POST

ERABST

RACTS

Results: 65% on C had PRU above 200 compared to those on P. More % of SA had higherPRU (over 220) than reported in Caucasians. After BI, 85% in P group had PRU less than160 whereas 80% in C group still had PRU more than 160. No significant difference in PRUnoted in DM and Non DM groups. BI had no different influence in DM pts.Conclusion: More South Asians were C non-responders. BI significantly increased PRU.Significantly higher number of pts on P had PRU still less than 160 after BI. The results mayhave implications on the use of adjunct pharmacotherapy during PCI. This also raisesquestion about which sample for PRU value after oral administration of a thienopyridine tobe used for defining drug resistance for p.Disclosure of Interest: None Declared

PT206

Main Platelet volume in patients older than 65 years with acute coronary syndrome.A case-control study

Claudio Dizeo*1, Daniel Chirino Navarta1, Alicia Murua2, Florencia Baglioni2, Ariel Monteros1,Graciela Trejo11Cardiología, 2Hematologia, Unidad Asistencial Por Mas Salud Dr. César Milstein, Buenos Aires,Argentina

Introduction: Main Platelet volume (MPV) has been associated to myocardial infraction(MI) and is a predictor of cardiovascular events in these patients. Many studies publishedhave an average age lower to 65 years old. The target of this study is to evaluate if MPV isassociated to MI and cardiovascular events in patients older than 65 year.Objectives: The target of this study is to evaluate if MPV is associated to MI and cardio-vascular events in patients older than 65 year.Methods: Case- control study. There were included patients with supra ST elevationmyocardial infraction (STEMI), without ST elevation (NSTEMI) and control cases(admitted for a different cause than acute coronary syndrome, ACS). There were dividedinto three groups: patients with MI (according to the last universal definition of MI), pa-tients with unstable angina (UA), and group control. MPV was analyzed at admission in thethree groups. Hospital evolution in patients with MI and UA was analyzated. The primaryend point was the combinated of mortality, recurrent angina, heart failure and myocardialinfraction during the hospital station.Results: There were included 48 patients with MI, 53 with UA, and 68 controls. Patientswith MI and UA were younger than control ( 73,8� 8 vs 72,4 � 7 vs 78,5 � 9 years,respectably; p¼0,001), had history of dyslipidemia ( 67 % vs 88% vs 32%; p¼0,001) andthere was no difference of hypertension (81% vs 88% vs 76 %), diabetes (31% vs 30% vs27%) and smoking (12% vs 15% vs 8%) in the three groups. MPV had no differencebetween the three groups at admission (10,6� 1fl vs 10,4�0,9 fl vs 10,5� 1 fl).Furthermore, there was not association between MVP and severe coronary artery disease,meaning left main coronary artery and/ or three vessels disease (10,4 �0,9 fl vs 10,8 � 1 fl;p¼0,4). MPV had no correlation with age (r¼0,14; p¼0,07). Primary end point waspresent in 22% of patients with MI and UA, and was associated with lower MPV (10,2�1vs 10,8�0,9; p¼0,02). In multivariable analysis, MPV was associated independently tocombinated end point (OR 0,92 IC: 95% 0,86-0,99; p¼0,02).Conclusion: In patients older than 65 years, MPV was not associated to MI or severecoronary artery disease. However, a lower MPV was associated with more hospital events.Disclosure of Interest: None Declared

PT207

Association of Red Cell Distribution Width (RDW) in Diabetic Patients WithCoronary Artery Disease

Ismail R. Johan*1, Ibrahim Zubin1, Arshad Kamal1, Abd Rahman Effarezan1,Zainal Abidin Hafisyatul1, Lim Chiao Wen1, Kasim Sazzli11Cardiology, UiTM, Sungai Buloh, Malaysia

Introduction: Red cell distribution width (RDW) is a measurement of the variation of redblood cell (RBC) size. Recent study has showed the RBC in diabetes patient has ultra-structure changed that could impair its function. Further more, diabetes is also known tocause erythrocyte membrane architecture abnormality and compromise the function atmolecular level that lead to coronary thrombosis. A few study have been done before toassess the association and impact of RDW in coronary artery disease patients. However littleis known about RDW association in diabetic patients with coronary artery disease.Objectives: To assess association of RDWwith coronary artery disease among diabetic patients.Methods: This was a single-centre, observational study of 472 patients who were admittedfor coronary angiogram for various indicated reasons from Jan 2012 to Dec 2012. Baselineblood analysis was done on admission using automated complete blood count machine.Significant coronary artery disease is defined as any coronary artery obstruction of morethan 50%. Cut off point of RDW is taken as 14.8% base on the normal lab value.Results: The mean patient age was 56.9 � 9.4 years and 77.3% of the patients were male.54.4% of the patients were diabetic. Mean RDW was 14.4% � 0.5. Among diabetic patients54.5% (79) had increase RDW of more than 14.8% and 59.3% (213) had significantcoronary artery stenosis. In diabetic patients with CAD the mean RDW was slightly higherat 14.4 � 1.4 compared to non-CAD patients 14.2 � 1.3. However there was no significantdifference of RDW between this two group, p ¼ 0.62. When 14.8% taken as cut-off valuefor RDW, 84.8% (67) diabetic patients with CAD had higher RDW level as compared to15.2% (12) in non-CAD patients. There was no association between RDW level in diabeticpatients with CAD and non-CAD patients, p ¼ 0.30.Conclusion: Our results show that there is no association of RDW level in diabetic patientswith coronary artery disease.Disclosure of Interest: None Declared

e208

PT208

Bivalirudin versus Heparin alone in Primary PCI for ST-segment ElevationMyocardial Infarction

