Acute coronary syndromes in anaemic patients: the bad or the ugly?

Abstract Funding Acknowledgements Type of funding sources: None. Background Patients with anaemia are at increased risk of composite cardiovascular (CV) events and all-cause mortality. However, anaemia poses a challenge to doctors when in the context of an acute coronary syndrome (ACS) and the urge to offer intervention treatment and therefore antiplatelet therapy. Purpose To study the prognostic impact of anaemia in a population with ACS. Methods 436 ACS patients admitted to a single coronary care with anaemia (male gender, haemoglobin [Hb] <13 g/dL; female gender, Hb < 12 g/dL) who were discharged from hospital were included. The primary endpoint was long-term all-cause mortality. Cox regression was conducted to evaluate the impact on the primary endpoint. The median of follow-up was 36 (± 31) months. Results Sixty-four percent of the patients were male, with a mean age 75 ± 10 years old. The majority (47%) was admitted with non-ST elevation myocardial infarction. Most of them had previous history of hypertension (87%), dyslipidaemia (63%) and chronic kidney disease (58%), while a minority had a diagnosis of diabetes mellitus (46%). Most of the patients remained in Killip-Kimbal class I throughout hospital-stay. Coronary angiography was not conducted in 15% of the patients. Thirty-six percent of the patients were conservatively treated (not submitted to percutaneous coronary intervention or coronary artery bypass graft). At discharge, 1% of the patients had no antiplatelet or anticoagulation therapy prescribed; 7% had simple antiplatelet therapy; 1% only had anticoagulation therapy; 67% had double antiplatelet therapy; 1% had double therapy (anticoagulation plus a single antiplatelet agent) and 5% had triple therapy (anticoagulation plus two antiplatelets agents); missing data about therapy at discharge in 18% of the patients. 224 patients met the primary outcome. In univariate analysis, nor antiplatelet neither anticoagulation strategies were related to the outcome (P = 0.59; P = 0.73, respectively). In a multivariable model adjusted for age, Hb level, glomerular filtration rate, heart failure diagnosis, left ventricular function (3 categories), maximum troponin I and treatment option (conservative vs revascularization), Hb level remains an important prognosis predictor (HR 0.86, 95% CI 0.77-0.97, per each g/dL increase). In this model, besides from Hb level, only age (HR 1.04, 95% CI 1.02-1.05) and moderate to severely impaired LV function (HR 1.91, 95% CI 1.38-2.63) remained associated with the outcome. Conclusion The outcome attributed to anaemia patients seems to be independent of treatment strategies and it is related to the Hb level itself. This reinforces the need to explore reversible causes of anaemia, as small increases in Hb level may have a major impact on the prognosis of these patients.

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P6419Machine learning in critical care: the role of diabetes and age in acute coronary syndromes

European Heart Journal ◽

10.1093/eurheartj/ehz746.1013 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

E Cenko ◽

M Van Der Schaar ◽

J Yoon ◽

Z Vasiljevic ◽

S Kedev ◽

...

Keyword(s):

