acute myocardial infarction ii

Acute MyocardialInfarction II

Wednesday, September 25, 2002

9:00–10:00 AM

3:00–4:00 PM

Main Lobby

(Abstract nos. 468–497)

TCT-468Outcomes and Costs in Acute Myocardial Infarction: Results of theNational Glycoprotein IIb/IIIa Inhibitor Study. P.L. McCollam1,D.A. Foster2, J.S. Riesmeyer1. 1Eli Lilly & Co., Indianapolis,Indiana, USA; 2Solucient Inc., Ann Arbor, Michigan, USA.

Background: We hypothesized that outcomes would be better in acutemyocardial infarction (AMI) patients who received adjunctive glyco-protein (GP) IIb/IIIa inhibitors during percutaneous coronary interven-tion (PCI). This study used a large national hospital database fromactual clinical practice to examine inhospital mortality, complications,incremental costs, and length of stay.

Methods: Data (January 1, 2000 through June 30, 2001) fromSolucient’s (Evanston, IL) national all-payor database were analyzed todetermine the above outcomes for any AMI patient undergoing PCI andreceiving a GPIIb/IIIa inhibitor (abciximab, eptifibatide, or tirofiban)compared with non-GPIIb/IIIa recipients. Risk adjustment for mortalityand complications was performed by logistic regression using pub-lished methods. It accounts for differences in patient characteristics(age, sex, diagnoses, procedures, clinical grouping, length of stay) anddifferences in institution characteristics (bed size, census division,teaching status, urban or rural setting). The definition of complicationswas an all-inclusive composite of 42 variables (cardiac, noncardiac,procedural, and nonprocedural), death was not included here because itwas evaluated separately. Incremental costs and length of stay weredetermined by least-squares regression to fit general linear models. Alldata refer to the inhospital time period.

Results: Data were from 32,529 patients in 99 hospitals. Onlyabciximab recipients demonstrated a significantly shorter length ofstay, 0.21 days fewer (range, 0.09–0.34; 95% confidence interval [CI];p �0.0013) than the non-GPIIb/IIIa group. The Table shows oddsratios and 95% CI versus the non-GPIIb/IIIa group.

Odds Ratio(95% CI)

Risk-AdjustedMortality

Risk-AdjustedComplications

IncrementalHospital Costs

Abciximab 0.74* 0.92 1,807†

(n � 11,816) (0.59–0.92) (0.81–1.03) (1529–2085)Eptifibatide 0.87 0.86† 1,147‡

(n � 10,093) (0.68–1.10) (0.75–0.98) (849–1445)Tirofiban 0.99 0.94 644‡

(n � 3,700) (0.73–1.34) (0.79–1.12) (252–1036)

*p � 0.07.†p � 0.02.‡p �0.0001.

Conclusion: These recent data provide additional insight into con-temporary use of GPIIb/IIIa inhibitors in AMI patients undergoing PCIin actual clinical practice. Only abciximab demonstrated a significantsurvival benefit versus the non-GPIIb/IIIa group.

TCT-469Direct Costs of Primary Stenting Versus Thrombolysis in AcuteMyocardial Infarction. M.R. Le May, H. Sherrard, M. Labinaz,R.F. Davies, G. Nichol, J-F. Marquis, L.A. Laramee, E. O’Brien,R.S.B. Beanlands, W.L. Williams, L.A. Higginson. University ofOttawa Heart Institute, Ottawa, Ontario, Canada.

Background: We have recently shown that compared with acceleratedtissue-plasminogen activator (t-PA), primary stenting reduces the6-month composite of death, reinfarction, stroke or repeat target vesselrevascularization for ischemia. However, the direct costs have not beenfully evaluated. We evaluated the direct hospital costs of primarystenting compared with thrombolysis with accelerated t-PA, in patients(pts) with ST-elevation acute myocardial infarction (AMI) randomizedin the Stenting Versus Thrombolysis in Acute Myocardial InfarctionTrial (STAT).

Methods: Pts presenting to our hospital with AMI were randomlyassigned to primary stenting (n� 62), or to accelerated t-PA (n� 61).Detailed inhospital costs during the 6-month follow-up period of thestudy were available for all pts. Exact costs of cardiac catheterization,thrombolytic medication, electrocardiography, radiology, nuclear med-icine, and physician billings were obtained. Average costs per patient-day based on known institutional figures for the period of the studywere used to calculate costs relating to coronary care unit, operatingroom, recovery room, cardiac surgical unit, step-down unit, and wards.This study did not allocate overhead administrative costs.

Results: The total 6-month mean costs per patient were $2,953lower in the stent group ($10,711� $11,615) compared with thethrombolysis group ($13,664� $10,131), p� 0.134. The total cost ofcardiac catheterization was $197,870 for the stent group and $103,752for the thrombolysis group. The median length of the initial hospital-ization was shorter in the stent group compared with the t-PA group (4days vs 7 days; p�0.001). At 6 months, the total number of hospitaldays was also less in the stent group (526 vs 739 for the thrombolyticgroup).

Conclusion: Compared with accelerated t-PA, primary stenting isa cost-effective strategy for ST-segment elevation AMI. In centerswhere facilities and experienced interventionists are available, primarystenting is an attractive alternative to thrombolysis.

References: Le May, MR et al. Stenting Versus Thrombolysis inAcute Myocardial Infarction Trial(STAT). J Am Coll Cardiol 2001;37:985-91.

TCT-470Comparison of Radial Versus Femoral Percuutaneous CoronaryIntervention in Acute Myocardial Infarction. A. Ziakas, P.Klinke, E. Fretz, R. Mildenberger, M.B. Williams, R.D. Kinloch, A.J.Della Siega, S.D. McCauley, K.D. Theman, J.D. Hilton. RoyalJubilee Hospital, Victoria, British Columbia, Canada.

Background: Access site complications are reduced using radial per-cutaneous coronary intervention (PCI). There is concern that technicaldifficulties using this approach can delay achievement of reperfusion.

Methods: We studied 153 patients (pts) who underwent primary orrescue angioplasty, radial (Group 1, 95 pts) or femoral (Group2, 58pts), between April 2000 and April 2002. Time to achieve reperfusion,total procedure time, procedural success, procedural complications,inhospital major adverse cardiac events (MACE), and vascular accesssite complications were compared in the 2 groups.

180H The American Journal of Cardiology� SEPTEMBER 24, 2002 TCT ABSTRACTS/Poster

POSTER

ABSTRACTS

WEDNESDAY 9/25/02 9:00–10:00 AM and 3:00–4:00 PM (Main Lobby)

Results: We were unable to perform the procedure through theradial approach in 12 pts (12.6%); they were switched to the femoralapproach. Glycoprotein IIB/IIIA inhibitors were used in similar rates inboth groups (61.5% in Group 1 vs 64.5% in Group 2, p �0.05). Theamount of contrast (187 � 77 mL vs 207 � 73 mL), and heparin(7,726 � 4,149 IU vs 8,653 � 4,206 IU) used were similar in bothgroups (p �0.05). Time from arrival in the catheterization laboratory tothe first balloon inflation was also similar (32.13 � 18.45 minutes vs35.32 � 22.22 minutes, p �0.05). Total procedural time was longer ingroup 2 (41.31 � 16.77 minutes vs 48.59 � 18.14 minutes, p �0.01).In all, 64.8% of the pts in Group 1 had PCI only of their culprit lesion,29.7% had 2-vessel PCI, and 5.5% 3-vessel PCI. The numbers weresimilar in Group 2 (69.4%, 24.2%, and 6.4% respectively, p �0.05).TIMI flow pre and post PCI was similar in both groups (75.6% vs77.6% TIMI 0-1 pre, and 100.0% vs 94.4% TIMI 3 post; p �0.05).There were no procedure-related complications in both groups andprocedure success was achieved in 100% of the cases in Group 1 and98.3% in Group 2 (p �0.05). Inhospital MACE were similar in bothgroups (1 vs 2 deaths). However vascular access complications weresignificantly higher in Group 2 (2.2% vs 12.9%, p �0.01).

Conclusion: Primary and rescue PCI via the radial approach is asfast and successful as the femoral approach but has fewer complica-tions.

TCT-471Angiographic Features of Ruptured Plaque in Patients withAcute Myocardial Infarction. Y. Nishibori, T. Kawarabayashi, A.Tanaka, T. Sano, Y. Nishida. Baba Memorial Hospital, Sakai, Japan.

Background: Ruptured plaque is recognized as a major cause of acutecoronary syndrome. However, there were no studies that revealed theangiographic features of plaque rupture in vivo. We have reported thatpreintervention intravascular ultrasound (IVUS) could identify rup-tured plaque in the acute phase of acute myocardial infarction (AMI).The purpose of this study was to investigate angiographic features ofruptured plaque using preintervention IVUS.

Methods: We studied 81 patients with AMI who underwent pre-intervention IVUS. They were divided into the ruptured plaque groupand the nonruptured plaque group according to the preinterventionIVUS image. Angiographic findings were evaluated both pre and postguidewire crossing. In TIMI 0 cases, angiographic findings were clas-sified into the following 4 types: A, abrupt closure; B, crab claw; C,hazy end; D, tapered. In TIMI 1–3 cases, angiographic findings wereclassified into the following 4 types: E, concentric lesion; F, eccentriclesion; G, multiple irregularities lesion; H, complex lesions. Angio-graphic complex lesions were defined as the presence of extra cap,intimal flap, and/or ulceration.

Results: Ruptured plaque identified by preintervention IVUS wasobserved in 32 (40%) patients. There were no differences in patients’characteristics and lesion characteristics between the both groups. InTIMI 0 cases, there were no differences in angiographic findingsbetween the both groups. When the guidewire crossed the lesion, TIMIflow grade was significantly improved. In TIMI 1–3 cases, complexlesions were observed only in the ruptured plaque group (rupturedplaque 50% vs nonruptured plaque 0%, p �0.01).

