Acute Coronary Syndromes & Interventional Cardiology最新文献

{"title":"40 Saphenous vein graft radio-opaque markers and femoral access reduce contrast use in coronary angiography and graft studies","authors":"Elshaddai Game, V. Cheng, M. Dorsch, A. Raza, P. Cheung, B. Tyrrell, N. Brass","doi":"10.1136/HEARTJNL-2020-BCS.40","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.40","url":null,"abstract":"Background Saphenous vein grafts (SVG) are often employed for bypass in addition to internal mammary arteries during CABG operations. Despite the improvement in surgical technique most post CABG patients will require additional coronary artery catheterization in their lifetimes. Radio-opaque markers for SVGs are safe and easy to implant during the CABG operation. The markers were found to have no impact on long term graft patency. However, these markers should make repeat coronary angiography and graft studies easier and allow these procedures to be performed with less contrast thereby reducing the risk of contrast induced nephropathy. Methods We systematically reviewed consecutive diagnostic coronary angiograms of all patients with previous CABG at a single large Canadian interventional centre. Basic demographic and clinical data, access site, number of grafts, operator, and amount of contrast used were recorded for analysis. Predictors of amount of contrast used were identified using multiple regression analysis with stepwise elimination of factors utilizing SPSS software. Results Between Jan 2016 and May 2019, 746 diagnostic coronary angiograms and graft studies were performed. 328 cases were excluded because the patients had additional procedures done in the same setting. Mean age of patients was 71 (9) years, 12 % were female. 41% of patients had a clip inserted at the time of their bypass surgery. 15% of patients had a single vein graft used at the time of surgery, 43% had two vein grafts and 42% of patients three or more grafts. 56 % of the procedures were performed via the femoral route. Independent predictors of contrast volume used were access site (187 (64) ml for radial vs 170 (60) ml for femoral), number of grafts used (+ 24 ml per additional graft) and use of radio-opaque markers during CV surgery (166 (54) ml with surgical clips versus 186 (66) ml without clips). Age, gender and operator were not predictive of the amount of contrast used. Conclusions Positioning graft markers at the time of CV surgery can significantly reduce the contrast requirement for subsequent cardiac catheterisation. Even in a high volume radial centre further reductions of contrast use can be achieved by using femoral rather than radial access. Conflict of Interest None","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"2016 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":"127351092","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":"36 Higher serum vitamin D levels are associated with higher physical health-related quality of life in high-risk, older adults following non-st elevation acute coronary syndrome undergoing invasive care","authors":"Benjamin Beska, D. Neely, V. Kunadian","doi":"10.1136/HEARTJNL-2020-BCS.36","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.36","url":null,"abstract":"Introduction A large proportion of older patients with cardiovascular disease have low serum vitamin D levels. Such deficiency states have been linked with lower health-related quality of life (HRQoL). The Improve Cardiovascular Outcomes in High Risk PatieNts (ICON-1) study (NCT01933581) has previously demonstrated that serum vitamin D levels do not predict major adverse cardiovascular events (MACE) at 1 year in high-risk older adults being managed invasively for non-ST elevation acute coronary syndrome (NSTEACS). However, the relationship between serum vitamin D levels and HRQoL in older patients with NSTEACS is unclear. This further analysis of the ICON-1 cohort aims to investigate the relationship between serum vitamin D and HRQoL in high-risk, older adults managed invasively for NSTEACS. Methods Patients aged ≥75 years presenting with NSTEACS (n=293) were recruited to the multi-centre prospective cohort ICON-1 study. Baseline serum total vitamin D was measured by electrochemiluminescent immunoassay prior to coronary angiography, split into two groups by the median for analysis. HRQoL was assessed within 24 hours post-procedure using the Short Form 36 Health Survey (SF-36) (License Number QM033917), values reported as norm-based scores. At one-year follow-up SF-36 scores were repeated. SF-36 consists of 4 physical subscales, summarised as Physical