CAD and comorbidities
563
(ROC) comparison was done to determine the individual predictive values for
ACS.
Results: From 269 patients (63±14.3years, 52.8% men), 35.3% had metabolic
syndrome based on WHO criteria. ApoB was found to be the only significant
independent risk factor for predicting ACS (OR 1.54, 95% CI 1-2.36, p=0.036).
ROC comparison revealed apoB had the highest area under the curve (AUC) with
a non-significant trend towards having the strongest performance measure for
predicting ACS (Figure). In contrast, all other lipid measures were not significant
independent risk factors in patients without metabolic syndrome.
The Kaplan-Meier survival curves
Conclusions: Screening for CHD at the stating dialysis could play a role for improving of prognosis in ESKD patients.
P3096 | BEDSIDE
Investigation of asymmetric dimethylarginine in patients with
coronary artery disease
A. Cziraki 1 , Z. Ajtay 1 , E. Sulyok 2 , I. Horvath 1 , A. Nemeth 1 , Z. Lenkey 1 ,
Z. Nemeth 3 , S. Szabados 1 , A. Koller 3 , S.M. Bode-Boger 4 . 1 Heart Institute,
Medical School, University of Pécs, Hungary, Pécs, Hungary; 2 Institute of Health
Promotion and Family Care, Faculty of Health Sciences, University of Pécs,
Pécs, Hungary; 3 Department of Pathophysiology and Gerontology, Faculty of
Medicine and Szentagothai Res. Centre, Pécs, Hungary; 4 Institute of Clinical
Pharmacology, University Hospital, Otto-von-Guericke University, Magdeburg,
Germany
P3097 | BEDSIDE
Apolipoprotein B predicts risk for acute coronary syndrome in
patients with metabolic syndrome
R. Pitts 1 , K. Bhatt 2 , V. Varghese 1 , P. Joshi 3 , Z. Qian 1 , O. Wassim 1 , J. Lee 1 ,
S. Rinehart 1 , J. Miller 1 . 1 Piedmont Heart Institute, Atlanta, United States of
America; 2 Emory University School of Medicine, Division of Cardiology, Atlanta,
United States of America; 3 Johns Hopkins University, Division of Cardiology,
Baltimore, United States of America
Background: In patients with metabolic syndrome, low-density lipoprotein
cholesterol (LDL-C) may not be an accurate reflection of atherogenic burden.
Studies show apolipoprotein B (apoB) better predicts CV events over LDL-C and
non-high-density lipoprotein cholesterol (non-HDL-C). We compared LDL-C, nonHDL-C and apoB as predictors for acute coronary syndrome (ACS) in patients
with metabolic syndrome.
Methods: We performed a retrospective case-control study on patients presenting to our hospital with ACS, based on admitting and discharge diagnosis. A multivariate logistic regression analysis was used to determine if LDL-C, non-HDLC and Apo B were independent risk factors for ACS. Receiver-operating curves
P3098 | BEDSIDE
Effect of trimetazidine on recurrent angina and left ventricular
function in elderly multivessel coronary heart disease patients with
diabetes mellitus after elective percutaneous coronary interventio
X.H. Xu, W.J. Zhang, Y.J. Zhou, Y. Zhao, Z.M. Zhou, H.Y. Ma. Beijing Anzhen
Hosp. of the Capital Univ. of Medical Sciences, Beijing Heart, Lung & Blood
Vessel, Beijing, China, People’s Republic of
Objective: To evaluate the effect of trimetazidine (TMZ) on recurrent angina and
left ventricular function in elderly multivessel coronary heart disease (CHD) patients with diabetes mellitus (DM) after elective percutaneous coronary intervention (PCI).
Methods: In this single-center, prospective, randomized evaluation study, 400 patients with DM aged 65 and over undergoing coronary angiography were recruited
to randomly receive or not TMZ (20 mg three times daily orally) as an addition to
the conventional treatment of CHD at admission before angiography. Recurrent
angina and echocardiogram were followed at 2 years after PCI.
Results: Two hundred and fifty-one patients who successfully underwent elective
PCI were finally enrolled, 125 in the TMZ group and 126 in the control group. At 2year follow up, patients in the TMZ group showed a significant improvement in the
proportion of angina patients (40 (31.2%) vs 58 (46.0%), P=0.023) and anginafree survival (P=0.003). The independent predictors of 2-year recurrent angina included no TMZ treatment, current smoking, hypercholesterolemia and BMI. TMZtreated patients showed a significant greater left ventricular function and smaller
left ventricular diastolic and systolic diameters compared with patients in the control group (LVEF: 65.65±3.870% vs 62.34±3.008%; LVEDD: 47.6±4.637 mm vs
50.86±3.597 mm; LVESD: 31.00±4.255 vs 33.06±3.371 mm, all P<0.01). E:A
ratio in TMZ-treated patients was better than that in the control group without significant difference (0.849±0.256 vs 0.808±0.313, P=0.464). Although there was
a trend towards a decrease in cumulative cardiovascular events in TMZ-treated
patients, there was no significant difference in event–free survival for composite
major adverse cardiac events including death, MI, TVR and hospitalization for
cardiac causes (P=0.163).
