S40 J O U R N A L O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y , V O L . 6 9 , N O . 1 6 , S U P P L S , 2 0 1 7

CONCLUSION Three-vessel disease is a predictor of the developmentof VF during FFR performed with the aid of papaverine, especially ifaccompanied by one or more of low left ventricular function, hypo-kalemia, or bradycardia.

TCTAP A-072

Association Between Coronary Artery Calcification and MyocardialInjury After Percutaneous Coronary Intervention in Patients withChronic Coronary Artery Disease

Mori Atsushi11National Hospital Organization Iwakuni Clinical Center, Japan

BACKGROUND Periprocedural myocardial infarction (PMI), which isdefined as peak high-sensitivity cardiac Troponin T (hs-cTnT) during the24 hours after PCI �0.07 ng/ml, is not an uncommon complication, andis associated with increased adverse cardiac event after PCI. The severityof coronary artery calcification (CAC) is well known as an independentpredictor for coronary event and all-cause mortality. The object of thisstudy is to clarify whether the severity of CAC is associated with inci-dence of PMI in patients with chronic coronary artery disease.METHODS 84 patients who underwent elective PCI from February2014 to May 2015 were examined. Subjects with a history of PCI orCABG, acute coronary syndrome, hs-cTnT �0.07 ng/ml before PCIwere excluded. We assessed cardiac biomarker by hs-cTnT and N-terminal Brain Natriuretic Peptide (NT-proBNP) on the day before andthe following day of PCI. Multi-detector computed tomography wasperformed within 1 month before PCI. The CAC score was calculatedusing the standard Agatston criteria. We assessed major complicationby death, myocardial infarction and bleeding. We compared theincidence of a cardiac event; cardiac death, heart failure admission,acute myocardial infarction, and revascularization.RESULTS Patients were divided into 2 groups according to hs-cTnTlevel after PCI: high TNT group (hs-cTnT�0.7 ng/ml, n¼38) and lowTNT group (hs-cTnT<0.7 ng/ml, n¼46). CAC score was higher in highTNT group (1467 � 1374 vs 836 � 943, p¼0.0243). An increase of NT-proBNP level after PCI was larger in high TNT group (696 � 1173 vs 1321� 1889, p<0.05). PMI was associated with CAC score >400 (ORs, 2.939,1.067-8.095, p¼0.037) and eGFR (ORs, 0.963, 0.929-0.998, p¼0.039) inmultivariable analysis. Many more cardiac events occurred in highCAC score >400 group and high TNT group. During the follow-upperiod, PCI for new lesion was performed more frequently in high TNTgroup (0% vs 24%, p¼0.000). The rate of any revascularization wasalso higher (9% vs 29%, p¼0.016).CONCLUSION High CAC score before PCI was associated with PMIafter PCI. Measuring CAC score before PCI may help in predicting afuture coronary event in these patients.

TCTAP A-073

Predictive Value of Left Bundle Branch Block in Coronary ArteryDisease at Zagazig University Hospitals in Egypt

Islam Elsayed Shehata,1 Amroo Abdul-Monem Ateya,1

Ahmed Saeid ElDamanhory,1 Tarek Naguib1

1Zagazig University, Egypt

BACKGROUND Left bundle branch block (LBBB) has a perceived un-favorable result and is connected with hypertension, Coronary ArteryDisease (CAD), idiopathic dilated cardiomyopathy, aortic stenosis anddegenerative ailment of the conductive framework.Diagnostic coronary angiography has gotten to be one of the

essential tools of heart catheterization; coronary angiography remainsthe clinical highest quality level for the diagnosis of CAD.The current study aimed to determine association between com-

plete LBBB, CAD severity, site and CAD risk factors. Because thepresence of complete LBBB makes the non-invasive identification ofCAD less informative, patients with complete LBBB often are referredfor coronary angiography to assess the presence and severity of CAD.METHODS In our study, patients were selected out of those referred toroutine laboratories and echocardiographic examination in our hospitalsfor diagnosis and evaluation of CAD, during the period between November2014 and October 2016. The study was conducted in 80 patients withLBBB, 52 males (65%) and 28 females (35%) with their age ranged from 39to 77 years with a finding of coronary angiography into two groups:

Group I: included 56 patients (37 males and 19 females) with significantCAD (diameter of stenosis �70% in one or more epicardial vessels.Group II: included 24 patients (15 males and 9 females) with normalcoronary arteries.

All patients underwent thorough history taking and full clinicalexamination, standard 12 resting ECG, laboratory investigation, chestX-ray, echocardiography and coronary angiography.

