0425: Predictive factors of side effects of amiodarone in the amiotox registry

BackroundAmiodarone is a widely used antiarrhythmic drug in Tunisia and worldwide. However, its side effects are quite frequent hampering its use despite its efficacy.ObjectiveThe purpose of our study was to determin the prevalence of amiodarone side effects and to analyse its predictors in our population.ResultsFrom May 1st 2010 to April 30th 2012, 200 consecutive patients (mean age: 61.9±12.9 years) were included. Mean duration of amiodarone therapy was 51.9±48.4 months with a mean dose of 288.1±274.2g. Atrial fibrillation (81.5%) was the most common indication. Amiodarone side effects occurred in 144 patients (72%). Refering to multivariate analysis, independent predictors were:–Advanced age (p=0.02), treatment duration (p<0.001) and cumulative dose (p<0.001) for occurrence of all side effects.–Treatment duration > 6 months (p=0.008) for corneal deposits.–Age >70 years (p=0.001) and cumulative dose (p<0.00.1 with a logarithmic correlation) for thyroid toxicity.–Cumulative dose (p<0.001) and thyroid disease history (p=0.047) for hypothyroidism.–Age >70 years (p=0.002) and treatment duration (p<0.001 with a linear correlation) for cutaneous toxicity.–Cumulative dose >300g (p=0.012) and heart failure (p= 0.05) for bradycardia.–Cumulative dose >100g (p= 0.012) for QT prolongation–Treatment duration (p<0.001 with a linear correlation) and betablokers concomittent use (p=0.046) for PR elongation.–Treatment duration (p<0.001 with an exponential correlation) and concomittent VKA use (p=0.018) for hepatic toxicity.–Treatment duration > 18 months (p=0.009) and concomittent CCB use (p<0.001) for neurological toxicity.ConlusionThe results of our study confirmed that amiodarone side effects are quite frequent in our population, and that in addition to treatment dose and duration, other predictors for these effects were identified such as age and some drug associations

057 A simple prediction score for significant renal artery stenosis in patients with coronary artery disease

BackgroundRenal artery stenosis (RAS) is a strong independent predictor of mortality in patients (pts) with coronary artery disease (CAD).Aim of studyTo develop and validate a score predicting RAS in patients with CAD.MethodsThree hundred consecutive pts (50 females) with significant CAD underwent abdominal aortography following coronary angiography to screen for significant RAS defined as luminal narrowing of > 50%. Univariate and multivariate analyses were performed comparing pts with and without RAS. Significant factors associated with RAS were included in constructing a score that predicts RAS.The score was internally validated in pts randomly selected from the entire study group (validation group; n=103), using ROC curves and the Hosmer-Lemeshow goodness-of-fit test.ResultsTwenty-seven pts (9%) had a significant RAS. Univariate predictors of significant RAS were: age > 65 years (OR=4.5, p < 0.0001), hypertension (OR=3.6, p=0.001), and female gender (OR=3.6, p=0.015). We found a tendency of more prevalent renal insufficiency (37.1% vs. 21.5%; p=0.05) and the presence of 2 or more significant CAD lesions (70.4% vs. 50.9%; p=0.05) in pts with RAS.Multivariate analysis showed that age > 65 years (OR=4.1%, 95% CI=1.6-10.3, p=0.003) and hypertension (OR=3.1, 95% CI=1.2-7.7, p=0.015) were independent predictors of RAS. The ranged from 0 to 7: 2 points for age > 65 years and hypertension 1 point for female gender, renal insufficiency, and > 3-vessel disease). Internal validation showed a good performance (ROC curve = 0.79 and Chi2 Lemeshow = 3.45). For a score < 2, the negative predictive value is 98%. Applying this criteria, 48.3% of our population would not require systematic abdominal angiography.ConclusionThe performance of our predictive score was good, and significant reduction in the need to perform systematic abdominal aortography could be expected with the use of this score