Acute Coronary Syndromes & Interventional Cardiology最新文献

{"title":"72 Prevalence of behavioural and biological risk factors for cardiovascular disease among patients with acute coronary syndrome admited to a tertiary care hospital in sri lanka","authors":"C. Wickramarachchi, Jagath Herath, N. Amarasena","doi":"10.1136/heartjnl-2022-bcs.72","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-bcs.72","url":null,"abstract":"","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124075199","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":"64 Contrast nephropathy in ppci","authors":"S. Littlewood, P. Mota","doi":"10.1136/heartjnl-2022-bcs.64","DOIUrl":"https://doi.org/10.1136/heartjnl-2022-bcs.64","url":null,"abstract":"","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125275813","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":"23 Performance of the grace 2.0 score in patients with type 1 and type 2 myocardial infarction","authors":"J. Hung, A. Roos, Erik Kadesjö, D. McAllister, Anoop S. V. Shah, A. Anand, F. Strachan, K. Fox, N. Mills, M. Holzmann, A. Chapman","doi":"10.1136/HEARTJNL-2020-BCS.23","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.23","url":null,"abstract":"Introduction The Global Registry of Acute Coronary Events (GRACE) score was developed to evaluate risk in patients with myocardial infarction. However, its performance in type 2 myocardial infarction is uncertain. Methods In two cohorts of consecutive patients with suspected acute coronary syndrome from ten hospitals in Scotland (n=48,282) and a tertiary care hospital in Sweden (n=22,589), we calculated the GRACE 2.0 score to estimate death at one year. Discrimination was evaluated by the area under the receiver-operator-curve (AUC), and compared for those with an adjudicated diagnosis of type 1 and type 2 myocardial infarction using DeLong’s test. Results Type 1 myocardial infarction was diagnosed in 4,981 (10%) and 1,080 (5%) patients in Scotland and Sweden, respectively. At one year, 720 (15%) and 112 (10%) patients died with an AUC for the GRACE score of 0.83 (95% confidence interval [CI] 0.82 to 0.85) and 0.85 (95% CI 0.81 to 0.89). Type 2 myocardial infarction occurred in 1,121 (2%) and 247 (1%) patients in Scotland and Sweden respectively, with 258 (23%) and 57 (23%) deaths at one year. The AUC was 0.73 (95% CI 0.70 to 0.77) and 0.73 (95% CI 0.66 to 0.81) in type 2 myocardial infarction, which was lower than for type 1 myocardial infarction in both cohorts (P Conclusions The GRACE score provided good discrimination for all-cause death at one year in patients with type 1 myocardial infarction, and moderate discrimination for those with type 2 myocardial infarction. Conflict of Interest None","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"4 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":"114949764","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":"20 Investigating sodium-glucose co-transporter 1 (SGLT1) in myocardium and its role in hyperglycemia ischaemia-reperfusion injury","authors":"A. Almalki, I. Harding, Hussain Jasem, Sapna Arjuin, D. Yellon, Robert Bell","doi":"10.1136/HEARTJNL-2020-BCS.20","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.20","url":null,"abstract":"Introduction Hyperglycaemia is a common finding in diabetic and non-diabetic patients presenting with ACS, and is a powerful predictor of prognosis and mortality. The role of hyperglycaemia in ischemia-reperfusion injury (IRI) is not fully understood, and whether the Sodium Glucose co-Transporter 1 (SGLT1) plays a role in infarct augmentation, before and/or after reperfusion, remains to be elucidated. However, diabetes clinical trials have shown SGLT inhibition improves cardiovascular outcomes, yet the mechanism is not fully understood. Purpose (1) Characterise the expression of SGLT1 in the myocardium, (2) determine the role of high glucose during IRI, (3) whether SGLT1 is involved in a glucotoxicity injury during IRI, and (4) whether inhibiting SGLT1 with an SGLT inhibitor may reduce infarct size. Methods RT-PCR and in-situ hybridization (RNAScope) techniques were used to detect SGLT1 mRNA expression in Sprague-Dawley whole myocardium and isolated primary cardiomyocytes. An Ex-vivo Langendorff ischemia-reperfusion perfusion model was used to study the effect of high glucose (22mmol) on the myocardium