AS-190Impact of Age on Midterm Angiographic and Clinical Outcomesof Percutaneous Coronary Intervention with Drug-Eluting Stentsin Patients with Alcoholism. Byoung Geol Choi, Seung-Woon Rha,Ji Young Park, Kanhaiya L. Poddar, Sureshkumar Ramasamy,Lin Wang, Ji Bak Kim, Seung Yong Shin, Cheol Ung Choi,Hong Euy Lim, Jin Won Kim, Eung Ju Kim, Chang Gyu Park,Hong Seog Seo, Dong Joo Oh. Korea University Guro Hospital,Seoul, Republic of Korea.

Background: Age is known to be a strong risk factor for coronary arterydisease (CAD). However, there is still controversy about whether alcoholconsumption is significantly associated with worse outcomes after percutane-ous coronary intervention (PCI) in the drug-eluting stent (DES) era. Weinvestigated the impact of age on midterm angiographic and clinical outcomesafter PCI with DES only in patients with chronic alcohol consumption.

Methods: A total of 551 consecutive patients with alcoholism whounderwent PCI with DES between 2004 and 2008 were enrolled for theanalysis. Patients were divided into 2 groups according to age (olderage: �60 years, n � 303 patients; and younger age: �60 years, n �248 patients). The 6-month angiographic outcomes and 12-month clin-ical outcomes were compared between the 2 groups.

Results: Baseline characteristics were not different between the 2groups, except that diabetes mellitus (37.4% vs 25.2%, p � 0.02), cerebralvascular disease (9.3% vs 1.3%, p �0.01), and peripheral vascular disease(13.7% vs 4.6%, p � 0.04) were more common in the older age group. At6 months, the incidence of angiographic binary restenosis was higher in thegroup with elderly patients with alcoholism. However, major clinicaloutcomes comprising cardiac death, Q-wave myocardial infarction, targetlesion and vessel revascularization, and major adverse cardiac events werenot different between the 2 groups up to 12 months (Table).

Conclusion: We consider that elderly patients are at risk of worseangiographic and clinical outcomes after PCI with DES, however, agein patients with chronic alcohol consumption did not show a negativeimpact on major clinical outcomes up to 12 months. This suggests thatolder age cannot be a major limitation factor in patients with alcohol-ism who need coronary revascularization.

AS-191Impact of Diabetes Mellitus on Midterm Outcomes of ChronicTotal Coronary Occlusion Intervention with Drug-Eluting Stents.Seung-Woon Rha, Ji Young Park, Kanhaiya L. Poddar,Sureshkumar Ramasamy, Lin Wang, Byoung Geol Choi, Ji Bak Kim,Seung Yong Shin, Cheol Ung Choi, Hong Euy Lim, Jin Won Kim,Eung Ju Kim, Chang Gyu Park, Hong Seog Seo, Dong Joo Oh.Korea University Guro Hospital, Seoul, Republic of Korea.

Background: Chronic total occlusion (CTO) intervention is still chal-lenging because of the limited procedural success rate and higher targetfailure. It is not clear whether diabetes mellitus (DM) will significantlyaffect the angiographic and clinical outcomes in patients with CTOtreated with drug-eluting stents (DES).

Methods: A total of 184 patients who underwent CTO interventionwith DES were compared according to the presence of DM (DM, n �65 patients; non-DM, n � 119 patients). In-hospital and 6-monthoutcomes were compared between the 2 groups.

Results: The baseline clinical characteristics were balanced, exceptthere were more men (58.5% vs 79.0%, p �0.01) in the non-DM group,

and the DM group was older (62.2 � 8.5 years vs 58.3 � 11.9 years,p � 0.01) and more hypertensive (76.9% vs 50.4%, p �0.01). Theoverall procedural success rate is similar between the 2 groups (96.9%vs 93.2%, p � 0.33). Procedural characteristics and procedure-relatedcomplications, including perforation and dissection, were not differentbetween the 2 groups. At 6 months, these 2 groups had similar favor-able clinical and angiographic outcomes, including the rates of binaryrestenosis, late loss, death, Q-wave myocardial infarction, target vesselrevascularization, and major adverse cardiac events (Table).

