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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

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consecutive STEMI patients undergoing PPCI withoutclopidogrel pre-treatment from April 2004 to October2007 and compared outcome after on-table proceduralGPIIb/IIIa (n = 626, 73.8%) versus no GPIIb/IIIa (n = 222,26.2%).

Results: Patients receiving procedural GPIIb/IIIa hadless hypertension (44.9% vs 59.0%; p < 0.001), prior stroke(3.5% vs 7.7%; p = 0.015), prior myocardial infarction (11.9%vs 23.1%; p < 0.001), prior PCI (8.3% vs 14.0%; p = 0.018) andprior CABG (1.6% vs 5.4%; p = 0.005). This group also hada trend towards less diabetes (14.3% vs 19.8%; p = 0.054)and heart failure (1.1% vs 3.2%; p = 0.06). Other baselinecharacteristics including age, gender, renal impairment,cardiogenic shock and Killip class were well matched.

No differences were seen in 30 day mortality (6.1% vs6.8%), reinfarction (1.6% vs 3.6%), stroke (0.8% vs 0.5%),TVR (target vessel revascularization) (4.0% vs 4.5%), TLR(target lesion revascularization) (3.4% vs 4.5%) and MACE(major adverse cardiac event) (9.7% vs 13.1%) or 1 yearmortality (8.1% vs 9.0%), reinfarction (5.0% vs 7.2%), stroke(1.3% vs 0.9%), TVR (10.4% vs 8.6%), TLR (5.9% vs 6.8%)and MACE (19.3% vs 21.2%). However, there was increasedbleeding in the GPIIb/IIIa group (3.8% vs 0.5%; p = 0.009).

Conclusion: Patients with STEMI undergoing PPCIwithout clopidogrel pre-treatment receiving on-table pro-cedural GPIIb/IIIa had fewer risk factors but showed noadditional outcome benefit and increased bleeding, whencompared with those without GPIIb/IIIa.

doi:10.1016/j.hlc.2009.05.565

520PROGNOSTIC SIGNIFICANCE OF Q WAVES ON THEPRESENTING ECG IN STEMI TREATED WITH PRI-MARY PCI

Saurabh Kumar, Calvin Hsieh, Alisdair Ryding, ArunNarayan, Hera Chan, Andrew T.L. Ong, Norman Sadick,Pramesh Kovoor

Westmead Hospital, NSW, Australia

Background: Prior to the initiation of thrombolysis, Qwaves on presentation predicts adverse outcomes betterthan symptom to door time. The aim was to investigatethe significance of Q waves on the presenting electro-cardiograph (ECG) in ST segment elevation myocardialinfarction (STEMI) treated with primary percutaneouscoronary intervention (PPCI).

Methods: In 739 STEMI patients treated with PPCI(Q = 368, no Q = 371), Q waves on the presenting ECG, STsegment resolution (STR), regional wall motion (RWM)and left ventricular ejection fraction (EF) were assessed.The composite endpoint was of mortality and adverse car-diovascular events (repeat myocardial infarction, stroke orheart failure at 30 days).

Results: Q wave on presentation was associated withless mean STR (immediately post: 37% vs. 54%; p < 0.001),greater incidence of akinetic, aneurysmal or dyskineticRWM (33% vs. 19%, p < 0.001), lower LVEF (44% vs. 53%;p < 0.001). Thirty day composite endpoint was higher in

the Q vs. non Q groups (17.5% vs. 5.5% p < 0.001) regard-less of adequate STR immediately post PCI, presentationwithin 3 h or infarct location. Q waves on presentationand not the symptom to door time was an independentpredictor of the composite endpoint (adjusted hazardratio [HR] 2.7; 95% CI 1.8–4.0; p < 0.001). In comparison topatients with no Q on presentation and STR ≥ 70%, fourrisk subgroups were identified: No Q/STR < 70% (HR 3.1,p = 0.007); Q/STR ≥ 70% (HR 3.4, p = 0.006); Q/STR < 70%(HR 7.8, p < 0.001).

Conclusion: Q wave status on presentation especiallywhen combined with STR Immediately post PCI is a usefultool to assess outcomes in STEMI treated with PPCI.

doi:10.1016/j.hlc.2009.05.566

521PROSPECTIVE AUDIT OF THE COST OF A PROTOCOLDRIVEN MANAGEMENT OF PRIMARY PCI

Y. Malaiapan, P.L. See, W. Ahmar, J.D. Cameron, I.T.Meredith

Monash Cardiovascular Research Centre, MonashHEART,Southern Health & Department of Medicine (MMC), MonashUniversity, Melbourne, Australia

Background: Although primary PCI (PPCI) is the treat-ment of choice in patients with ST Elevation MyocardialInfarction (STEMI), it is costly because of the increasingnumber of treatment strategies.

Aim: To audit procedural costs of a protocol driven treat-ment of PPCI.

Method: A prospective audit was carried out in 202 con-secutive STEMI patients who underwent PPCI between1st June 2008 and 28th February 2009. Beginning 1st June2008, we adopted a thrombus burden (TB) guided proto-col for PPCI. Small TB was defined as <2X vessel diameter(VD); to receive glycoprotein 2b3a Inhibitor (GPI) andlarge TB was defined as >2X VD; to undergo aspirationof thrombus with Export catheter ± GPI. Four treatmentgroups were identified: Group 1: GPI only (50 pts), Group2: thrombus aspiration usage with our without GPI (52 pts),Group 3: thrombus aspiration only (49 pts) and Group 4:PCI/stenting without GPI or thrombus aspiration (51 pts).Prospective procedural costing was done using an inven-tory tracking system (hTrak). Procedural success, finalTIMI 3 flow and TIMI myocardial perfusion grade (TMPG)were recorded prospectively.

Results: Mean procedural costs: Group 1:$5877.7 ± 1997.8, Group 2: 5320.2 ± 2849, Group 3:$3876 ± 1327.3 and Group 4: $3760 ± 1574.4. There wereno differences in procedural success, final TIMI 3 flowand TMPG in all 4 groups; P = NS for all).

Conclusion: In PPCI although multiple treatment strate-gies increased procedural cost, the equivalent proceduraloutcome may indicate that a protocol driven managementof PPCI may actually identify pts who need these strate-gies.

doi:10.1016/j.hlc.2009.05.567