Conclusion: Angiographic complex lesions such as extra cap,intimal flap, and/or ulceration are suggested by the presence of rupturedplaque. Additional angiography after wire crossing the lesion may helpin the detection of ruptured plaque in AMI.

TCT-472Distal Protection in Native Coronary Arteries During PrimaryAngioplasty in Acute Myocardial Infarction. A. Delgado, P.

Silva, S. Klugmann. Cardiology Department, A. De Gasperis,Niguarda Ca’ Granda Hospital, Milan, Italy.

Background: Percutaneous coronary intervention (PCI), when feasi-ble, is a good alternative to systemic thrombolysis in patients with acutemyocardial infarction (AMI) because of a greater myocardial savage,better TIMI flow, less mortality or recurrence of ischemia. The pres-ence of thrombus, however, may increase the risk of distal emboliza-tion, with deterioration of distal flow and further infarct extension. Thisstudy reports the clinical and angiographic findings of PCI with 2different systems of mechanical distal protection (MDP) in nativecoronary arteries in patients with AMI.

Methods: We included patients undergoing primary PCI within 12hours of onset of symptoms who were hemodynamicaly stable. In thefirst part of the study, we used an occlusion/aspiration system (Percu-Surge Guardwire; Medtronic) and in the second part the device usedwas a filter (FilteWire; Boston). MDP was tried if the coronary arteryhad a proximal reference diameter �3 mm without marked tortuosityand if a persistent angiographyc appearance of thrombus, after 5minutes of administration of abciximab was present.

Results: From June 1999 to April 2002 34 patients were included;24 were treated with PercuSurge Guardwiresystem and 10 with FilterWire Ex. Mean age of patients was 58 � 10 years, 21% had diabetes.Most patients had single-vessel disease: the culprit artery was the rightcoronary artery in 62%, the left anterior descending artery in in 29%,and the left circumflex in 9%. The procedure was successful in 32 of 34patients (94%). A distal protection device was successfully placed in 28of 32 cases (88%), 19 of 22 (86%) with PercuSurge and 9 of 10 (90%)with Filter Wire Ex. The procedural results are summarize in the Table.

TABLE Procedural Results

% Stenosi pre (mean � SEM) 98 � 5%% Stenosi post (mean � SEM) 2 � 11%TIMI 3 flow, n (%) 24/28 (86%)

PercuSurge 16/19 (84%)Filter Wire 8/9 (89%)

Distal embolization, n (%) 4/28 (14%)PercuSurge 2/19 (10%)Filter Wire 2/9 (22%)

Distal spasm, n (%) 2/9 (22%)

The material extracted was mainly thrombus and in some cases cho-lesterol clefts. No complications were seen during hospitalization orafter 1-month follow-up.

Conclusion: MDP in native coronary arteries in AMI is safe andfeasible. More friendly and dedicated devices, however, are needed.Larger randomized trials are needed to evaluate the clinical impact ofMDP in this setting.

TCT-473Primary Percutaneous Coronary Intervention for CardiogenicShock at a Community Hospital with Off-Site Cardiac SurgicalBackup. N.S. McNamara, T.P. Wharton Jr, J.E. Anderson, F.A.Fedele, D. DeBoard, T. LaRochelle, L. Wason, E. Lanseigne, R.Gagnon, K. Benson, S. Coffey, S. Cronin, W. Lannon, ExeterHospital, Exeter, New Hampshire, USA.

Background: Emergency percutaneous coronary intervention (PCI) isadvocated for patients with cardiogenic shock complicating acute myo-cardial infarction (AMI), yet this is generally available only at tertiarycenters. Patients with shock presenting to community hospitals face thedelay and risk of transfer and a mortality of 60% to 80%. We inves-tigated the speed, safety, and efficacy of primary PCI for shock at ahospital with cardiac surgical backup off-site.

The American Journal of Cardiology� SEPTEMBER 24, 2002 TCT ABSTRACTS/Poster 181H

POSTER

ABSTRACTS


Methods: We prospectively monitored outcomes of AMI patientswith cardiogenic shock (systolic blood pressure �90 mm Hg, PCW�18, poor tissue perfusion, no bradycardia or hypovolemia) at acommunity hospital where experienced operators and an experiencedteam routinely perform primary PCI around-the-clock as first-line AMIcare. Patients with acute mechanical complications of AMI were ex-cluded.

Results: Eighty-six consecutive AMI patients with shock survivingthe emergency department underwent emergency angiography: 48%were aged �70, 49% were women, 43% were intubated, and 22% hadventricular fibrillation and/or required CPR before catheterization. PCIwas performed in 72%. We achieved TIMI 3 flow with �50% residualstenosis in 89% of PCI patients. Of the non-PCI cases, 83% of non-PCIcases had TIMI 3 flow in the infarct vessel. An intra-aortic balloonpump (IABP) was placed in 81%. The median prehospital time was 69minutes and the door-to-angiogram time was 99 minutes. Inhospitalmortality was 29%. Reinfarction occurred in 3 patients and stroke in 1patient (nonhemorrhagic). Thirteen patients (15%) were triaged tocoronary artery bypass grafting (CABG) within 24 hours because ofhigh-risk anatomy: 12 of these with open vessels (5 opened by PCI);none were for complications of PCI. Ten CABG patients (77%) sur-vived.

Conclusion: This first single-center report of primary PCI in car-diogenic shock at a community hospital with off-site surgical backupindicates that mechanical intervention in this setting can be providedrapidly, safely, and effectively in this very high-risk group, with out-comes that compare favorably to those reported from tertiary centers.Key elements to our success include rapid triage to angiography,aggressive use of the IABP, a high rate of immediate revascularizationat the point of first contact, and prompt referral for CABG whenappropriate. The lack of cardiac surgery need not limit the applicationof this valuable approach in the treatment of shock.

TCT-474Prognostic Signification and Kinetic of C-Reactive ProteinRelease in Patients with ST-Elevation Acute MyocardialInfarction Undergoing Primary Percutaneous CoronaryIntervention. P. Ohlmann1, J.P. Monassier1, L. Jacquemin1, M.O.Michotey2, N. Berenger3, R. Dallemand1, J. Levy1, G. Laval1.Departments of 1Cardiology, 2Biochemistry, and 3Nuclear Medicine,Mulhouse Hospital, France.

Background: Peak-level C-reactive protein (CRP) has been recog-nized as a marker of infarct size and short-term prognosis after acutemyocardial infarction (AMI). Thrombolysis is able to reduce mortalityand peak level of CRP. However, there are no data in the literatureconcerning CRP level in the setting of primary percutaneous coronaryintervention (PCI) for AMI. We investigated in this study the charac-teristics of CRP kinetic in AMI and the relation between this markerand long-term prognosis.

Methods: Serial dosages of troponin I (cTnI), creatine kinase (CK),and CRP were performed at admission, just after PCI (0 hours) and 24,48, and 72 hours after primary PCI in 87 patients hospitalized for AMI.Enzymatic infarct size was estimated by cumulative release of hy-droxybutyrate dehydrogenase during the first 72 hours (Q72), andradionuclide left ventricular ejection fraction (LVEF) was performed at1 month in 63 patients. Total mortality was evaluated after a meanfollow-up of 42 � 8 months.

Results: CRP was elevated at admission in 26% of patients. Peaklevel of CRP was reached 49.4 � 5.7 mg/L after a mean delay of 52 �16 hours. Levels of CRP at 48 hours and at peak, and levels of cTnI at6 hours and at 72 hours, correlated with enzymatic infarct size and with1-month LVEF. Total mortality was 12.6% and cardiac mortality was6.9%. Killip score; CRP concentration at admission, at 48 hours, and atpeak level; and cTnI concentration at 6 hours and 72 hours were

significant indicators of mortality in univariate analysis. In multivariateanalysis, only Killip score (odds ratio [OR], 9.9; p � 0.013) and cTnIlevel at 72 hours after PCI (OR, 9.43; p � 0.004) were related toprognosis.

Conclusion: This study showed that CRP concentrations at admis-sion, at 48 hours, and at peak are linked with long-term mortality afterprimary PCI. CRP concentration at 48 hours, at peak level but not atadmission, correlated with infarct size. However, in the multivariateanalysis, only Killip score and cTnI level at 72 hours were associatedwith long-term mortality.

TCT-475PAMI Risk Score: Predicting Mortality in ST ElevationMyocardial Infarction Treated with Primary Angioplasty. S.Addala1; C.L. Grines1; S.R. Dixon1; G.W. Stone2; J.A. Boura1; A.B.Ochoa1; G. Pellizzon1, J.K. Kahn. 1Division of Cardiology, WilliamBeaumont Hospital, Royal Oak, Michigan, USA; 2Lennox Hill Heartand Vascular Institute, New York, New York, USA.

Background:Our objective was to develop a risk score using clinicalfindings that can be used readily at bedside in ST elevation myocardialinfarction (STEMI). There is considerable variation in mortality riskamong patients with STEMI. Complex multivariable models identifyindividual risk factors and their relative contribution to mortality inpatients treated with thrombolytics, but are too cumbersome to use inroutine clinical practice. Moreover, limited data exist with regard topatients treated with percutaneous coronary intervention (PCI). Wedeveloped a simple clinical score for predicting mortality in STEMIpatients undergoing PCI.

Methods: We pooled patients from PAMI-1, PAMI-2, AIR PAMINo SOS and STENT PAMI (3,452 patients) and then examined deathat 4 intervals: in hospital, 1 month, 6 months, and 1 year. Usingstepwise multiple logistic regression analysis, 6 independent predictorsof death at 6 months were identified and were assigned a risk scorebased on odds ratio: age �75 years (p �0.0001, risk score [RS] � 7);age 65 to 75 years (p �0.0001, RS � 3), anterior myocardial infarctionor new left bundle branch block (p � 0.0011, RS � 2), Killip �1(p�0.0001, RS � 2), heart rate �100 beats per minute (p �0.0008, RS �2), history of diabetes (p � 0.0078, RS � 2). Total risk score was thencalculated for each patient, with a range from 0 to15.