Medical Treatment ◽

Primary Endpoint ◽

Left Ventricular ◽

Adverse Outcomes ◽

Secondary Endpoint ◽

Coronary Syndrome ◽

Increased Risk ◽

All Cause Mortality ◽

Patients With Diabetes ◽

The Impact

Abstract Background Patients with diabetes and non-ST elevation acute coronary syndrome (NSTE-ACS) have an increased risk of mortality and adverse outcomes following percutaneous coronary intervention (PCI). Purpose We aimed to investigate the impact of early, within 24 hours PCI compared with only routine medical treatment on clinical outcomes in a large international cohort of patients with NSTE-ACS and diabetes. Methods We identified 1,250 patients with diabetes and NSTE-ACS from a registry-based population between October 2010 and April 2016. The primary endpoint was 30-day all-cause mortality. The secondary endpoint was the composite outcome of 30-day all-cause mortality and left ventricular dysfunction (ejection fraction <40%). We undertook analyses to explore the heterogeneity of treatment effects using meta-classification (MC) algorithms followed by propensity score matching and inverse-probability-of-treatment weighting (IPTW) from a landmark of 24 hours from hospitalization. Results Of 1,250 NSTE-ACS first-day survivors with diabetes (median age 67 years; 59%, men), 470 (37.6%) received early PCI and 780 routine medical treatment. The overall 30-day all-cause mortality rates were higher in the routine medical treatment than the early PCI group (6.3% vs. 2.5%). The prediction results of the MC algorithms accounted for only one interaction term that was statistically significant: age ≥65 years. After propensity-matched analysis as well as IPTW, early PCI was associated with reduced 30-day all-cause mortality in the older age (OR: 0.35; 95% CI: 0.14 to 0.92 and 0.43; 95% CI: 0.21 to 0.86, respectively), whereas younger age had no association with the primary endpoint. Similar results were also obtained for the secondary endpoint. Conclusions Among patients with diabetes hospitalized for NSTE-ACS, an early, within 24 hours, PCI strategy is associated with reduced odds of 30-day mortality only for patients aged 65 years or over. MC algorithms provide accurate identification of treatment effect modifiers.

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Prognostic impact of atrial fibrillation in patients undergoing primary PCI with versus without left ventricular function impairment

European Heart Journal ◽

10.1093/ehjci/ehaa946.2522 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

A Pavlovic ◽

D.G Milasinovic ◽

Z Mehmedbegovic ◽

D Jelic ◽

S Zaharijev ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Ventricular ◽

Lv Function ◽

Prognostic Impact ◽

Primary Pci ◽

Lv Dysfunction ◽

Risk Of Mortality ◽

Increased Risk ◽

Tertiary Center ◽

The Impact

Abstract Background Atrial fibrillation (AF) and impaired left ventricular (LV) function have both been separately associated with increased risk of mortality following primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). Purpose Our aim was to comparatively evaluate the impact of LV dysfunction and AF on the risk of mortality in primary PCI-treated patients. Methods This analysis included 8561 patients admitted for primary PCI during 2009–2019, from a prospectively kept, electronic registry of a high-volume tertiary center, from whom echocardiographic parameters were available. LV dysfunction was defined as EF<40%. Adjusted Cox regression models were used to assess 30-day and 1-year mortality hazard. Results AF was present in 3.2% (n=273), whereas 37% had LV dysfunction (n=3189). Crude mortality rates were increased in the presence of either AF or LV dysfunction, and were the highest in the group of patients having both AF and impaired LV function, at 30 days (1.8% in no AF and no LV dysfunction vs. 5.4% if AF only vs. 7.0% if EF<40% only vs. 14.9% if AF and LV dysfunction concurrently present, p<0.001) and at 3 years (10.5% if no AF and no LV dysfunction vs. 35.8% if AF only vs. 28.5% if EF<40% only vs. 60.3% if AF and LV dysfunction both present, p<0.001). After multivariable adjustment for other significant mortality predictors, including age, previous stroke, MI, diabetes, hyperlipidemia, anemia and Killip≥2, LV dysfunction alone and in combination with AF was an independent predictor of mortality at both 30 days (HR=2.2 and HR=2.5, respectively, p<0.001 for both) and at 3 years (HR=1.9 and HR=2.9, respectively, p<0.001 for both). However, presence of AF alone, in the absence of an impaired LV function, was not independently associated with mortality at 30 days (HR 1.34, CI 95% 0.58–3.1, p=0.48), but rather at 3 years (HR 1.74, CI 95% 1.91–2.54, p=0.004). Conclusion Atrial fibrillation is associated with long-term mortality in STEMI patients undergoing primary PCI, irrespective of the LV function. Conversely, short-term prognostic relevance of atrial fibrillation in STEMI is dependent on the presence of LV dysfunction. Kaplan Meier curve_AF_LV dysfunction Funding Acknowledgement Type of funding source: None

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Impact of bleeding during dual antiplatelet therapy in patients with coronary artery disease

Scientific Reports ◽

10.1038/s41598-020-78400-4 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Ying-Chang Tung ◽

Lai-Chu See ◽

Shu-Hao Chang ◽

Jia-Rou Liu ◽

Chi-Tai Kuo ◽

...