Component Summary. Statistical differences between groups were assessed with Kruskal-Wallis testing. Multi-variate linear regression was used to probe the impact of serum vitamin D on HRQoL adjusted for the a priori co-variates of age and sex. Results Mean age was 80.4±4.8 years (61.8% male). Baseline median vitamin D was 29.0 [IQR 16.0–53.0] nmol/L. Patients were split by the median baseline vitamin D: low serum vitamin D (n=147, median 16.0 [IQR 12.0–23.0] nmol/L) and high serum vitamin D (n=146, median 53.0 [IQR 40.0–75.0] nmol/L). Both at baseline and at 1 year, those with a high serum vitamin D had significant higher scores in physical functioning (P Conclusions There is an association, independent of age and sex, between serum vitamin D and physical health-related quality of life at both presentation and at 1-year follow-up after invasive management of NSTEACS in high-risk older adults. Although vitamin D deficiency has not been shown to predict MACE, it may play a plausible role in the significant morbidity experienced by older adults with cardiovascular disease. Conflict of Interest None to declare","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":"130628875","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":"49 Dapt score: can we apply it to practice and identify those at risk of recurrent major adverse cardiovascular events?","authors":"S. Fhadil, Jannelle Marriott, P. Wright, S. Antoniou","doi":"10.1136/HEARTJNL-2020-BCS.49","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.49","url":null,"abstract":"Introduction Approximately 20% of patients suffer from major adverse cardiovascular events (MACE), within 5 years of stopping dual antiplatelet therapy (DAPT), following an acute coronary syndrome (ACS) event. As such, prolonged DAPT, with aspirin and ticagrelor, has shown significant reductions in MACE, offset by an increased risk of major bleeding. The DAPT score offers a means to predict those who would derive benefit from prolonged therapy. We sought to evaluate applicability of the DAPT score to our population in a tertiary heart attack unit. Method Anonymised data was reviewed as part of a larger quality improvement initiative associated with management of ACS. ACS was defined according to standard international criteria. DAPT scores were calculated and compared against our cohort of patients who would have met criteria for prolonged DAPT as per PEGASUS. Patients were excluded if they were at high risk of bleeding, as assessed using CRUSADE scores ≥ 41, or required anticoagulation. Results Between September to December 2019, 304 patients presented with ACS, of which 89 patients were excluded due to high bleeding risk (56) and concomitant anticoagulation (33). 38 patients were excluded as there was insufficient data to calculate DAPT scores. Of the remaining 177 patients, 55% met PEGASUS criteria for prolonged DAPT, largely driven by multivessel disease (66%). When undertaking the DAPT score, this suggested benefit from prolonged DAPT in 53% of patients meeting PEGASUS criteria. Conclusion Applying the DAPT score identified just upward of 50% of patients that may benefit from prolonged DAPT. Patients over the age of 65 is a key inclusion criterion in PEGASUS that derived benefit from prolonged therapy; however, is also a risk factor for major bleeding and as such, a negative predictor factor in the DAPT score. This may contribute to the 50% of patients who met criteria for prolonged DAPT as per PEGASUS but would not warrant prolonged DAPT when applying the DAPT score. This review suggests that risk stratification through use of a suitable risk tool (DAPT score) may help to widen the risk benefit of prolonged DAPT by excluding those likely to bleed while ensuring patients at highest ischemic risk are appropriately targeted. Conflict of Interest None","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"7 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":"114248986","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":"51 Adherence to cardiologist recommendations regarding extended duration of ticagrelor for patients undergoing PCI for myocardial infarction","authors":"Kok Weng Ow, William A. E. Parker, E. Onwordi, R. Storey","doi":"10.1136/HEARTJNL-2020-BCS.51","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.51","url":null,"abstract":"Introduction Ticagrelor is a potent, reversible, platelet P2Y12 receptor antagonist. Patients with a history of a myocardial infarction (MI) have a persistently increased risk for future ischaemic events. PEGASUS-TIMI 54 demonstrated that patients with a history of