at reperfusion compared to normoglycaemia (11mmol). The mixed SGLT1&2 inhibitor, Phlorizin was introduced following ischaemia, at reperfusion and its effect on infarct size measured using triphenyltetrazolium chloride (TTC) staining. Results RT-PCR found SGLT1 mRNA is expressed in whole myocardium and in individual cardiac chambers. SGLT1 expression was not detected in isolated cardiomyocyte but it is detected in the non-cardiomyocyte population. Cardiomyocytes were found to express mRNA SGLT1 if incubated overnight. RNAscope detected SGLT1 mRNA within intact myocardium: not in the cardiomyocyte, but rather in a perivascular distribution. Importantly, hyperglycaemia (22mmol) at reperfusion increased infarct size (51.80 ± 3.52% vs 40.80 ± 2.89%; p-value: 0.026) compared to normoglycaemia, and the mixed SGLT inhibitor, Phlorizin, significantly attenuated infarct size (from 64.7±4.2%to 36.6±5.8%; p-value Conclusion We have shown that SGLT1 is present in the myocardium, but not expressed in cardiomyocytes. The cell type is yet to be determined, but the distribution of SGLT1 is perivascular. Hyperglycaemia appears augment myocardial infarction and inhibition of SGLT1&2 attenuates this increase. We suspect SGLT1 may plays a role in exacerbating the injurious effect of glucotoxicity during ischemia-reperfusion. Conflict of Interest No","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"58 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":"121865746","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":"44 Dedicated bifurcation stents versus drug eluting stents in coronary bifurcation lesions: a systemic review and meta-analysis","authors":"Christopher E Uy, Ahmed Alsunbuli, V. Maravilla","doi":"10.1136/HEARTJNL-2020-BCS.44","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.44","url":null,"abstract":"Introduction Coronary bifurcation lesions (CBL) constitute a fifth of all coronary lesions and have no optimal method for treatment.(1) Multiple trials were conducted to investigate different modalities of treatment such as drug eluting stents, bioresorbable scaffolds, and dedicated bifurcation stents.(2) There are limited data discussing the clinical outcomes of these trials as most tend to report procedural outcomes.(3) This systematic review aimed to compare clinical outcomes of DBS compared to DES, while excluding bare metal stents and bioresorbable scaffolds.(4) Methods Following the PRISMA guidelines,(5) a systematic data search was conducted including EMBASE, PUBMED, MEDLINE, CINAHL, Cochrane database, TRIP database, and clinicaltrials.gov. Inclusion criteria were for prospective two-arm randomised trials published between the years from 2015 to 2018 comparing DBS and DES exclusively and reported clinical outcomes including cardiac death, myocardial infarction, target lesion revascularisation, and stent thrombosis. Risk of bias was assessed using Cochrane risk of bias assessment tool RoB1.(6) Two reviewers extracted data independently using Microsoft Excel 365 ProPlus. Meta-analysis is performed by restricted maximum-likelihood method comparing relative risks (RR) of clinical outcomes,(7) using MAJOR R pack through Jamovi platform and reported in logarithmic relative risk (Log RR).(8, 9) Results Six trials comparing DBS and DES involving 1914 patients met the inclusion criteria. Most of the studies were conducted in Europe, participants’ ages were DBS: 65.56, DES: 65.18 (p-value = 0.52). Participants of male gender were DBS: 74.9% DES: 77.5% (p-value = 0.44) and patients with smoking history were DBS: 28%, DES: 27.36% (p-value=0.70). Patients who presented with acute coronary syndrome were a fifth of all participants (p-value = 0.74). Around 70% of each arm participants had hypertension, and around 25% suffer from diabetes, as well as smoking. A third of participants had previous myocardial infarction (Table-1). Clinical outcomes were reported for 12 months in all study but one (Genereux et al. – 9 months).