Keyword(s):

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

East Asian ◽

Asian Population ◽

Adverse Outcomes ◽

Research Database ◽

Coronary Syndrome ◽

Asian Patients ◽

Increased Risk ◽

The Impact

AbstractThis nationwide retrospective cohort study used the National Health Insurance Research Database of Taiwan to compare the impact of bleeding on clinical outcomes in patients with acute myocardial infarction (AMI) versus chronic coronary syndrome (CCS). Between July 2007 and December 2010, patients with AMI (n = 15,391) and CCS (n = 19,724) who received dual antiplatelet therapy after coronary stenting were identified from the database. AMI was associated with increased risks of MI (AMI vs. CCS: 0.38 vs. 0.16 per 100 patient-months; p < 0.01), all-cause death (0.49 vs. 0.32 per 100 patient-months; p < 0.01), and BARC type 3 bleeding (0.22 vs. 0.13 per 100 patient-months; p < 0.01) at 1 year compared with CCS, while the risk of BARC type 2 bleeding was marginally higher in the CCS patients than in the AMI patients (1.32 vs. 1.4 per 100 person-months; p = 0.06). Bleeding was an independent predictor of MI, stroke, and all-cause death in this East Asian population, regardless of the initial presentation. Among the patients with bleeding, AMI was associated with a higher risk of ischemic events at 1 year after bleeding compared with CCS (MI: 0.34 vs. 0.25 per 100 patient-months; p = 0.06; ischemic stroke: 0.22 vs. 0.13 per 100 patient-months; p = 0.02). The 1-year mortality after bleeding was comparable between the two groups after propensity score weighting. In conclusion, bleeding conferred an increased risk of adverse outcomes in East Asian patients with AMI and CCS.

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P3122Complete versus culprit-vessel only revascularization for patients with acute coronary syndromes and multivessel disease

European Heart Journal ◽

10.1093/eurheartj/ehz745.0197 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J Ferreira ◽

S Monteiro ◽

R Baptista ◽

F Goncalves ◽

P Monteiro ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Left Ventricular ◽

Multivessel Disease ◽

Left Ventricular Ejection ◽

Great Loss ◽

Coronary Syndrome ◽

Propensity Matching ◽

All Cause Mortality ◽

The Impact

Abstract Background Recent randomized clinical trials have suggested that complete revascularization (CR) instead of culprit-vessel only revascularization (CVO) strategies may take a stand in the optimal management of patients admitted for acute myocardial infarction (AMI) with multivessel (MV) disease undergoing primary percutaneous coronary intervention (P-PCI). However, despite the 2017 ST-elevation acute coronary syndrome (STEMI) guidelines update with a new class of recommendation for CR, it remains controversial whether this strategy leads to better outcomes. Purpose To compare CR versus CV strategies during hospitalization in patients presenting with AMI with multivessel disease at P-PCI. Methods We analyzed data from all patients admitted with non-ST acute myocardial infarction (NSTEMI) and STEMI in a portuguese coronary care unit (CCU), between 2007 and 2016. We then evaluated potential differences of CR versus CVO with PCI during hospitalization in AMI patients with multivessel disease, defined by at least 2 different diseased main coronary vessels, saphenous vein or mammary artery conduits. We used 1:1 ratio propensity score matching to study the impact of CR on patient mortality and adjusted data for relevant risk factors at admission time. Results A total of 4758 patients were admitted for AMI, 2690 NSTEMI (56.5%) and 2068 STEMI (43.5%). Access to PCI records was possible in 3162 (66.5%) patients, of which 1707 (54%) underwent CR versus 1455 (46%) who underwent CVO. CVO patients were older (67.9±11.8 vs. 63.5±13.1 years, p<0.001), more diabetic (56.5% vs. 47.1%, p<0.001), hypertensive (78.4% vs. 72.2%, p<0.001), dyslipidemic (82.1% vs. 75%, p<0.001), had greater GRACE score at admission (mean score 143.4±37.2 vs. 131.2±131.2, p<0.001), had more severe coronary disease (mean number of diseased vessels – 2.56±0.6 vs. 2.18±0.4, p<0.004), reached higher Killip class (mean – 1.42±0.9 vs. 1.26±0.7, p<0.001) and had lower left ventricular ejection fraction (48.07±11.6 vs. 51.25±10.5, p<0.001). No significant differences were found in peak troponin-I release between CR and CV (44.7±69 vs. 46.9±76, respectively, p=0.468). After propensity matching, we obtained 130 CR and 133 CVO patients. In this cohort all-cause mortality was lower in CR group at 6-month (RR 0.262, CI 95% 0.071–0.962, p=0.031) and 1-year (RR 0.340, CI 95% 0.119–0.973, p=0.036) follow-up. When comparing STEMI versus NSTEMI all-cause mortality was nonsignificantly lower in CR (RR 0.394 vs. 0.226, p=0.12 vs. p=0.16). Conclusions In patients presenting with AMI and MV disease, CR strategy during hospitalization leads to greater 6-month and 1-year survival when compared with CVO strategy. Despite not having found significant differences when STEMI was directly compared to NSTEMI, we believe this was due to the great loss of patient numbers after propensity matching, requiring larger trials to prove the effect.

