1016-53 An Inexpensive, Easy to Use and Highly Portable Quantitative Angiographic System

Ouantitative angiography is considered the ″gold standard″ for the assessment of coronary arterial dimensions. The presence in the actual systems of one or more disadvantages such as high cost, difficulty in usage and poor portability, have prevented the wide utilization of this method. To implement a similar system, the acquisition of the computer, software, digitizing board and cineprojector with CCD camera is usually required. We developed a system running on every Macintosh computer with only one special requirement, that of a commercially available slide scanner. A public domain software, NIH Image (written by Wayne Rasband) was modified and expanded to perform the following tasks: acquisition and storage of the digitized angiographic frames, automatic edge detection and measurements, and saving of the results in a text format file, readable from every database, spreadsheet or statistical package. Films (courtesy of Dr. Patrick W. Serruys, Rotterdam) of coronary phantoms with known size (0.5, 0.7, 1.0, 1.4, 1.9 mm) implanted in pigs, were used for system validation. The angiographic frames (24 × 18 mm) were digitized with a spatial resolution of 1850 pixels/inch (slide scanners with higher resolution are also available) and 256 gray levels. Using isocenter calibration, the measurements resulted in a correlation coefficient of 0.96 (y=0.86×+0.12), accuracy of –0.03 mm and precision of 0.15 mm. A correlation coefficient of 0.92 (y=0.67x+0.33), an accuracy of –0.03 mm and a precision of 0.23 mm were found using catheter calibration. With the same phantoms, the mean reproducibility was 0.08 mm for the interpolated reference diameter (RD), 0.03 mm for the minimal luminal diameter (MLD), 1.4% for the diameter stenosis (DS) and 0.6 mm for the lesion length. The variability of coronary measurements was also assessed in 23 patients who had 2 angiograms, a median of 21 days apart. The mean (±SD) of the difference between the 2 measurements was 0.09±0.28 mm for RD, 0.06±0.30 mm for MLD, 1.5±9.1% for DS, and 0.32±1.7 mm for lesion length. Less than 1 hour of training was needed for learning how to use this system efficiently

ST-segment resolution after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction

Background: The association between ST-segment resolution and clinical outcome in patients with acute ST-segment elevation myocardial infarction (STEMI) after primary percutaneous coronary intervention (PPCI) remains unclear. Recent studies on the association between ST-segment resolution and mortality have given conflicting results. We undertook this study to assess whether ST-segment resolution in electrocardiograms recorded 90&#8211;120 min after initiation of PPCI predicts long-term mortality in patients with STEMI. Methods: The study included 900 patients with STEMI presenting within the first 24 h after symptom onset who were treated with PPCI. The ST-segment resolution was assessed in electrocardiograms recorded 90&#8211;120 min after the first balloon inflation. The ST-segment resolution was dichotomized as follows: < 30% (no resolution), 30% to &le; 70% (partial resolution) and > 70% (complete resolution). The primary endpoint was five-year mortality. Results: ST-segment resolution was < 30% in 263 (29.0%) patients, between 30% and &le; 70% in 356 (40.0%) patients and > 70% in 281 (31.0%) patients. There were 62 deaths during the follow-up. In patients with ST-segment resolution < 30%, 30 to &le; 70% and > 70%, the Kaplan-Meier estimates of mortality were 8.3% (n = 17 deaths), 11.5% (n = 29 deaths) and 6.8% (n = 16 deaths), respectively; unadjusted hazard ratio (HR) = 0.88, 95% confidence interval (CI) 0.46&#8211;1.67, p = 0.695 for ST-segment resolution > 70% vs < 30%; adjusted HR = 0.91, 95% CI 0.61&#8211;1.33; p = 0.607, for ST-segment resolution > 70% vs ST-segment resolution < 30%. Conclusions: In patients with STEMI undergoing PPCI, ST-segment resolution in electrocardiograms recorded 90&#8211;120 min after initiation of PPCI did not predict long-term mortality. (Cardiol J 2012; 19, 1: 61&#8211;69

