Chaitman, Bernard R.

Gussak, Ihor

Jacobs, Alice K.

Krone, Ronald J.

Mullany, Charles J.

Ohman, E.Magnus

Rosen, Allan D.

Sopko, George

Sutton-Tyrrell, Kim

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JACC February 1996 ABSTRACTS-Poster 361A 
the data using a multivariate logistic regression model to control for dilfer- 
encos in patients' clinical charactedstica for the occurrence of the composite 
endpolnt, consisting of death, myocardial infarction, abrupt vessel closure, 
and coronary artery bypass surgery, The mean age was 60 (SD ± 11) years, 
with 72% men, and 46.2% received reused catheters. Composite ndpoInt 
occurred In 57 patients, with ACC/AHA lesion type, angina class, procedure 
time, and residual stsoosls as predictors for outcome. 
Odds Ratio 95% Confidence tnlarval 
Catheter Reuse 0.59 0.31-1.14 
A~e 1.00 0.97--1.O3 
Male 0,57 0.29-1.14 
Angina class 1.95 1.23-8.11 
ACCIAHA lesion type 2.30 1.03-5.11 
Rssi¢lual stsnosis 1.03 1.01-1.04 
Procedure 1~me 1.02 1.02-I.03 
We ooncluds that, after controlling for baseline clinical and angingrephlo 
characteristlos, reuse of PTCA catheters did not appear to be associated 
with an increase in in-hospital complications. 
1 1010"1!2 1 Vorlebility in Balloon Sizing During Routine 
PTCA ~ Quantitative Coronary and Ultrasound 
Analysis 
Grogs W. Stone, Fred G. St. Goat, Tom Unnemeier, Helen Sheahan, John 
McB. Hedgson. El Camino Hospital, Mountain View, CA: University 
Hospitals of Cleveland, Cleveland, OH 
A balloon:artery (b:a) ratio of 1.0-1.1 is considered optimal for the podor- 
menco of PTCA. To assess variability of balloon sizing, coronaw angiography 
and ultrasound images from 48 lesions in 47 pts undergoing PTCA by 3 expe- 
rienced operators were analyzed by an independent core lab. QCA measured 
b:a ratios at peak preSSure inflation were determined. 
Results: The maximal b:a ratio was 1.0-1.1 in only 14 Isns (29%); the b:a 
ratio was < 1.0 in 18 Isos (38%) end > 1.1 in 16 tsos (33%), ranging from 
036 to 1.44. Implications of the variability in balloon sizing appear below: 
Ba[loon:arteryretlo . < 1.0 1.0-1.1 > 1.1 p 
Peak pressure (aim.) 7.2 4-1.4 7.3 4-1.9 6.4 4-1.2 NS 
QCA ref. seg. ella. (ram) 2.94-0.3 2.5:1:0.4 2.24-0.3 0.001 
QCA die. %stenos~s pro 574-14% 63 ~: 13% 65±10% NS 
QCA die. %slenosls post 31 4-13% 354-11% 194-23% 0.03 
Adia. %stenosts pro.post -35 4-17% -29 ~- 15% -45 4- 24% 0.07 
81sn MLD(mm) pro-post 1.0 4- 0.5 0.9 :t: 0.4 1.2 4- 0.7 NS 
D,~sect~an score >_ typeB 1 (';~| 3 (17%) 4(25%) NS 
ICUS area %stenosis post 48 4-19% 46 4-17% 43:1:14% NS 
ICUS plaque burden post 77 4- 7% 80 4-10% 76 ± 9% NS 
Conclusions: Contrary to expectations, the balloons that experienced op- 
eretors choose result in markedly variable b:a ratios dunng PTCA, with 
relatively larger balloons used in smaller vessels. When safely applied, a b:a 
ratio of > 1.1 results in a lower angiographic residual stenasis. By ICUS, 
however, a large residual plaque burden is present after PTCA independent 
of b:a ratio. 
1 1010-1131 Rapid Assessment of Platefat InhiblUon Usleg a 
ModiBad Whole Blood Aggregometer 
(Aggrsstat") in PTCA Patients Receiving 
ReoPro 
Maw Ann Mascalll, Ellen Lance, Sabine Mack, Hadan Weisman, 
Thomas Schalble, Robert Jordan. Centocor, Inc., Maivem, PA 
ReaP~ TM pOtently blocks GPflb/llla, inhibits platelet aggregation and reduces 
Ischemlo complications inhigh dsk PTCA patients. Currently, no bedside taste 
are available for rapid and accurate measurement of plalalet inhibition dudng 
and following ReaPre TM treatment. To address this need, a bedside device 
(Aggrastat') that measures platelet aggregation in whole blood using elec- 
trical impedance was developed and compared in 12 patients to standard 
measurement using light transmittance through platelet rich plasma (PRP). 
All patients received ReaPro~'; 0.25 mg/kg bolus plus a 10 pg/mln infusion 
for 12 hr. inhibition of platalet aggregation in whole blood assessed by the 
Aggrestat" yielded similar results to aggregation in PRP using light trans- 
mlttanca and showed the same close correletion with GPIIb/llla blockade 
(results are mean .4- SD): 
%GPllb/llla % Inhibition of Aggregation 
Blockade Agg tat TM PRP Agg~. 
15 rain post-ReoPre~ bolus 96~1.6 ~4-4.2 974-2.4 
2 h post-ReoPre" bolus 92 4- 2.7 88 4- 7.5 97 :l: 2.2 
12 h post-ReoPre TM infusion 66 d: 7.5 69 4.13 63 4- 20 
These results indicate that the Aggrestat TM is a practical method for rapid 