MI, coupled with a high risk of ischaemic events and absence of conditions associated with excessive bleeding risk, may benefit from extended duration of dual antiplatelet therapy (DAPT) with aspirin 75-150mg once daily and ticagrelor 60mg twice daily (BD) beyond the first year after MI. This strategy is endorsed by current European Society of Cardiology guidelines and approved by NICE. Cardiologists may recommend this strategy but it remains unclear how often this is followed in a primary care setting. Methods A list of consecutive patients who underwent percutaneous coronary intervention (PCI) between March 2015 to August 2018, performed by a single clinician was obtained. The discharge summaries of these patients were evaluated to determine whether they had been treated for MI and received the recommendation of extended DAPT duration with ticagrelor 60mg BD. The summary care records of patients who were found to have received the recommendation of extended DAPT duration were interrogated to determine compliance with the recommendation. Reasons for non-adherence were recorded if available. Results 399 patients underwent PCI during the study period. 323 patients (81%) underwent PCI as part of their management for an acute coronary syndrome (ACS) while 76 patients (19%) underwent PCI as an elective case. Of 323 ACS patients, 6 patients died during their ACS hospital admission and were excluded. 61 out of 317 ACS patients (19%) and 3 out of 76 (4%) elective patients were recommended extended duration of ticagrelor with down-titration from 90mg BD to 60mg BD after the first year of treatment. On interrogation of the summary care record more than 1 year after hospital discharge, adherence to the recommendations was observed in 38 out of 61 ACS patients (62%) and 3 elective patients (100%). 23 out of 61 ACS patients (38%) did not receive the recommended lower dose of 60mg BD: 1 patient remained on ticagrelor 90mg BD and required reminder to down titrate; 1 patient was admitted for another ACS and restarted 1 year of ticagrelor 90mg BD; 2 patients discontinued ticagrelor due to rash or breathlessness; and 2 patients received an alternative P2Y12 inhibitor (1 prasugrel, 1 clopidogrel). The remaining 17 patients (28% of patients with recommendation for extended therapy) had no documentation why ticagrelor 60mg BD was not continued. Conclusions Treatment recommendations for extended DAPT in a discharge letter leads to reasonable levels of adherence but further work is required to determine if improved long-term communication between cardiologists and primary care physicians leads to better care and clinical outcomes following myocardial infarction. Conflict of Interest None","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"30 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":"128683361","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":"45 Feasibility and immediate safety of distal trans radial access in coronary intervention: a UK centre experience","authors":"S. Dutta, K. Adnan, H. Hashim, V. Venugopal, Juan Fernández","doi":"10.1136/HEARTJNL-2020-BCS.45","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.45","url":null,"abstract":"Background and Aim Over the last few years, there has been a drive towards using distal trans-radial (dTRA) access for coronary angiography and interventional procedures. The suggested benefits are better radial arterial patency post-procedure, relatively rapid haemostasis and improved ergonomics for left radial access. The findings from observational studies are promising and a large multicenter randomized trial is now underway. However, so far there is no published data from any centers in the UK about its use and safety. Due to the various potential benefits, this approach was used in our institute which is a busy District General Hospital in the UK providing tertiary cardiology service to a population of 750,000. Data was collected prospectively for the initial 100 cases to assess feasibility and immediate safety of dTRA. Methods Patients included were from acute and elective cases under the care of 2 consultants where a strong distal radial pulse was palpable. Operators included 2 consultants, 1 senior interventional fellow and 2 Specialty registrars. Arterial puncture was performed using seldinger technique by manual palpation; use of ultrasound was optional. 