Results: There was a strong correlation between the risk score andmortality at all the time intervals examined (p �0.001 for all 4 timeintervals). Moreover, there was a �33-fold graded increase in mortalitybetween those with a risk score of 0 (6-month mortality, 0.6%) andthose with a score of 9 (6-month mortality, 20%) (p �0.0001).

Conclusion: The PAMI clinical risk score for STEMI is a powerfulpredictor of mortality and can be used readily at bedside. Moreover, itis a powerful predictor of adverse angiographic outcomes as well aslonger duration of hospitalization. These data are useful for risk strat-ification of PCI-eligible patients with STEMI.

TCT-476Safety, Feasibility, and Efficacy of Transradial PrimaryAngioplasty in Patients with Acute Myocardial Infarction. O.Valsecchi 1, G. Musumeci 1, A. Vassileva 1, M. Tespili1, G.Guagliumi 1, A. Saino2, A. Gavazzi 1, P. Ferrazzi 1. 1InterventionalCatheteriation Laboratory, Cardiovascular Department, OspedaliRiuniti of Bergamo, Bergamo, Italy; 2Clinica Medica, University ofMilano, Bicocca, Italy.

Background: In the recent years, the transradial approach (TRA) hasincreasingly been used as an alternative way to perform coronaryangioplasty (PTCA).


POSTER

ABSTRACTS


Methods: We studied 621 patients (pts; 476 men; mean age, 61 �11 years) with a diagnosis of acute myocardial infarction (�12 hoursafter onset; Killip class I–III) submitted to primary PTCA. TRA (GroupA) was used in 136 consecutive pts (107 men; mean age, 61 � 12years) with a normal Allen test as performed by a single experiencedoperator. The transfemoral approach (Group B) was used in the re-mainder of pts (n � 485).

Results: No significant differences in baseline characteristics wereobserved between the 2 groups. Radial access was obtained in all pts inGroup A but 9 were switched to either left radial (n � 7) or rightfemoral approaches (n � 2). Time of radial artery cannulation was inevery case �2 minutes. The cannulation time (from skin anesthesia tothe time of arterial cannulation) and the total procedure time (from ptarrival at the catheterization room to the completion of the procedure)were not significantly different between Group A and Group B (1.7 �0.4 minutes vs 1.6 � 0.6 minutes, p � NS; 62 � 23 vs 61 � 22minutes, p � NS, respectively). In 70% of cases in Group A, a singlecatheter was used for diagnostic angiography of right and left coronaryarteries and left ventricle. Balloon angioplasty alone was performed in6% of Group A pts versus 10% of Group B pts (p � NS). Primarysuccess was identical: 98.5% radial, 95.6% femoral. There were noaccess site bleeding complications in the radial group as opposed to 10(2.2%) in Group B (p �0.01). In Group A patients, there was noforearm ischemia or loss of radial pulse during the 30-day follow-upperiod. Total hospital length of stay was slightly shorter in the radialgroup, although this difference was not statistically significant (5.9 �1.9 vs 6.4 � 2.8 days, p � 0.08). At 30-day follow-up, the incidenceof major adverse cardiac events (death, reinfarction, heart failure, targetlesion revascularization) was 8% in Group A versus 6.2% in the GroupB (p � NS).

Conclusion: Thus, provided it is performed by experienced oper-ators, TRA can represent a safe and feasible approach for performingprimary PTCA with similar results, fewer bleeding complications, andshorter hospital length of stay as compared with the transfemoralapproach.

TCT-477Reducing Microvascular Injury by Aspirating Thrombus DuringCoronary Intervention for Acute Myocardial Infarction. M.Matsushita, T. Muramatsu, R. Tsukahara, Y. Itoh, K. Hirano, M.Nakano. Kenji Shida Kawasaki Social Insurance Hospital, Divisionof Cardiology, Kawasaki, Japan.

Background: The no-reflow phenomenon is a potential issue in per-cutaneous coronary intervention (PCI) for acute myocardial infarction(AMI). It may be possible to reduce the risk of no-reflow by removingthrombus from the coronary artery using thrombus aspiration. Our goalwas to assess the merits of aspirating occlusive thrombus material usinga Doppler guidewire (FloWire) and zero-flow pressure (Pzf).

Methods: Out of a total group of 48 AMI patients (mean age, 69 �9 years) admitted to our institution within 24 hours of the onset ofsymptoms, we compared 19 patients who underwent coronary angiog-raphy immediately after thrombus aspiration; 8 patients achieved TIMI3 flow and 11 had �TIMI 2 flow, with the remaining 29 who weretreated with balloon angioplasty and stenting. We recorded peak cre-atine phosphokinase (CPK) levels, final corrected TIMI frame counts(CTFC), as well as FloWire-derived predictive factors of long-term leftventricular functional deterioration, namely the incidence of earlysystolic reverse flow (ESRF) and Pzf, as an index of microvascularfunction. For both left anterior descending and right coronary arterylesions, we also used left ventriculograms immediately after interven-tion and in the subacute phase to assess regional wall motion (SD/chord).

TIMI 3 TIMI �2 POBA � Stent

Peak CPK (IU/L) 2.7 � 1.9 � 103 3.5 � 1.9 � 103 2.9 � 2.5 � 103CTFC 19 � 6 32 � 18 24 � 25ESRF 0/8 (0%) 4/11 (36%) 4/29 (14%)Pzf (mm Hg) 38 � 10* 54 � 17* 48 � 14Post-SD/chord �1.7 � 0.7* �2.5 � 0.6* �2.2 � 0.7Subacute SD/chord �1.5 � 0.6* �2.6 � 0.7* �1.8 � 0.9

POBA � plain old balloon angioplasty.*p �0.05; for all others, p � NS.

Results: There were no significant differences in patient age, sex,risk factors, target vessel diameter, or stent size.

Conclusion: Patients with TIMI 3 flow after thrombus aspirationhad better preserved left ventricular function than patients with �TIMI2 flow. These patients also tended to have better left ventricularfunction than patients treated conventionally with ballooning and stent-ing. These results suggest that aspirating a considerable amount ofthrombus may reduce microvascular injury in patients in the earlystages of onset of AMI.

TCT-478Relation Between Culprit Lesion Coronary Artery Morphologyat the Time of Reperfusion for Acute Myocardial Infarction andthe Coronary Flow-Pattern and Zero-Flow Pressure. M.Masashirou, T. Muramatsu, R. Tsukahara, Y. Itoh, K. Hirano, M.Nakano. Kenji Shida Kawasaki Social Insurance Hospital, Divisionof Cardiology, Kawasaki, Japan.

Background: The slow-flow phenomenon can be one of the keyobstacles to successful reperfusion in the setting of acute myocardialinfarction (AMI), but to date it is unclear exactly what type of lesionsare susceptible to this phenomenon.

Methods: The study population consisted of 25 patients (mean age,68 � 10 years) admitted for emergency intervention at this institutionand successfully evaluated with intravascular ultrasound (IVUS). Pa-tients were classified according to the degree of remodeling observedby measuring the vessel diameter at either side of the culprit lesion andat the lesion site to obtain the vessel area. For each patient, theremodeling index (RI) was calculated as: lesion site area � 2 / distalarea � proximal area, with an RI �1.05 classed as positive remodeling,and RI �0.95 as negative remodeling. Preintervention IVUS thereforeresulted in a PR Group (n � 17, RI � 1.20 � 0.17) with positiveremodeling at the lesion site, and an NP Group (n � 8, RI � 0.96 �0.03) of patients with negative remodeling or no remodeling at thelesion site. We used IVUS to measure and record plaque area (PA),plaque morphology, and the presence or absence of plaque rupture atthe lesion site, as well as the frequency of early systolic reverse flow(ESRF) in the coronary flow pattern and zero-flow pressure (Pzf)immediately after reperfusion.

Results: PA was significantly higher in the PR group (17.2 � 7.8mm2) than in the NP group (12.4 � 6.4 mm2). Also, investigation of lesionmorphology revealed that 14 of 17 lesions (82%) in the PR group con-tained soft plaque, and in 8 of 17 lesions (53%) we observed a lipid coreand evidence of plaque rupture. In the NP group, however, 6 of 8 lesions(75%) contained hard plaque, and we saw no clear sign of plaque ruptureor a lipid core. We detected ESRF in 3 of 17 PR patients (18%), but therewas not a single case in the NP group. There was no significant differencein Pzf values (49 � 25 mm Hg in the PR group vs 43 � 6 mm Hg in theNP group). Only 4 subjects had Pzf �6 mm Hg, all in the PR group, andall with lesions characterized by soft plaque.

Conclusion: Patients presenting with positive remodeling are morelikely to have a high plaque burden, evidence of a lipid core, and todevelop slow-flow and have higher Pzf values.


POSTER

ABSTRACTS


TCT-479Intracoronary Endoscopic and Pathologicl Findings of theAspirated Tissue in Acute Myocardial Infarction. K. Hirano, T.Muramatsu, R. Tsukahara, M. Hou, Y. Ito, M. Nakano, M.Matsushita. Shida Kenji Division of Cardiology, Kawasaki SocialInsurance Hospital, Kanagawa, Japan.

Background: Our purpose was to examine the histopathologic findingsof thrombi and plaques collected using a thrombus aspiration catheter(Rescue [RC]) and intracoronary endoscopic (ICES) findings in acutemyocardial infarction(AMI) patients.

Methods: The subjects were 22 AMI patients (average age, 63 �10 years) who first underwent ICES examination of infarct-relatedlesions before we performed reperfusion therapy using RC. The pa-tients were divided into the early group (Group E, 6 patients), whoreceived treatment within 3 hours after onset, and the late group (GroupL, 16 patients), who received treatment �3 hours after onset.