Statin pretreatment and presentation patterns in patients with coronary artery disease

Background: Knowledge on the impact of pretreatment statin therapy on presentation of patients with coronary artery disease (CAD) is incomplete. The aim of this study was to investigate the impact of statin pretreatment on presentation patterns of patients with CAD. Methods: The study included 12,989 consecutive patients with CAD who underwent coronary angiography. The primary outcome was presentation as stable angina or acute coronary syndrome (ACS) according to statin pretreatment. Results: At the time of presentation, 8147 (62.7%) patients were receiving statins and 4842 (37.3%) patients were not receiving statins. Presentation pattern in patients receiving statins vs. those not receiving statins was: stable angina in 5939 (72.9%) vs. 2102 (43.4%) patients; odds ratio (OR) = 3.50, 95% confidence interval (CI) 3.25&#8211;3.78; p < 0.001; unstable angina in 1435 (17.6%) vs. 1011 (20.9%) patients; OR = 0.81, 95% CI 0.74&#8211;0.89; p < 0.001; non- -ST-segment elevation myocardial infarction (NSTEMI) in 463 (5.7%) vs. 505 (10.4%) patients; OR = 0.52, 95% CI 0.45&#8211;0.59; p < 0.001; and ST-segment elevation myocardial infarction (STEMI) in 310 (3.8%) vs. 1224 (25.3%) patients; OR = 0.11, 95% CI 0.10&#8211;0.13; p < 0.001. Gensini score (median [25th to 75th percentiles]) was significantly higher in patients on statins presenting with stable angina (26.5 [13.0&#8211;59.5] vs. 21.0 [10.5&#8211;47.4]; p < 0.001) or ACS (39.3 [17.5&#8211;77.0] vs. 37.0 [18.0&#8211;64.0]; p = 0.001). In multivariable analysis, statin therapy was an independent correlate of reduced presentation with ACS (adjusted OR = 0.35 [0.32&#8211;0.39]; p < 0.001) or STEMI (adjusted OR = 0.18 [0.16&#8211;0.22]; p < 0.001). Conclusions: Despite having a higher coronary atherosclerotic burden, patients with CAD on statin therapy have reduced odds for presentation with ACS and STEMI compared to patients not receiving statins

Vessel Size and Outcome After Coronary Drug-Eluting Stent Placement Results From a Large Cohort of Patients Treated With Sirolimus- or Paclitaxel-Eluting Stents

ObjectivesThis study sought to investigate the influence of vessel size on the outcomes of patients after drug-eluting stent (DES) implantation.BackgroundThere are no dedicated studies on the influence of vessel size on the outcomes of patients treated with different DES.MethodsThe study population was composed of 2,058 consecutive patients who received sirolimus-eluting stents (SES) or paclitaxel-eluting stents (PES). Patients were grouped into tertiles according to vessel size (<2.41 mm in the lower tertile, 2.41 to 2.84 mm in the middle tertile, and >2.84 mm in the upper tertile). The primary end point was target lesion revascularization (TLR). Secondary end points were binary angiographic restenosis and the composite of death or myocardial infarction.ResultsVessel size did not influence the composite end point of death and myocardial infarction. The TLR rates were higher among patients in the lower tertile (12.1%) as compared with the middle (8.4%) and upper (8.0%) tertiles (p = 0.02). In a multivariate analysis, vessel size emerged an independent predictor of TLR (p = 0.009). The model showed also a significant interaction between DES type and vessel size regarding TLR (p = 0.008). There was a significant difference in TLR rates among patients treated with SESs (8.6%) and PESs (16.4%) in the lower tertile (p = 0.002), but not in the middle and upper tertiles.ConclusionsThe influence of vessel size on restenosis is related to the specific DES used, with SESs providing better outcomes than PESs in small but not in large coronary vessels