Boetker, Hans Erik

Clemmensen, Peter

Engstrøm, Thomas

Helqvist, Steffen

Holmvang, Lene

Jorgensen, Erik

Kaltoft, Anne

Kelbaek, Henning

Kløvgaard, Lene

Kofoed, Klaus F.

Køber, Lars

Lassen, Jens F.

Lønborg, Jacob T.

Saunamäki, Kari

Terkelsen, Christian J.

Thuesen, Leif

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TCT-214 Five-year prognostic impact of distal embolization during primary percutaneous coronary intervention in ST elevation myocardial infarction patients treated with or without distal protection 

One year mortality by Quintiles / Deciles of Risk
STEMI NSTE-ACS Total
N % died N % died N % died
Q1 (lowest risk) 1038 0.60% 1075 0.50% 2113 0.50%
Q2 1123 1.10% 991 0.90% 2114 1.00%
Q3 1109 2.30% 1005 1.80% 2114 2.10%
Q4 926 3.70% 1188 2.60% 2114 3.10%
D9 (next highest) 415 5.50% 642 6.70% 1057 6.20%
D10 (highest risk) 332 15.40% 724 19.90% 1056 18.50%
www.jacctctabstracts2013.com TUESDAY, OCTOBER 29, 2013, 3:30 PM–5:30 PM
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SSTEMI/NSTEMI/ACS
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Tuesday, October 29, 2013, 3:30 PM–5:30 PM
Abstract nos: 213-264
TCT-213
Everolimus-eluting stent versus bare metal stent in proximal left anterior
descending ST-elevation myocardial infarction
Josep Gomez Lara1, Salvatore Brugaletta2, Angel Cequier3,
Joan Antoni Gomez-Hospital1, Manel Sabate4
1Hospital Universitari de Bellvitge, Hospitalet de Llobregat, Spain, 2Clinic Thorax
Institute, Barcelona, Spain, 3Hospital of Bellvitge, Barcelona, Spain, 4University of
Barcelona, Barcelona, Spain
Background: ST-elevation myocardial infarctions (STEMI) caused by proximal left-
anterior descending (LAD) lesions have more myocardium at risk and worse outcomes
than those located in other segments. The aim is to compare outcomes of patients with
STEMI and proximal-LAD lesions treated with bare-metal stents (BMS) versus
everolimus-eluting stents (EES).
Methods: The EXAMINATION trial randomized 1498 STEMI patients to BMS vs.
EES. The primary endpoint was the patient-oriented combined of all-cause death, any-
recurrent myocardial infarction (MI) and any-revascularization. The secondary
endpoint included the device-oriented combined of cardiac death, target-vessel MI and
target-lesion revascularization (TLR).
Results: STEMI with a proximal-LAD occlusion was observed in 290 patients
(BMS¼132 and EES¼158). Both groups were similar except for diabetes (12.9% vs.
24.1%; p¼0.016). At 1 year, the primary end-point was observed in 18.9% and 9.5%
of patients treated with BMS and EES, respectively (p¼0.023). The secondary end-
point was observed in 11.4% and 5.1%, respectively (p¼0.053). There were no
differences in cardiac death (4.5% vs. 3.8%; p¼0.750) and MI (1.5% vs. 0%;
p¼0.121). BMS had higher rate of TLR compared to EES (6.8% vs. 1.3%; p¼0.014).
Patients with proximal-LAD STEMI had higher mortality than patients with non
proximal-LAD STEMI (5.5% vs. 2.9%; p¼0.027). Proximal-LAD lesions treated with
BMS tended to increase the risk of the primary end-point compared with other
segments (18.9% vs. 13.0%; p¼0.079). However, EES implanted in proximal-LAD
had similar outcomes compared with other locations (9.5% vs. 12.0%; p¼0.430).
Adjusting for confounders, the interaction between BMS and proximal-LAD location
was associated with the primary end-point.
Conclusions: Patients with STEMI and proximal-LAD lesions treated with EES have
better outcomes compared with BMS at 1-year. Although further investigations are
required, it seems reasonable to consider EES for proximal-LAD STEMI-lesions.
TCT-214
Five-year prognostic impact of distal embolization during primary percutaneous
coronary intervention in ST elevation myocardial infarction patients treated with
or without distal protection
Jacob T. Lønborg1, Henning Kelbaek2, Steffen Helqvist3, Lene Holmvang4,
Erik Jorgensen5, Lene Kløvgaard3, Kari Saunamäki6, Klaus F. Kofoed1,
Leif Thuesen7, Anne Kaltoft8, Christian J. Terkelsen9, Hans Erik Boetker10,
Jens F. Lassen11, Lars Køber3, Peter Clemmensen4, Thomas Engstrøm12
1Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark,
2Rigshospitalet Copenhagen, Copenhagen, Denmark, 3Rigshospitalet, Copenhagen,
Denmark, 4Department of Cardiology, Copenhagen University Hospital,
Copenhagen, Copenhagen, 5Rigshospitalet, University of Copenhagen, Copenhagen,
Denmark, 6Department of Cardiology, Rigshospitalet, Copenhagen, Denmark,
Copenhagen, Denmark, 7Department of Cardiology, Aarhus University Hospital,
Skejby, Denmark, Aarhus, Denmark, 8Dept. of Cardiology, Aarhus Universityhospital,
Skejby, Denmark, Aarhus, Denmark, 9Aarhus University Hospital, Skejby, Aarhus N,
Denmark, 10Aarhus University Hospital, Aarhus N, Aarhus, 11Department of
Cardiology, Aarhus University Hospital, Skejby, Aarhus N, Denmark, 12Department
