The American Journal of Cardiology® | October 12-17, 2008 | TCT Abstracts/ORAL 47i

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WEDNESDAY, OCTOBER 15, 2008, 2:00 PM - 5:25 PM

Confrontational Angioplasty- Fiercely Debating the Issues

Room 151AB

Wednesday, October 15, 2008, 2:00 pm - 5:25 pm

(Abstracts Nos 99-102)

TCT-99

on Mortality: Results from the HORIZONS-AMI Trial

Helen Parise1, Roxana Mehran1, Bernhard Witzenbichler2, Giulio Guagliumi3, Jan Z Peruga4, Bruce R Brodie5, Dariusz Dudek6, Ran Kornowski7, Franz Hartmann8, Bernard J Gersh9, Stuart J Pocock10,George Dangas1, S. Chiu Wong11, Ajay Kirtane1, Alexandra J Lansky1,Gregg W Stone1

1Columbia University Medical Center and the Cardiovascular Research Foundation, New York, NY; 2Charité Campus Benjamin Franklin, Berlin, Germany 3Ospedali Riuniti di Bergamo, Bergamo, Italy 4Silesian Center for Heart for Heart Disease, Lodz, Poland 5LeBauer Cardiovascular Research Foundation and Moses Cone Hospital, Greensboro, NC; 6Jagiellonian University, Krakow, Poland 7Rabin Medical Center, Petach Tikva, Israel 8Universitätsklinikum Schleswig-Holstein Campus Lubeck, Lubeck, Germany 9Mayo Clinic, Rochester, MN; 10London School of Hygiene and Tropical Medicine, London, United Kingdom 11New York-Presbyterian Hospital at Columbia University Medical Center and Weill Cornell Medical Center, New York, NY

Background: MACE and bleeding complications are strongly associated with subsequent mortality in AMI pts treated with anticoagulant and antiplatelet therapies. The relative impact of MACE and bleeding on overall mortality in AMI is not well understood.Objectives and Methods: We sought to assess the relative impact of MACEand major bleeding events on mortality in 3,602 pts with STEMI undergoing primary PCI in the HORIZONS-AMI trial. A multivariable Cox model

components of the primary composite endpoint from the trial (reinfarction,

updated covariates. Bleeding was assessed using various bleeding scales.Results: Within 30 days of randomization, there were 93 deaths (2.6%); 26 following a major bleed (non CABG-related) in 238 pts, 10 following a

Conclusion: After accounting for baseline predictors, both reinfarction and

population. While the hazard ratio for reinfarction is nominally higher, there are more deaths attributable to major bleeding as compared to a reinfarction.

reinfarction in preventing deaths after primary PCI for STEMI.

* Adjusted for baseline covariates and time updated reinfarction.** Interval for attributable deaths calculated from the lower and upper bounds

*** 88 deaths in 3550 patients.

TCT-100

Antiplatelet Therapy In Patients With Oral Anticoagulant Undergoing Percutaneous Coronary Stenting : A Prospective Multicenter Registry Stentico

Martine Gilard1, Didier Blanchard2, Gérard Helft3, Didier Carrier4,Hélène Eltchaninoff5, Loic Belle6, Gérard Finet7, Herve Le Breton8,Jacques Boschat1, GACI 1CHU la Cavale Blanche, Brest, France 2Clinique St Gatien, Tours, France 3CHU la pitié salpétrière, Paris, France 4CHU Toulouse, Toulouse, France 5CHU rouen, Rouen, France 6CH Annecy, Annecy, France 7CHU Lyon, Lyon, France 8CHU Rennes, Rennes, France

Purpose:Patients who are under chronic oral anticoagulant therapy (OAC) and

aspirin, clopidogrel and OAC. However, the use of this triple therapy increases the rate of adverse outcomes as showed by retrospective studies. This study is

using a dual antiplatelet therapy in addition or not to OAC.Methods: From June 2005 to September 2006, all patients with OAC who underwent Percutaneous Coronary Intervention (PCI) in 40 French cath labs were included in the STENTICO registry. Continuation or interruption of OAC was decided for each case by the medical team before performing PCI. We collected initial parameters such as biological data, OAC indication and concomitant therapy surrounding PCI. All clinical outcomes were also collected during hospitalization, at 2 and 12 months after PCI.Results: We prospectively analysed 359 patients (83% males; age 71+/- 10).

pulmonary embolism and deep venous thrombosis (12.3%) miscellaneous (12.3%). In 234 (65.2%) patients (group 1), OAC was discontinued while dual antiplatelet therapy was mandatory. The mean discontinuation time was 22+/- 31days. In 125 (34.8%) both dual antiplatelet therapy and OACwere continued. The two groups were not statistically different in terms of

coronary disease. Radial approach was more often performed in group 2 (65.6 vs 43.8%, p = 0.003); Less Drug eluting stents were implanted in group 2 (33.3 vs 24.8%; p = 0.021); Physicians prescribed less Anti GP IIb IIIa therapies in group 2 (5.6 vs 8.5%; p = 0.023).

