0410 : Validation of the GRACE risk score for predicting death within 6 months of follow-up in a contemporary cohort of patients with acute coronary syndrome: Algerian cohort

Introduction and ObjectivesThe Global Registry of Acute Coronary Events (GRACE) risk score provides an estimate of the probability of death within 6 months of hospital discharge in patients with acute coronary syndrome (ACS). Our aim was to assess the validity of this risk score in a contemporary cohort of patients admitted to an Algerian hospital.MethodsThe study involved 383 consecutive patients with ACS evaluated between January 2010 and January 2014. Their vital status was determined 6 months after hospital discharge and the validity of the GRACE risk score was evaluated by assessing its calibration and its discriminatory capacity.ResultsIn total, 142 (37%) patients were admitted for ST-elevation myocardial infarction (STEMI) and 241 (67%) for non-ST-elevation myocardial infarction (NSTEMI). Percutaneous revascularization was performed in 249 (65%). The median GRACE risk score was 121 [interquartile range, 96-144]. Mortality 6 months after discharge was 4.9%. The calibration of the GRACE risk score was acceptable and its discriminatory capacity was excellent.ConclusionsThe GRACE risk score for predicting death within 6 months of hospital discharge was validated and can be used in patients with ACS. It would be wise to include the GRACE risk score in the medical records of these patients

0264: Short- and long-term prognosis of previous and new-onset atrial fibrillation in ST-segment elevation acute myocardial infarction in Algeria

Introduction and objectivesThe impact of atrial fibrillation on the prognosis of myocardial infarction is still the subject of debate. We analyzed the influence of previous and new-onset atrial fibrillation on in-hospital and long-term prognosis in patients with acute myocardial infarction.MethodsProspective study of 1265 patients with ST-segment elevation acute myocardial infarction (military hospitals of Algiers and Constantine). We studied all-cause in-hospital and long-term mortality (median 4.2 years) using adjusted models.ResultsIn total, 4.5% of patients had previous atrial fibrillation and 10.6% had new-onset atrial fibrillation. In general, both groups of patients had a high baseline risk profile and an increased likelihood of in-hospital complications. The crude in-hospital mortality rate was higher in patients with previous atrial fibrillation than in those with new-onset atrial fibrillation (22% vs 12%; P<.001; 30% vs 10%; P<.001). The long-term mortality rate was 11.11/100 patient-years in patients with previous atrial fibrillation and 5.35/100 patient years in those with new-onset atrial fibrillation (both groups, P<.001). New-onset fibrillation alone (odds ratio=1.55; 95% confidence interval, 1.08-2.22) was an independent predictor of in-hospital mortality. Previous atrial fibrillation (hazard ratio=1.24; 95% confidence interval, 0.94-1.64) and new-onset atrial fibrillation (hazard ratio=0.98; 95% confidence interval, 0.80-1.21) were not independent predictors of long-term mortality.ConclusionNew-onset atrial fibrillation during hospitalization is an independent risk factor for in-hospital mortality in acute myocardial infarction

0132: Ischemic mitral regurgitation and non-ST-segment elevation acute myocardial infarction: long-term prognosis in Algerian cohorte

Introduction and objectivesIschemic mitral regurgitation (MR) is a common complication of acute myocardial infarction and has a negative impact on prognosis. However, few studies have been carried out on MR after non-ST-segment elevation acute myocardial infarction (NSTEMI). Our objective was to investigate the incidence, clinical predictors, and long-term prognostic implications of MR in patients with NSTEMI.MethodsThe prospective study included 165 consecutive patients who were discharged in functional class I or II after a first NSTEMI. Each underwent echocardiography during the first week of admission, and patients were followed up clinically for a median of 2.3 years. The incidence of readmission for heart failure, unstable angina, reinfarction, death, or all combined (ie, the combined event or major adverse cardiac event [MACE]) was recorded.ResultsThe patients’ mean age was 68 years and 69% were male. The incidence of MR was 40% (grade I in 45 patients, grade II in 11, grade III in 7, and grade IV in 3). Age, diabetes mellitus, multivessel disease and MR (HR=2.17; 95% confidence interval, 1.30–3.64; P=.003) were all independently associated with a poor long-term prognosis, in terms of MACEs. Even the milder grades of MR were associated with more events.ConclusionsIn our milieu, MR frequently occurs after NSTEMI. Its presence together with other unfavorable factors implies a poor long-term prognosis. This is also true for milder grades of MR. Consequently, MR should be fully assessed and followed-up after NSTEMI in all patients

0250: Prognostic value of body mass index and waist circumference in patients with chronic heart failure: Algerian experience

Introduction and objectivesTo analyze the association between higher body mass index and waist circumference, and the prognostic values of both indicators in total and cardiac mortality in patients with chronic heart failure.MethodsThe study included 1954 patients who were followed up for 4 years in military hospitals of Algeria. Obesity was classified as a body mass index>30 and overweight as a body mass index of 25.0-29.9. Central obesity was defined as waist circumference>88cm for women and>102cm for men. Independent predictors of total and cardiac mortality were assessed in a multivariate Cox model adjusted for confounding variables.ResultsObesity was present in 38% of patients, overweight in 46%, and central obesity in 63%. Body mass index and waist circumference were independent predictors of lower total mortality: hazard ratio=0.84 (P<.001) and hazard ratio=0.97 (P=.01), respectively, and lower cardiac death (body mass index, hazard ratio=0.84, P<.001; waist circumference, hazard ratio=0.97, P=.01). The interaction between body mass index and waist circumference (hazard ratio=1.001, P<.01) showed that the protective effect of body mass index was lost in patients with a waist circumference>120cm.ConclusionsMortality was significantly lower in patients with a high body mass index and waist circumference. The results also showed that this protection was lost when these indicators over a certain limit

0063 : Radial vs femoral access after percutaneous coronary intervention for ST-segment elevation myocardial infarction. Thirty-day and one-year mortality results in Algerian cohort

Introduction and ObjectivesLittle attention has been given to the effect of vascular access site on mortality, while an increasing body of evidence is showing that radial access has much more benefit than femoral access for STsegment elevation myocardial infarction patients. We aimed to assess the influence of vascular access site on mortality at 30 days and at 1 year in STsegment elevation myocardial infarction patients.MethodsWe included all patients with ST-segment elevation myocardial infarction who had undergone angioplasty at military hospitals of Constantine and Algiers and the hospital of erriadh (ESH erriadh) between 2010 and 2013. We performed 2 multivariate regression models for each endpoint (30-day and 1-year mortality). The only difference between these models was the inclusion or not of the vascular access site (femoral vs radial). We also tested the interaction between hemodynamic instability and vascular access.ResultsWe included 395 patients with a mean age of 62. Of these patients, 32% had radial access and 7.4% had hemodynamic instability. Allcause mortality was 8.6% (34/395) at 30 days and 13.1% (52/395) at 1 year. Vascular access site follows hemodynamic instability and age in terms of effect on mortality risk, with an odds ratio of 5.20 (95% confidence interval, 2.80-9.66) for 30-day mortality. A similar effect occurs for 1-year mortality.ConclusionsVascular access site should be taken into account when predicting mortality after a primary percutaneous coronary intervention