Confrontational Angioplasty- Fiercely Debating the Issues

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  • The American Journal of Cardiology | October 12-17, 2008 | TCT Abstracts/ORAL 47i








    WEDNESDAY, OCTOBER 15, 2008, 2:00 PM - 5:25 PM

    Confrontational Angioplasty- Fiercely Debating the Issues

    Room 151AB

    Wednesday, October 15, 2008, 2:00 pm - 5:25 pm

    (Abstracts Nos 99-102)



    Helen Parise1, Roxana Mehran1, Bernhard Witzenbichler2, Giulio Guagliumi3, Jan Z Peruga4, Bruce R Brodie5, Dariusz Dudek6, Ran Kornowski7, Franz Hartmann8, Bernard J Gersh9, Stuart J Pocock10,George Dangas1, S. Chiu Wong11, Ajay Kirtane1, Alexandra J Lansky1,Gregg W Stone11Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY; 2Charit Campus Benjamin Franklin, Berlin, Germany 3Ospedali Riuniti di Bergamo, Bergamo, Italy 4Silesian Center for Heart for Heart Disease, Lodz, Poland 5LeBauer Cardiovascular Research Foundation and Moses Cone Hospital, Greensboro, NC; 6Jagiellonian University, Krakow, Poland 7Rabin Medical Center, Petach Tikva, Israel 8Universittsklinikum Schleswig-Holstein Campus Lubeck, Lubeck, Germany 9Mayo Clinic, Rochester, MN; 10London School of Hygiene and Tropical Medicine, London, United Kingdom 11New York-Presbyterian Hospital at Columbia University Medical Center and Weill Cornell Medical Center, New York, NY

    Background: MACE and bleeding complications are strongly associated with subsequent mortality in AMI pts treated with anticoagulant and antiplatelet therapies. The relative impact of MACE and bleeding on overall mortality in AMI is not well understood.Objectives and Methods: We sought to assess the relative impact of MACEand major bleeding events on mortality in 3,602 pts with STEMI undergoing primary PCI in the HORIZONS-AMI trial. A multivariable Cox model LGHQWLHGVLJQLFDQWEDVHOLQHSUHGLFWRUVRIPRUWDOLW\ZLWKLQGD\V7KHcomponents of the primary composite endpoint from the trial (reinfarction, LVFKHPLF795VWURNHDQGPDMRUEOHHGLQJZHUHDGGHGWRWKHPRGHODVWLPHupdated covariates. Bleeding was assessed using various bleeding scales.Results: Within 30 days of randomization, there were 93 deaths (2.6%); 26 following a major bleed (non CABG-related) in 238 pts, 10 following a UHLQIDUFWLRQLQSWVIROORZLQJLVFKHPLF795LQSWVDQGIROORZLQJVWURNH LQ SWV ,Q WKH IXOO\ DGMXVWHG PRGHO WLPH XSGDWHG UHLQIDUFWLRQDQG QRQ&$%*PDMRU EOHHGLQJZHUH VLJQLFDQWO\ DVVRFLDWHGZLWK GD\PRUWDOLW\ ZKLOH LVFKHPLF 795 DQG VWURNH ZHUH QRW0DMRU EOHHGLQJ ZDVVWURQJO\DVVRFLDWHGZLWKPRUWDOLW\UHJDUGOHVVRIWKHGHQLWLRQ)LJXUHConclusion: After accounting for baseline predictors, both reinfarction and PDMRUEOHHGLQJKDYHDVLJQLFDQWLPSDFWRQPRUWDOLW\LQWKHUVWGD\VLQWKLVpopulation. While the hazard ratio for reinfarction is nominally higher, there are more deaths attributable to major bleeding as compared to a reinfarction. 7KHVHQGLQJVLOOXVWUDWHWKHLPSRUWDQFHRIUHGXFLQJERWKPDMRUEOHHGLQJDQGreinfarction in preventing deaths after primary PCI for STEMI.

    * Adjusted for baseline covariates and time updated reinfarction.** Interval for attributable deaths calculated from the lower and upper bounds RIWKHFRQGHQFHLQWHUYDOIRUWKH+5*** 88 deaths in 3550 patients.


    Antiplatelet Therapy In Patients With Oral Anticoagulant Undergoing Percutaneous Coronary Stenting : A Prospective Multicenter Registry Stentico

    Martine Gilard1, Didier Blanchard2, Grard Helft3, Didier Carrier4,Hlne Eltchaninoff5, Loic Belle6, Grard Finet7, Herve Le Breton8,Jacques Boschat1, GACI 1CHU la Cavale Blanche, Brest, France 2Clinique St Gatien, Tours, France 3CHU la piti salptrire, Paris, France 4CHU Toulouse, Toulouse, France 5CHU rouen, Rouen, France 6CH Annecy, Annecy, France 7CHU Lyon, Lyon, France 8CHU Rennes, Rennes, France