Conclusion: The safety profile and midterm angiographic andclinical outcomes were similar between the DM and non-DM groups,possibly because of the high success rate of CTO intervention at indexprocedure. Long-term follow-up with a larger population will be nec-essary to elucidate a final conclusion.

AS-192Clinical Outcomes of the New Zotarolimus-Eluting Stent inDifferent Clinical Subjects. Afzalur Rahman, Moenuddin Ahmed,Moshin Ahmed, Sadat Chaudhury, Mohammad Husnayen,Golam Azam, Nazmul Islam. National Institute of CardiovascularDiseases, Dhaka, Bangladesh.

Background: New generations of drug-eluting stents (DES) bearingnewer antiproliferative drugs and newer polymer coatings have beendeveloped and are being used in practice. Limited clinical data areavailable for the new-generation zotarolimus-eluting stent (ZES) ingeneral, and specifically, in subjects with coronary artery restenosis andwith very long lesions. This study was conducted to determine thesafety, performance, and efficacy of the ZES in the treatment ofpatients with de novo and restenotic coronary artery lesions.

Methods: This cohort study included 62 patients treated with the newEndeavor Resolute ZES. Restenotic lesions and de novo lesions with adiameter stenosis �70% and a vessel diameter �2.5 mm and �3.5 mmwere included. Patients with left main stenting, primary percutaneouscoronary intervention (PCI), PCI in cardiogenic shock, and overlappingstents were excluded from the study. Major risk factors were recorded,including hypertension, diabetes mellitus, smoking, and dyslipidemia. Theoverall incidence of major adverse cardiac events (MACE; cardiac death,acute stent thrombosis and subacute stent thrombosis, ST-elevation myo-cardial infarction [STEMI] and non-STEMI, target vessel revasculariza-tion [TVR], and subjects requiring coronary artery bypass graft [CABG])were recorded at 1 month and 6 months.

Results: Of the 62 patients, 90% were men and 10% were women,and the mean (�SD) age was 54.7 � 9.1 years. Patients also had diabetes(45%), American College of Cardiology/American Heart Association typeB or C treated lesions (87%), multivessel PCI (12%), CTO (6%), restenoticlesions (10%), left anterior descending coronary osteal lesions (6%), bi-furcation stenting (15%), and 38-mm stents (23%). The device success ratewas 100%, and the procedural success rate was 98.4%. The mean (�SD)lesion length was 20.3 �8.1 mm, and the reference vessel diameter was2.5 � 0.4 mm. The overall incidence of 30-day and 6-month MACE wasdeath, 0%; acute STEMI, 1.6%; subacute STEMI, 0%; late STEMI, 0%;non-STEMI, 0%; STEMI, 0%; TVR, 0%; and CABG, 0%.

Conclusion: The 6-month follow-up results in subjects treated withthe Endeavor Resolute ZES demonstrated an excellent procedural anddevice success rate when deployed in both restenotic and de novo

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stenosis lesions up to 38 mm of length. To our knowledge, this may bethe first report on the Endeavor Resolute, especially regarding this kindof restenotic and very long lesion. In our study, there were no cases ofclinically driven target lesion revascularization, subacute or late stentthrombosis, or MI. Long-term follow-up as well as a large sample sizewith randomization is needed to confirm the continued safety andefficacy of the Endeavor Resolute in this kind of complex lesion group.

AS-193Simultaneous Versus Sequential Kissing Stenting in Real-WorldUnprotected Left Main Intervention with Drug-Eluting Stents.Seung -Woon Rha, Ji Young Park, Kanhaiya L. Poddar,Sureshkumar Ramasamy, Lin Wang, Ji Bak Kim, Seung Yong Shin,Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim,Chang Gyu Park, Hong Seog Seo, Dong Joo Oh. Korea UniversityGuro Hospital, Seoul, Republic of Korea.

Background: Unprotected left main (LM) bifurcation angioplasty withdrug-eluting stents (DES) is being performed by either simultaneous orsequential kissing stenting, but their safety and efficacy has not yetbeen reported. We evaluated the safety and efficacy of different kissingstenting strategies in true LM bifurcation intervention up to 12 months.