Results: The weight of the specimens was larger in Group L (23 �11 mg) than in Group E (12 � 0.4 mg). Platelet thrombus was observedin all patients in GroupE and in 87.5% of patients in Group L.Macrophages, fibroblasts, and cholesterol clefts were observed in theplaque of 27% of patients in GroupE and 59% of patients in Group L.All of these components were significantly more frequent in Group L(p �0.05). For ICES findings, white, mixed, and red thrombi wereobserved in 38%, 50%, and 12%, respectively, of patients in Group Eand 9%, 36%, and 55%, respectively, in Group L. Histopathologically,these 3 types of thrombi were observed in 31%, 50%, and 19% ofpatients in Group E and 18%, 27%, and 55% in Group L. ICES andhistopathologic findings were consistent with each other.

Conclusion: Comparison of pathologic and ICES findings ofthrombi and plaques revealed that platelet thrombus was more frequentin Group E, whereas a plaque component was more frequently ob-served in Group L. Our results may be of help in elucidating themechanism of the time course of AMI.

TCT-480Usefulness of Reperfusion Therapy with a Distal ProtectionDevice (Percusurge) for Acute Myocardial Infarction. Y. Ito, T.Muramatsu, R. Tsukahara, M. Ho, K. Hirano, M. Nakano, M.Matsushita. Kenji Shida Division of Cardiology, Kawasaki SocialInsurance Hospital, Kanagawa, Japan.

Background: The purpose of this study was to examine the clinicalresults in patients who received a coronary intervention using a distalprotection device for acute myocardial infarction (AMI).

Methods: The study population consisted of 15 consecutive AMIpatients (mean age, 65.4 years; 3 women), admitted within 12 hours ofonset. The culprit lesion was crossed by a GuardWire Plus wire. Weperformed aspiration therapy using an Export aspiration catheter afterocclusion with distal protection balloon. Subsequently, we performedaspiration therapy immediately after stent implantation with distalprotection. We investigated a procedural success rate, TIMI flow grade,and frequency of TIMI frame count (TFC), slow flow (SF), distalembolism (DE), and pathologic findings.

Results: The average elapsed time was 2.7 � 3.5 hours. TIMI flowgrade before intervention was TIMI �1 for all patients. All patientsimproved in TIMI flow grade after the first thrombus aspiration, andTIMI 3 flow was observed in 12 patients (80%). Stent implantation wassuccessful in all patients. All patients had TIMI 3 flow after stentimplantation; the average of TFC was 21 � 7. In addition, there wereno occurrences of SF or DE. We identified a large amount of blood cellcomponents and plaque components, such as macrophage or choles-terol crystal and collagen fiber, after the first and second aspiration.

Conclusions: These results showed that the reperfusion therapywhich used distal protection device (Percusarge) for AMI was useful.

TCT-481Do Acute Myocardial Intervention Patients Without ST-SegmentElevation Have Better Outcomes After Primary PercutaneousCoronary Intervention? An Analysis from the CADILLAC Trial.D. Cox1, C. Grines2, T. Stuckey3, E. Garcia4, J. Griffin5, J. Tcheng6,J. Pasquini1, G. Guagliumi7, B. Brodie3, M. Turco8, A. Lansky9,G.Stone9. 1Mid Carolina Cardiology, Charlotte, North Carolina, USA;2William Beaumont Hospital Royal Oak, Michigan, USA; 3LeBauerCardiovascular Research Foundation, Greensboro, North Carolina,USA; 4Hospital Gregario Maranon, Madrid, Spain; 5Virginia BeachGeneral Hospital, Virginia Beach, Virginia, USA; 6Duke UniversityMedical Center, Durham, North Carolina, USA; 7Ospedali RiunitiDi Bergamo, Bergamo, Italy; 8Washington Adventist Hospital,Washington, DC; 9The Cardiovascular Research Foundation, NewYork, New York, USA.

Background: Numerous studies have demonstrated that clinical out-comes in patients (pts) with ST-segment elevation (STE) AMI reper-fused by primary percutaneous coronary intervention (PCI) are im-proved compared with lytic therapy. However, pts without ST-segmentelevation (NSTE) AMI were excluded from these trials. Comparativeoutcomes between STE and NSTE pts undergoing primary PCI forAMI have not been previously reported.

Methods: A total of 2,082 AMI pts of any age within 12 hours ofsymptom onset (excluding shock) with any electrocardiographic (ECG)pattern were randomized to primary PTCA with or without abciximabvs MultiLink stenting with or without abciximab. For this analysis,clinical outcomes of 1,725 pts (83%) with ST-elevation or left bundlebranch block (STE) on their initial ECG were compared with 239(12%) with NSTE; 5% of pts were excluded for uninterpretable (eg,paced), missing, or incomplete tracings.

Results: Compared with STE, NSTE pts more often had insulin-dependent diabetes mellitus (6.7% vs 3.2%, p � 0.008), prior MI (17.2%vs 12.6%, p � 0.05), and prior PCI (15.1 vs 10%, p � 0.02), but nodifferences in age, sex, smoking, hypertension, Killip class, or multivesseldisease were noted. At 30 days, STE pts had greater mortality than NSTE(2.2% vs 0.4%, p � 0.06); rates of reinfarction, disabling cerebrovascularaccident (CVA), subacute thyroiditis (SAT), ischemic target vessel revas-cularization (TVR), or major adverse coronary events (MACE) weresimilar. Further results are noted in the Table.

STE NSTE p-Value

LAD-IRA 38% 27% 0.0007RCA-IRA 47% 39% 0.03CX-IRA 15% 34% �0.0001Onset Sx to ER (hr) 1.75 hr 2.38 hr 0.0002ER to 1st inflation (hr) 1.92 hr 3.20 hr �0.0001Initial EF (core lab) 55.8% 58.7% 0.0012Initial TIMI-3 flow 19.4% 37.3% �0.0001Final TIMI-3 flow 95.1% 97.9% 0.421-yr follow-upDeath 4.4% 3.4% 0.43Reinfarction 2.2% 3.0% 0.47Disabling CVA 0.6% 0.4% 0.74Ischemic TVR 11.9% 21.8% �0.0001MACE 16.6% 24.0% 0.007

Cx � circumflex; EF � ejection fraction; Sx � symptoms.

Conclusion: NSTE pts undergoing primary PCI for AMI presentedlater and had significant delays in revascularization. Despite greaterinitial preservation of LV function and TIMI 3 flow, NSTE AMI pts


POSTER

ABSTRACTS


had similar long-term mortality to STE pts, and higher rates of ischemicTVR and MACE. These data emphasize the high-risk nature of pts withNSTE AMI despite mechanical reperfusion therapy and in whom closefollow-up is warranted.

TCT-482Declining Length of Stay in Primary Angioplasty in MyocardialInfarction (PAMI) Studies Despite Increased Disease Severity.B.A. Bartholomew1, K.J. Harjai1, J.A. Boura1, L.L. Grines1, G.W.Stone2, D. Cox3, B. Brodie3, W. O’Neill1, C.L. Grines1.1 WilliamBeaumont Hospital, Michigan, USA; 2Lenox Hill Hospital, NewYork, New York, USA; 3Presbyterian Hospital, USA; 4LebaurCardiovascular Research, USA.

Background: Recent studies suggest a trend toward decreased lengthof stay (LOS) in patients (pts) with acute myocardial infarction (AMI).Whether this trend is related to lower disease severity or other factorsis unclear. We explored temporal patterns of hospital LOS in ptsenrolled in the PAMI studies.

Methods: Between 1990 and 1999, 3,732 pts were enrolled in thePrimary Angioplasty in Myocardial Infarction (PAMI) studies. ThePAMI studies enrolled pts with acute myocardial infarction (AMI)presenting within 12 hours of symptoms, without initial evidence ofcardiogenic shock. Using �2 analysis, 2 periods (1990–1994 and 1995–1999) were examined.

Results: Compared with pts enrolled in 1990–1994, those enrolledin 1995–1999 were older and more likely to have a left anteriordescending (LAD) culprit, multivessel disease, and a lower ejectionfraction (EF). A trend toward more pts with diabetes pts is also seen.Sex, systolic blood pressure, heart rate and Killip class were similar,whereas TIMI 3 flow improved (Table).

Variable 1995–1999 1990–1994 p-Value

Age �70 yr 27.35% 20.98% �0.0001Female sex 27.27% 26.11% 0.45Diabetes 17.34% 15.12% 0.08Systolic BP

�100 mm Hg30.98% 28.33% 0.11

Heart rate �100beats per min

22.32% 20.81% 0.3

Killip class 1 86.63% 86.17% 0.6993LAD culprit 43.50% 37.68% �0.0001Multivessel disease 52.65% 42.82% �0.0001EF �0.40 20.16% 17.28% 0.05TIMI 3 flow 12.68% 9.01% �0.0001LOS (days) 5.8 7.8 �0.0001

LOS was significantly lower in pts enrolled in 1995–1999. Pts enrolledafter 1994 had a higher usage of Reopro 15.6% versus 0% (p �0.001)and increased stent placement 50.2% versus 1.1% (p �0.001).

Conclusion: Pts presenting with an AMI in 1995–1999 havegreater disease severity as seen by advanced age, multivessel disease,lower EF, and LAD culprit. Despite increased severity, the averageLOS has decreased. This decrease in LOS maybe due to better under-standing of clinical outcomes and, perhaps, better ancillary strategies.