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AB0434 PREVALENCE OF ANTIPHOSPHOLIPID SYNDROME COMPONENTS IN MEN WITH STABLE СORONARY HEART DISEASE AND POSTINFARCTION CARDIOSCLEROSIS AND CONECTION WITH ECHOCARDIOGRAPHIC EVALUATION OF CARDIAC STRUCTURE AND FUNCTION 1.0.0.20

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.6317 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 1516.2-1516

Author(s):

M. Nazarva ◽

M. Stanislavchuk ◽

L. Burdeina ◽

N. Zaichko

Keyword(s):

Myocardial Infarction ◽

Heart Disease ◽

Antiphospholipid Syndrome ◽

Left Ventricular ◽

Cardiomyocyte Apoptosis ◽

Myocardial Remodeling ◽

Postinfarction Cardiosclerosis ◽

Coronary Syndrome ◽

Increased Risk ◽

The Impact

Background:Antiphospholipid syndrome (APS) as an independent factor in different forms of coronary heart disease (CHD) has been attracting more attention in recent years [1]. The prevalence of AFS in the general population is low (1-5%) but among patients with acute coronary syndrome it ranges from 6.1% to 43.3%. The persistence of high titers of antiphospholipid (aPL) antibodies, especially antibodies to cardiolipin, accelerates the development of endothelial dysfunction and atherothrombotic lesions of the coronary arteries, worsens the course of acute myocardial infarction. It has been experimentally demonstrated that aPL antibodies can directly affect myocardial status through pro-apoptotic signaling pathways and increased cardiomyocyte apoptosis [2].The impact of aPL antibodies on the course of postinfarction myocardial remodeling in patients with CHD has not been established.Objectives:To study the prevalence of APS components in men with stable CHD with postinfarction cardiosclerosis and to evaluate the relationship with structural and functional state of left ventricular myocardium.Methods:164 patients with CHD with postinfarction cardiosclerosis were examined (100% males at the average age of 53,0±9,14 (M±σ)). The diagnosis of CAD was made according to the recommendations of the ANA / ACC (2014) and ESC (2013). The content of IgG and IgM of aPL antibodies - antibodies to cardiolipin, phosphatidylserine, phosphatidylinositol, phosphatidylacetate and levels of IgG and IgM to β2-glycoprotein I (β2-GP-I) in the blood serum were determined by ELISA. Echocardiography in M-, B- and D-modes was performed.Results:Among 164 patients with post-infarction cardiosclerosis: 75% had Q myocardial infarction (MI), 10.4% had recurrent MI, 7.9% had a stroke or transient ischemic attack and 4.2% had livedo reticularis. 93 (56.7%) patients had positive levels of total aPL antibodies and antibodies to β2-GP-I of IgG class (58 (35,4%) patients had low positive levels of antibodies, 35 (21.3%) patients had medium positive levels of one or both types of antibodies. Positive levels of aPL antibodies and antibodies to β2-GP-I of IgM were detected in 11.6% of patients. Positive levels of aPL antibodies and antibodies to β2-GP-I were more commonly found in men who had Q MI (OR 2.58 95% CI 1.26 - 5.28) and recurrent MI (OR 2.52 95% CI 0.83 - 7.67). Increases of levels of aPL antibodies and antibodies to β2-GP-I correlated with an increase of left ventricle (LV) mass index (r = 0.259 and 0.331, p <0.001). In patients with positive levels of antibodies of IgG to β2-GP-I in postinfarction LV remodeling was more likely to occur by concentric type of hypertrophy of LV than in patients with negative levels of antibodies to β2-GP-I (OR 6.50, 95% CI 2.49 - 16.9, p <0.001). Hypertension had no significant differences within these groups.Conclusion:The risk of persisting positive levels of aPL antibodies and antibodies to β2-GP-I in the postinfarction period is significantly increased in men who had Q MI. Patients with CHD with positive antibodies to β2-GP-I of IgG are associated with an increased risk of postinfarction LV myocardial remodeling by concentric type of hypertrophy of LV.References:[1]Kolitz, T., Shiber, S., Sharabi, I., Winder, A., & Zandman-Goddard, G. (2019). Cardiac manifestations of antiphospholipid syndrome with focus on its primary form.Frontiers in immunology,10, 941.[2]Bourke, L. T., McDonnell, T., McCormick, J., Pericleous, C., Ripoll, V. M., Giles, I., ... & Ioannou, Y. (2018). Antiphospholipid antibodies enhance rat neonatal cardiomyocyte apoptosis in an in vitro hypoxia/reoxygenation injury model via p38 MAPK.Cell death & disease,8(1), e2549-e2549.Disclosure of Interests:None declared