(10) There was only one cardiac death in the DBS arm compared to six cardiac deaths in the DES arm. A meta-analysis was performed for MACE (Figure-1), myocardial infarction (MI), stent thrombosis (ST), and target lesion revascularisation (TLR). Major adverse cardiac events (MACE) were 13.3% for DBS and 12.4% for DES with a RR of 1.078 (Log RR = 0.07, p-value = 0.612) (Figure-1 & Table-2). Other measured outcomes showed no superiority for either arms. Conclusion When comparing the one-year clinical outcomes for coronary bifurcation lesions stenting; there was no statistically significant difference between dedicated bifurcation stents and drug eluting stents regarding MACE, CD, MI, TLR, and ST. Conflict of Interest None","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"1 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":"127414015","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":"38 Local experience of ultrasound assisted catheter directed thrombolysis in london northwest university healthcare NHS trust for sub-massive pulmonary embolism","authors":"M. Chabok, P. Kalia, J. Wolff, J. Shah","doi":"10.1136/HEARTJNL-2020-BCS.38","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.38","url":null,"abstract":"Background and Objective Despite availability of sensitive diagnostic tests, the mortality and morbidity related to pulmonary embolism (PE) continues to cause tremendous economic burden. The objective of this service evaluation was to compare the length of stay and safety profile of newly adopted Ultrasound Assisted Catheter Directed Thrombolysis (UACDT) for patients with sub-massive PE and right heart strain to a historic control group of patients with a primary discharge diagnosis of PE. Methods and Results The historic control group was made of patients identified with a primary discharge diagnosis of PE in the calender year 2016 (131 patients). Of these 75 (57.3%) patients had sub-massive PE defined as radiologically large thrombus burden and evidence of right heart strain seen on CT pulmonary angiogram (CTPA). Only patients with a length of stay (LOS, defined as date of discharge – date of scan in days) > 2 days were included in the analysis. The final historical control group was made of 68 (51.1% of the total cohort) patients, mean age = 67.5 ± 17.9 years, 28 (36.8%) males, mean pulmonary artery pressure (PAP) on echo = 37.3 ± 17.7 mmHg (echo data available in 74.7% of the cohort). These patients were compared against the UACDT group. To be eligible for UACDT, patients needed to have sub-massive PE with radiologically large thrombus burden, right heart strain seen on CTPA and echocardiogram and elevated Troponin and or BNP on blood tests. The UACDT group comprised of 25 patients (mean age = 61.2 ± 14.1 years, 19 (76%) male, mean PAP 38.6 ± 22.3 mmHg on echo, all patients had echo data available prior to the procedure) that underwent the procedure at our district general hospital between June 2018 and Sep 2019. Time to procedure was a mean of 1.2 days (median of 1day with min of 0 and Max of 5 days). There was no death in the UACDT cohort whilst 3 deaths (3.9%) were observed in the historical control group (p = 0.6). Death or readmission occurred in 8 (10.5%) of the historical control group compared to 1 (4%) in the UACDT group (p = 0.4). One (4%) patient had haematemesis post UACDT with new diagnosis of gastric Cancer. There were 3 (12%) patients with new diagnosis of cancer among UACDT group and further 2 with known metastatic cancer. The LOS numerically lower in the UACDT group compared to the historical control group which was not significantly different (mean difference = 2.4 days, 95% CI = -0.5, 5.3 days, p = 0.1). Conclusion UACDT is a safe procedure and although there is no difference in LOS with the procedure there is a potential that this difference will become more important as confidence with the procedure increases. There is a 12% incidence of occult cancer in this group of patients. Conflict of Interest no","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"22 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":"116425598","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":"53 Invasive angiography following FFRCT – a real world nhs experience","authors":"D. Murphy, J. Graby, D. Mckenzie, R. Kandan, D. Augustine, R. Lowe, Richard Mansfield, J. Easaw, A. Garg, K. Carson, B. Hudson, J. Rodrigues","doi":"10.1136/HEARTJNL-2020-BCS.53","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.53","url":null,"abstract":"Introduction Computed Tomography Coronary Angiography (CTCA) is NICE recommended as the diagnostic investigation of choice for patients presenting with stable angina. The technology is well recognised for