6 Fr radial glide sheath was used for all cases. Haemostasis was achieved either by a modified conventional TR band or dedicated TR band for dTRA. A proforma was designed to capture relevant data prospectively. Results are presented in percentage. Results Table 1 shows the important baseline characteristics and findings of this study. Puncture for dTRA was successful in 96% cases. In 2 cases, there was cross-over to contralateral dTRA due to severe spasm and radial artery tortuosity. In 4 cases, dTRA access was unsuccessful either due to failed puncture or inability to advance the guidewire and operator crossed-over to conventional radial route (Figure 1). Radial spasm was experienced by 7 patients in total. There were no immediate major complications. 3 patients developed small haematoma due to displacement of the modified conventional TR band which resolved by manual compression. This issue did not recur after using dedicated dTRA TR bands. Conclusions This small study demonstrates that the dTRA route might be a safe and effective alternative to the conventional radial route with high success rate without any immediate major complications. The extent of spasm and small haematoma noted in this study is not different from using conventional approach. The current literature suggests several potential benefits of this access route but data from large randomised trials are required to assess long term safety and efficacy to decide whether this should become the preferred option or to be used in selected cases such as for left radial access and in patient who might require a fistula for dialysis. Conflict of Interest None","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"6 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":"132003409","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":"35 The (troponin) – manchester acute coronary syndrome rules in the emergency department systematic review and meta-analysis","authors":"G. McDowell, A. Mcmullen, M. Almashali, C. Austin, N. Dempsey-Hibbert, M. Stout, M. Slevin, R. Body","doi":"10.1136/HEARTJNL-2020-BCS.35","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.35","url":null,"abstract":"Introduction Chest pain is one of the most common reasons for emergency hospital admission. The Manchester Acute Coronary Syndrome (MACS), and subsequent Troponin only-MACS (T-MACS), rule risk stratify patients presenting with chest pain into 4 groups (Very low risk, low risk, moderate risk and high risk) with the aim of enabling immediate rule-in or rule-out of acute coronary syndromes in the ED. Low risk patients can be safely discharged from the ED with low probability of major adverse cardiac events (MACE) without further testing. We aimed to summarise the evidence for the use of the (T)MACS rules in the immediate rule-out of ACS in the ED in the very low risk category by undertaking a systematic review and meta-analysis. Methods We performed a keyword literature search of MEDLINE, EMBASE and Web of Science using MACS, T-MACS and acute coronary syndrome as search terms. After removal of duplicates, 2 authors reviewed the title and abstract to shortlist for full text review. Data was extracted independently by 2 authors, with disagreement resolved by discussion. Outcomes included were prevalent AMI and incident MACE. Quality assessment was performed using a QUADAS-2 model and meta-analysis was performed using STATA 15 running the METANDI and MIDAS commands. Results 9 studies were included (5 reporting T-MACS and 4 MACS). Data showing the summary AUC, combined sensitivity, and specificity for prevalent AMI and incident MACE in the very low risk (safe for immediate discharge) strata are shown in Table 1. Representative Forrest Plots for MACS and T-MACS are shown in figures 1 and 2 respectfully. Conclusion The MACS and T-MACS rules provide an accurate tool to identify a low risk chest pain population safe for immediate discharge from ED without the need for followup biomarker testing, with high sensitivity for AMI and ACS. Conflict of Interest None","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"37 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":"128841139","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":"41 Use of sirolimus-coated balloon in de novo small vessel coronary lesions; mid-term follow-up from a two-centre registry","authors":"Boyang Liu, Sophia Khattak, M. Ishaq, S. Athukorala, R. Watkin, K. Lee, G. Pulikal, J. Ment, G. Bhatia, B. Freestone, M. Pitt, S. Basavarajaiah","doi":"10.1136/heartjnl-2020-bcs.41","DOIUrl":"https://doi.org/10.1136/heartjnl-2020-bcs.41","url":null,"abstract":"","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"75 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":"127217982","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":"30 A case control study of percutaneous coronary