TCT-483Impact of Small Vessel Size on Long-Term Outcomes AfterPrimary Angioplasty and Stenting in Acute MyocardialInfarction: Results from the CADILLAC Trial. D. Cox1, C.Grines2, A. Lansky3,T. Stuckey4, E. Garcia5, J. Williams1, J.Tcheng6, G. Guagliumi7 , J. Griffin8, G. Stone3. 1Mid CarolinaCardiology Charlotte, North Carolina, USA; 2William BeaumontHospital Royal Oak, Michigan, USA; 3The Cardiovascular

ResearchFoundation, New York, New York, USA; 4LeBauerCardiovascular Research Foundation, Greensboro, North Carolina,USA; 5Hospital Gregario Maranon, Madrid, Spain; 6DukeUniversity Medical Center, Durham, North Carolina, USA;7Ospedali Riuniti Di Bergamo, Bergamo, Italy; 8Virginia BeachGeneral Hospital, Virginia Beach, Virginia, USA.

Background: Small vessel size is an independent predictor of targetvessel revascularization (TVR) and restenosis after elective interven-tion. In contrast, the relation between vessel size and adverse outcomesafter acute myocardial infarction (AMI) intervention is not well estab-lished. Moreover, 2.5-mm vessels have been excluded from mostprimary stenting AMI trials.

Methods: In the CADILLAC trial, 2,082 AMI patients (pts) of anyage within 12 hours of symptom onset (excluding shock) were randomizedto primary PTCA with or without abciximab versus MultiLink stentingwith or without abciximab. Given the availability of the 2.5-mm MultiLinkDuet stent, vessels as small as 2.5 mm and lesion lengths up to 64 mmwere actively enrolled. Protocol angiographic follow-up was performed in656 pts at 7 months. Outcomes were stratified into 3 similarly sized tertilesof increasing reference vessel diameter.

Results: Pts with AMI due to small vessels undergoing primaryPCI had higher rates of reinfarction and major adverse coronary events(MACE), especially if stented (Table).

1-Year EventRates

<2.75mm

2.75mm�3.25 mm

>3.25mm p-Value

StentN 308 373 324MACE (%) 16.9 12.3 10.2 0.04Death (%) 7.8 3.8 2.2 0.002Reinfarction (%) 2.9 2.1 1.5 0.47Ischemic TVR (%) 8.4 7.5 7.4 0.87PTCAN 359 346 294MACE (%) 22.6 22.0 17.4 0.21Death (%) 5.9 3.2 4.1 0.21Reinfarction (%) 3.8 2.3 1.3 0.12Ischemic TVR (%) 16.4 19.1 13.3 0.14

In contrast, ischemic TVR was not strongly related to vessel size. In theangiographic follow-up cohort, however, smaller vessels had greaterrestenosis (35.2% for �2.75-mm vessels vs 22.7% for �3.25-mmvessels, p � 0.024).

Conclusion: Vessel size is a powerful, though not widely recog-nized, correlate of clinical outcomes after primary PCI in AMI. Patientswith smaller vessels undergoing primary stent placement have greatermortality, reinfarction, and MACE at 1 year and deserve close follow-up. Restenosis rates were also increased in small vessels undergoingPCI for AMI, though ischemic TVR was not, possibly because of lessangina due to from the small amount of partially infarcted myocardium.

TCT-484Factors Affecting Length of Stay in Acute Myocardial InfarctionPatients Undergoing Primary Angioplasty. B.A. Bartholomew,K.J. Harjai, J.A. Boura, L.L. Grines, G.W. Stone, D. Cox, B. Brodie,M. Yerkey, W. O’Neill, C.L. Grines. William Beaumont Hospital,Michigan, USA.

Background: We sought to identify clinical and angiographic vari-ables that predict length of stay (LOS) in patients (pts) with acutemyocardial infarction (AMI) undergoing primary angioplasty.

Methods: A total of 3,678 patients were enrolled in the PrimaryAngioplasty in Myocardial Infarction (PAMI) studies. Patients were


POSTER

ABSTRACTS


randomly divided into a derivation cohort (n � 1,795), used toderive predictors of LOS, and a validation cohort (n � 1,883), usedto validate the predictors. We developed a score to predict theprobability of extended LOS beyond 5 days. Based on their LOSscore, we classified patients in each of the 2 cohorts into 4 groupsfor comparison of LOS.

Results: The predictors of extended LOS with their risk pointsare in-hospital CABG (16); non-USA site (6); year prior to 1995 (5);age �70 (2); female sex (2); Killip class �1 (2); 3-vessel disease(2); left anterior descending lesion (2); left ventricular ejectionfraction �0.40 (2), and initial TIMI �2 (2). The sum of LOS pointsyields a score of 0 to 41. The mean LOS� standard deviation (SD)and incidence of extended LOS between groups are shown in theTable.

Score0–5

Score6–10

Score11–15

Score>16 p-Value

Derivation groupN 402 531 218 119Los � SD 4.23 � 2.54 6.23 � 4.46 9.27 � 7.93 12.4 � 8.67 �0.0001Pts with LOS

�5 days (%)14 46 78 92 �0.0001

Validation groupN 394 578 190 136LOS � SD 4.24 � 2.45 6.46 � 5.19 8.97 � 5.55 12.4 � 8.01 �0.0001Pts with LOS

�5 days (%)19 50 64 90 �0.0001

Conclusion: Clinical and angiographic variables can predict LOSin patients with AMI undergoing primary angioplasty. Non-USA siteand year prior to 1995 are strong predictors of an extended LOS. Oldage, female sex, Killip class �1, 3-vessel disease, or bypass graft alsoindependently predict increased LOS. These findings can be used toprospectively estimate inhospital resource utilization.

TCT-485Variation in Hospital Length of Stay in Patients with AcuteMyocardial Infarction Undergoing Primary Angioplasty: Do WeNeed Multiple Diagnostic Related Groups? B.A. Bartholomew,K.J. Harjai, J.A. Boura, M. Yerkey, L.L. Grines, G.W. Stone, D. Cox,B. Brodie, W.W. O’Neill, C.L. Grines. William Beaumont Hospital,Michigan, USA.

Background: Currently, patients (pts) presenting with acute myocar-dial infraction (AMI) treated with primary angioplasty (percutaneouscoronary intervention [PCI]) fall into the same diagnostic-related group(DRG) regardless of hospital resource utilization. Our objective is toevaluate variations in hospital length of stay (LOS) and assess the needfor multiple DRGs in pts with AMI undergoing PCI.

Methods: Primary Angioplasty in Myocardial Infarction (PAMI)studies enrolled 1,899 US pts; 287 pts were excluded for inhospitalbypass graft, no PCI, or death within 7 days, and the remaining 1,612pts were randomly divided into derivation (n � 801) and validationcohorts (n � 811). We developed a clinical and angiographic LOSscore to predict the probability of extended LOS �5 days. Based on theLOS score, pts in each of the 2 cohorts were classified into 3 groups forcomparison of mean LOS and incidence of extended LOS.

Results: The 6 predictors of extended LOS with their risk pointsare: age �70 (3), female sex (2), multivessel disease (2), left anteriordescending (LAD) culprit (2), left ventricuar ejection fractionLVEF�0.40 (2), and initial TIMI flow �2 (2). Each patient has anaggregate score of 0 to 13. Mean LOS and incidence of extended LOSbetween groups are shown (Table).

LOS Score*Mean

LOS � SDLOS >5

Days, n (%)

Derivation group0–3 (n � 205) 3.8 � 1.9 (8)4–9 (n � 504) 5.0 � 3.7 (25)�9 (n � 34) 9.7 � 11 (68)

Validation group0–3 (n � 175) 3.9 � 2.7 23 (13)4–9 (n � 504) 5.1 � 4.4 151 (27)�9 (n � 34) 8.2 � 5.1 24 (69)

*p �0.0001 for all score categories in both groups.

Conclusion: Significant differences in LOS exist among patientswith AMI treated with primary PCI. Clinical and angiographic char-acteristics can prospectively identify patients at risk for an extendedLOS. Our findings suggest the need for a multi-tier DRG system forAMI patients treated with PCI.

TCT-486National Registry of Interventional Treatment of AcuteMyocardial Infarction in Uruguay (RENATIA): 30-DayMortality Results. C. Pardinas, D. Mallo, F. Buitron, A. Duran, R.Lluberas, C. Artucio, P. Dıaz, T. Dieste, B. Erramun, A. Fiandra, D.Fiandra, A. Firszt, J. Gaspar, S. Lopez, H. Menendez, J. Mayol,J. Mussetti, A. Tuzman, F. Urrutia, P. Vazquez. InterventionalCardiology Committee of the Uruguayan Society of Cardiology,Uruguay.

Background: Our aim was to analyze the 30-day mortality rates inpatients undergoing an acute myocardial infarction (AMI) treated withprimary percutaneous transluminal coronary angioplasty (PTCA) inUruguay.

Methods: We used a national prospective registry of patients withAMI within 12 hours of symptoms onset treated with primary PTCA.

Results: Between March 2001 and April 2002, 258 patients under-went primary PTCA in the first 12 hours of AMI (mean age, 60.6 �12.6 years; men, 71.7%). The radial approach was used in 111 patients(43.0%), and 233 patients (90.3%) received �1 stent. The stenting ratewas 1.24 per patient. At 30 days, the global mortality rate was 17 of 258(6.6%). Mortality rates for different groups of patients are shown in theTable.

Yes,n (%)

No,(n (%) p-Value

Age �70 yr 8/66 (12.1) 9/192 (4.7) �0.05Male sex 13/185 (7.0) 4/73 (5.5) NSDiabetes 3/39 (7.7) 14/219 (6.4) NSAnterior AMI 7/117 (6.0) 10/141 (7.1) NSKillip-Kimball class IV 9/20 (45.0) 8/238 (3.4) �0.05Time of onset to reperfusion

�6 hours9/202 (4.5) 8/56 (14.3) �0.05

Hospital with cath lab 5/125 (4.0) 12/133 (9.0) NSFinal TIMI 3 flow 11/225 (4.9) 6/33 (18.2) �0.05Radial approach 3/111 (2.7) 14/147 (9.5) �0.05Radial approach (no Killip IV class) 2/108 (1.9) 6/130 (4.6) NSGlycoprotein IIb/IIIa inhibitors 3/77 (3.9) 14/181 (7.7) NS

Conclusion: The mortality rate for primary PTCA for AMI inUruguay is similar to that in other registries. Older patients, cardiogenicshock, late reperfusion, lack of final TIMI 3 flow, and femoral approachwere significantly associated with higher mortality rates. If patientswith cardiogenic shock are excluded, there were no significant differ-ences in mortality rates between the femoral and radial approaches.


POSTER

ABSTRACTS


TCT-487Efficacy of Suction Thrombectomy for Acute MyocardialInfarction. Y. Ito, T. Muramatsu, R. Tsukahara, M. Ho, K. Hirano,M. Nakano, M. Matsushita. Kenji Shida Division of Cardiology,Kawasaki Social Insurance Hospital, Kanagawa, Japan.

Background: Our goal was to examine the efficacy of suction throm-bectomy for acute myocardial infarction (AMI) in each infarctedbranch based on reperfusion flow and left cardiac functions.

Methods: The study was conducted in 107 (mean age, 65.6 � 10.6years; n � 25 women) of 114 successive patients, who visited thehospital within 12 hours after onset and underwent suction thrombec-tomy using Rescue as reperfusion therapy and stenting; 7 patients inwhom the circumflex branch was the responsible coronary artery wereexcluded. The subjects were subdivided into 2 groups—RCA group(right coronary artery; n � 39) and LAD group (left anterior descend-ing; n � 68)—depending on the coronary artery responsible for in-farction. The effects of thrombus aspiration using the Rescue catheterwere compared between successful suction thrombectomy (ResS) andunsuccessful suction thrombectomy (ResU). TIMI grade immediatelyafter Rescue (PostR) and after stenting, TIMI frame count (TFC),incidence of distant embolism (DE), and left ventricular functions (leftventricular ejection fraction [LVEF]) on the day of discharge (onaverage, day 9) were assessed.

Results: There was no difference in the backgrounds of patients inthe RCA and LAD Groups. There was no difference in the time ofhospital visit and pretreatment TIMI grade between ResS and ResU inboth groups. In all, 23 patients (76.7%) in the RCA group had TIMI �2by PostR, which was higher in the percentage (p �0.05) of 3 ResUpatients (33.3%) (p �0.05). In the RCA group, PostR and final TFCwere 40.5 � 37.6 and 19.7 � 11.1 in ResS and 101.7 � 75.9 and42.6 � 50.1 in ResU, respectively, indicating that PostR was signifi-cantly lower in ResS (p �0.05). In the LAD group, postR and final TFCwere 49.1 � 34.5 and 33.3 � 34.5 in ResS and 43.7 � 22.4 and 27.9 �18.2 in ResU, respectively, indicating that there was no significantdifference between ResS and ResU. There was no significant differencein DE between ResS and ResU in the 2 groups. LVEF at discharge was0.615 � 0.107 in ResS and 0.541 � 0.201 in ResU in the RCA groupand was slightly higher in ResS, but the difference was not significant(p � NS). There also was no significant difference in LAD group.

Conclusion: The results indicate that successful prestenting suctionthrombectomy using Rescue can contribute to the containment ofslow-flow if RCA is the responsible coronary artery.

TCT-488Success or Lack of Success of Suction Thrombectomy Using theRescue Catheter System in Acute Myocardial Infarction andFindings of Intravascular Ultrasound. Y. Ito, T. Muramatsu, R.Tsukahara, M. Ho, K. Hirano, M. Nakano, M. Matsushita. KenjiShida Division of Cardiology, Kawasaki Social Insurance Hospital,Kanagawa, Japan.

Background: To examine the possible relation between success or lackof success of suction thrombectomy using the Rescue catheter systemin acute myocardial infarction (AMI), findings of intravascular ultra-sound (IVUS), and clinical results.

Methods: The subjects were 77 consecutive patients with AMIpresenting within 12 hours of the onset of AMI who underwent notonly intervention after suction thrombectomy using the Rescue cathetersystem but also IVUS. These patients were divided into those whosuccessfully underwent thrombus suction (Rescue suction [RS] group,n � 54; 65.8 � 10.1 years) and the those who did not undergo Rescuesuction (no-Rescue suction [RU] group, n � 23; 68.6 � 10.4 years), tocompare the time to hospital admission, total vessel area (TVA), lumen

area (LA), remodeling index before treatment (RI � TVA at the targetlesion/average reference TVA), plaque area (PA � TVA � LA),incidence of plaque rupture, percentage of successful TIMI 3 flowimmediately after the procedure using the Rescue catheter system,percentage of eventually successful TIMI 3 flow, ejection fraction (EF)immediately after treatment and that before discharge (average, 9 � 2days) in patients who had TIMI 0 flow before treatment.

Results: The time to hospital admission was 4.1 � 2.6 hours in theRS group and 4.3 � 2.6 hours in the RU group; the RI before treatmentwas 1.1 � 0.2 in the RS group and 1.2 � 0.3 in the RU group,exhibiting no difference. The TVA (in mm

2) before treatment was

16.5 � 4.3 in the RS group and 17.5 � 8.7 in the RU group; the LAwas 1.9 � 0.5 in the RS group and 2.0 � 0.4 in the RU group; the PAwas 14.6 � 4.2 in the RS group and 15.5 � 8.7 in the RU group,exhibiting no difference. Plaque rupture was observed in 20 patients(37.0%) in the RS group and in 3 patients (13.0%) in the RU group,demonstrating a significantly higher incidence in the RS group (p�0.05). The percentage of successful TIMI 3 flow immediately afterthe procedure using the Rescue catheter system in patients with TIMI0 flow before treatment was 22 of 46 (47.8%) in the RS group, and 4of 13 (30.8%) in the RU group, indicating improvement in the RSgroup. The percentage of eventually successful TIMI 3 flow was 47 of54 (87%) in the RS group, and 17 of 23 (73.9%) in the RU group, againindicating favorable results in the RS group. Both the EF in the acutephase and that before discharge were favorable in the RS group.

Conclusion: The time to hospital admission, RI of the target lesion,LA, and plaque volume did not affect the success of the procedureusing the Rescue catheter system in patients with AMI. In patients whounderwent suction, the incidence of plaque rupture was higher than inthose who did not undergo suction, and the percentage of successfulTIMI 3 flow immediately after the procedure using the Rescue cathetersystem and that of eventually successful TIMI 3 flow were also higher,indicating usefulness of the suction thrombectomy using the Rescuecatheter system.

TCT-489Sixty-Minute Balloon Occlusion of the Left Anterior DescendingArtery: results in a Predictable Porcine Model of LeftVentricular Dysfunction After Acute Myocardial Infarction.M.J. Price, S. Kar, D. McClane, A.C. De Lara-Llarena, R. Makkar.Cardiovascular Intervention Center, Cedars Sinai Medical Center,Los Angeles, California, USA.

Background: There is a need for a large animal model of left ventric-ular remodeling after acute myocardial infarction (AMI) that is relevantin the current era of reperfusion therapy. This model would be usefulin the evaluation of newer therapies such as intramyocardial gene, cell,or protein therapy.

Methods: A group of 20-kg pigs (n � 8) were premedicated withamiodarone (400 mg/day for 7 days preoperatively, 200 mg/day for 3days thereafter), atenolol (25 mg/day for 3 days preoperatively, dailythereafter), aspirin (325 mg/day for 3 days preoperatively, daily there-after), and plavix (75 mg/day for 3 days, daily thereafter). An over-the-wire 2.5 � 10-mm balloon was advanced just distal to the secondlargest diagonal. A preconditioning inflation of 1 minute was per-formed at the smallest atmospheric pressure that completely occludeddistal flow as determined by angiography. A second ballon inflation ata similar pressure was then performed for 60 minutes. Lidocaine 50 mgintravenously (IV) was administered before balloon occlusion (BO), 25mg IV given just prior to deflation, and additional boluses of 25 mg IVwere given at operator discretion for significant ventricular arrhyth-mias. Left ventricular (LV) angiography in the lateral and PA projec-tions provided views similar to those of the standard views in humans;LV ejection fraction (EF) was determined by taking the mean LVEF ofthese views derived from the Simpson formula. At 3 months, the


POSTER

ABSTRACTS


animals were killed, and myocardial infarction (MI) size was deter-mined by scar planimetry. Statistical analysis was performed using a2-tailed Student t test.

Results: The mean baseline LVEF was 0.57 � 0.05, and at 3months was 0.44 � 0.04 (p � 0.002). The mean decrease in LVEF was0.13 � 0.05. The mean infarct size was 4.7% � 1.6% of the LV mass.Two pigs died suddenly within 48 hours after the procedure; none hadfatal arrhythmias during BO or reperfusion.

Conclusion: In pigs, 60-minute BO of the mid left anterior de-scending artery, with appropriate premedication, provides a clinicallyrelevant, predictable model of LV dysfunction with acceptable attrition.This model may be helpful in studying the effects of post-MI therapyin the current era of reperfusion in AMI.

TCT-490Cardiac Enzyme Kinetic, ST-Segment Change and LeftVentricular Function Recovery in Patients with Anterior AcuteMyocardial Infarction Treated with Primary PercutaneousCoronary Intervention Followed by Left Anterior DescendingHyperoxemic Blood Infusion. D. Trabattoni, F. Fabbiocchi, P.Montorsi, G. Marenzi, A. Loaldi, P. Ravagnani, S. Galli, L.Grancini, S. Cozzi, A.L. Bartorelli. Centro Cardiologico Monzino,IRCCS, Institute of Cardiology, Milan, Italy.

Background: Intracoronary infusion of hyperoxemic blood has beendemonstrated to attenuate reperfusion microvascular injury. Microvas-cular injury may result in poor recovery of left ventricular (LV)function despite primary percutaneous coronary intervention (PCI).Our aim was to assess cardiac enzyme kinetic, ST-segment evolution-ary changes, and left ventricular (LV) function recovery in primary PCIpatients (pts) treated with intracoronary hyperoxemic blood infusionand compare them with the results obtained in matched control pts.

