C92. Successful Percutaneous Coronary Intervention (PCI) in Rare Case of Anomalous Aortic Origin of the Right Coronary Artery from the Opposite Sinus (AAORCA) Presenting as Inferior ST Elevation Myocardial Infarction (STEMI)

Abstract Background AAORCA from opposite sinus is a rare congenital anomaly that can present with symptoms similar to coronary artery disease, even sudden cardiac death. AAORCA with Inferior STEMI is a rare combination situation. Management of acute myocardial infarction with AAORCA is not well established and still debatable. Case Summary We presented a case 61 years old aged male with STEMI and AAORCA. He admitted to our hospital with complaint of retrosternal chest pain with ST segment elevation in inferior lead thus we diagnosed as Inferior STEMI. He underwent an emergency coronary angiography (CAG) that showed anomalous of right coronary artery (RCA) and total occlusion of the proximal RCA with atherosclerotic lesion. Stent then implanted at proximal of RCA. Further work-up by Computed Tomography Angiography (CTA) revealed an AAORCA with interarterial course. Discussion AAORCA with interarterial course that presents as inferior STEMI is a rare case. Diagnosis requires CAG and coronary CTA to identify anatomy and physiology so revascularization can be carried out appropriately. It is still arguable whether atherosclerosis or the interarterial course of AAORCA that caused acute MI. There is evidence that anomalous coronary arteries doesn’t increase atherosclerosis risk than normal. Total occlusion located at the distal to interarterial course reinforce that atherosclerosis may be the possible cause of acute MI. PCI could be the preferred choice in patients with inferior STEMI accompanied by AAORCA with evidence of atherosclerotic lesion, because may result in complete reperfusion and good clinical outcome. </jats:sec

C92. Successful Percutaneous Coronary Intervention (PCI) in Rare Case of Anomalous Aortic Origin of the Right Coronary Artery from the Opposite Sinus (AAORCA) Presenting as Inferior ST Elevation Myocardial Infarction (STEMI)

Abstract Background AAORCA from opposite sinus is a rare congenital anomaly that can present with symptoms similar to coronary artery disease, even sudden cardiac death. AAORCA with Inferior STEMI is a rare combination situation. Management of acute myocardial infarction with AAORCA is not well established and still debatable. Case Summary We presented a case 61 years old aged male with STEMI and AAORCA. He admitted to our hospital with complaint of retrosternal chest pain with ST segment elevation in inferior lead thus we diagnosed as Inferior STEMI. He underwent an emergency coronary angiography (CAG) that showed anomalous of right coronary artery (RCA) and total occlusion of the proximal RCA with atherosclerotic lesion. Stent then implanted at proximal of RCA. Further work-up by Computed Tomography Angiography (CTA) revealed an AAORCA with interarterial course. Discussion AAORCA with interarterial course that presents as inferior STEMI is a rare case. Diagnosis requires CAG and coronary CTA to identify anatomy and physiology so revascularization can be carried out appropriately. It is still arguable whether atherosclerosis or the interarterial course of AAORCA that caused acute MI. There is evidence that anomalous coronary arteries doesn’t increase atherosclerosis risk than normal. Total occlusion located at the distal to interarterial course reinforce that atherosclerosis may be the possible cause of acute MI. PCI could be the preferred choice in patients with inferior STEMI accompanied by AAORCA with evidence of atherosclerotic lesion, because may result in complete reperfusion and good clinical outcome. </jats:sec

Role of neutrophil-lymphocyte ratio in predicting mortality in acute coronary syndrome patients

Abstract Funding Acknowledgements Type of funding sources: None. Background  Inflammation is the basic mechanism of acute coronary syndrome (ACS). Among the various inflammatory markers related to ACS is the neutrophil-lymphocyte ratio (NLR). Neutrophils act as a mediator of inflammatory response to acute damage of myocardium, while lymphocytes decrease because of apoptosis caused by inflammation. Therefore, high NLR suggests further risk of infarction of the myocardium. Purpose This study determines the cut-off value and the role of NLR at admission in predicting in-hospital mortality of ACS patients.  Methods  A retrospective cohort study was conducted using data of patients admitted with ACS from the SCIENCE registry between February 2019 and November 2020. The inclusion criterion was complete blood count measurement at presentation. NLR was calculated from the absolute neutrophil and lymphocyte count. The optimal cut-off value of NLR was determined using receiver operating characteristic (ROC) curve and Youden index (J) analysis. Patients was divided into two groups based on the NLR cut-off value. In-hospital mortality between the two groups was compared using Chi-square test with a risk estimate to obtain the relative risk. Results  A total of 1147 ACS patients aged 60,70 ± 10,951 years old were included in the study. Area under the ROC curve was 0,607 (95% CI: 0,559-0,655; p &amp;lt;0,001). The optimal cutoff value of NLR to predict mortality was 10,7566 (sensitivity: 39,8%, specificity: 79,5%, J: 0,193). In-hospital mortality occurred in 64 of 266 (24,1%) patients with NLR &amp;gt;10,7566 and in 97 of 881 (11%) patients with NLR &amp;lt;10,7566, with relative risk 2,185 (95% CI: 1,645-2,904; p &amp;lt;0,001). Conclusion  In ACS patients with NLR &amp;gt;10,7566, there is an increased mortality risk 2,185 times higher compared to ACS patients with NLR &amp;lt;10,7566. Therefore, NLR can be used to predict in-hospital mortality in ACS patients. Mortality incidence between NLR groupsNLR &amp;gt;10.7566 (n= 266)NLR &amp;lt;10.7566 (n= 881)P-valueRelative risk95% CIMortality64 (24.1%)97 (11%)&amp;lt;0.0012.1851.645-2.904Non-mortality202 (75.9%)784 (89%)NLR neutrophil-lymphocyte ratio, CI: confidence interval, P-value considered significant if &amp;lt;0.005Abstract Figure. ROC curve of NLR </jats:sec