J O U R N A L O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y , V O L . 6 9 , N O . 1 6 , S U P P L S , 2 0 1 7 S41

RESULTS The clinical and demographic characteristics of both groupswere comparable; there was male preponderance in both groups. Therisk factors of CAD were more in group I than in group II.In our study CAD 56 (70%), left ventricular systolic dysfunction

(LVSD) 51 (63.8%). Hypertension found in 38 (47.5%), diabetes melli-tus (DM) in 31 (38.8%), DM and left ventricular systolic dysfunction(LVSD) were more associated with significant CAD.In our study:

1-LBBB was more common in elderly, male and hypertensive patients.2-LBBB was significantly associated with a significant coronary lesionin elderly, diabetics and hypertensive so these risk factors are a strongpredictor of CAD in LBBB.

Coronary angiography detected LAD artery lesion in 49 patients(87.5%), LCX artery lesions in 15 patients (26.7%) and RCA arterylesions in 14 patients (25%). So:

3-LAD was the most frequently diseased artery and to less extent LCXand RCA.

In our study coronary angiography detected single vessel diseaselesion in 37 patients (46.2%), two vessel disease lesion in 16 patients(20%), three vessel lesion in 3 patients (3.8%) and normal vessels in24 patients (30%). So:

4-Frequency of single vessel disease was high in this study. There wasno involvement of LMCA.1 Our Study does not favor the hypothesis that presence of LBBBwith coronary artery disease predicts the severity of coronary arterydisease (in terms of LMCA, involvement or three-vessel disease).

Side effects were minimal and transient, no major complications inthe form of mortality, infarction or serious arrhythmias haveoccurred.

CONCLUSION There is a significant association between coronaryartery disease and LBBB and since the patients with ECG evidence ofLBBB have an increasing risk of left ventricular dysfunction andreduced survival rate, therefore we recommend that:

1 Coronary angiography should be considered in patients with LBBBwho have ischemic chest pain or who have risk factors for CAD.

2 Invasive Coronary angiography is often needed to confirm or deferobstructive CAD in patients with LBBB for accurate diagnosis.

3 Since the number of cases in the present study was limited, furtherwork is needed on a large number of patients to evaluate and supportthe results of this study.

CLINICAL IMPLICATIONS Coronary angiography is a major and inva-sive diagnostic tool for CAD present in tertiary centers so selectioncriteria are required to clarify patients with LBBB who are likely to beat risk of CAD and need this invasive procedure, on the other hand,avoid over diagnosis of CAD, unnecessary hospital admissions andconsumption of anti-anginal medication.

S42 J O U R N A L O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y , V O L . 6 9 , N O . 1 6 , S U P P L S , 2 0 1 7

TCTAP A-074

The Clinical Outcome of Percutaneous Coronary Intervention forVery Elderly Ischemic Coronary Artery Disease Patients in Japan

Takayuki Yabe,1 Toshiya Muramatsu,1 Masatsugu Nakano,1

Hideyuki Takimura11Tokyo General Hospital, Japan

BACKGROUND Our country is a super-aged society and this is anunlike any other in the world. We must consider the treatmentstrategy for their disease enough. In this study, we examined theclinical outcomes of percutaneous coronary intervention (PCI) forvery elderly ischemic coronary artery disease patients in Japan.METHODS From October 2014 to October 2015, 143 patients with 196lesions had been implanted drug-eluting stent for ischemic coronaryartery disease in our hospital. The patients were divided into the veryelderly patients (VE) group (�80 year: 37 patients, 50 lesions) and thenon-VE group (106 patients, 146 lesions). The groups were comparedfor lesions characteristics, procedure characteristics, and the inci-dence of major adverse cardiac events (MACE) at 1 year.RESULTS The tortuous lesion (VE group: 45% vs. non-VE group: 22%,P¼0.04) and calcified lesion (52% vs. 34%, P¼0.03) were significantlyhigher in the VE group than the non-VE group. Contrast volume(111.6 � 46.15 ml vs. 89.2 � 54.67 ml, P¼0.03) and radiation dose(1.54 � 1.61 Gy vs. 0.98 � 0.45 Gy, P¼0.02) were significantly higher inthe VE group. But, there were no significant differences in post-min-imal lumen diameter, post % diameter stenosis, and the incidence ofMACE between the two groups.CONCLUSION As for the very elderly patients, the lesion morphologyis complicated, but there was no significant difference in the clinicaloutcome. It is thought that PCI for the very elderly patient is anallowable treatment strategy in Japan.