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Prognostic impact of right ventricular overload in patients with acute coronary syndrome

European Heart Journal ◽

10.1093/ehjci/ehaa946.1535 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

T Sato ◽

Y Ogihara ◽

T Kurita ◽

H Mizutani ◽

A Takasaki ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Right Ventricular ◽

Laboratory Data ◽

Prognostic Impact ◽

Entire Study ◽

Poor Prognostic Factor ◽

Coronary Syndrome ◽

Increased Risk ◽

All Cause Mortality

Abstract Background Right ventricular (RV) overload is associated with adverse outcome in patients with chronic heart failure. However, its prognostic value in acute coronary syndrome (ACS) patients remains unknown. Purpose The purpose of this study was to investigate the prevalence and prognostic impact of right ventricular overload in ACS patients. Methods We studied 2797 ACS patients from Mie ACS registry, a prospective and multicenter registry in Japan. They were divided into 4 subgroups according to the severity of RV overload and the extent of Left Ventricle Ejection Fraction (LVEF) assessed by echocardiography before hospital discharge. High RV overload was defined as trans-tricuspid pressure gradient (TRPG) ≥40mmHg and preserved LVEF was defined as ≥50%. The primary outcome was defined as 2-year all-cause mortality. Median follow up duration was 730 days (1–2215 days). Results High RV overload was detected in 76 patients (2.7%). In basic patients characteristics, high RV overload patients were significantly older and higher killip classification than low RV overload patients (P<0.01, respectively). Laboratory data in high RV overload patients showed lower hemoglobin level and higher serum creatinine level than those in low RV overload patients (P<0.01, respectively). Echocardiographic findings in high RV overload represented lower LVEF, higher rate of moderate or severe mitral regurgitation and left atrial enlargement than those in low RV overload patients (P<0.01, respectively). During the follow-up periods (median 730 days), 260 (9.3%) patients experienced all-cause death. Multivariate cox hazard regression analysis for all-cause mortality demonstrated that high RV overload was an independent poor prognostic factor in the entire study population. Among patients with preserved LVEF, high RV overload resulted in an increased risk of all-cause mortality compared to low RV overload (P<0.0001). Conclusion In ACS patients, high RV overload strongly contributes to worsening of prognosis regardless of the extent of LVEF. Kaplan-Meier survival curve Funding Acknowledgement Type of funding source: None

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Abstract P265: Low Hemoglobin Predicts Poor 1-Year Outcome in Acute Coronary Syndrome

