent vs. SCB + Limus stent) assessing for either a synergistic or a toxic-effects. Methods and Results We evaluated patients treated with DCB between January 2016 and June 2019 at our centre. Results are reported as death, cardiac death, target vessel myocardial infarction (TVMI), target lesion revascularisation (TLR) and MACE (combination of cardiac death, TVMI and TLR). During the study period; 890 lesions (766-patients) were treated with DCB. Of them; 433 were treated with PCB and 477 with SCB. Total of 81-lesions (9%) needed bailout stenting for either dissection and/or recoil of >50%. This included; 42-lesions in PCB group and 39-lesions in SCB group. There were no significant differences in the baseline characteristics between the two groups. During the median follow-up period of 18-months, the clinical outcomes between PCB and SCB group were; death: 3 (7%) vs. 0; p=0.3, cardiac death: 2 (5%) vs. 0; p=0.5, TVMI: 0 vs. 1 (2.6%); p=0.4, TLR: 1 (2.4%) vs. 3 (7.7%); p=0.5, MACE: 3 (7%) vs. 3 (7.7%); p=0.7. There were no reported cases of stent thrombosis in either group. Conclusions The bailout stenting rate was relatively low in our group (9%) as compared to previously published studies. No significant differences were observed between the two-bailout stenting groups, although numerically PCB + limus stent group had lower rates of TLR, but had higher mortality rates as compared to SCB + limus stent, implying potential synergistic effect, but maybe at the cost of toxicity? This needs to be confirmed with larger patient group with multi-centre experience. Conflict of Interest None","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"29 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132861347","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"52 Incidence and outcomes of bailout stenting following use of sirolimus drug coated balloon","authors":"Sophia Khattak, Boyang Liu, M. Ishaq, S. Athukorala, R. Watkin, K. Lee, G. Pulikal, J. Ment, G. Bhatia, B. Freestone, M. Pitt, E. Viganò","doi":"10.1136/HEARTJNL-2020-BCS.52","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.52","url":null,"abstract":"Introduction Bailout stenting post-Paclitaxcel drug coated balloon use (DCB) is done with Limus eluting stent as we don’t use Paclitaxcel eluting stent anymore. However, when using Sirolimus DCB, bailout stenting is done with Limus eluting stent, but this raises the issue of drug toxicity with double dose of Limus to the vessel wall. In this study, we evaluate all patients treated with Limus DCB that required bailout stenting for safety and clinical outcomes. Methods and Results We evaluated all patients who were treated with MagicTouch Sirolimus eluting DCB (Concept Medical limited, India) March 2018-June 2019. Bailout stenting per lesion were identified and studied for endpoints which included cardiac death, target vessel MI, stent thrombosis, target lesion revascularisation and MACE. Between the study period; 406 patients (477-lesions) with a mean age of 66 ± 11.2 years (range; 37-90) were treated with MagicTouch DCB. Bailout stenting was required in 39 lesions (8%) and of which 22 were due to dissections and 17 were due to >50% recoil following DCB use. During a median follow-up of 302 days; there were no cases of cardiac death, 1-case of target vessel MI (2.6%) and 3-cases (7%) of TLR. The MACE rate was 7%. There were no cases of stent thrombosis as per the ARC definition. Conclusion One of the highlighting features of our study is low-rates of bailout stenting (9%). This may be due to our criteria of not stenting mild dissections (unless they are flow limiting) and not to expect stent like results. The outcomes in the bailout stenting group is excellent with very low hard clinical endpoints indicating there may not be any toxic effect from double dose of Limus drug (DCB + DES). Conflict of Interest None","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"198 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133902066","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"37 Shockwave intravascular lithotripsy in calcified coronary lesions: a retrospective, observational, international multi-centre analysis","authors":"A. Aziz, Sophia Khattak, A. Lelasi, B. Cortese, L. Testa, E. Viganò, Rami Mokdad, M. Pitt, S. Basavarajaiah","doi":"10.1136/HEARTJNL-2020-BCS.37","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.37","url":null,"abstract":"Introduction Sub-optimal stent expansion due to coronary calcification augments the risk of restenosis and stent thrombosis. Calcium modification is generally achieved by rotational atherectomy or specialized balloons (scoring and cutting balloons), which carries risk of complications. Intravascular lithotripsy (IVL) appears safe and also aids in cracking deep seated adventitial calcium. Although, there are reported studies on this novel technology, there is a lack of real-world data. In this study, we report the experience from 4 centres that undertake high-volume complex coronary interventions. Methods We enrolled all patients treated with IVL between September 2018 and October 2019 at 4 centres (1 in UK and 3 in Italy). Procedural