CONGENITAL HEART DISEASE (ASD, PDA, PFO, VSD)(TCTAP A-075 TO TCTAP A-078)

TCTAP A-075

Transcatheter Closure of Complex Atrial Septal Defects:Morphological Predictors of Outcome with Modified Techniques ofDevice Deployment

Ajith Ananthakrishna Pillai,1 Amar Nath Upadhyay,1 Saranya Gousy11Jawaharlal Institute of Postgraduate Medical Education and Research,India

BACKGROUND The success of transcatheter closure (TCC) in ostiumsecundum atrial septal defects (OS-ASD) is largely determined by themorphology of the defects. Modified techniques are being used forcircumventing the anatomic complexities and increasing success. Weplanned a prospective study looking at different morphological fea-tures of complex ASD identified in TEE and their association with theoutcome of TCC of ASD with such modified device delivery techniquesafter conventional techniques failed.METHODS We prospectively looked at various morphological complex-ities associated with modified techniques of TCC of OS ASD and to study ifthese anatomic variables can predict the outcome of TCC by logisticregression analysis. Seven parameters, viz. defect size, an absence ofaortic rim, septal aneurysm, septal malalignment, deficiency of posteriorrim and deficient inferior vena caval rims were analyzed for the outcome.Size more than 44 mm and complete absence of inferior vena caval rimwere exclusion criteria. We used balloon assistance in 72% cases andpulmonary vein deployment technique in 23%. In 5% cases, a modifiedsheath was used. In all these patients a conventional technique had failed.RESULTS TCC was successful in 84% (67 out of 80) of patients withmodified techniques. Out of the seven parameters studied, mean defectsize, absent aortic rim, septal aneurysm and multiple defects did notshow any difference in the outcome. Mean defect size was 31.8 � 3.2 mm(22.9-39.1) with success and 32.6 � 4.5 mm (CI 23.1-39.7) with failure(P¼0.06). Patients with malalignment had a high failure rate of 71.4%(P<0.001). The proportion of patients with deficient posterior rim was44% (35/80). The success rate was 68.6% with deficient posterior rim vs.95.6 with adequate posterior rim (P¼0.019). The inferior vena caval rimwas deficient in 19 (24%) and procedure failed in 52.6% of these patients(P<0.001). The odds ratio for procedural failure was 25.3 (4.3- 143.8) inpatients with septal malalignment, 8.3 (1.4- 48.5) with deficient inferiorcaval rim and 4.1 (2.5-19) for a deficient posterior rim.CONCLUSION The modified techniques for device deploymentoffered good chances of success in TCC of OS ASD (84%) after a failedstandard approach. Mean defect size and presence of a septal aneu-rysm did not affect an outcome as absent aortic rim. But a presence ofseptal malalignment, an absence of posterior and or inferior venacaval rim predicted failure of TCC with modified device delivery.

TCTAP A-076

Transcatheter Closure of Patent Foramen Ovale: Clinical Efficacyfor Prevention of Recurrent Cryptogenic Stroke or MigraineHeadache

Teiji Akagi,1 Yoichi Takaya,2 Koji Nakagawa,3 Hiroshi Ito41Okayama University Hospital, Japan; 2Department of CardiovascularMedicine, Okayama University, Graduate School of Medicine,Dentistry, Japan; 3Okayama University Graduate School of Medicine,Japan; 4Okayama University, Japan

BACKGROUND Transcatheter closure of patent foramen ovale (PFO)for prevention of recurrent cryptogenic cerebrovascular events (CVE)has not been officially approved in Japan. However, previous studiessuggested that >10000 patients/year are suffered from a cryptogenicstroke due to PFO in Japan. Additionally, several studies revealed theimprovement for a migraine after PFO closure.METHODS Since 2007, we have performed transcatheter closure ofPFO in 34 patients. Mean age at procedure was 45 years, including 26patients with stroke, 3 with TIA, 4 with a migraine and 1 with brainabscess. A presence of interatrial right-to-left shunts was demon-strated by transesophageal contrast echocardiography in all. PFOclosure was performed using Amplatzer Septal Occluder (n¼15),Amplatzer Cribriform device (n¼5) or Amplatzer PFO Occluder (n¼14).RESULTS All procedures were successfully performed. During thefollow-up period (40 � 11 months), no device-related complications wereobserved. Recurrent TIA attack without of evidence of MRI stroke findingwas observed in 1. In 11 of 15 patients complicated with a migraine before,complete resolution or significant reduction was observed.