EFFECT OF EECP (ENHANCED EXTERNAL COUNTER PULSATION) ON LEFT VENTRICULAR FUNCTION AS MEASURED BY ECHOCARDIOGRAPHY USING STRAIN.

India stands as one of the fastest developing countries in the world. It has entered quickly into an epidemiological transition leading to a 1 phenomenal increase in non-communicable diseases . Of them leading the way is coronary artery disease. 0 It has been estimated that 4 lakh 2 deaths a year are attributable to cardiovascular disease. The most common symptom in CAD is angina pectoris. The treatment for angina includes medical therapy and coronary revascularization by PTCA or CABG. However, a large number of these patients are not suitable to the usual procedures due to unfavorable coronary anatomy, repeated revascularization attempts, elderly age group, associated comorbidities and patient's preference.

Factors influencing the outcomes of coronary artery stenting with everolimus-eluting stents in acute coronary syndromes without ST segment elevation

Introduction. Percutaneous interventions used in the treatment of acute coronary syndrome (ACS) may be complicated by the recurrence of the ischemia clinical picture due to the late lumen loss of the stent. Factors influencing the risk of the restenosis developing may differ depending on the clinical situation and stent characteristics.Objective. To identify risk factors for repeated revascularization in patients with ACS without ST-segment elevation after placement of everolimus-eluting stents. Materials and methods. The study included 126 patients with ACS, who received platinum-chromium containing everolimus-eluting stents. The main clinical and laboratory parameters of the patients were analyzed. After 12 months, the combined endpoint (death, myocardial infarction in the basin of the stented artery, repeated revascularization of the stented vessel) was assessed.Results. During the followup, 18 of 126 patients (14.3 %) reached the combined endpoint. Among patients who reached the endpoint, there were more women (10 (24.4 %) and 8 (9.4 %); p=0.02). In patients who reached the endpoint, the level of highly sensitive troponin was significantly higher (0.032 (0.007; 0.32) ng/ml versus 0.005 (0.002; 0.022) ng/ml; p=0.005), there was a lower left ventricular ejection fraction (52.2±12.3 % vs 58.6±8.9 %; p=0.02) and glomerular filtration rate (68.5±15.7 ml/min vs 76.3±18.2 ml/min; p=0.04), and there was also a significantly lower level of triglycerides (1.3±0.4 mmol/L and 1.8±0.9 mmol/L, p=0.004) and VLDL (0.6±0.2 mmol/L and 0.8±0.4 mmol/L, p=0.006). According to multivariate regression analysis, the leading factors influencing the risk of repeated revascularization were diabetes mellitus (OR 4.25; 95 % CI: 1.12–16.15; p=0.03), glomerular filtration rate and triglyceride level (OR 0.25; 95 % CI: 0.07–0.93; p=0.03).Conclusions. When using everolimus-eluting stents, diabetes mellitus, decreased glomerular filtration rate and low blood triglyceride levels are among the main factors affecting the risk of in-stent restenosis.

Clinical Outcomes in Chronic Total Occlusion Revascularization Versus No Chronic Total Occlusion Revascularization: Variability by Target Vessel

We aimed to investigate the impact of target vessel on clinical outcomes in chronic total occlusion (CTO) revascularization versus no CTO revascularization. This multicenter, retrospective, cohort study involves patients with ≥1 CTO. After classification based on different CTO target vessels or multiple CTOs, patients were further categorized as the CTO revascularization group and the no CTO revascularization group based on treatment received. The primary outcome was a composite of death, myocardial infarction, stroke, repeated revascularization, and hospital admission due to ischemic symptoms. From August 2016 to August 2017, 1712 eligible patients were consecutively enrolled. Chronic total occlusion revascularization was associated with lower risk of 1-year major adverse cardiovascular and cerebrovascular events (MACCEs; adjusted hazard ratio [HR]: 0.36; 95% CI: 0.20-0.67; P = .001) compared with no CTO revascularization in left anterior descending (LAD) CTO patients. The benefit of CTO revascularization was not evident among those with left circumflex (LCX; adjusted HR: 0.51; 95% CI: 0.23-1.10; P = .087), right coronary artery (RCA; adjusted HR: 1.17; 95% CI: 0.59-2.33; P = .648), and multiple CTOs (adjusted HR: 1.00; 95% CI: 0.41-2.44; P = .994). Revascularization for LAD CTO, but not LCX, RCA, or multiple CTOs, was associated with lower risk of 1-year MACCEs compared with no CTO revascularization.