Circulation Cardiovascular Quality and Outcomes ◽

10.1161/circoutcomes.4.suppl_1.ap265 ◽

2011 ◽

Vol 4 (suppl_1) ◽

Author(s):

SMITA NEGI ◽

Zarina Salt ◽

Michael Miller Craig

Keyword(s):

Univariate Analysis ◽

Cardiovascular Complications ◽

Left Ventricular ◽

Index Hospitalization ◽

Discriminative Ability ◽

Coronary Syndrome ◽

Recurrent Angina ◽

All Cause Mortality ◽

The Impact ◽

New Onset

Background There is lack of evidence to assess the impact of hemoglobin level at presentation on long term prognosis after ACS. We investigated if hemoglobin on presentation affected cardiovascular outcomes in ACS over a 12- month period. Methods Clinical data at baseline and over a 12 month period were extracted for 160 consecutive patients admitted with a diagnosis of ACS. Primary endpoints were repeat event and all-cause mortality. Secondary endpoints were recurrence of significant angina (requiring ER visit/hospitalization), new onset left ventricular failure (LVF), new arrhythmia, composite of all cardiovascular complications, prolonged index hospitalization and repeat admission for cardiovascular causes. Results On univariate analysis, low hemoglobin was associated with prolonged index hospitalization (OR: 0.85, 95% CI: 0.74-0.98, p=0.02), repeat admissions (OR: 0.77, 95% CI: 0.66-0.90, p=0.001), composite cardiovascular complications (OR: 0.75, 95% CI: 0.63-0.88, p=0.005), recurrent angina (OR: 0.65, 95% CI: 0.54-0.78, p<0.001) and repeat event (OR:0.75, 95% CI: 0.59-0.97, p=0.03). There was no significant association of low haemoglobin with new-onset LVF (OR: 0.76, 95% CI: 0.60-1.01, p=0.08), new-onset arrhythmias (OR: 0.99, 95% CI: 0.62-1.56, p=.97) and all-cause mortality (OR: 0.84, 95%CI: 0.68-1.04, p=0.1). On a multivariate regression, low hemoglobin retained significant association with repeat admissions (r:0.4, p=0.02), composite cardiovascular complications (r:0.3, p=0.007), recurrent angina (r:0.5, p<0.001) and repeat events (r:0.2, p=0.06). Receiver-operating characteristic (ROC) curves showed significant discriminative ability of low hemoglobin for prolonged index hospitalization (area, 0.67; p=0.002), repeat admissions (area, 0.71; p<0.001), composite complications (area, 0.70; p<0.001), recurrent angina (area, 0.74; p<0.001) and repeat event (area, 0.70; p=0.01). Conclusions Low baseline hemoglobin in ACS patients predicts 12-month risk of repeat admissions, composite cardiovascular complications, recurrent angina and repeat event. This association appears independent of the infarct size and would justify closer follow up for these patients.

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P5535Gender differences with short-term vs 12 months dual antiplatelet therapy in patients with acute coronary syndrome treated with the COMBO dual therapy stent: a 1-year analysis of the REDUCE trial

European Heart Journal ◽

10.1093/eurheartj/ehz746.0481 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

M Verdoia ◽

H Suryapranata ◽

S Damen ◽

C Camaro ◽

E Benit ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Antiplatelet Therapy ◽

