compared to CRUSADE (AUC 0.76), that is mantained when we compared the risk status of the two scores (AUC 0.78 vs. 0.72). For an ATRIA>2.5pts we have a sensitivity (S) of 74% and specificity (E) of 75% for HE vs. S of 71% and E of 68.8% with CRUSADE>28.5pts.
Conclusion:The ATRIA bleeding score proved to be useful for stratifying the risk of HE in P undergoing PCI. The comparison with the CRUSADE score, currently validated for this type of population, allowed us to verify that the ATRIA bleeding is superior in its performance. Its use in clinical practice may allow a better stratification and a more individualized approach to hemorrhagic risk. Having a pre-procedure Hgb of less than 11 g/L had the major impact on choice of stent used during PCI (OR: 0.51; 95% CI: 0.45 to 0.57; p<0.001). Within the HBR patient, having 3 or more HBR criteria was associated with less likelihood to receive DES than patients with one or two risk factors (OR: 0.50; 95% CI: 0.44 to 0.57; p<0.001). When we looked into the trends of DES use on HBR population, there was slow increase then slowed down around 2006 when FDA has released stent thrombosis alert. With the development of second generation DES, there was increase again of DES in HBR population.
P5122 | BEDSIDE
Conclusions:Presence of HBR has a significant impact upon the decision to use DES. The optimal treatment of patients with at least one HBR risk factor needs to be further explored. Background: Bleeding events in relation to primary percutaneous coronary intervention (pPCI) in ST-segment elevation Myocardial Infarction (STEMI) has been shown to have a strong association to short-and long-term mortality. However, arterial access, anticoagulation and antiplatelet strategies vary between studies and new regimens have evolved. Purpose: To investigate incidences and predictors of serious in hospital bleeding events in a contemporary STEMI population consisting of the DANAMI-3 patient population.
P5123 | BEDSIDE Incidences and predictors of serious bleeding events in a contemporary STEMI population. A DANAMI-3 substudy
Methods:The Third DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction (DANAMI-3) aimed to improve outcome in STEMI patients by different revascularization strategies. This nationwide all-comer study included 2217 STEMI patients with symptom duration under 12 hours. In this substudy, hospital charts from admission and until discharge, were read in order to detect in hospital bleeding episodes. Bleeding events were assessed using TIMI criteria. Results: Pre-hospital antithrombotic medication consisted of 10.000 units unfractionated heparin in 96% of patients, and a similar proportion received 300 mg aspirin in combination with loading of either Clopidogrel, Ticagrelor or Prasugrel before arrival in the cath.lab. A total of 76% received additional bivalirudin and/or glycoprotein inhibitor (GPI) (19%) during and after pPCI. Access site was femoral in 94%. In hospital non-CABG related TIMI major bleeding occurred in 16 (0.7%...
Background: Primary percutaneous coronary intervention (PCI) improved prognosis of patients with acute ST-elevation myocardial infarction (STEMI). However, studies have shown sex-based disparities in outcomes after primary PCI. Purpose: This study sought to investigate the influence of gender on short and long-term mortality in unselected STEMI patients treated with primary PCI. Methods: Data of all consecutive STEMI patients admitted for primary PCI between 8/2009 and 12/2012, enrolled in a prospective registry of a high volume tertiary centre, were analyzed. In-hospital bleeding was assessed using Bleeding Academic Research Consortium (BARC) criteria. The primary outcomes were 30-day, 1-year, and 4-year all cause mortality. Results: Of the 3034 consecutive STEMI patients underwent emergency coronary angiography, 2715 were treated with primary PCI, of whom 807 (29.7%) were female. In comparison to men, women were significantly older, with higher prevalence of diabetes, hypertension and hypercholesterolemia. Women also showed higher incidence of Killip class II-IV, renal insufficiency and anaemia at admission, and higher rates of in-hospital BARC type ≥2 bleeding (11.9% vs. 3.9%, p<0.001). Compared with man, women had significantly higher rates of 30-day (9.4% vs. 5.2%; p<0.001), 1-year (16.0% vs. 9.8%; p<0.001) and 4-year (21.6% vs. 15.7%; p<0.001) all-cause mortality. Kaplan-Meier curves for 4-year survival are shown in Figure. However, after adjusting baseline differences using multivariate analysis, female sex was not an independent predictor of mortality at 30-days (HR 1.08, 95% CI 0.74-1.56; p=0.692) as well as at 1-year (HR 1.05, 95% CI 0.80-1.38; p=0.704) and at 4-years (HR 0.87, 95% CI 0.70-1.08; p=0.214) follow up.
Kaplan-Meier curves for 4-year survivalConclusion: This study found that women treated with primary PCI had higher risk profile, more co-morbidity and were at increased risk of bleeding as compared to men. However, female gender was not an independent predictor of short and long-term mortality. Background: The role of antiplatelet treatment before emergent revascularization is controversial as well as routine manual thrombectomy although both strategies can improve angiographic results. The aim of our study was testing the impact of pre-treatment on manual thrombectomy results. Methods: Observational and prospective study of all consecutive patients referred for emergent angiography in a single centre between February and December 2016. TIMI flow-3 after thrombectomy or angioplasty were considered as successful result. Pre-treatment was collected from medical reports as considered when it was administered before patient arrived to the cath-lab. Results: 286 patients were included, mean age 63.7 (13.2) age and 79.3% males. Median (IQ ranges) time delays were: symptoms to first medical contact 75 (32.25) minutes; first-medical contact to system activation 34,5 (20-60); arrival to hospital admission 50 (26-72); door-to-angioplasty 20 (15-25). Pre-treatment was administered in 226 (79.0%) patien...
a canine model with MI, with higher T2 values in the infarct. We investigated its reproducibility in the clinical setting using native T1-and T2-mapping CMR in ST-segment elevation myocardial infarction (STEMI) patients treated by primary percutaneous coronary intervention (PPCI). Methods: We included STEMI patients with CMR performed at median of 3 (2-4) days, and excluded those with late microvascular obstruction, intramyocardial haemorrhage or >75% transmural extent of infarct. One short-axis slice per patient of native T1-mapping by Modified Look-Locker Inversion sequence, T2-mapping, and late gadolinium enhancement (LGE) images were analysed. Manual ROIs were drawn in the infarcted, salvaged and remote myocardium using CVI42 (Figure 1). Results: Out of 48 STEMI patients, 15 met the inclusion criteria. Majority (13/15) were males with median age of 56 (42-67) years old. Median MI size was 19 (10-28)% of the left ventricle (%LV) and area-at-risk was 39 (31-53)%LV. T2 values in the infarcted and salvaged myocardium were higher than remote myocardium (T2infarct: 64±5ms versus T2remote: 48±3ms, P<0.001; T2salvage 62±7ms versus T2remote: 48±3ms; P<0.001). However, there was no difference between T2infarct and T2salvage (P=0.45). A similar pattern was observed with native T1 mapping (T1infarct: 1284±81ms versus T1remote: 993±49ms; P<0.001; T1salvage 1235±61ms versus T1remote: 993±49ms, P<0.001, T1infarct versus T1salvage; P=0.38). Conclusion: Native T1 and T2-mapping CMR were unable to distinguish between infarcted and salvaged myocardium in reperfused STEMI patients. LGE remains the gold standard for identifying infarcted myocardium, whereas T1 and T2-mapping remain the reference to detect oedema-based area-at-risk.
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