Identify Unsuitable Patients with Left Main Coronary Artery Disease in Intermediate SYNTAX Scores Treated by Percutaneous Coronary Intervention

Background: With the follow-up extending to 5 years, the outcomes of SYNTAX (Synergy Between Percutaneous Coronary Intervention with TAXUS and Cardiac Surgery) trial were comparable between coronary artery bypass graft (CABG) and percutaneous coronary intervention (PCI) in left-main (LM) patients with intermediate SYNTAX scores of 23–32. A subdivision depending on SYNTAX score will help to identify unsuitable LM patients with intermediate SYNTAX scores to receive PCI treatment.Methods: Between January 2011 and June 2013, 104 patients with LM Coronary Artery Disease (CAD) undergoing PCI were selected retrospectively. We compared clinical outcomes in patients with SYNTAX score <27 and ≥27. The follow-up time was 25.23 ± 7.92 months. Kaplan-Meier survival analyses and Cox proportional hazards models were used to compare various outcomes between two groups.Results: Higher rates of repeated revascularization (18.2% versus 4.2%, P = .027) and major adverse cerebro-cardiovascular events (MACCE) (24.2% versus 7.0%, P = .014) were shown in patients with SYNTAX score ≥ 27. After multivariate adjustment, a significant higher risk of repeated revascularization (hazard ratio: 6.25, 95% confidence interval: 1.48 to 26.37, P = .013) and MACCE (hazard ratio: 4.49, 95% confidence interval: 1.41 to 14.35, P = .011) were also found in patients with SYNTAX score ≥ 27.Conclusions: Based on the higher rate of repeated revascularization and MACCE, patients with LM CAD and intermediate SYNTAX scores will need a subdivision to identity the one not benefit from PCI. CABG is still the standard treatment method for patients of LM CAD with a SYNTAX score of ≥ 27.

Effects of diabetes compensation by various classes of antihyperglycemic agents on endovascular intervention outcomes in patients with type 2 diabetes mellitus

Introduction of drug-eluting stents for percutaneous coronary interventions opened novel options for treating coronary heart disease (CHD) in patients with diabetes mellitus. However, mortality and myocardial infarction rates are still higher among diabetes patients. They also require repeated revascularization of the target vessel more often than euglycemic individuals do. Current review discusses possible effects of diabetes compensation by various classes of antihyperglycemic agents on endovascular intervention outcomes.

Determinants of haemodialysis access survival

Background: Vascular access patency is of vital importance for patients requiring haemodialysis. This analysis validates potential risk factors and benefits in patients undergoing vascular access procedures. Patients and methods: Vascular access procedures performed over a two-year period were retrospectively analysed. Clinical data and concomitant medication were retrieved from files as were surgical data following a standardized data capture sheet. Outcome parameters were primary (PP) and secondary patency (SP) as well as freedom from repeated revascularization. Minimal follow-up with functioning access was 679 days. Results: During the observation period, 244 patients (mean age 62.2 ± 0.9 years, 60.7 % male patients, 36.1 % pre-emptive, 31.1 % late referral) underwent vascular accesses procedures. PP and SP were 35.6 % and 45.6 %, respectively, at 540 days. Presence of diabetes mellitus was associated with decreased PP (OR: 0.6, 95 %-CI: 0.3 - 1.0) and SP (OR: 0.4, 95 %-CI: 0.2 - 0.7), whereas female gender was associated with lower SP (OR: 0.6, 95 %-CI: 0.3 - 0.9) and freedom from repeated revascularization rates (OR: 0.6, 95 %-CI: 0.3 - 1.0). In contrast, presence of hyperparathyreoidism was associated with higher SP (OR: 1.7, 95 %-CI: 1.0 - 3.0) and freedom from repeated revascularization (OR: 1.7, 95 %-CI: 1.0 - 3.0) rates. Conclusions: Haemodialysis access performs worst in patients with diabetes mellitus and in women. The benefit of hyperparathyroidism should be interpreted as hypothesis generating.