Nadim Shah*1, Dinesh K. Natarajan1, Rifly Rafiudeen1, Soe K. Ko1, Anis Taeed1, Kean Soon1,Nicholas Cox1, Western Health Cardiovascular Research Group1Department of Cardiology, Western Health, Melbourne, Australia

Introduction: The use of Bivalirudin, a direct thrombin inhibitor, in the setting of primarypercutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction(STEMI) is associated with reduced major bleeding and major adverse cardiovascular events(MACE)when comparedwith the combination of heparin and glycoprotein IIb/IIIa inhibition.Recent data however suggests removal of the glycoprotein IIb/IIIa inhibitor from this com-bination for acute coronary syndromesmanagedwith PCImay result in contrasting outcomes.Objectives: We investigated the rate of major bleeding and MACE with the use of Biva-lirudin versus heparin alone for patients proceeding to primary PCI for STEMI.Methods: Consecutive patients undergoing primary PCI for STEMI between August 2012and July 2013 were included. Patients receiving a glycoprotein IIb/IIIa inhibitor wereexcluded. Cardiogenic shock and intra-aortic balloon pump use did not preclude inclusion.Definitions of major bleeding and MACE were derived from the HORIZONS-AMI trial.Results: 69 patients met inclusion criteria with 50 (72.5%) patients receiving heparin aloneand 19 (27.5%) Bivalirudin. Mean patient age was 62.7�12.8 and 58.3�12.9 years with66.0% and 78.9% (p¼0.17) males in the Heparin and Bivalirudin groups respectively. Therewere no statistically significant differences in the rate of femoral access or achievement ofTIMI 3 flow between the groups. 30-day MACE rates were 8.0% and 5.3% in the Heparinand Bivalirudin groups respectively (p¼0.7) with no statistical difference in the acute orsubacute stent thrombosis rates. There were no major bleeds in the Heparin group whereas5.3% of patients in the Bivalirudin group suffered a major bleeding complication (p¼0.2).Conclusion: In comparison with heparin alone, without the administration of a glyco-protein IIb/IIIa inhibitor, use of Bivalirudin in primary PCI for STEMI is associated with atrend towards higher major bleeding rate with no additional benefit in MACE outcomes.Disclosure of Interest: None Declared

PT209

“High On-treatment” Platelet Reactivity, But Not Pre-treatment Hyperaggregability,Predicts Clopidogrel Response

Vivek B. Nooney*1,2, Yuliy Chirkov3,4, John Horowitz51School of Pharmacy and Medical Sciences, University of South Australia, 2Cardiology, BasilHetzel Institute, 3University of Adelaide, 4Basil Hetzel Institute, 5Cardiology and ClinicalPharmacology, The Queen Elizabeth Hospital, Adelaide, Australia

Introduction: Although responsiveness to antiaggregatory agents require blood sampling beforeand after initiation of treatment, most studies have used on-treatment measures of agonist (ADP)induced aggregation as an index of clopidogrel response. The contribution of thrombin andthromboxane A2 to platelet aggregation and their relevance to on-treatment aggregability is notwell understood. We have previously shown that PGE1 response predicts clopidogrel response.Objectives: To investigate relationships between PGE1 response, as an indirect measure ofclopidogrel response with ADP, TRAP (thrombin receptor activating peptide) and U46619(analogue of thromboxaneA2) induced platelet aggregation.Methods: Baseline and post-clopidogrel 600mg (4hrs) blood samples were taken frompatients (n¼31) with coronary artery disease, scheduled for non-emergent stent insertion.Whole blood impedance aggregomtery was performed. Platelet PGE1 (30nmol/L) responseswere determined at baseline based on inhibition of ADP (2.5mmol/L) induced aggregation.Aggregation induced with TRAP (3mmol/L) and U46619 (1mmol/L) was also recorded forbaseline and 4hr blood samples. Clopidogrel response (DADP) was measured as % changein platelet aggregation post clopidogrel.Results: PGE1 response was inversely associated with baseline ADP(r ¼ -0.68, p ¼ 0.001),TRAP(r ¼ -0.59, p ¼ 0.0005) and U46619 (rs ¼ -0.53, p ¼ 0.002) induced aggregation.Despite the pre-existing hyper-aggregability, baseline responses to ADP, TRAP and U46619were not significantly associated with the impairment of clopidogrel response. Howeverthere was a significant relationship between on-treatment hyperaggregability to ADP, TRAP,U46619 and hypo responsiveness to clopidogrel ([ADP, p < 0.001], [TRAP, p ¼ 0.024],[U46619, p ¼ 0.003]: using Fisher’s exact test).Conclusion: “High on-treatment” platelet reactivity to ADP is indeed a valid index ofimpaired clopidogrel response in most cases. Furthermore, persistent hyperaggregability toother pro-aggregants (TRAP, U46619) has similar predictive value, emphasising the effectof P2Y12 antagonists of limiting aggregation induced by agonists other than ADP.Disclosure of Interest: None Declared

PT210

Clinical outcome in dialysis patients who underwent percutaneous coronaryintervention

jiangming fam*1, chunyuan khoo1, jonanthan yap1, khung keong yeo1, james xinzhe cai1,yeehow lau2, lingling sim2, soo teik lim1, terrance siang jin chua1, tian hai koh11Cardiology, National Heart Centre Singapore, 2Singapore Cardiac Data Bank, Singapore, Singapore

Introduction: Percutaneous coronary intervention (PCI) in patients with renal failure ondialysis have been shown to be associated with high periprocedural mortality and poorclinical outcome. However, there are limited data in Asian patients.Objectives: The aim of this study is to study the angiographic characteristics and clinicaloutcomes of dialysis dependent patients treated with PCI in an Asian society.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters