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Heart, Lung and Circulation S2152013;22:S126–S266 CSANZ 2013 Abstracts

510

Gender Differences in Outcomes Amongst PatientsUndergoing Coronary Angiography

M. Arstall 1,2,∗, R. Dreyer 1,3, R. Tavella 1,3, M. Worthley 1,4,S. Worthley 1,4, D. Chew 5,6, C. Zeitz 1,3, J. Beltrame 1,3

1 The University of Adelaide, Australia2 Lyell McEwin Hospital, Australia3 The Queen Elizabeth Hospital, Australia4 Royal Adelaide Hospital, Australia5 Flinders University, Australia6 Flinders Medical Centre, Australia

Background: Despite extensive research within gen-der differences in acute coronary syndrome’s (ACS) (i.e.myocardial infarction), there is comparatively little dataon gender-based differences in registries pertaining todiagnostic catheterisation.

Methods: The Coronary Angiogram Database ofSouth Australia (CADOSA) Registry is a comprehensivedatabase of all public cardiac catheterisation proceduresperformed within South Australia. Registry data for 2012was utilised to assess gender differences in (a) proce-dure information for diagnostic coronary angiography,(b) in-hospital outcomes and (c) discharge referral sta-tus/medications.

Results:MenN = 2825

WomenN = 1388

p

Age (mean ± SD) 64 ± 12 66 ± 13 <0.001

Elective Angiography (n %) 1519 (57%) 790 (59%) 0.058

Angiography for ST-elevation myocardialinfarction (STEMI) (n, %)

398 (155) 134 (10%) <0.001

Percutaneous coronary intervention (PCI)performed (n, %)

859 (32%) 275 (21%) <0.001

No Coronary Disease Finding (n, %) 318 (12%) 344 (26%) <0.001

In-hospital death (n, %) 30 (1%) 22 (2%) 0.195

Referral for coronary artery bypass grafting(n, %)

340 (13%) 104 (8%) <0.001

Cardiac rehabilitation referral (n, %) 925 (33%) 323 (23%) 0.001

Discharge Aspirin (n, %) 2340 (83%) 1024 (74%) <0.001

Discharge Statin (n, %) 2058 (73%) 914 (66%) <0.001

Discharge ACE Inhibitor (n, %) 1346 (48%) 525 (38%) <0.001

Discharge Beta blocker (n, %) 1420 (50%) 574 (41%) <0.001

Discharge Calcium channel blocker (n, %) 996 (35%) 428 (31%) 0.003

Conclusion: Consistent with ACS data, women are bothless likely to undergo angiography for STEMI and receiveless life saving PCI. On discharge, women are also man-aged poorly and do not receive appropriate cardiac referralor maintenance medications in comparison to men.

http://dx.doi.org/10.1016/j.hlc.2013.05.512

511

Glomerular Filtration Rate Derived from Cystatin C isMore Predictive of Death Following Cardiac Surgery ThanCreatinine Based Estimates

J. Mooney 1,2,∗, C. Chow 1,2, B. Cuthbertson 3,4, B. Croal 5,G. Hillis 1,6

1 The George Institute for Global Health, Sydney, Australia2 Department of Cardiology, Westmead Hospital, Sydney,Australia3 Department of Critical Care Medicine, Sunnybrook HealthSciences Centre, Canada4 Department of Anesthesia, University of Toronto, Toronto,Ontario, Canada5 Department of Clinical Biochemistry, Aberdeen Royal Infir-mary, Aberdeen, United Kingdom6 Department of Cardiology, Concord Repatriation GeneralHospital, Sydney, Australia

Background: Renal dysfunction predicts mortality aftercardiac surgery. Estimated glomerular filtration rate(eGFR) and cystatin C are better predictors of post-operative death than creatinine alone. The relativeprognostic value of newer methods of calculating eGFRwith the CKD-EPI equation, including cystatin C, has notbeen analysed in this setting.

Methods: A prospective cohort study was conducted of1010 patients undergoing cardiac surgery. Creatinine andcystatin C was collected prior to surgery, and eGFR cal-culated from these. Clinical variables were collected, andpost-operative vital status established.

Results: Mean age was 66 years with 77% male. Averagefollow up was 4.8 years with 141 deaths. Renal function wasa powerful and independent predictor of death howevermeasured. After adjustment with the EUROSCORE, eGFRderived from cystatin C showed the strongest associationwith death, though other measures remained signifi-cant (see table). Receiver operating characteristic curvesshowed eGFR derived from cystatin C showed the greatestpredictive utility (see table).

Conclusions: Estimated GFR using cystatin C levels andthe CKD-EPI equation are more powerful predictors ofdeath following cardiac surgery than creatinine basedmeasures.Marker Hazard Ratio 95%

ConfidenceInterval

P-value Area under theCurve

95%ConfidenceInterval

Cystatin C 2.05 1.57–2.69 0.000 0.67 0.62–0.72

eGFR (Modified Diet in RenalDisease)

0.98 0.97–0.99 0.001 0.61 0.58–0.66

eGFR (CKD-EPI) 0.98 0.96–0.99 0.000 0.63 0.58–0.68

eGFR (cystatin c CKD-EPI) 0.97 0.96–0.98 0.000 0.68 0.63–0.73

eGFR (creatinine and cystatin cCKD-EPI)

0.98 0.97–0.99 0.000 0.66 0.61–0.71

CKD-EPI, Chronic Kidney Disease Epidemiology Collaboration.

http://dx.doi.org/10.1016/j.hlc.2013.05.513