Abstract 2298: Impact of Preopeartive Anemia on Long-term Outcomes Following Isolated Coronary Artery Bypass Surgery

Background: The prognostic and clinical value of preopeartive anemia in patients undergoing cardiac surgery has recently been recognized. However, very limited information exists on the impact of preopeartive anemia on long-term outcomes following coronary artery bypass graft (CABG) surgery. This study aimed at examining the degree to which preopeartive anemia affects long-term outcomes after isolated CABG surgery. Methods: A unicenter study was conducted on 5488 consecutive survivors of isolated CABG between January 1999 and December 2005. Preopeartive anemia was defined according to the World Health Organization definition (hemoglobin < 13g/dL for male; hemoglobin < 12g/dL for female). Long-term outcomes of interest were total mortality, myocardial infarction (MI), repeated revascularization, and major adverse cardiac events (MACEs=total mortality or MI or repeated revascularization). These outcomes were compared after adjustment for differences in baseline risk factors among the patients. Results: 1437 (26.2%) patients had preoperative anemia. After a mean follow-up of 43.3±18.3 months, preoperative anemia was found to be an independent risk factor for total mortality (hazard ration [HR]: 1.490; 95% CI: 1.074 to 2.067; p=0.017), MI (HR: 1.595; 95% CI: 1.028 to 2.474; p=0.037) and MACEs (HR: 1.363; 95% CI: 1.059 to 1.755; p=0.016). We also found that aspirins and beta-blockers were underused in patients with anemia during follow-up. Conclusions: Preopeartive anemia has a strong negative impact on long-term outcomes following isolated CABG. Our data also suggest that the incorporation of preoperative anemia into the risk assessments of long-term outcomes after CABG is recommended. Future intense and systematic studies are needed to help ensure high-quality cardiac care of patients with anemia.

Abstract 2279: A Comparison of Early and Long-Term Outcomes Following Off-Pump and On-Pump Coronary Artery Bypass Surgery: Variation by Renal Function

Background: The two surgical strategies for coronary artery bypass graft (CABG) surgery are on-pump CABG and off-pump CABG (OPCAB). Earlier studies comparing these two strategies have shown only small differences in clinical outcomes. In light of the growing interest in tailored therapy, the identification of patient subset in which major differences in outcomes exist based on surgical strategy is highly important. Patients with impaired renal function may be a potential target because this patient subset is at increased risk for adverse cardiovascular outcomes. Methods: We analyzed data from 5550 consecutive patients undergoing isolated CABG surgery between 1999 and 2005 according to the surgical strategy and the estimated glomerular filtration rate (eGFR), which was calculated with the 4-point Modification of Diet in Renal Disease equation. Early outcomes were in-hospital mortality and postoperative morbidities; and long-term outcomes included total mortality, repeated revascularization, myocardial infarction (MI), and major adverse cardiac events (MACEs=total mortality or repeated revascularization or MI). These outcomes were compared after adjustment for differences in baseline risk factors among the patients. Results: 1543 (27.8%) patients had impaired renal function (eGFR<60ml/min/1.73 m 2 ). In this patient subset, OPCAB was associated with lower rates of 2 postoperative morbidities and comparable in-hospital mortality rate, but long-term outcomes appeared to be inferior for OPCAB with regard to total mortality [hazard ratio (HR) 1.662, 95%CI 1.037 to 2.664], repeated revascularization (HR 2.099, 95%CI 1.177 to 3.743), MI (HR 2.046, 95%CI 1.110 to 3.774), and MACEs (HR 1.834, 95%CI 1.236 to 2.722). Among patients with preserved renal function (eGFR≥60 ml/min/1.73 m 2 ), the analysis showed no significant differences in clinical outcomes between the two surgical strategies. Conclusions: We observed a significant heterogeneity in treatment effect of surgical strategy (off-pump/on-pump surgery) in relation to renal function. These data suggest that impaired renal function may identify a target patient subset that would be most likely to benefit from on-pump strategy.