Methods: We studied 41 pts treated by primary PCI for ST-elevation anterior AMI. In 21 pts (AO group), hyperoxemic blood(PO2, 760–1,000 mm Hg) was selectively infused with the TherOx AOSystem for 90 minutes into the left anterior descending artery (LAD)via a 4Fr infusion catheter immediately after coronary recanalization,while the other 20 pts (control group) had spontaneous normoxemicblood autoperfusion. The 2 groups were matched in clinical and an-giographic characteristics and showed similar preprocedural LV func-tion (2-D echocardiography). No significant difference was also ob-served in time to presentation (AO group, 3.5 � 1.6 hours; controlgroup, 2.75 � 1.77 hours) and maximum ST elevation (AO group,6.2 � 3.6 mm; control group: 5.6 � 3.2 mm). LV function recoverywas evaluated by serial 2-D echocardiography (ejection fraction [EF]and WMSI) at 24 hours, 7 days, and 6 months in both groups.

Results: LAD recanalization (100% stenting) was successful in allpts. No difference was observed in creatine kinase (CK) peak levelsbetween the AO group (3,609 � 2,214 IU/L) and the control group(4,024 � 2,649 IU/L). However, the AO group showed a 4.8 �2.2–hour shorter time to peak CK release (p � 0.001) and a shorter CKhalf-life period (23.4 � 8.9 hours vs 30.5 � 5.8 hours, p � 0.006)compared with the control group. Furthermore, AO group had a moresignificant reduction of ST-segment elevation after LAD recanalization(5.2 � 0.8 mm vs 3.8 � 2.2, p � 0.02). Compared with baseline values,a significant mean relative improvement of LV function (%EF) at 24hours, 7 days, and 6 months was observed only in AO pts (AO, 13.6%,17.8%, and 24.5%, respectively) while control pts did not show anysignificant change (2.4%, 4.5%, and 2.5%, respectively).

Conclusion: After successful primary PCI, cardiac enzyme kineticand ST-segment evolutionary changes in AO treated pts suggest fasterand more complete microvascular reperfusion. This may explain thesignificantly better LV function recovery in AO treated pts comparedwith controls.

TCT-491Comparison of Baseline and 6-Month Follow-up Results ofNOGA Endocardial Mapping After Revascularization of theInfarct-Related Artery. M. Gyongyosi, A. Khorsand, S. Graf, W.Sperker, C. Strehblow, D. Glogar. Division of Cardiology, Universityof Vienna Medical Center, Vienna, Austria.

Background: Myocardial viability and segmental wall motion wereassessed by NOGA endocardial mapping in order to evaluate thechanges in myocardial electrical and mechanical activities at baseline(within 1 month after acute myocardial infarction) and 6 months aftercoronary intervention of the infarct-related coronary artery in patientswith acute myocardial infarction (AMI) and thrombolysis.

Methods: The results were compared with the 201Tl rest and laterest uptake of myocardial perfusion scintigraphy. For the quantitativeanalysis of the endocardial maps, the transformation of the 3-D NOGAmaps into a polar map was performed similarly to the bull’s-eyeanalysis of tracer uptakes. The quantitative rest and late rest 201Tlmyocardial perfusion scintigraphy was analyzed by using polar maps,dividing the myocardium into 12 segments comparable to the NOGAreconstruction.

Results: Baseline and follow-up quantitative analysis of the endo-cardial mapping and 201Tl resting myocardial perfusion scintigraphy of8 patients (61 � 5 years, 88% men) were performed 18 � 12 days afterthe onset of AMI and 6 � 4 months later. Coronary angiographyrevealed the left anterior descending coronary artery in 5 (63%), the leftcircumflex coronary artery in 1 (13%), and the right coronary artery in2 (24%) patients as infarct-related arteries. Endocardial mapping pro-cedure revealed a significant improvement in endocardial voltage val-ues (7.1 � 2.2 mV to 8.8 � 2.9 mV, p �0.05) and a trend toward anincrease in regional wall motion (from 6.6 � 4.2 to 9.3 � 5.8%, p �0.08) 6 � 4 months after coronary interventions in the territory of theinfarct-related artery. The late rest 201Tl uptake increased moderatelybut significantly at the follow-up as compared with the baseline values(from 55.4 � 9.2% to 60 � 8.7%, p �0.05), indicating an improvementin myocardial viability at follow-up.

Conclusion: Endocardial electrical activity of the ischemic areaimproves after coronary intervention of the infarct-related artery, indi-cating a possibility of the diagnosis of stunned myocardium by usingendocardial mapping.

TCT-492Comparison Between 2 Different Distal Protection Devices inAcute Myocardial Infarction Treated with PercutaneousCoronary Intervention. F. Fabbiocchi, G. Calligaris, S. DeMartini, P. Montorsi, S. Galli, D. Trabattoni, A. Loaldi, L. Grancini,A.L. Bartorelli. Centro Cardiologico Monzino, IRCCS, Institute ofCardiology, Milan, Italy.

Background: Distal embolization of thrombus and plaque debris maycompromise myocardial reperfusion after percutaneous coronary inter-vention (PCI) in acute myocardial infarction (AMI) patients (pts). Ourgoal was to compare the feasibility, safety, and efficacy of distalprotection using 2 different devices, a temporary occlusion system(GuardWire [GW]) and a porous filter system (FilterWire [FW]) duringPCI in AMI.

Methods: From September 2001 to May 2002, 50 AMI pts under-went primary (77%) or rescue (23%) PCI with distal protection. GWwas used in 27 pts and FW in 23. The 2 groups were matched forclinical and angiographic characteristics. The infarct-related artery inGW versus FW was: left anterior descending, 52% versus 48%; leftcircumflex, 11% versus 8%; right coronary artery, 33% versus 43%;and left main coronary artery, 4% versus 0%. Culprit lesion diameterstenosis was 98 � 3% in GW and 97 � 5% in FW (p � NS). Baseline


POSTER

ABSTRACTS


TIMI 0-1 flow was present in 81% and 63% of GW and FW pts,respectively (p � NS). Time to reperfusion was 3.4 � 2 hours in GWand 4.4 � 2 hours in FW (p � NS). Cardiogenic shock and cardio-pulmonary resuscitation before PCI occurred in 11% and 15% of GWpts, and in 17% and 13% of FW pts, respectively. Abciximab wasadministered in 44% of GW and in 47% of FW pts (p � NS).Systematic stenting was performed in all pts.

Results: GW was correctly positioned in all cases, whereas FWfailed to cross the occlusion in 4 (17%) pts. Successful coronaryrecanalization was obtained in 100% of cases in both groups. TIMI-3and and TIMI 2-3 flow was achieved in 70% and 96% of GW pts andin 79% and 95% of FW pts, respectively (p � NS). Final blush gradewas 2.0 � 1 in GW and 1.9 � 1 in FW pts (p � NS). No-reflowoccurred in 1 pt in both groups. One pt died in GW group (3.7%)because of gastrointestinal hemorrhage after abciximab administration.No other major adverse coronary events occurred at 30 days in eithergroup.

Conclusion: This study demonstrates the easy and safe applicationand the potential benefit of distal protection using the GW and FWsystems in AMI patients treated with PCI. Clinical and angiographicsigns of distal embolization were similarly minimized by both systems.

TCT-493The Incidence, Predictors, and Outcomes of Early ReinfarctionAfter Primary Angioplasty for Acute Myocardial Infarction. S.Kernis, K. Harjai, M. Yerkey, L. Grines, C. Grines. WilliamBeaumont Hospital, Royal Oak, Michigan, USA.

Background: Our objective was to assess the incidence, predictors,and outcomes of early reinfarction (re-MI) in patients (pts) treated withprimary angioplasty (percutaneous coronary intervention [PCI]) foracute myocardial infarction (AMI). Background Early re-MI occurs in2% to 6% of pts with AMI after successful fibrinolysis and causesincreased morbidity and mortality. There are few data on the predictorsor consequences of early re-MI in the era of primary PCI.

Methods: We pooled data on 3,603 pts enrolled in the PAMI trials.Early re-MI was defined as recurrence of clinical symptoms (or newelectrocardiographic changes) and new elevation of creatine kinase(CK) or CK-MB enzymes within 1-month after PCI. We comparedclinical and angiographic data and 1- and 6-month outcomes (death,ischemic target vessel revascularization [I-TVR]) between pts with andwithout re-MI.

Results: Re-MI occurred in 55 (1.6%) pts. Univariate correlates ofre-MI were age �70 years, Killip class �1, lower stent use, lower leftventricular ejection fraction (LVEF), final TIMI flow �3, and finalstenosis �30%. In multivariate analysis, age �70 years (odds ratio[OR], 2.3; 95% confidence interval [CI],1.2–4.6), and lower LVEF(OR, 0.96; 95% CI,0.93–0.99) were independent correlates of re-MI.Patients with re-MI had significantly worse clinical outcomes (Table).

Re-MI, %(n � 55)

No Re-MI, %(N � 3,548) p-Value

1 moDeath 15 2 �0.0001I-TVR 23 3 �0.0001

6 moDeath 19 3 �0.0001I-TVR 40 9.4 �0.0001

Further, re-MI independently predicted 1-month death (OR, 8.0; 95%CI, 3.1–21.0) and I-TVR (OR, 24.9; 95% CI, 11.2–55.2), as well as6-month death (OR, 7.4; 95% CI, 3.1–17.5), and I-TVR (OR, 8.2, 95%CI, 4.1–16.3).

Conclusion: Re-MI is uncommon in AMI pts treated with primaryPCI, and tends to occur in older patients with depressed LVEF. Re-MIindependently predicts death and I-TVR at 1 and 6 months.