Stent Thrombosis ◽

Primary Endpoint ◽

Dual Antiplatelet Therapy ◽

Study Endpoint ◽

Primary Study ◽

Coronary Syndrome ◽

The Impact

Abstract Background Gender differences in the thrombotic and bleeding risk have been suggested to condition the benefits of antithrombotic therapies in Acute Coronary Syndrome (ACS) patients, and mainly among those undergoing percutaneous coronary interventions with drug eluting stents (DES). Therefore, the impact of gender on the optimal duration of dual antiplatelet therapy (DAPT) treated is still unclear and was therefore the aim of the present sub-study. Methods REDUCE is a prospective, multicenter, randomized, investigator-initiated study, designed to enroll 1500 ACS patients after treatment with the COMBO Dual Stent Therapy, based on a non-inferiority design. Patients were randomized in a 1:1 fashion to either 3 or 12 months of DAPT. Primary study endpoint was a composite of all-cause mortality, myocardial infarction, definite/probable stent thrombosis (ST), stroke, target-vessel revascularization (TVR) and bleeding (BARC II, III, V) at 12 months. Secondary endpoints were cardiovascular mortality and the individual components of the primary endpoint. Results From June 2014 to May 2016 300 women and 1196 men were randomized in the trial. Among them 43.7% of females and 51.9% of males were assigned to the 3 months DAPT treatment. Baseline characteristics were well matched between the two arms, but of a lower rate of TIMI flow <3 (p<0.001) and lower systolic blood pressure (p<0.05) among women and a more advanced age (p=0.05) among men receiving a shorted DAPT. At 1 year follow-up, no difference in the primary endpoint was observed according to DAPT duration (females: 6.9% vs 5.9%, HR [95% CI]=1.19 [0.48–2.9], p=0.71; males: 8.2% vs 9%, HR [95% CI]=0.92 [0.63–1.35], p=0.67). Results were confirmed after correction for baseline differences (females: adjusted HR [95% CI]=1.12 [0.45–2.78], p=0.81; males: adjusted HR [95% CI]=0.90 [0.61–1.32], p=0.60). Comparable rates of survival, thrombotic (MI, stent thrombosis, TVR, stroke) and bleeding events were observed with the two DAPT strategies, with no impact of gender. Conclusions The present study shows that among ACS patients randomized in the REDUCE trial, a 3 months DAPT strategy offers comparable results as compared to a standard 12 months DAPT at 1-year follow-up in both male and female gender. Acknowledgement/Funding None

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2232Circulating levels of ST2 are associated with myocardial injury, left ventricular function and future adverse clinical events in patients with ST-elevation myocardial infarction

European Heart Journal ◽

10.1093/eurheartj/ehz748.0128 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

C Shetelig ◽

T Ueland ◽

S Limalanathan ◽

P Hoffmann ◽

P Aukrust ◽

...

Keyword(s):

Myocardial Infarction ◽

Clinical Outcome ◽

Infarct Size ◽

Left Ventricular ◽

St Elevation Myocardial Infarction ◽

Lv Function ◽

Clinical Events ◽

Increased Risk ◽

All Cause Mortality ◽

St Elevation

Abstract Background Soluble ST2, a member of the IL-1 receptor family, seems to be associated with adverse outcome in acute myocardial infarction and heart failure (HF), and is suggested to be involved in left ventricular (LV) remodelling. Purpose To elucidate a possible role of ST2 in LV injury, remodelling and prognosis in ST-elevation myocardial infarction (STEMI) patients. The main objectives of the study were to investigate whether circulating ST2 levels were associated with infarct size, LV function, adverse remodeling and clinical outcome in a cohort of patients with STEMI. Methods 270 patients with clinically stable first-time STEMI treated with primary percutaneous coronary intervention (PCI) were included. Blood samples were drawn before and immediately after the PCI procedure, at day 1 (median 18.3 hours after PCI) and after 4 months. Cardiac magnetic resonance (CMR) was performed in the acute phase and after 4 months. Clinical events and all-cause mortality were registered during 12 months' and 70 months' follow-up, respectively. A composite endpoint was defined as death, MI, unscheduled revascularisation >3 months after the index infarction, rehospitalisation for HF or stroke. Associations between ST2 and CMR parameters and clinical events were evaluated with linear regression and logistic regression, respectively. Results There was a significant increase in ST2 levels from the PCI procedure to day 1 with a subsequent decline from day 1 to 4 months in the POSTEMI cohort. Patients with high ST2 levels (>median) at all sampling points during hospitalisation had significantly larger infarct size, lower myocardial salvage, lower LVEF, larger increase in EDV and higher frequency of MVO. After adjustment for relevant clinical variables, peak CRP and peak troponin T, ST2 measured at day 1 remained associated with infarct size (β 2.0 per SD of ST2, p<0.001) and LVEF (β −1.8 per SD of ST2, p=0.02) at 4 months. High levels of ST2 measured at day 1 (>75th percentile) were associated with increased risk of having an adverse clinical event during the first year and with long-term all-cause mortality (Figure). High levels of ST2 measured in a stable phase 4 months after STEMI were also associated with an increased risk of all-cause mortality (Figure). Figure 1 Conclusions High levels of ST2 in STEMI patients were associated with large infarct size, impaired recovery of LV function, and adverse clinical outcome in patients with STEMI. ST2 measured 4 months after STEMI remained associated with all-cause mortality.