    Purpose:Patients who are under chronic oral anticoagulant therapy (OAC) and EHQHWIURPDFRURQDU\VWHQWPXVWEHWUHDWHGZLWKDWULSOHWKHUDS\DVVRFLDWLQJaspirin, clopidogrel and OAC. However, the use of this triple therapy increases the rate of adverse outcomes as showed by retrospective studies. This study is WKHUVWSURVSHFWLYHPXOWLFHQWHUUHJLVWU\WKDWHYDOXDWHVVDIHW\DQGHIFDF\RIusing a dual antiplatelet therapy in addition or not to OAC.Methods: From June 2005 to September 2006, all patients with OAC who underwent Percutaneous Coronary Intervention (PCI) in 40 French cath labs were included in the STENTICO registry. Continuation or interruption of OAC was decided for each case by the medical team before performing PCI. We collected initial parameters such as biological data, OAC indication and concomitant therapy surrounding PCI. All clinical outcomes were also collected during hospitalization, at 2 and 12 months after PCI.Results: We prospectively analysed 359 patients (83% males; age 71+/- 10). 2$&LQGLFDWLRQVZHUH$WULDOEULOODWLRQYDOYXODUGLVHDVHVpulmonary embolism and deep venous thrombosis (12.3%) miscellaneous (12.3%). In 234 (65.2%) patients (group 1), OAC was discontinued while dual antiplatelet therapy was mandatory. The mean discontinuation time was 22+/- 31days. In 125 (34.8%) both dual antiplatelet therapy and OACwere continued. The two groups were not statistically different in terms of JHQGHUDJHFDUGLRYDVFXODUULVNVIDFWRUVLQGLFDWLRQRIWKH3&,DQGVHYHULW\RIcoronary disease. Radial approach was more often performed in group 2 (65.6 vs 43.8%, p = 0.003); Less Drug eluting stents were implanted in group 2 (33.3 vs 24.8%; p = 0.021); Physicians prescribed less Anti GP IIb IIIa therapies in group 2 (5.6 vs 8.5%; p = 0.023).:H UHSRUWHG RI VWURNH LQ JURXS YHUVXV LQ JURXS S According to GUSTO criteria, severe and moderate bleedings occurred in 2.1 and 6.4% respectively in groups 1 and 2 (p = 0.042). We detected another LPSRUWDQW EOHHGLQJ ULVN IDFWRU LQ WKLV SDUWLFXODU SRSXODWLRQ WKH IHPRUDODSSURDFK ZKLFK FDUULHV D EOHHGLQJ ULVN YHUVXV IRU WKH UDGLDOapproach (p = 0.02).Conclusion:7KLV SURVSHFWLYH PXOWLFHQWULF UHJLVWU\ FRQUPV WKDW DGGLQJ DGXDODQWLSODWHOHW WKHUDS\ WRDSUHH[LVWLQJ2$&LQFUHDVHV WKHEOHHGLQJ ULVNper- and post- PCI. A temporary discontinuation (when possible) reduces WKLVEOHHGLQJULVNEXWWHQGVWRZDUGLQFUHDVLQJWKHULVNRIVWURNH7KHUDGLDOapproach for PCI could be a good alternative to the conventional femoral route to avoid bleedings.

  • 48i The American Journal of Cardiology | October 12-17, 2008 | TCT Abstracts/ORAL







    TS, OCTOBER 15, 2008, 2:00 PM - 5:25 PM


    Passive Versus Active Thrombectomy In Primary And Rescue Percutaneous Coronary Intervention For ST-elevation Acute Myocardial Infarction

    Giandomenico Tarsia1, Domenico Polosa1, Giuseppe Biondi-Zoccai2,Giuseppe Del Prete1, Fabio Marco Costantino1, Sergio Caparrrotti1,Rocco aldo Osanna1, France sco Sisto1, Imad Sheiban2, Pasquale Lisanti11San Carlo Hospital, Potenza, Italy 2Division of Cardiology; University of Turin, Turin, Italy

    Objective: We compared passive thrombus-aspiration catheters versus active mechanical thrombectomy devices in patients who underwent primary or rescue percutaneous coronary angioplasty (PTCA) in a tertiary hospital.Background: Many thrombectomy devices in the setting of patients with ST-segment elevation acute myocardial infarction (STEMI) are proved to be safe and effective in thrombus burden reduction and in ST-segment resolution (STR); yet there are no comparative data between devices.Methods: We analysed 232 consecutive patients underwent to primary or rescue PTCA from 2000 to 2007 in single tertiary hospital. Patients with V\PSWRPV RQVHWUVW HPHUJHQF\ URRP FRQWDFW WLPH KZHUH LQFOXGHGDQGWKRVHZLWKDFXOSLULWYHVVHOPPDQG7,0,RZZLWKRXWDQ\HYLGHQFHWKURPEXV ZHUH H[FOXGHG 3ULPDU\ HQG SRLQW ZDV WKH 675 7KHsecondary end-points were: angiography reperfusion parameters; procedural characteristics; in-hospital major cardiac adverse events (MACE).Results: The passive group (PG) included 110 patients, mainly Export, and the active gorup (AG) 122 patients, mainly Angiojet. The two groups were similar for all the clinical characteristics but the higher frequency of anterior myocardial location in the active group (57% versus 44%; p=0.043). The patients in PG LQFRPSDULVRQZLWKWKRVHLQ$*KDGDVLJQLFDQWORZHUFRUUHFW7,0,IUDPHcount (16 frames/sec versus 19 frames/sec; p=0,01). MACE were similar in two groups: 10% in PG vs 9,8% in PG. Procedural median time was longer in the AG than in PG [65min (IQR 54-81) versus 89.5min (IQR 74.8-110.3); p