TCT-494Late Hemodynamic Compromise After Successful PrimaryAngioplasty for Acute Myocardial Infarction. M.W. Yerkey1, K.J.Harjai1, G.W. Stone2, D.A. Cox3, T.D. Stuckey4, J.A. Boura1, B.A.Bartholomew1, S.J. Kernis1, C.L. Grines1. 1William BeaumontHospital, Royal Oak, Michigan, USA; 2Lenox Hill Hospital, NewYork, New York, USA; 3Mid-Carolina Cardiology, Charlotte, NorthCarolina, USA; 4LeBauer Cardiovascular Associates, Greensboro,North Carolina, USA.

Background: The hospital course of patients with acute myocardialinfarction (AMI) undergoing primary percutaneous coronary interven-tion (PCI) may be complicated by late hemodynamic compromise. Wesought to identify the incidence, predictors, and clinical impact ofsustained hypotension (SH) after successful angioplasty.

Methods: We screened 2,753 patients presenting with AMI not inshock who were enrolled in the Primary Angioplasty in MyocardialInfarction studies (PAMI-I, PAMI-II, and Stent PAMI). Patients withcardiac arrest or malignant arrhythmias in the catheterization laboratorywere excluded. In the remaining 1,957 patients, we compared clinicaland angiographic characteristics and mortality and major adverse car-diac events (MACE; combined endpoint of death, target vessel revas-cularization, and reinfarction) at 30 days and at 6 months betweenpatients who developed SH (systolic blood pressure [SBP] �100 mmHg for �30 minutes requiring inotropic agents or intra-aortic balloonpump [IABP]) and those who did not.

Results: SH occurred in 61 patients (3.1%) during the index hos-pitalization. Independent predictors of SH were initial SBP�100 mmHg (odds ratios [OR], 4.2; 95% confidence interval [CI], 2.2–8.1), leftventricular ejection fraction (LVEF) �0.40 (OR, 2.9; 95% CI, 1.5–5.5),peripheral vascular disease (PVD; OR, 3.8; 95% CI, 1.6–9.3), andaspirin not given before PCI (OR, 3.9; 95% CI, 1.4–10.6). Patients withSH had a higher mortality at 30 days (13% vs 2.3%, p �0.0001) andat 6 months (20% vs 3.5%, p �0.0001), as well as increased MACE at30 days (24% vs 6.7%, p �0.0001) and at 6 months (37% vs 15%, p�0.0001). In multivariate analysis, SH was an independent predictor ofmortality (OR, 5.0; 95% CI, 1.9–13.6) and MACE (OR, 3.1; CI,1.4–6.9) at 30 days. Patients with transient (�30 minutes) hypotensionhad inhospital mortality (1.5% vs 2.0%, p � 1.00) and MACE (4.2%vs 5.1%, p � 0.61) similar to normotensive patients.

Conclusion: Late hemodynamic compromise after successful an-gioplasty portends significantly worse clinical outcomes. Patients withinitial SBP�100 mm Hg, LVEF�0.40, PVD, and those who do notreceive aspirin before PCI are at high risk and may require longerperiods of intensive hemodynamic monitoring. As SH independentlypredicts worse outcomes, immediate and aggressive measures shouldbe instituted for patients with post-PCI hypotension.

TCT-495Primary Stenting in Acute Myocardial Infarction: The Influenceof Age on Results: the Brazilian CENIC Registry. A.G.M.R.Sousa1,2, L.A. Mattos1,2, C. Campos1, A. Paes1, J. Saad2, A.Labrunie2, C. Costantini2, J. Eduardo Sousa1,2 on behalf of CENICparticipants. 1Institute Dante Pazzanese of Cardiology, Sao Paulo,Sao Paulo, Brazil; 2Brazilian Society of Interventional Cardiology ,Sao Paulo, Sao Paulo, Brazil.

Background: The benefit of primary stenting (PST) in elderly patients(pts) with acute myocardial infarction (AMI) is uncertain althoughelderly people account for a large proportion of deaths.


POSTER

ABSTRACTS


Methods: We examined the inhospital mortality and the combinedend point of death or re–myocardial infarction (MI) of 6,939 ptsundergoing PST for AMI, between January 1997 and December 2001in 179 Brazilian hospitals. Pts were divided into 2 groups, according toage (�70 years and �70 years), and data were prospectively collectedand entered into a dedicated database. Logistic regression was per-formed to determine the independent predictors of inhospital outcomes(re-MI, death, and death or MI).

Results: The independent predictors of inhospital death or re-MIafter stenting for AMI are age (p �0.01), sex (p �0.01), diabetes (p�0.01), and ejection fraction (EF; p �0.01) (Table).

<70 yr(5,264 P)

>70 yr(1,675 P) p

Female (%) 24.3 42.2 � 0.0001Diabetes (%) 15.4 19.3 � 0.0001EF � 0.40 (%) 38.8 45.2 � 0.0001LM (%) 0.6 0.9 0.211ADA (%) 49.5 47.8 0.224Calcium (%) 12.7 24.5 0.002ReoPro (%) 18.1 18.6 0.655ReMI (%) 1.3 1.7 0.204Death (%) 2.7 7.6 � 0.0001Death or reMI (%) 3.6 8.6 � 0.0001

Conclusion: Primary coronary stenting in patients �70 yearsyielded a significant decrease in clinical benefit when compared withyounger patients.

TCT-496Post-Thrombolytic Management of Acute Myocardial Infarction:Early Invasive, Late Invasive, or Conservative Management?Insights from the Global Registry of Acute Coronary Events(GRACE). I. Sadiq1, H. Dauerman2, R. Goldberg3, W. Klein4, D.Brieger5, P.G. Steg6, G. Montalescot7, J. Lopez-Sendon8, A. Budaj9,J. Gore3. 1Saint Vincent Hospital and University of MassachusettsMedical School, Worcester, Massachusetts, USA; 2University ofVermont College of Medicine, Vermont, USA; 3University ofMassachusetts Medical School, Worcester, Massachusetts, USA;4Medizinische Universitatsklinik, Graz, Austria; 5Concord Hospital,Sydney, Australia; 6Hopital Bichat, Paris, France; 7Hopital Pitie-Salp etriere, Paris, France; 8Hospital Universitario GregorioMaranon, Madrid, Spain; 9Grochowski Hospital, Warsaw, Poland.

Background: Thrombolytics (lytics) decrease mortality of patients(pts) with acute ST-segment elevation myocardial infarction (STE MI).However, the impact of a subsequent invasive strategy on improvingoutcomes has not been studied in an international population-basedsetting.

Methods: A group of 1,679 pts enrolled in the Global Registry ofAcute Coronary Events (GRACE) with STE MI were analyzed. Ptswere divided into 3 groups based on the receipt of a cardiac catheter-ization (cath) �12 hours of lytics (early cath), �12 hours after lytics(late cath), or no cath (conservative treatment). Clinical characteristics

of these pts were compared, and the likelihood of inhospital mortalitywas determined using multivariate analysis.

Results: Factors predicting the use of a subsequent invasive man-agement included prior revascularization, prior statin use, and tissue-plasminogen activator administration on diagnosis. The incidence ofinhospital death was significantly lower in the late cath group ascompared with the lytics only group (2% vs 6.8%, p 0.0002). Thisrelation persisted even after controlling for differences in baseline andinhospital characteristics between the 2 groups (late cath mortality oddsratio, 0.3; 95% confidence interval, 0.13–0.63). Paradoxically, thelikelihood of a reinfarction was increased in the late cath group.

Conclusion: Although thrombolytic therapy substantially de-creases mortality after an acute STE MI many pts may derive additionalbenefit from the use of an invasive strategy.

TCT-497Intracoronary Thrombus Score and Corrected TIMI FrameCount in Rescue Stenting Compared with Primary Stenting inAcute Myocardial Infarction. M. Salem, J. Freeman, S. Katz, S.Green, D. Marchant, B. Kaplan, R. Jauhar, L. Ong. North ShoreUniversity Hospital, Manhasset, New York, USA.

Background: Intracoronary thrombus has been associated with ad-verse outcomes during coronary intervention in acute myocardial in-farction (AMI). We compared the thrombus burden in patients under-going primary stenting and those undergoing rescue stenting afterfailed thrombolysis and its effect on the procedural outcome.

Methods: A retrospective analysis was performed on 231 patientstreated with stenting for AMI at our institution. Thrombus score andcorrected TIMI frame count (CTFC) were measured in 115 patientswith AMI who underwent primary stenting (Group P) and in 116patients referred because of clinical signs of failed thrombolysis. Ofthese, 71 (61%) had TIMI flow �3 (CTFC �40) and underwent rescuestenting (Group R). Abciximab was used in 30% of patients in GroupP and 2% in Group R. The thrombus burden was assessed at initialangiography or after establishing antegrade flow in vessels with totalocclusion and was graded on a TIMI scale of 0 to 4.

Results: The thrombus score after establishing antegrade flow washigher in Group R compared with Group P (2.25 � 1.46 vs 1.83 �1.48; p � 0.06). At the end of the procedure there was no differencebetween the 2 groups in final TIMI flow grade (2.87 � 0.52 vs 2.77 �0.48; p � NS). However, the final CTFC, which has been related toincreased inhospital and long-term mortality, was significantly higherin Group R compared with Group P (30.26 � 16.26 vs 24.88 � 20.02;p � 0.05). Regression analysis revealed thrombus score and initialCTFC to be independent predictors of final CTFC (p � 0.028 and p �0.001, respectively).

Conclusion: Failed thrombolysis is associated with larger throm-bus burden, and rescue stenting resulted in higher CTFC, as comparedwith primary stenting in patients who did not receive thrombolysis.Concern about the risk of bleeding limits the use of glycoproteinIIb/IIIa inhibitors after full-dose thrombolysis. We suggest that distalprotection and thrombus extraction devices be considered during rescuestenting to potentially improve outcome.


POSTER

ABSTRACTS


acute myocardial infarction ii

Documents