Conclusion: Adjunctive therapy of TMZ (20 mg tid) after PCI reduces the occurrence of recurrent angina, improve left ventricular function and inhibit left ventricular remodeling in elderly multivessel CHD patients with DM.
P3099 | BEDSIDE
Risk factors in the never-smoker patients with Coronary Spastic
Angina (CSA)
R. Nakayama. International Goodwill Hospital,Internal medicine,Cardiology,
yokohama, Japan
Backgrounds: Nicotine is the strong risk factor in the patients with CSA, Statin
is reported to inhibit spasm. Although another risk factors are unknown in the
never-smoker.
Methods: We investigate from data of diagnosed for 706 CSA by symptoms or
ECG and normal CAG or spontaneous or provocated coronary spasm>75% compared with 552 normal control. Logistic-regression analysis (Odds Ratio (OR),
95% CI) were performed by PASW Statics (SPSS).
Results: Dyslipidemia (OR 1.76 (1.36-2.27), p<0.0001), Smoking (OR 1.51
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Purpose: Prospective clinical trials provided firm evidence that elevated concentration of asymmetric dimethylarginine (ADMA) in the plasma and pericardial fluid
(PF) is an independent predictor of worse cardiovascular events in patients undergoing coronary revascularization. Our aim was to investigate the changes of
ADMA levels in patients with coronary artery disease (CAD), who underwent percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG)
surgery.
Methods: 64 patients who underwent PCI or CABG surgery were enrolled in
this study (65.5±8.2 years). 52 patients who underwent valve replacement (VR)
served as control subjects (59±6.9 years). Exercise stress test was performed
on a treadmill according to the Bruce protocol. ADMA levels were determined by
liquid chromatography – tandem mass spectrometry.
Results: Patients in the CAD group had significantly elevated plasma concentrations of ADMA at rest, compared to the control group (0.59±0.02 μM/l vs.
0.46±0.03 μM/l; p<0.01). Serum ADMA levels exhibited similar, slight decrease
in both groups during the exercise stress test on the treadmill (-0.01±0.19
for the control and -0.02±0.06 μmol/l for the CAD group; p=0.82). In the PCI
group ADMA decreased substantially immediately after stent placement (Posthoc ANOVA with factor time: F=10.8, p<0.0001) and remained low even 30
days after the intervention. ADMA levels which were collected from the coronary sinus showed a significant elevation in the group of patients who underwent cardiopulmonary bypass (CPB) (F=0.416, p=0.685 and F=14.751, p<0.001
for off-pump and CPB groups, respectively). Similarly, a significant increase of
ADMA was observed in the peripheral blood (F=30.738, p<0.001) during CPB.
The L-arginine/ADMA ratio of both plasma (125.4±10.7 vs. 76.7±8.7) and PF
(110.4±7.2 vs. 80.8±6.04) were significantly higher in the CABG group compared
to the VR group.
Conclusions: The findings of this clinical study suggest that dysregulation
of coronary circulation is well indicated by the altered ADMA levels and Larginine/ADMA ratios in plasma and PF providing further evidence for the importance of the investigation of these mechanisms in patients with CAD.
Conclusion: ApoB had the strongest association with ACS, which may support
the utility of apoB as a better predictor for CV events in patients with metabolic
syndrome. Future studies of apolipoprotein-based risk prediction models may be
warranted given current lipid guidelines may underestimate CV risk in this patient
population.
564
CAD and comorbidities
(1.13-2.03), p=0.006), Apolipoprotein B100 (ApoB) (OR 1.007 (1.002-1.012),
p<0.01) and non-HDLC (OR 1.004 (1.001-1.008), p=0.002) are significant risk
factors in the all patients with CSA. Risk of CSA in the current-smoker (n=252,
CSA163) shows dyslipidemia (OR2.01 (1.09-3.69), p=0.025) and male (OR 2.30
(1.06-4.99), p=0.035). Risk of CSA in the Ex-smoker (n=208, CSA127) shows
no significant risk factor. In the never-smoker (n=734, CSA391) total cholesterol (TC) (213±34.8 vs. 204±41.1mg/dl, p=0.002), direct-LDLC (132±32.6 vs.
