n � 401) vs normal level (platelet counts �150 � 109/L, n � 6749).The rates of adverse outcomes were adjusted by means of proportionalhazards methods to account for differences in severity of patients’illness according to platelet counts.

Results: During 4-year follow-up, the unadjusted rate of all-causemortality and cardiac death was significantly lower in patients with lowplatelet counts compared with those with normal platelet counts (12.9%vs 6.3%, p �0.001; 4.8% vs 2.9%, p � 0.02, respectively). Afteradjustment for baseline differences, the overall risk of all-cause deathwas consistently higher in patients with low platelet count (adjustedhazard ratio [HR] 1.68; 95% confidence interval [CI] 1.28–2.20; p�0.001), but adjusted risk of cardiac death in patients with low plateletcounts was not significant (p � 0.177; Figure 1). In addition, adjustedrisk for stent thrombosis was significantly higher in patients with lowplatelet counts (HR 1.79; 95% CI, 1.10–2.92; p � 0.02; Figure 2).

Conclusion: In this large cohort of PCI patients, baseline throm-bocytopenia was significantly associated with increased risks of mor-tality and stent thrombosis.

AS-216Percutaneous Coronary Interventions without On-Site CardiacSurgery Support. Afzalur Rahman, Jahurul Haque,Shahinur Rahman, Habib Chaudhury, Anisur Khan,Khondoker Asaduzzaman, Nurus Sabah, Bakar Siddique. SirSalimullah Medical College Hospital, Dhaka, Bangladesh.

Background: There is still controversy regarding elective percutane-ous coronary interventions (PCI) performed in centers without on-sitecardiac surgery. Because on-site cardiac surgery may not be possible inall the places, greater attention is being given to this topic. We soughtto determine the safety of PCI without cardiac surgical support on-siteand specifically the safety of complex elective procedures. The proce-dures performed at our outreach university medical center are reported.

Methods: This was a prospective study. Between March 2009 andAugust 2009, 72 elective PCI procedures were prospectively analyzed.Clinical and procedural outcomes were recorded. The overall 30-day majorcardiac events (MACE; cardiac death, acute stent thrombosis, subacutestent thrombosis, ST and non-ST myocardial infarction [MI], target vesselrevascularization [TVR], or coronary artery bypass grafting [CABG]) wererecorded. Staged procedure was followed in high-risk multivessel PCI. Onthe day before the procedure, all the patients were treated with loading

dose of 300 mg aspirin and 600 mg clopidogrel; daily 150 mg aspirin and150 mg clopidogrel were continued thereafter. Just before the procedure,injected (Inj) heparin 5000 IU bolus IA was given, and a subsequentheparin bolus was given to maintain activated clotting time between 300and 400 seconds. Two to three hours after the removal of the sheath, Injlow-molecular-weight heparin (1 mg/kg body weight, subcutaneous) wasgiven, followed by 3 such doses. High-pressure stent deployment andpostdilatation were the standard strategy.

Results: Of 72 patient, 77% were men and 23% were women; themean (� SD) age was 53 (� 9.2). Complex PCI was performed withmultivessel PCI in 37.5%, bifurcation PCI in 8%, chronic total occlusions(CTO) in 4.5%, osteal lesion in 10%, saphenous vein graft interventions in0%, and left main stenting in 0%. Of the cohort, 37% were diabetic, and75.3% of the lesions treated were either American College of Cardiology(ACC)/American Heart Association (AHA) type B or C lesions. Thedevice success rate was 98.6% (1/72), and procedural success rate was98.6%. The mean (� SD) lesion length was 18.8 (� 7.2) mm, and that ofreference vessel diameter was 2.6 (� 0.3) mm. The overall incidence30-day major cardiac events (MACE) were death 0 (0%), intraproceduralthrombosis 1 (1.4%), acute stent thrombosis 0 (0%), subacute stent throm-bosis 0 (0%), non-ST MI 0 (0%), ST MI 0 (0%), TVR 0 (0%), and CABG0 (0%). Only 1 (1.4%) patient developed thrombosis during the procedure,and another developed nonfatal in-hospital puncture-site hematoma.

Conclusion: Among the subjects, there were no MACE except 1patient who developed intraprocedural thrombosis during PCI. Ourresults support that elective PCI performed under thorough medicinalmanagement can be safely performed even in high-risk multivessel PCIwithout on-site cardiac surgery by experienced operators followed astaged procedure and high-pressure stent deployment.

AS-217Can the Use of an Iso-osmolar Contrast Agent (Iodixanol)Reduce the Incidence of Contrast-Induced NephropathyCompared with a Low-Osmolar Contrast Agent (Iopromide)?Deuk-Young Nah1, Kwan Lee1, Jun-Ho Bae1, Gyung-Mi Lee1,Yong Seok Kim2, Moo Yong Lee2, Young Kwon Kim2,Myoung Mook Lee2. 1Dongguk University Gyeongju Hospital,Gyeongju, Republic of Korea; 2Dongguk University Illsan Hospital,Illsan, Republic of Korea.

Background: Contrast-induced nephropathy (CIN) is one of the mostcommon causes of hospital-acquired renal failure after diagnostic cor-onary angiography (CAG) and interventional procedures. There issome debate whether the use of an iso-osmolar contrast agent comparedwith a low-osmolar contrast agent would be associated with a lowerincidence of CIN. The aim of this study was to compare the renal safetyof the iso-osmolar Iodixanol vs the low-osmolar agent Iopromide andto determine risk factors for CIN.

Methods: In this retrospective study, we examined 383 patientswho received an iso-osmolar contrast agent (Iodixanol 320) or a low-osmolar contrast agent (Iopromide 370) during diagnostic CAG with orwithout percutaneous coronary intervention (PCI). We compared theeffects of Iodixanol 320 and Iopromide 370 on CIN.

Results: See Table (* p �0.05). The incidence of CIN in Iodixanol320 group was 6.0% and Iopromide 370 group was 3.7%. Totalincidence of CIN was 5.2%. In the binary logistic regression analysis,serum creatinine �1.5 mg/dL (odds ratio [OR] � 6.2, 95% confidenceinterval [CI] 1.2–31.9), the history of diuretic use before CAG with orwithout PCI (OR � 5.1, 95% CI 1.3–19.4), the history of statin usebefore CAG with or without PCI (OR � 0.2, 95% CI 0.06-0.88), andbody mass index (OR � 0.77, 95% CI 0.6–0.99).

92B The American Journal of Cardiology� APRIL 28–30 2010 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster

E-POSTER

ABSTRACTS

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