According to GUSTO criteria, severe and moderate bleedings occurred in 2.1 and 6.4% respectively in groups 1 and 2 (p = 0.042). We detected another

approach (p = 0.02).Conclusion:

per- and post- PCI. A temporary discontinuation (when possible) reduces

approach for PCI could be a good alternative to the conventional femoral route to avoid bleedings.

48i The American Journal of Cardiology® | October 12-17, 2008 | TCT Abstracts/ORAL

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WEDNESDAY, OCTOBER 15, 2008, 2:00 PM - 5:25 PM

TCT-101

Passive Versus Active Thrombectomy In Primary And Rescue Percutaneous Coronary Intervention For ST-elevation Acute Myocardial Infarction

Giandomenico Tarsia1, Domenico Polosa1, Giuseppe Biondi-Zoccai2,Giuseppe Del Prete1, Fabio Marco Costantino1, Sergio Caparrrotti1,Rocco aldo Osanna1, France sco Sisto1, Imad Sheiban2, Pasquale Lisanti1

1San Carlo Hospital, Potenza, Italy 2Division of Cardiology; University of Turin, Turin, Italy

Objective: We compared passive thrombus-aspiration catheters versus active mechanical thrombectomy devices in patients who underwent primary or rescue percutaneous coronary angioplasty (PTCA) in a tertiary hospital.Background: Many thrombectomy devices in the setting of patients with ST-segment elevation acute myocardial infarction (STEMI) are proved to be safe and effective in thrombus burden reduction and in ST-segment resolution (STR); yet there are no comparative data between devices.Methods: We analysed 232 consecutive patients underwent to primary or rescue PTCA from 2000 to 2007 in single tertiary hospital. Patients with

secondary end-points were: angiography reperfusion parameters; procedural characteristics; in-hospital major cardiac adverse events (MACE).Results: The passive group (PG) included 110 patients, mainly Export, and the active gorup (AG) 122 patients, mainly Angiojet. The two groups were similar for all the clinical characteristics but the higher frequency of anterior myocardial location in the active group (57% versus 44%; p=0.043). The patients in PG

count (16 frames/sec versus 19 frames/sec; p=0,01). MACE were similar in two groups: 10% in PG vs 9,8% in PG. Procedural median time was longer in the AG than in PG [65min (IQR 54-81) versus 89.5min (IQR 74.8-110.3); p<0.001] as well procedural cost was higher in AG than in the PG [2538euros (IQR 1985-3340) versus 7806euros] (IQR 6258-9673); p<0,001]. STR was 68% in PG vs 59% in AG (p=0,087). At multivariable-propensity analysis score the STR was

thrombectomy (OR=0.81 [95%CI 0.46-1.44], p=0.474).Conclusion: This study showed that thrombus-aspiration catheters are preferable to the active mechanical thrombectomy devices in patients who

thrombus-aspiration catheters reduce procedural cost and time.

TCT-102

24/7 Primary PCI - Providing a Rapid Door to Balloon Time Response. The MonashHEART and Metropolitan Ambulance Service Acute Myocardial Infarction (MonAMI-MAS) Pilot Trial

John Koutsoubos, Adam Hutchison, Yuvaraj Malaiapan, Ian T Meredith Monash Cardiovascular Research Centre, MonashHEART, Southern Health & Department of Medicine (MMC), Monash University, Melbourne, Australia

Background: S-T segment elevation acute myocardial infarction (STEMI) is a life threatening condition for which prompt cardiac reperfusion is essential. Previously, thrombolysis (TL) was the accepted treatment modality for STEMI. Current evidence indicates that primary percutaneous coronary intervention (PPCI) provides superior outcomes compared with TL. However, the provision of PPCI for acute myocardial infarction (AMI) patients within 90 minutes as per the current guidelines remains challenging.Method: A pilot program (MonAMI-MAS) was established in conjunction

transmission of 12 - lead ECG from on-site in the community, along with direct

activation of the infarct team prior to patient arriving at the hospital. We assessed door-to-balloon times (D2BT) following the implementation of this study.Results: A prospective observational study involving 152 patients undergoing PPCI at a single tertiary referral institution was performed. The D2BT of all

group) was compared to 120 consecutive patients who underwent PPCI prior

in the MonAMI-MAS group was 57.5 minutes compared to 102 minutes in the Pre-MonAMI-MAS group (p<0.002). This was driven by a reduction in the median door-to-cath lab time: (30 versus 69 minutes (p=0.011)). The median cath lab-to-balloon time remained unchanged (26 minutes versus 29 minutes p=0.389). The proportion of patients who achieved a D2BT of <=90 minutes increased from 38% in the Pre-MonAMI-MAS group to 91% in the MonAMI-MAS group (p<0.0001).Conclusion: A co-ordinated multidisciplinary approach with on-going review via a quality improvement program is effective in reducing management times in patients with acute STEMI. In particular the activation of the on call infarct team prior to the patient arrival at the hospital is effective in reducing median D2B times.