success and complication were assessed. The clinical outcomes evaluated were; cardiovascular death, target vessel MI (TVMI), target lesion revascularisation (TLR) and MACE (composite of cardiovascular death, TVMI and TLR). Results During the study period, 100 lesions (in 94 patients) with a mean age of 71±9.7 years (range;30 - 88) were treated using IVL. 70% (n=70) were male, 85% (n=80) had hypertension, 51% (n=48) had diabetes and 20% (n=19) had chronic kidney disease. Acute coronary syndromes accounted for 40% of patients (n=38). De-novo lesions accounted for 66% of cases (n=66) and the remaining 34% (n=34) were restenotic lesions. Left anterior descending artery (56%) accounted for most cases followed by right coronary artery (22%), left circumflex artery (21%), left main (17%) and saphenous vein grafts (3%) procedures. Upfront use of IVL occurred in 18% of cases whilst the rest were bail-out procedures due to inadequate pre-dilatation with conventional balloons. Adjuvant rotational atherectomy (Rota-tripsy) was used in 10 cases (10%) prior to the use of IVL. The mean diameter of IVL balloon was 3.3 ± 0.5mm. Intravascular imaging (IVUS) was used in 19% of cases. Procedural success was achieved in 100% of cases with a complication rate of 2% (2-cases of coronary perforation and one of them resulted in in-hospital mortality). During the median follow-up of 150 days, there were no clinical events including cardiac death, TVMI and TLR. Conclusion Initial experience and short-term clinical follow-up from IVL use appears safe and effective PCI strategy for dealing with calcified coronary lesions. A high success rate was observed with low event rates and procedural complications. We are enrolling more patients from other centres as part of a larger multi-centre registry and will be able to report this with higher numbers and longer follow-up at BCS 2020. Conflict of Interest nil","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"166 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115565769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"47 Hba1c testing in patients admitted with acute coronary syndromes identifies poor glycaemic control and facilitates new diagnoses of diabetes","authors":"Howell Williams, M. Kelshiker, Florence Mouy, A. Rendall, J. Sabin, S. Thrower, E. Hui, T. Raina, J. Shah","doi":"10.1136/HEARTJNL-2020-BCS.47","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.47","url":null,"abstract":"Background Diabetes is a powerful but modifiable vascular risk factor, and it is well-established that effective glycaemic control improves cardiovascular outcomes. Current international guidelines do not recommend routine measurement of HbA1c in patients with acute coronary syndrome (ACS). We hypothesise that measuring HbA1c levels in all patients during admission to hospital with ACS would allow: Identification of patients with known diabetes and poor glycaemic control Increased diagnoses in patients with previously undiagnosed diabetes Aims To identify how often HbA1c was measured in patients admitted with ACS, and when measured whether HbA1c identified poor glycaemic control in patients with known diabetes and/or led to new diagnoses of diabetes. Methods Measurement of HbA1c was audited among patients admitted with ACS to two large acute NHS Trusts. Electronic records of patients admitted with ACS during a two-month period at Trust 1 and a three-month period at Trust 2 were analysed. Results 218 patients were admitted with ACS (122/218 Trust 1, 96/218 Trust 2). Mean age was 71 (range 34-97), 70% male. 77/218 (35%) had known diabetes. HbA1c was measured during admission (or 64mmol/mol) was identified in 16/36 (44%) patients with known diabetes. 15/51 patients did not have known diabetes; in this population mean HbA1c was 40mmol/mol (range 31-50). HbA1c testing led to 1 new diagnosis of diabetes being confirmed. Among patients with known diabetes, 33/36 who had an HbA1c test underwent invasive angiography; 15/33 had an HbA1c >64mmol/mol and 18/33 HbA1c 64mmol/mol population were more likely to undergo CABG than be managed with PCI or medical therapy alone than the HbA1c 64mmol/mol (n=16) and HbA1c Conclusion In this study of patients admitted with ACS, HbA1c testing identified poor glycaemic control in a large number of patients with known diabetes. Only 1 new diagnosis of diabetes was made, likely due to established screening programs in primary care being effective in prior identification. Among patients with known diabetes, revascularisation with CABG was more common in those with poor glycaemic control in keeping with current revascularisation guidelines. HbA1c testing therefore identified a higher risk group within the ACS population, as well as identifying poor glycaemic control. These results, taken together with the recent development of novel therapies for diabetes, suggest that HbA1c testing should be considered routinely in all patients admitted with ACS. Conflict of Interest None","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"39 5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115731247","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}