The American Journal of Cardiology® | October 20-25, 2007 | TCT Abstracts/ORAL 29L

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SMONDAY, OCTOBER 22, 2007, 8:00 AM - 12:00 PM

http://www.aievolution.com/tct0701/

Confrontational Angioplasty - Fiercely Debating the Issues

Room 151AB

Monday, October 22, 2007, 8:00 am - 12:00 noon

(Abstract Nos. 73-76)

TCT-73

Late and Very Late Stent Thrombosis following Elective Drug Eluting Stent Implantation in Unprotected Left Main Coronary Artery: a Multicentre Registry

Alaide Chieffo1, Young H Kim2, Emanuele Meliga3, Seung J Park2, Marco Valgimigli3, Seong W Park2, Duk W Park2, Renata Rogacka1, Valeria Magni1, Flavio Airoldi1, Matteo Montorfano1, Patrick Serruys3, Antonio Colombo1 1San Raffaele Hospital, Milano, Italy2Asan Medical Ctr, Seoul, Republic of Korea3Erasmus Medical Ctr, Thoraxcenter, Rotterdam, The Netherlands

Background: Some concerns have been recently raised regarding the risk of late and very late stent thrombosis (ST).Methods: All consecutive patients (pts) who had sirolimus (SES) or paclitaxel-eluting stent (PES) electively implanted in de novo lesions on LMCA between

Results: 534 consecutive patients were analyzed. One-hundred and thirty-eight (25.8%) patients were diabetics, 171 (32.0%) unstable angina, mean age 62.4±11.4 years, EF 54.1± 11.2 %. Distal location occurred in 417 (78.0%) of the patients. Fifty-seven (10.6%) patients had a peri-procedural myocardial infarction. At 1067 (775.3-1277) day clinical follow-up, 32 (5.9%) patients died: 23 (4.3%) were adjudicated as cardiac. One patient had an acute ST (with cardiogenic shock

at 3 months while on antiplatelet therapy). None of the patients had a very late

Conclusion: Treatment of LMCA stenosis with DES appears safe with a

3 years.n=534 Probable PossibleAcute 1(0.2%) 0 0Sub-acute 1(0.2%) 3(0.6%) 0Late 1(0.2%) 0 4(0.7%)Very Late 0 0 9(0.7%)Total 3(0.6) 3(0.6%) 13(2.4%)

TCT-74

Dual Antiplatelet Therapy following Percutaneous Coronary Intervention with Stent Implantation in Patients on Chronic Oral Anticoagulation

Renata Rogacka, Alaide Chieffo, Iassen Michev, Flavio Airoldi, Azeem Latib, Matteo Montorfano, Mauro Carlino, John Cosgrave, Alfredo Castelli, Cosmo Godino, Valeria Magni, Antonio Colombo San Raffaele Hospital, Milan, Italy

Background: It is well established that antiplatelet therapy with aspirin ad thienopiridines is required following percutaneous coronary intervention (PCI) with stent implantation. Some patients have also indication for long-term AC. The optimal antithrombotic strategy following PCI in such patients is unclear. The objective was to evaluate the safety of dual antiplatelet therapy in patients in whom long-term anticoagulation (AC) with warfarin is recommended.

Methods: All consecutive patients who underwent PCI with stent implantation

thienopyridines and AC with warfarin) were analyzed.Results: One-hundred and twenty-seven patients with 224 lesions: 86.6% males, mean age 69.9±8.8 years were included in the study. Drug-eluting stents (DES) were positioned in 71 (55.9%) and bare metal stent (BMS) in

for AC treatment, followed by prosthetic valves (12.4%) and mural left ventricular (LV) thrombus (9.1%). Average risk of thromboembolic events in the subgroup with AF was 1.79 ± 1.23 according to CHADS2 score. The mean triple therapy duration was 5.6±4.6 and clinical follow-up 21.0±19.8 months. During the triple therapy period, 6 patients (4.7%) developed major bleeding

differences between DES and BMS were observed in the incidence of major (respectively 5.6% vs. 3.8%, p=1.0) and minor bleeding (respectively 1.4% vs. 3.8%, p=0.57) and mortality (respectively 5.6% vs. 1.9%, p=0.39). Four patients died in DES group: 3 of major bleeding complications and one of ischemic stroke. The only death in the BMS group was due to subarachnoid

vessel revascularization (14.1% vs. 28.3%, p=0.041).Conclusion: While on triple therapy, major bleeding complications occurred in 4.7% of patients, half of them were lethal and most (67%) occurred within

TCT-75

we pushing the limits?