providing coronary anatomy and descriptive analysis of coronary disease. Fractional Flow Reserve derived from CTCA (FFRCT) is an additional, FDA approved non-invasive technique for defining the probability of flow-limiting coronary artery stenosis that correlates with invasive FFR measurements. Previous studies undertaken at this District General Hospital highlighted the value of this tool in streamlining invasive strategies. This follow-up study sought to assess the next step in the patient pathway, comparing those identified as intermediate to high risk based for flow limiting disease on FFRCT with the findings and management strategy employed at subsequent invasive coronary angiography. Methods A retrospective analysis of all CTCA’s (SOMATON Definition edge, Siemens) reports between April 2018 and January 2019 with FFRCT (Heartflow Inc.) undertaken were reviewed. Any imaging that reported an intermediate to high risk of flow limiting coronary disease based on FFRCT were included, (values of Results A total of 108 studies were sent for Heartflow analysis, of which 27 had intermediate or high likelihood of flow limiting coronary disease reported and have had subsequent invasive angiography. This consisted of 60% male, with a mean of age 67 (range 42-83 years). Invasive pressure wire assessment via iFR (instantaneous wave free ratio) and/or FFR was carried out in 9 (33%) patients at angiography. In total, 43 vessels with FFRCT intermediate or high likelihood vessels were assessed invasively. Table 1 below outlines the FFRCT findings versus invasive angiography management. FFRCTInvasive Coronary angiogram iFR/FFR -veiFR/FFR +veDirect Re-vascularisation (PCI)Direct Re-vascularisation (CABG)Not Invasively assessed Intermediate73115 High0112103 Table 1. This table compares FFRCT findings with invasive angiography strategy / findings. Of the 3 vessels with ‘high probability of flow-limiting disease’ that were not invasively assessed, all were branch vessels (2 diagonals and 1 obtuse marginal). Conclusions This study represents a real world NHS experience of activity undertaken in the catheter lab when functional information of coronary flow is known in advance of an invasive procedure. In some cases (13/16 [81%] of patients with a high probability of flow limiting disease) a direct decision on re-vascularisation was taken by the operator without further invasive pressure wire assessment, which may have reduced procedure duration. Further experience with FFRCT may increase operator confidence and thus increase the frequency of proceeding directly to re-vascularisation where indicated, thus reducing both procedure and fluoroscopic screening times. A further assessment of the role of FFRCT employed for stent planning pre-procedure is intended. Conflict ","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"50 6","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114101516","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":"31 Tetramethoxystilbene-loaded liposomes potentiate small coronary arterial dilator function, in an acute hypertension murine model, ex vivo","authors":"Azziza Zaabalawi, M. Azzawi","doi":"10.1136/HEARTJNL-2020-BCS.31","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.31","url":null,"abstract":"Introduction The methylated analogue of the polyphenol Resveratrol (RV), 2, 3’, 4, 5’-Tetramethoxystilbene (TMS), displays significantly more antioxidant effects than RV and is a potent inhibitor of CYP1B1, shown to contribute to the development of hypertension. While TMS bioavailability is low1, liposomes are a promising modality for TMS encapsulation and delivery to improve uptake into tissues2. The objective of this study was to determine the effect of TMS, delivered via liposomes, on endothelial cell viability and vasodilator responses of isolated coronary arteries, after acute pressure elevation, ex vivo, and assess mechanisms involved. Methods Liposomes were synthesised using a thin-lipid film process and characterised using UV-Vis and fluorescence spectroscopy, Dynamic Light Scattering and Fourier-transform infrared spectroscopy. The effect of TMS-loaded liposomes on human coronary artery endothelial cell viability was determined in vitro using Alamar Blue assay. Small coronary arteries were isolated from male Wistar rats (in accordance with Home office guidelines and