of Cardiology, Copenhagen University Hospital, Copenhagen, Copenhagen
Background: The impact of angiographically visible distal embolization (DE)
following primary percutaneous coronary intervention (PCI) on clinical outcome has
been scarcely studied in patients with ST elevation myocardial infarction (STEMI).
Moreover, the use of distal protection during primary PCI seems to improve both
epicardial ﬂow and left ventricular function, but has so far failed to impact clinical
outcome. Thus, the objective of this study was to evaluate the association between
(DE) and 5-year outcome in patients randomized to primary PCI with or without distal
protection.
Methods: In this post-hoc study 591 STEMI patients were randomized to conven-
tional primary PCI or primary PCI with distal protection. Primary outcome was 5-yearJACC Vol 62/18/Suppl B j October 27–November 1, 2013 j TCT Abstrmajor adverse cardiac events (all cause mortality, admission for heart failure and
reinfarction).
Results: DE was observed in 8.3% of all patients. There seemed to be interaction
between distal protection and DE in terms of MACE (p¼0.08), all cause mortality
(p¼0.02) and reinfarction (p¼0.06), but not admission for heart failure (p¼0.40). DE
was related to increased risk of admission for heart failure independently of distal
protection (12.0% versus 5.0; p¼0.015). The MACE rate was 31.3% for patients
treated with standard PCI with DE compared to 24.8% for patients without DE
(p¼0.30), and 44.4% for patients treated with distal protection with DE compared to
17.9% for patients without DE (p¼0.005). DE was not related to all cause mortality
(p¼0.52) or reinfarction (p¼0.52) among patients treated with standard PCI, but was
related to higher rates of mortality (p¼0.012) and reinfarction (p¼0.008) when distal
protection was used.
Conclusions: The occurrence of DE during primary PCI leads to increased risk of
development of heart failure. DE occurring during the use of a distal protection device
aggravates the prognosis, whereas successful distal protection improves it.
TCT-215
Predictors of 1-year mortality at hospital discharge after ACS STEMI and
NSTE-ACS: a new risk score from the EPICOR study
stuart j pocock1, L. Annemans2, H. Bueno3, Nicolas Danchin4, Muriel Licour5,
Jesús Medina6, Frans Van de Werf7, Lin Zhang8
1LSHTM, london, MA, 2Department of Public Health, UGent, VUB, Ghent, Belgium,
3Hospital General Universitario Gregorio Marañón, Madrid, Spain, 4Hôpital
Européen Georges Pompidou, & René Descartes University, Paris, France, 5Medical
Department, AstraZeneca France, Rueil-Malmaison, France, 6AstraZeneca Medical
Evidence Center, Madrid, Spain, 7University Hospitals Leuven, Leuven, Belgium,
8AstraZeneca Medical Evidence Center, Wilmington, DE
Background: At hospital discharge after an ACS event, patients vary markedly in
their prognosis. There is a need for a reliable prediction tool to identify patients with
high mortality risk.
Methods: EPICOR (NCT01171404) is a prospective cohort study of 10568 consec-
utive hospital survivors after an ACS event (4943 STEMI and 5625 NSTE-ACS).
65.1% underwent PCI and 2.5% CABG. They were enrolled from 555 hospitals in 20
European and Latin American countries between October 2010 and March 2011.
Postdischarge mortality was recorded up to 12 months. From over 50 potential
predictor variables a new risk score for 1 year mortality was developed using forward
Cox regression, and examined for goodness-of-ﬁt and discriminatory power.
Results: 402 patients (3.8%) died within 1 year of discharge. We identiﬁed twelve
highly signiﬁcant independent predictors of mortality. In order of predictive strength
they are: age, LVEF, poorer EQ-5D quality of life, elevated serum creatinine, COPD,
in-hospital cardiac complications, PAD, no PCI or CABG after NSTEACS, low
haemoglobin, male gender, on diuretics at discharge, elevated blood glucose.
Combined into a new risk score excellent discrimination was achieved (C-statistic ¼
0.81). For both STEMI and NSTE-ACS there was a steep gradient in mortality across
risk-score quintiles, with top quintile split into two deciles (see Table). One year
mortality ranged from 0.5% in the lowest quintile to 18.5% in the highest decile. Note
NSTE-ACS contributes over twice as many high-risk patients as STEMI.
Conclusions: Postdischarge mortality for ACS patients remains of concern. Our new
user-friendly risk score can readily identify who is at high risk. Whether the poor
prognosis of such patients can be improved warrants further study.acts/POSTER/STEMI/NSTEMI/ACS B69


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TCT-214 Five-year prognostic impact of distal embolization during primary percutaneous coronary intervention in ST elevation myocardial infarction patients treated with or without distal protection

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