Methods: All patients with unprotected LM bifurcation lesions electivelytreated with sirolimus-(SES; Cypher), paclitaxel- (PES; Taxus), or zotaroli-mus- (ZES; Endeavor) eluting stents by kissing stenting strategy were enrolled.LM bifurcation lesions were treated by kissing stenting, crushing technique, orstent crossover (stent/balloon). This study assessed whether the 2 differentkissing stenting strategies, simultaneous kissing or sequential kissing, wouldhave similar clinical and angiographic outcomes up to 12 months.

Results: Of 117 patients (men, n � 73; mean age, 64.1 � 9.9 years)who underwent standard percutaneous coronary intervention (PCI)with DES in unprotected LM lesions, 28 patients who had LM bifur-cation lesions (28 of 117, 23.9%) were treated with kissing stenting.DES type was not different between the 2 groups. The simultaneouskissing group received DES with a higher deployment pressure. At 6–9months, angiographic follow-up results showed a larger follow-upminimal luminal diameter (MLD) and a lower late loss (LL) in thesequential kissing group (Table). There were no significant differencesin major clinical outcomes between the groups up to 12 months.

Conclusion: Sequential kissing stenting appears to be the bettertechnical strategy in reducing restenosis and late loss in LM bifurcationintervention but failed to show the better clinical outcomes up to 12months. Further updated data with a larger study population will beneeded to get the final conclusion.

AS-194Influence of Acetylcholine Provocation Test Results on 12-MonthClinical Outcomes in Patients Treated with Drug-Eluting Stentsin Asian Population. Ji Young Park, Seung-Woon Rha,Kanhaiya L. Poddar, Sureshkumar Ramasamy, Lin Wang,Byoung Geol Choi, Ji Bak Kim, Seung Yong Shin, Un-Jung Choi,Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim,Chang Gyu Park, Hong Seog Seo, Dong Joo Oh. Korea UniversityGuro Hospital, Seoul, Republic of Korea.

Background: Coronary stenting leads to disruption of the endotheliallayer, and previous studies have reported that drug-eluting stents (DES)have long-term adverse effects on local coronary endothelial function.However, it is unclear whether patients who undergo percutaneouscoronary intervention (PCI) with DES with combined coronary arteryspasm (CAS) may have a different clinical course compared with thatof patients treated with DES without CAS. We evaluated the majorclinical outcomes of patients with DES spasm compared with those ofpatients without DES spasm up to 12 months.

Methods: Among 1,862 consecutive patients treated with DES,1,010 patients who underwent follow-up coronary angiography (CAG)either because of recurrent chest pain or routine follow-up during 12months were enrolled. Among them, 160 patients with suspicious CASunderwent the acetylcholine (Ach) provocation test, with incrementaldoses of 20, 50, and 100 �g injected into the left coronary arterybetween March 2004 and April 2009. We compared the 12-monthclinical outcomes of patients with DES-associated CAS (DES spasmgroup, n � 112) with those of patients without CAS (No DES spasmgroup, n � 48).

Results: The baseline characteristics were similar between the 2groups (Table). Incidence of DES spasm was found in 112 of 1,862(6.01%) PCI patients in a real-world setting. At 12 months, clinicaloutcomes, including the incidence of death, myocardial infarction (MI),repeat PCI, stenting of de novo lesions, major adverse cardiac events(MACE), and follow-up CAG because of recurrent chest pain, weresimilar between the 2 groups.

Conclusion: The overall incidence of DES spasm was 6%, whichwas confirmed by the Ach provocation test. Prior DES placement wasan independent risk factor of Ach-induced significant CAS. However,patients with DES spasms did not exert any negative impact on majorclinical outcomes compared with those of patients with no DES spasmup to �1 year, suggesting relatively a favorable prognosis with addi-tional antianginal medical therapy.

80B The American Journal of Cardiology� APRIL 28–30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster

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Wednesday, April 28 - Friday, April 30, 2010 (E-Poster Abstract Zone)