intervention in spontaneous coronary artery dissection","authors":"D. Kotecha, A. Premawardhana, M. García-Guimarães, D. Pellegrini, Jan Ziaullah, T. Bastante, A. Wood, A. Maas, R. Geuns, F. Alfonso, D. Adlam","doi":"10.1136/HEARTJNL-2020-BCS.30","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.30","url":null,"abstract":"Background Spontaneous Coronary Artery Dissection (SCAD) has emerged as an important cause of acute coronary syndrome (ACS) particularly in young-middle aged women. The mechanism of coronary obstruction, acute vessel response to percutaneous coronary intervention (PCI) and natural course of conservatively managed lesions differs significantly in SCAD when compared with atherosclerotic ACS. Revascularization is challenging due to an underlying disrupted and friable coronary vessel wall leading to widely reported worse outcomes than for atherosclerotic coronary disease. Therefore, a conservative approach where possible is favoured however in some cases haemodynamic instability, ongoing ischaemia and reduced distal flow mandates consideration of revascularization. Purpose To compare SCAD survivors managed with PCI or conservatively in terms of presentation characteristics, complications and long-term outcomes. Methodology and Results Two hundred and twenty-five angiographically confirmed SCAD survivors (95% female, 47±9.7yrs) who underwent PCI were compared in a case control study with two hundred and twenty-five angiographically confirmed SCAD survivors (92% female, 49±9.9yrs) who were conservatively managed. Patients were recruited from UK, Spanish and Dutch SCAD registries and both groups were well matched in terms of baseline demographics. Those treated with PCI were more likely to present with proximal SCAD (30.8% vs 7.6% P Analysis of all cases reveal complications in 85 (38.8%). SCAD lesion length was associated with presence of complications (P=0.025). However, when assessed for the clinical significance of that complication (defined by a reduction in flow in a proximal/mid vessel, stent extension into left main stem, iatrogenic dissection requiring PCI and CABG as a consequence of PCI), only 26 cases (11.6%) met seriousness criteria with iatrogenic dissection accounting for nearly half (44.6%). There was a non-significant trend towards major adverse cardiovascular events (MACE) occurring more frequently in those undergoing PCI (18 % vs 11% P=0.067) driven by revascularisation (5% vs 1% P=0.036). Median follow up was 2.7 years. Conclusions PCI in SCAD is most often performed in higher risk cases. Whilst overall complication rates were similar to those widely reported, clinically significant complications were uncommon and most interventions in this context were associated with improved angiographic endpoints. Conflict of Interest NA","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":"126745462","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":"32 Does ‘real-world’ mechanical circulatory support match randomised controlled trials? The United Kingdom impella (Ukpella) registry","authors":"M. Ryan, K. O’Gallagher, V. Vetrugno, S. Thirunavukarasu, N. Briceno, Sohail Q Khan, B. Clapp, C. Hendry, I. Webb, J. Townend, Y. Al-Najjar, J. Byrne, F. Fath-ordoubadi, J. Hill, S. Redwood, P. Ludman, D. Perera","doi":"10.1136/HEARTJNL-2020-BCS.32","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.32","url":null,"abstract":"Background Impella utilisation is increasing but reimbursement and usage patterns vary significantly around the world. The National Institute for Health and Care Excellence (NICE) recently approved the use of Impella for high-risk percutaneous coronary intervention (PCI) in centres with specific expertise in the use of mechanical circulatory support and with specific arrangements for governance, audit and consent in place. Hypothesis: In the United Kingdom (UK), due to increased selection, Impel is used in higher-risk cases than in randomised controlled trials (RCT). Methods All patients undergoing Impella implants between 2008 - 2019 in the four highest volume UK Impella centres (St. Thomas’ Hospital and King’s College Hospital, London; Queen Elizabeth Hospital, Birmingham; Manchester Royal Infirmary, Manchester) were included. Demographic, clinical, procedural and outcome data were extracted from electronic health records. Patients were stratified by the presence of cardiogenic shock at presentation. Pre-procedural characteristics and outcomes (30-day and 1-year all-cause mortality) were compared to the BCIS-1, PROTECT-2 and IABP-SHOCK2 trial cohorts respectively. Multivariate logistic regression