125±32.8 mg/dl, p=0.006), ApoB (103±22.6 vs. 98.8±24.9mg/dl, p=0.009), nonHDLC (148±35.0 vs. 141±40.1mg/dl, p=0.018), LDLC (124±32.0 vs. 118±36.8
mg/dl, p=0.021) and ApoA1 (152±26.8, 148±30.0 mg/dl, p=0.043)are significantly higher and risk of CSA shows LDLC>100 mg/dl (OR1.88 (1.33-2.65),
p=0.003), direct-LDLC>100mg/dl (OR 1.82 (1.21-2.74), p=0.004). TC>200mg/dl
(OR 1.53, (1.12-2.09), p=0.005), non-HDLC>140mg/dl (OR 1.44 (1.07-1.94),
p=0.016), ApoB>100mg/dl (OR 1.37, (1.02-1.84), p=0.037).
Conclusions: LDLC, direct-LDLC, TC, Non-HDLC, Apo B are the risk factors of
CSA in the never-smoker.
P3100 | BEDSIDE
Endothelial dysfunction versus early atherosclerosis: a study with
high resolution imaging
E. Cenko 1 , O. Manfrini 1 , R. Carnevale 1 , E. Verna 2 , J.A. Uriarte 3 , R. Bugiardini 1 .
1 University of Bologna, Department of Internal Medicine, Section of Cardiology,
Bologna, Italy; 2 University of Insubria, Hospital of Circolo and Foundation
Macchi, Department of Cardiology, Varese, Italy; 3 University of Insubria,
Department of Clinical Medicine, Varese, Italy
P3101 | BEDSIDE
Acute coronary syndrome up to 35 years old: what to expect?
L. Leite, H. Martins, N. Moreira, P. Mendes, R. Baptista, F. Goncalves,
S. Monteiro, P. Monteiro, L. Elvas, M. Pego. University Hospitals of Coimbra,
Coimbra, Portugal
Purpose: The investigation in acute coronary syndromes (ACS) is focused on
middle aged patients. Therefore, it is important to better characterize the younger
population with ACS. We aimed to assess the clinical characteristics, management and prognosis of ACS patients with less than 35 years at diagnosis.
Methods: We evaluated 4336 patients, admitted to an intensive care unit for ACS,
from May 2004 to November 2012. The patients were divided in two groups according to their age: group 1 - age ≤ 35 years (n=36, 0.8%); group 2 - age > 35
years (n=4300). The patients underwent a clinical and laboratorial characterization. The mean follow-up time was 83±72 months.
Results: Group 1 patients (age 32.9±2.1) were mainly men (75% vs. 67.4%,
p=0.38) and had a higher prevalence of ST segment elevation ACS (61.1% vs.
32.6%; p<0.001). Some cardiovascular risk factors were more frequent: smoking (66.6% vs. 16%, p<0.001), sedentary lifestyle (38.9% vs. 18.5%, p<0.005)
and family history of ACS (22.2% vs. 10.8%, p=0.05). Hypertension (33.3%
P3102 | BEDSIDE
Coronary artery disease burden and long-term outcomes in
patients with human immune deficiency virus (HIV) undergoing
percutaneous coronary intervention: results from a single-center
registry
K. Theodoropoulos, M. Mennuni, S. Sartori, P. Moreno, P. Krishnan, U. Baber,
G. Dangas, R. Mehran, S.K. Sharma, A. Kini. Mount Sinai Medical Center, New
York, United States of America
Purpose: Coronary artery disease (CAD) is a frequent complication of HIV infection and patients with HIV are increasingly referred for percutaneous coronary
intervention (PCI). Despite substantial cardiac morbidity, the angiographic pattern
or burden of CAD and outcomes following PCI in HIV patients has not been well
described.
Methods: We followed 112 consecutive patients with HIV who underwent PCI
from 1999 to 2011. Quantitative coronary angiographic (QCA) analysis was performed independently in all patients. We determined that the incidence of adverse
events including death, myocardial infarction, and revascularization. The mean
follow-up period was 2.4 years.
Results: We identified 112 HIV patients with 164 lesions undergoing PCI during
the study period. Patients with HIV were more frequently male (n=88, 79%) and
non-Caucasian (n=79, 71%) with a mean age of 57 years. The majority of patients
were treated with DES (n=66, 59%). Most lesions displayed minimal calcification
(67%), modest lesion length (16.6 mm±10.6) with a diameter stenosis of 69%,
and an overall SYNTAX score of 13.5±8.9. The rate of all-cause mortality, MI or
target vessel revascularization at 3 years was 29.5% while 19% of patients were
readmitted due to cardiac causes (Figure 1). Similar results were obtained for
both BMS and DES treated patients (29.8% vs 29.2%, P=0.95).