Abid Assali, Igal Teplitsky, Hana Vaknin-Assa, Shmuel Fuchs, Nili Zafrir, Alejandro Solodki, Nurit Shor, Alexander Battler, Ran Kornowski Rabin Medical Center, Ramat Gan, Israel

Background: Older age has been associated with adverse outcomes in patients undergoing percutaneous coronary intervention (PCI). As PCI technology evolves and the Israel population becomes proportionally older, assessment of PCI in very older age groups is essential.Aims:of age] in contemporary practice.Methods: years who underwent PCI due to severe refractory angina and/or MI.Results: Mean age 92±2 years [range 90-101] and 62% male. The clinical presentation was ACS in 60% and AMI in 22%. 28% had DM and 27% of patients had renal failure [Cr>1.2mg%]. Two or triple vessel disease was present in 85% of cases. Angiographic success was achieved in 92% of patients. One patient (1.5%) had post-PCI CVA. One month mortality was 14% and increased to 19% at six months. Factors related to mortality by univariate analysis are shown in Table:

r PClinical presentation [emergent PCI] 0.3 0.002Systolic BP -0.04 0.003LVEF -0.4 0.005DM 0.6 0.001Renal failure 0.3 0.04

-0.3 0.002

Conclusion: is feasible with good procedural success rate; 2) 30-days death rate is 14% and related to clinical presentation and to the presence of DM or renal failure, 3) Patient selection is an important factor to optimizing procedural success.

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30L The American Journal of Cardiology® | October 20-25, 2007 | TCT Abstracts/ORAL

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SMONDAY, OCTOBER 22, 2007, 8:00 AM - 12:00 PM

http://www.aievolution.com/tct0701/

TCT-76

Transfer of ST-Elevation Myocardial Infarction Patients with Cardiogenic Shock for Primary Percutaneous Coronary Intervention

Timothy D Henry, Katie M Menssen, Sue Duval, Barbara T Unger, Marc C Newell, Daniel L Lips, Yale L Wang, Michael R Mooney, Wes R Pedersen, Anil K Poulose, David M Larson Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN

Background: ACC/AHA guidelines recommend early revascularization for

transfer to PCI centers despite no data on the outcome of STEMI patients transferred with cardiogenic shock.Methods: We report the results of 1,500 consecutive patients with STEMI transferred to Abbott Northwestern Hospital (Minneapolis, MN) for direct PCI as part of the Level 1 MI integrated transfer program. 12.3% had

years, 14.3%).Results: Patients with cardiogenic shock were more likely to be older, female, hypertensive and to have had a cardiac arrest. As expected, patients with cardiogenic shock had a higher 30 day mortality (26.6% v. 2.1%, p<0.0001),

important predictor of mortality in patients with cardiogenic shock when adjusted for gender, hypertension and cardiac arrest.Conclusion: Our results support the ACC/AHA recommendations for transfer of STEMI patients with cardiogenic shock to PCI centers. Although patients

expected from published trials.

Mortality In-hospital 30-day

AgeCardiogenic Shock (n=184)

No Cardiogenic Shock (n=1,316)

p-valueCardiogenic Shock (n=184)

No Cardiogenic Shock (n=1,316)

p-value

(n=1,170)25/120 (20.8%)

9/1,050 (0.8%)

<0.000126/120 (21.7%)

13/1,050 (1.2%)

<0.0001

>75 (n=330)

21/64 (32.8%)

9/226 (3.4%) <0.000123/64 (35.9%)

14/266 (5.3%) <0.0001