analysis was used to identify independent predictors of complications. Continuous data are presented as mean ± SD or median (IQR) depending on normality. Results Two-hundred and thirty-four patients were included. The indication was cardiogenic shock in 83 (35.5%) and high-risk PCI in 146 (62.4%); of the latter 58.9% had acute coronary syndromes and 41.1% were elective) and bailout in 2.1%. PCI was performed via femoral access in 55.6%. Patients undergoing high-risk PCI were older than those with cardiogenic shock (73.3 ± 10.8 years vs. 59.9 ± 14.0 years, p High-risk PCI patients in UKpella had a higher BCIS-Jeopardy Score, more left main disease and underwent more calcium modification but had a higher left ventricular ejection fraction than in RCTs. UKpella high-risk PCI 30-day and 1-year mortality was 16.4% and 30.7% respectively, significantly higher than in RCTs (Table 1). Cardiogenic shock patients in UKpella had a higher 30-day mortality than RCT patients (56.1% versus 40.5%, p = 0.034) but 1-year mortality was similar. Figure 1 demonstrates mortality over follow up. Major bleeding (Bleeding Academic Research Consortium scale 3-5) occurred in around 20% of both shock and high-risk PCI cases. Femoral access for PCI was related to the risk of bleeding in high-risk PCI (odds ratio 2.65 [1.04-6.74], p=0.040) but not in cardiogenic shock. Vascular complications occurred more frequently in shock than high-risk cases (13.6% vs. 9.0%). Figure 2 shows the rates of implants, bleeding and vascular complications. Conclusions Patients selected for Impella in the UK are a group with a particularly adverse prognosis, in terms of baseline predictors of risk as well as higher short- and medium-term mortality than in RCTs. Bleeding and vascular complications occur","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"46 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":"125687829","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":"48 Predictors of revascularisation in patients with typical angina presenting to the rapid access chest pain clinic","authors":"A. Gall, J. Mora, G. Connolly, Mavin N. Kashyap, A. Dastidar, Nikhil Joshi, S. Dorman, K. Silva, J. Strange, T. Johnson, E. Sammut","doi":"10.1136/HEARTJNL-2020-BCS.48","DOIUrl":"https://doi.org/10.1136/HEARTJNL-2020-BCS.48","url":null,"abstract":"Background In the UK, the rapid access chest pain clinic (RACPC) is increasingly used as an open access resource for patients with chest pain presenting to GP surgeries or Emergency Departments. Patients are not uncommonly admitted for inpatient investigation and treatment from RACPC. This study aimed to assess the outcome of patients presenting to our RACPC and look for predictors of acute coronary syndrome and revascularisation. Methods Electronic notes of all patients assessed in our high-volume Rapid Access Chest Pain Clinic (RACPC) within a 12-month period (2018–19) were reviewed. Patients admitted directly from RACPC with ACS were compared to those felt to have typical anginal symptoms who were managed on an outpatient basis. Information on demographics, symptoms, initial investigations and management were obtained. Results 2416 patients were assessed in the RACPC during the study period. Of these, 378 (15.6%) presented with symptoms thought to represent typical anginal chest pain (CP), 1357 (56.2%) had atypical CP and 681 (28.2%) had non-anginal CP. Patients with typical angina had a median age of 68 years, 121 (22%) female, 216 (57%) had high cholesterol, 86 (23%) had diabetes, 220 (58%) had hypertension, 175 (46%) had a family history, and 218 (58%) were current or ex-smokers. The mean number of risk factors in those presenting with typical CP was 2.7. See Table 1. On univariate analysis regression, gender, ACS presentation, ischaemic ECG changes and regional wall motion abnormality on echocardiogram were predictors of revascularisation, however on multivariate analysis only gender (OR 2.447, CI 1.336-4.480, p= Conclusion The rapid access chest pain clinic is a valuable resource for prompt assessment of patients with suspected cardiac pain. Our experience suggests patients seen with typical angina represent a high-risk group with high rates of revascularisation, particularly in those with suspected ACS. Within our cohort, predictors of revascularisation were ACS presentation and male gender. Conflict of Interest None","PeriodicalId":102313,"journal":{"name":"Acute Coronary Syndromes & Interventional Cardiology","volume":"34 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":"124932409","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}