Primary percutaneous coronary intervention (PPCI) in ST-elevation myocardial infarction (STEMI): Use...

AB

ST

RA

CT

S

S228 Heart, Lung and CirculationAbstracts 2009;18S:S1–S286

MI within 1 year.Conclusion: This suggests that PCI for emergency AMI

involving the LMCA is a feasible and effective option inthis high-risk subset.

doi:10.1016/j.hlc.2009.05.562

517PRIMARY PERCUTANEOUS CORONARY INTER-VENTION (PPCI) IN ST-ELEVATION MYOCARDIALINFARCTION (STEMI): USE OF PERI-PROCEDURALGLYCOPROTEIN IIB/IIIA INHIBITORS (GPIIB/IIIA)IN PATIENTS ALREADY PRE-TREATED WITHCLOPIDOGREL

Michael Mok, Alexander J. Black, Andrew E. Ajani,Stephen J. Duffy, Nick Adrianopoulos, Angela L.Brennan, Christopher M. Reid, Gishel New, JeanetteDyson, Thomas Yip, on behalf of the MelbourneInterventional Group (MIG)

Background: Adjuvant GPIIb/IIIa and clopidogrel haveshown benefit in STEMI. It is unclear whether there isadditional benefit from periprocedural GPIIb/IIIa (PP-GPIIb/IIIa) in STEMI patients undergoing PPCI who havehad clopidogrel pre-treatment.

Methods: 234 consecutive patients with STEMI whounderwent PPCI and had clopidogrel pre-treatment wereidentified in the multicentre MIG registry between April2004 and October 2007. Clopidogrel pre-treatment isdefined as any use of clopidogrel pre-PPCI (with or with-out loading). PP-GPIIb/IIIa use is defined as GPIIb/IIIause prior to, during or after PPCI. Comparison of PP-GPIIb/IIIa (n = 177, 75.6%) versus no PP-GPIIb/IIIa (n = 57,24.4%) was made in terms of baseline characteristics,MACE at 30 days and 1 year, and bleeding complications.

Results: The two groups were well matched in base-line characteristics. No differences in 30 day and 1 yearoutcome were detected (p = NS).

PP-GPIIb/IIIa(%, 95% CI)

No PP-GPIIb/IIIa(%, 95% CI)

30 day MACE 6.8 (3.8–11.6) 7.0 (2.3–17.2)Death 4.0 (1.8–8.1) 0 (0)Re-infarction 0.6 (0–3.5) 3.5 (0.3–12.6)TVR 2.8 (1.0–6.6) 5.3 (1.2–14.9)

1 year MACE 11.9 (7.8–17.5) 14.0 (7.0–25.6)Death 6.2 (3.4–10.9) 5.3 (1.2–14.9)Re-infarction 2.3 (0.7–5.9) 5.3 (1.2–14.9)TVR 5.1 (2.6–9.5) 7.0 (2.3–17.2)

In-hospital bleeding 2.8 (1.0–6.6) 5.3 (1.2–14.9)

Conclusion: In this observational study, patients withSTEMI undergoing PPCI that have had clopidogrel pre-treatment displayed no additional benefits or bleeding riskwith peri-procedural GPIIb/IIIa.

doi:10.1016/j.hlc.2009.05.563

518PRIMARY PERCUTANEOUS CORONARY INTERVEN-TION IS ASSOCIATED WITH LESS MYOCARDIALINJURY IN AN OLDER POPULATION

C. Yu, R. McMahon, A. Beech, H. Nojoumian, S. Hoo, P.Hansen, H. Rasmussen, M. Ward, G. Nelson, R. Bhindi

Royal North Shore Hospital, Australia

Background: Primary Percutaneous Coronary Interven-tion (PCI) for suspected Acute Myocardial Infarction(AMI) is a well-validated treatment strategy in youngerpatients. However, there is little evidence in terms ofsafety data or prognostic benefit in the older age group.We hypothesised that this sub-group may represent aspecific cohort whose mode of presentation and subse-quent degree of myocardial damage is different to that ofyounger patients.

Methods: We examined all patients who presented toour institution with suspected AMI to identify (a) age ≥80yrs on admission, (b) biochemical evidence of significantmyocardial injury (CK), (c) time of symptom onset to reper-fusion of the infarct related artery (IRA).

Results: Between May 2005 and February 2009, 1297patients underwent coronary angiography for suspectedAMI. Complete data was missing in 195 patients. 264patients were found to have normal or minor disease intheir coronary arteries and were excluded from this study.Of the remaining 838 patients, 704 (84%) were aged <80yrs and 134 (16%) were aged ≥80 yrs. The mean CK val-ues of each group were 2008 U/L and 1476 U/L respectively(p ≤ 0.001). The average times of symptom onset to reper-fusion of the IRA were 56.8 min and 81.9 min respectively(p = 0.097).

Conclusions: Primary PCI is performed in a large num-ber of patients aged ≥80 yrs. This group has a trendtowards a longer reperfusion time. They also have asignificant reduction in myocardial injury. One possi-ble mechanism underlying this is the effect of chronicischaemia and preconditioning of “at-risk” myocardium.

doi:10.1016/j.hlc.2009.05.564

519PROCEDURAL GLYCOPROTEIN IIB/IIIA INHIBITOR(GPIIB/IIIA) USE IN PATIENTS WITH ST-ELEVATIONMYOCARDIAL INFRACTION (STEMI) WHOUNDERGO PRIMARY PERCUTANEOUS CORONARYINTERVENTION (PPCI) WITHOUT CLOPIDOGRELPRETREATMENT

Michael Mok, Alexander J. Black, David Clark, AndrewE. Ajani, Stephen J. Duffy, James A. Black, Gishel New,Christopher M. Reid, Nick Adrianopoulos, Thomas Yip,on behalf of the Melbourne Interventional Group (MIG)

Background: Peri-procedural administration ofGPIIb/IIIa in STEMI patients undergoing PPCI improvesoutcomes compared with placebo.

Methods: Using the multi-centre MIG registry, weanalysed early and intermediate-term outcome in 848