Special Feature / Cardiovascular Revascula

dilatation equipment in 0.4%. The complications associated with radialaccess included hematoma managed medically in 0.35%, bleedingrequiring blood transfusion in two cases (0.02%), and seven patientsrequired surgical intervention (one A-V fistula, two pseudo-aneurysm, andfour hematoma evacuation). The radial pulse was absent without symptomsor signs of ischemia in 4%. One patient has required late (7 months)angioplasty for subclavian artery occlusion after initial development ofradial artery thrombosis.Conclusion: In selected patients, the transradial approach performed bytrained operators is safe and feasible for PCI. The major clinical advantage ofthe radial approach is the absence of major vascular access complications.

doi:10.1016/j.carrev.2010.03.065

Predictors of in-hospital gastrointestinal bleeding followingpercutaneous coronary interventionMichael A. Gaglia Jr, Rebecca Torguson, Zhenyi Xue, Manuel A. Gonzalez,Sara D. Collins, Itsik Ben-Dor, Asmir I. Syed, Gabriel Maluenda,Cedric Delhaye, Kohei Wakabayashi, Nicholas Hanna,Kimberly Kaneshige, William O. Suddath, Kenneth M. Kent,Lowell F. Satler, Augusto D. Pichard, Ron WaksmanWashington Hospital Center, Washington, DC, USA

Background: The risk of gastrointestinal bleeding (GIB) is higher inpatients taking dual antiplatelet therapy, but other risk factors for GIB areless well defined.Methods: We compared 141 patients with in-hospital GIB to 19,181 patientswithout in-hospital GIB after percutaneous intervention (PCI). We defined GIBas clinical (coffee grounds emesis, melena, or hematochezia) or endoscopicevidence of an actively bleeding upper or lower site. We then performedmultivariable logistic regression to establish predictors of in-hospital GIB.Results: 21.5% of patients with GIB suffered death at 30 days, compared to2.4% of patients without GIB (Pb.001). This increased to 36.6% vs. 7.6% at 1year (Pb.001). Seventy-five percent of patients with GIB required transfusion,compared to 4.3% of patients without GIB (Pb.001). Patients with GIB weremore likely to receive glycoprotein IIb/IIIa inhibitors (GPI, 33.3% vs. 17.5%,Pb.001) and less likely to receive bivalirudin (41.1 vs. 61.7%, Pb.001). Thenumber of patients on warfarin was similar (6.4% overall). After multivariableadjustment, age, female gender, acute presentation, shock at presentation, peakcreatine kinase-MB, use of GPI, and history of chronic renal insufficiencyremained significantly associated with in-hospital GIB (Fig. 1).Conclusions: In-hospital GIB results in strikingly high mortality and isassociated with GPI but not with warfarin. Efforts should be made tominimize GIB, given the grave outcome.

doi:10.1016/j.carrev.2010.03.066

Fig. 1. Predictors of in-hospital GIB.

Safety and efficacy of the Xience V everolimus-eluting stent in patients

with bifurcation lesions: a subgroup analysis from the Spirit VProspective RegistryVladimir Dzavik a, Eberhart GrubebaPeter Munk Cardiac Centre, University Health Network, Toronto,ON, CanadabHELIOS Heart Center, Siegburg, Germany

Background: Earlier SPIRIT percutaneous coronary intervention (PCI)trials with the XIENCE V everolimus-eluting stent (EES), including SPIRITFIRST, II, III, and IV, met their prespecified primary and major secondaryendpoints; however, they were restricted to patients with highly selectedinclusion/exclusion criteria. The SPIRIT V Study provided an evaluation ofEES performance in ‘real-world’ complex patient and lesion subsets in aglobal patient population. The aim of this analysis was to analyze outcomesof patients undergoing EES treatment of bifurcation lesions, a subset inwhich treatment is particularly challenging.Methods: The registry arm of SPIRIT V enrolled 2700 patients outside theUnited States with de novo coronary artery lesions. Patients with coronaryartery disease and artery morphology suitable to be optimally treated with amaximum of four planned stents (maximum of one, de novo, target lesionper native major epicardial vessel or side branch) were enrolled; lesionevaluation was per visual assessment. The outcomes of the 508 patientsundergoing EES stenting of≥1 bifurcation lesion were compared with thosewith no bifurcation lesion treated.Results: The median distribution for the lesions was as follows: 1.1.1:25.7%; 1.1.0: 18.3%; 1.0.1: 9.9%; 0.1.1: 6.3%; 1.0.0: 18.7%; 0.1.0:15.6%; and 0.0.1: 5.5%. When compared to patients without bifurcationtreatment, patients with bifurcation treatment were more likely to havemultivessel disease (49.0% vs. 39.8%, P=.0002), left main treatment(3.2% vs. 0.9%), more lesions treated (1.5 vs. 1.3), more ACC type B2 orC lesions (96.4% vs. 80.1%), ostial lesions (17.1% vs. 8.2%), calcification(36.2% vs. 27.5%), and angulated lesions (29.1% vs. 21.1%) (allPb.0001). At 1 year, the composite rate of cardiac death, MI not clearlyattributable to a nontarget vessel, and TLR was 6.6% in patients withbifurcation PCI and 4.7% in those with nonbifurcation PCI (P=.09).Nonhierarchical rates of cardiac death, MI, TLR, and TVR, and rates ofARC-defined stent thrombosis (0.4% vs. 0.7%, P=.552) were notsignificantly different between the two groups.Conclusions: Despite greater patient and lesion complexity, treatment ofpatients with bifurcation lesions with EES in the SPIRIT V prospectiveregistry was safe and effective, with low overall event rates that were similarto those without bifurcation lesion treatment. The thin struts, durablefluoropolymer, and optimal everolimus release profiles for the EES may allcontribute to these results.

doi:10.1016/j.carrev.2010.03.067

Decreasing trend in in-hospital mortality of patients undergoingpercutaneous coronary intervention regardless of race or genderwith persistent higher mortality rates in women and minorities in theUnited StatesMohammad Reza Movaheda, Mehrtash Hashemzadehb, M. Mazen JamalbaThe Southern Arizona VA Health Care System and University of ArizonaSarver Heart Center, Tucson, AZ, USAbVA Long Beach Health Care System, Long Beach, CA, USA

Background: Significant advances have been made in the last few decades.We have recently shown that PCI-related mortality has been declining inrecent years. The goal of this study was to evaluate age-adjusted in-hospitalmortality rate in patients undergoing percutaneous coronary intervention(PCI) based on race and gender.Method: The Nationwide Inpatient Sample (NIS) database was utilized tocalculate the age-adjusted mortality rate for PCI from 1988 to 2004 in

211rization Medicine 11 (2010) 199–215