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P2444Comparison of 3D and 2D echocardiography-derived indices of left ventricular function and structure to predict long-term mortality in the general population: Southall And Brent Revisited (SABRE) study

European Heart Journal ◽

10.1093/eurheartj/ehz748.0776 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Cited By ~ 2

Author(s):

L Al Saikhan ◽

C Park ◽

T Tillin ◽

S Williams ◽

J Mayet ◽

...

Keyword(s):

Risk Factors ◽

General Population ◽

Population Based ◽

Left Ventricular ◽

Lv Function ◽

Kaplan Meier ◽

Increased Risk ◽

All Cause Mortality ◽

Dimensional Echocardiography ◽

2D And 3D

Abstract Background Three-dimensional echocardiography (3DE) may have advantages over two-dimensional echocardiography (2DE) for the assessment of left ventricular (LV) function and structure. However, studies comparing 3DE and 2DE-derived indices in relation to mortality are limited, particularly in the general population. Purpose We examined associations between 2DE and 3DE-derived LV ejection fractions (LVEF) and volumes for all-cause mortality in a population-based sample. Methods A total of 899 individuals (age, 69.6±6.1 years; 77.5%male) from the SABRE study, a UK-based tri-ethnic community cohort, underwent a comprehensive transthoracic echocardiography examination. 2D LVEF and volumes were calculated, and full-volume 3D LV datasets acquired over 4 sub-volumes were obtained using a matrix-array transducer and were analysed offline using Qlab advanced, v7.0. The associations between both 2D- and 3D-derived LVEF (≥55% vs. <55%), body surface area indexed end-diastolic volume (iEDV) and end-systolic volume (iESV), and all-cause mortality were determined using Cox proportional hazards models. Survival curves were constructed using the Kaplan-Meier method. Results Of the 899 individuals, 118 (13.1%) died over a median follow-up period of 8 years to 2018. Kaplan Meier survival estimates (Figure 1 illustrates LVEF) and Cox regression revealed that 2D and 3D LVEF, iEDV and iESV were associated with increased risk of all-cause mortality (LVEF (≥55% vs. <55%), 3DE: HR=0.53 (0.35, 0.80); 2DE: HR=0.51 (0.34, 0.75), iEDV (per 1SD increment), 3DE: HR=1.20 (1.0, 1.41); 2DE: HR=1.19 (1.0–1.41), iESV (per 1SD increment), 3DE: HR=1.27 (1.1, 1.52), 2DE: HR=1.32 (1.15, 0.1.51)). However, 3DE associations tended to be stronger in models adjusted for classical risk factors including age, sex, ethnicity, systolic blood pressure, cholesterol:HDL ratio, body mass index, antihypertensive medications, diabetes, and smoking (LVEF (≥55% vs. <55%), 3DE: HR=0.59 (0.39, 0.90); 2DE: HR=0.69 (0.46, 1.0), iEDV (per 1SD increment), 3DE: HR=1.20 (1.0, 1.41); 2DE: HR=1.10 (0.93, 1.31), iESV (per 1SD increment), 3DE: HR=1.27 (1.1, 1.52), 2DE: HR=1.20 (1.04, 0.1.39)). Figure 1. Kaplan-Meier curves. Conclusions In this population-based study, both 2DE and 3DE-derived indices of LV structure and function were associated with all-cause mortality independently of classical risk factors, with some indication that strengths of association were greater for 3DE-derived indices. Acknowledgement/Funding SABRE is funded by BHF, Diabetes UK, the MRC and the Wellcome Trust. LA holds a scholarship grant from Imam Abdulrahman Bin Faisal University, SA

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