measurement (within 10 minutes of blood draw) of plalelet function at the 
bedside dudng and following anti-platelet therapy. 
[ ~  Eight Year, Long Term Outc3me After PTCA: 
Factors Associated With Adverse Events. The 
NHLBI PTCA Registry 
David R. Holmes, Kathedne Delta, Wan I.in Web, Spencer King, 
Sheryl Kelssy. Mayo Clinic, Rochester, MN 
Risk factors assodated with poor outcome during long term follow up after 
percutaneous translumlnal coronary angioplasty (PTCA) remain poorly de- 
fined. In the NHLBI PTCA Registry, there is now 8 year follow up of 1759 pts 
who had initially successful PTCA. A multivariate model was used and 24 
clinical and angingraphlo factors including baseline demographics, present- 
ing symptoms, left ventdcLitar function and extent of coronary artery disease 
were evaluated to determine those factors assodated with a hierarchical 8
year adverse endpoint of death (D), death and myocardial infarction (Mi), 
and death, myocardial infarction and coronary surgery (CABG). Only factors 
with p < 0.001 were considered. 
Factor D D/MI D/MI/CABG 
RR" CI t RR CI RR Cl RR CI RR CI 
Hx ~CHF 2.65 (1.78, 3~94) 2.22 (1.57, 3.13) 2.17 (1.53, 3 .~ 
Severe non 2.56 (130, 3.85) 1.91 (1.34, 2.74) -
cardiac disease 
Diabetes 2.04 (1.48,2.81) .78 (1.38,2.31) .90 (1.46,2.47 
> 65 yre 1.98 (1.50, 2.62) -
MVD, 1.79 (132, 2.36) 1.58 (1.25,1.98) 1.58 (1.34, 2.16 
"RR = relative rlsk, tC! = 95% confidence fnten~ 
"MVD = multivessel disease, fCHF = congestive heart failure 
Easily recognizable baseline dsk factors are the factors most closely asso- 
dated with long term (8 year) adverse prognosis following PTCA irrespective 
of whether death, death and MI, or death MI and CABG are used as end- 
points; of these favors, a history of CHF at baseline is the most powerful. 
I 1 010-115 1 Pedprocedurs Myoca~llal Infarction R~tes in the 
Bypass Angleplesty Revassularization 
Investigation (BARI) 
Bernard R. Chairman, Alice K. Jacobe, E. Magn~ Ohman, Ronald J. Krone, 
Charles J. Mullany, George Sopko. thor Gussak, Kim Suifon-'ryrrell, Allan 
D. Rosen, and the BARI Invastigators. St. Louis University School of 
Medicine, St. louis, MO 
The Bypass Angloplasty Revascularization I vestigation (BARI) examined 
the hypothesis that an initial revascutarization strategy of percutaneous trans- 
luminal coronary angioplasty (PTCA) compared to coronary artery bypass 
greft (CABG) in pts with multivassel coronary disease does not compro- 
mise clinicel outCome during 5 year follow-up. We report he incident rate of 
proosdere-related myocardial infarction (MI), an event w~ a potential nega- 
tive impact on long-tom1 sunn'val, In each treatment group. Between August, 
1988 and August, 1991,914 and 915 pts were randomly assigned to PTCA or 
CABG. The MI event rates were examined in a pdod determined subgroups 
of unstable angina (69% of the population), severe chronic stable angina 
(16%), and mild or no angina with severe Ischsmia on noninvasive tasting 
(15%); and in patient subsets stratified by number of diseased vessels and 
left vantdcular ejection fraction; and in presence or absence of proximal left 
anterior descending stanosls > 50=/o, hypertension, diabetes, and congestive 
heart failure. Ascertainment ofMI was based on asfial ECG analysis, cardiac 
enzyme data, and dinloal history, and events were dassitied at St, Louis 
University Core laboratory. The new appearance of a 2 grade Minnesota 
code Q-wave progression defined a Q-weve MI event when it occurred < 96 
hours post procedure. If the event occurred > 96 hours postprocodure, MI 
was defined if a 2 grade Minnesota code Q-wove progression occurred; or if 
cardiac enzymes were abnomml in the presence of a new left bundle brenoh 
block; or if cardiac enzymes were abnormal in the wasenco of cheat pain 
or worsening ST-T wove abnormalities. The incident rate of Q-wave MI was 
compared within 96 hours post procedure and 3 months post procedure. The 
periprocodure Mi rates associated with the Index randomization and sub- 
sequent revascutadzation procedures will be presented for both treatment 
strategies. 


Periprocedure myocardial infarction rates in the bypass angioplasty revascularization investigation (BARI) 

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Periprocedure myocardial infarction rates in the bypass angioplasty revascularization investigation (BARI)

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