institutional ethics approval) and their function assessed at 60mmHg and following acute pressure elevation (150 mmHg, 30 minutes) to mimic a hypertensive environment. Endothelial-dependent (acetylcholine, ACh 1.0 nM – 1.0 mM) and independent (Sodium nitroprusside -SNP, 100 μM, Papaverine –PAPA, 100 μM) responses were measured in the presence/absence of TMS and TMS-loaded liposomes, using pressure myography. Data are expressed as mean percent dilation ± SEM. Results TMS-loaded liposomes (157 ± 6 nm diameter; zeta potential -13.13 ± 0.67 mV) maintained cell viability without toxicity, following 48h incubation. Acute pressure elevation significantly reduced endothelial-dependent dilator responses but did not affect endothelial-independent vasodilation. Co-incubation with TMS liposomes significantly improved endothelial-dependent vasodilation (@ ACh 100 μM: 86.06 ± 5.63% and 89.84 ± 3.05% for TMS liposomes and TMS solution respectively, compared to control PSS 38.52 ± 6.34; n = 5; p ≤ 0.01). The potentiated dilator response was sustained over a longer period (4h) with TMS liposomes, when compared to TMS solution (@ ACh 100 μM: 77.32 ± 8.70% vs 41.70 ± 8.70%; n = 4; p ≤ 0.05). Conclusion TMS-loaded liposomes have the potential to restore attenuated coronary endothelial-dependent dilator responses in an acute hypertensive environment. Our findings will help establish whether TMS-loaded liposomes are a valid therapeutic drug-delivery strategy in hypertension. References Nawaz et al., 2017. Nutrients, 9(11), p.1188. Hu et al., 2018. Molecular Pharmaceutics, 15(12), pp.5493-5500. Conflict of Interest None","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"1 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":"127267661","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":"26 Distribution of high sensitivity troponin levels in consecutive, unselected patients in the emergency department and relationship to in-hospital mortality","authors":"J. Hinton, M. Mariathas, L. Gabara, Z. Nicholas, R. Allan, S. Ramamoorthy, M. Mamas, M. Mahmoudi, P. Cook, N. Curzen","doi":"10.1136/HEARTJNL-2020-BCS.26","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.26","url":null,"abstract":"Introduction The introduction of high-sensitivity troponin assays has facilitated pathways to rapidly exclude myocardial infarction (MI) in patients presenting to the emergency department (ED) with chest pain. However, hs-cTn concentrations above the manufacturer-supplied upper limit of normal (ULN) are frequently detected in patients presenting to ED, despite only a small proportion having a type 1 MI. Furthermore, there is also increasing evidence that hs-cTn concentrations may act as a biomarker of cardiovascular risk in patients outside the context of acute coronary syndrome. In the current study, we report the distribution of hs-cTn in the subpopulation of CHARIOT who attended ED, in whom the assay was taken regardless of whether there was a clinical indication. Our aim was to test the hypothesis that hs-cTn may be a biomarker for in-hospital mortality, irrespective of the indication for its measurement. Method The study included 5708 consecutive patients attending ED in a single centre. In all cases hs-cTnI was measured either as requested by the clinical team, or as part of the study, in which case both the clinical team and the patient were unaware of the test. Basic demographics were available from the original CHARIOT study and both the electronic clinical record and coding data were interrogated to ascertain the clinical outcome. Results 491 (8.6%) patients had hs-cTnI concentrations above the manufacturer’s ULN. There were 4157 (72.8%) patients in whom the hs-cTnI was performed solely as part of the study, with 309 (7.4%) of these above the ULN. Five patients died in ED. Of the remaining patients, 3603 (63.2%) were admitted to hospital. The rate of admission increased with rising hs-cTnI concentrations (table 1). A cardiovascular diagnosis was the most frequent discharge diagnosis in those with a hs-cTnI above the ULN. However, a neurological condition was most common in the patients in whom the test was only performed as part of the study. Increasing hs-cTnI concentrations were associated with increasing in hospital mortality regardless of whether the hs-cTnI was requested for clinical reasons or not (figures 1 & 