Figure 1
Conclusion: Although the angiographic pattern of CAD in HIV patients suggests
a relatively low-risk phenotype, the risk for adverse events after PCI, particularly
revascularization, is significant. These findings suggest that atherosclerosis progression and restenosis is altered in the setting of HIV
P3103 | BEDSIDE
The ratio of contrast media volume to the estimated glomerular
filtration rate predicts 3-year cardiovascular renal outcome in
chronic kidney disease patients with emergency coronary
procedure
S. Kaoruko, Y. Takahisa, M. Takashi, F. Yoshio, I. Yusuke, K. Masato, K. Atsushi,
O. Kentaro, K. Takumi, Y. Hironori. Osaka General Medical Center, Osaka, Japan
Backgrounds: The ratio of contrast media volume to the estimated glomerular
filtration rate (CMV/eGFR) was reported to be a predictor of contrast-induced
nephropathy (CIN). However, it remains unclear whether CMV/eGFR would pre-
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Purpose: Endothelial dysfunction has been shown to be of prognostic significance in predicting major coronary events. Characterization of microstructural
changes of the vessel wall in coronary segment with endothelial dysfunction
may have potential prognostic importance for detection of ischemic heart disease
(IHD).
Methods: We studied 5 patients with IHD, found to have normal or near normal
angiograms. These patients received graded doses of intracoronary acetylcholine
(10-6, 10-5 and 10-4 mol/L over 3 minutes at 10 minutes intervals) to assess
endothelial dysfunction. Epicardial endothelial dysfunction was defined as >30%
epicardial vessel diameter reduction during testing. An intracoronary bolus dose
of 1000 μg of nitroglycerin was administered to relieve vasoconstriction; IVUS
was performed 10 minutes after relief of vasoconstriction and OCT 20 minutes
later. The OCT imaging wire was positioned at the site, and 1 cm proximal and
distal to of the observed coronary vasomotor abnormality. Each OCT image was
analyzed by two independent observers who were blinded to the results. Using
OCT imaging, the intima is identified by a signal-rich layer near to the lumen, the
media by a signal-poor middle layer, and the adventitia by a signal-rich outer layer.
Loss of layered architecture reflects early sign of atherosclerosis.
Results: A total of 7 coronary segments showed vasoconstriction. Wall morphology was evaluated by IVUS. Subjects with normal smooth coronaries exhibited
a thickness of the coronary wall<1mm. We obtained a total of 83 OCT images.
There were 49 images of "dysfunctional" sites and 34 of the control segments. Of
the 49 images of "dysfunctional" sites, 9 (19.4%) showed the usual layer structure
of a normal artery (three-layer structure: intima, media and adventitia), and the
remaining 40 (81.6%) showed early structural changes (single intimal thickened
layer up to 380 micron). 16 of these 40 images revealed small signal-poor regions
compatible with lipid deposits. Imaging of the control segments showed the usual
three-layer structure in 5 (14.7%) images, small signal-poor regions in 14 (41.2%)
images, and early structural changes in the remaining 15 (44.1%) images.
Conclusions: Our findings indicate that endothelial dysfunction and early
atherosclerosis, although related in many coronary segments, may exist separately. Functional alterations can be identified safely at a stage when atherosclerotic lesions are not detectable by any imaging technique. Acetylcholine testing
may be useful in designing early effective interventions that restore endothelial
function.
vs. 74.6%, p<0.001), dyslipidemia (39.3% vs. 71.9%, p<0.001) and type 2 diabetes (3.2% vs. 28.1%, p<0.001) were less prevalent. Group 1 patients had
lower HDL (33±3.6 vs. 39.5±11.3 mg/dL, p<0.05), fasting glucose (96.4±9.1
vs. 137±66 mg/dL, p<0.001) and oral glucose tolerance test (142.2±24.9 vs.
174.8±53.1 mg/dL, p<0.05). Hemoglobin (14.6±1.6 vs. 13.4±1.9 g/dL, p<0.005)
and platelets levels (263.8±86.5 vs. 218.9±67.9 x109/L, p<0.05) were higher. In
group 1, 83.3% of patients were submitted to angiography, that revealed a numerically higher prevalence of coronary arteries with non-significant stenosis (30%
vs. 17.9%, p=0.08) and single-vessel disease (60% vs. 36.4%, p<0.05). The clinical risk of the patients, as assessed by the GRACE (99.6±21.3 vs. 135.9±32.9,
p<0.001) or the TIMI (1.5±1 vs. 2.55±1.4, p<0.001) risk scores, was lower. No
intra-hospital deaths were recorded in this group (0% vs. 5.8%) and follow-up
all-cause mortality was also lower (2.9% vs. 19.6%, Log-rank p<0.05).
Conclusions: Patients up to 35 years old diagnosed with ACS have a specific
risk profile and have lower short term and long term mortality.