2). Furthermore, hs-cTnI demonstrated good discriminative ability for in-patient mortality (area under receiver operator curve 0.834). Hs-cTnI above the ULN remained an independent predictor of mortality on multivariate analysis. The median length of stay was also associated with increasing hs-cTnI concentrations. Conclusion In consecutive patients presenting to ED, hs-cTnI elevation is common. Furthermore, increasing hs-cTnI concentrations are associated with increased admission rates from ED, longer in-patient stays and higher in-hospital mortality. Hs-cTnI may therefore represent a biomarker for in hospital outcomes in these patients. Conflict of Interest Unrestricted research grant from Beckman Coulter (who had no role in the design, analysis, interpretation of the study)","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"109 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":"122430857","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":"46 Evaluation of management of lipid profile in high-risk PCI patients","authors":"U. Rao, D. Narayanan","doi":"10.1136/HEARTJNL-2020-BCS.46","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.46","url":null,"abstract":"Aim Dyslipidaemia is a major risk factor for development and progression of coronary arteriosclerosis. Low density lipoprotein-Cholesterol (LDL-C) concentration is strongly associated with an increase in atherosclerotic cardiovascular disease (CVD). Targeting LDL-C earlier significantly decreases the lifetime risk of CVD. Our main aim was to evaluate the management of lipids in high risk CVD patients admitted for PCI procedures at our tertiary centre. Methods This was a retrospective study performed over a period of 1 month which included all the patients admitted for urgent, elective and primary PCI(PPCI) in our centre and they were followed up to 12 months thereafter. A detailed case note evaluation was performed including discharge summaries. Data collected include demographics, risk factors, reason for admission, procedure performed, lipid parameters and management, family history and follow up including outpatient (OP) appointments or admissions for repeat procedures, lipid levels and mortality over 12 months. Definitions: Treatment to target LDL-C was defined as LDL-C ≤ 2 mmol/L. Lipid thresholds for consideration of Simon Broome criteria for Familial Hypercholesterolaemia - Total cholesterol ≥ 7.5 mmol/L and /or LDL-C a level ≥ 4.9 mmol/L (pre-treatment). Results A total of 101 patients (69 Male; 32 Female) were admitted for PCI procedures with a mean age of 65 years (42-90). They had multiple co-morbidities. Majority were admitted for PPCI (58,57.4%) followed by NSTEMI (23,22.4%) and elective (20,19.8%) procedures Lipid profiles were unavailable for review in (32,29.6%) patients (PPCI :14, NSTEMI :10 and electives:8). 37 patients had a Total Cholesterol of >5mmol/l(5-6.9) and 57 (56.4%) had an LDL level of > 2mmol/l (Mean LDL PPCI ,36: 3.1, NSTEMI ,10:3.1; Electives,9:3.3). At the time of discharge,97 patients were on statins, of whom 9 were on sub-optimum dose of statin and 4 statin naive. 5 patients fulfilled Simon Broome criteria for consideration of Familial Hypercholesterolaemia. High LDL group: In this group 65% had lipid profile tested for the first time at index admission and the rest (35%) though on statins had not been treated to target. Discharge summaries had insufficient information on family history of premature CAD, lipids on admission or treatment targets for primary care. As per our standard protocol, all patients post-PPCI and NSTEMI had one consultation in secondary care prior to being discharged to primary care. 12 months post PCI: Treatment target was achieved in 8(14%) patients, 7(12%) were not treated to target and 42(73%) of patients had no lipids available for comparison for the trend post-discharge. 27 (47%) events were recorded which included PCI:5; CABG:4; Angiograms:2, Death:4; PVD (peripheral vascular disease):4; Stroke:2; Permanent pacemaker insertion:1; OP appointments:4 (chest pain, breathlessness) At 12 months, 4 (7%) were not on any statins and 7 (12%) were on sub-optimum dose of statins. There were no r","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"33 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":"122032439","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}