Bartholomew, Beth A.

Boura, Judith A.

Brodie, Bruce R.

Cox, David

Dukkipati, Srinivas

Grines, Cindy L.

Grines, Lorelei L.

Harjai, Kishore J.

O'Neill, William W.

Stone, Gregg W.

Yerkey, Michael W.

Elsevier - Publisher Connector 

64A ABSTRACTS - Angiography & Interventional Cardiology 
observed: there were no arrhythmias, no conduction disturbances and no ST-segment 
modifications. Cardiac enzymes remained unchanged. Conclusion: Gadolinium 
enhanced coronary angiography is safe and well tolerated. The mixture of Gadolinium 
with non-ionic contrast allowed us to obtain diagnostic angiograms of excellent quality in 
all cases. In patients at high-risk for renal failure, Gadolinium constitutes an interesting 
adjunct to contrast agents for coronary artery imaging. 
1174-194 Nicorandil, a KATp Channel Opener, Facilitates the 
Recovery of Ventricular Contraction After Reperfusion 
Therapy in Acute Myocardial Infarction: Multicenter 
Registry in Japan 
Sunao Nakamura, Eita Saito, Takanori Miyauchi. Jin Yokoyama, Akihiko Kanazawa. 
Yasufumi Hayama, Koji Hozawa, Shotaro Nakamura, Hitoshi Nakamura, Kazutoshi 
Yamamoto, New Tokyo Hospital, Matsudo-shi, Japan, Kasori Hospital, Chiba-shi, Japan 
To clanfy whether Nicorandil (N) given after acute myccardial infarction (AMI) affects 
subsequent changes in contractile function, we randomized 209 consecutive AMI 
patients hospitalized within 6 hours and gave them either an i.v. drip infusion of 6 mgi 
hour of N (n = 107) or normal saline (S) as control (n = 102) (double blind controlled 
NIMIS trial). No differences existed between the groups in terms of age and gender; 
severity of AMI was also the same as determined by Killip or Forrester classification and 
the left ventriculogram (LVG). One hour before the reperfusion therapy, i.v. infuwn of N 
or S was started and LVG were recorded, as baseline data. Two weeks, 3 months and 
one year later, we repeated the Same tests and compared the results with the baseline 
data. 
Results: The incidence of ventricular arrhythmias (PVCs, VT) and global ejection frac- 
tion were not significantly changed between the groups. However, the regional wall 
motion determined by centerline method after reperfusion therapy was significantly 
greater in N than S group (Figure) and one year cardiac event fee rate was also smaller 
than in N than S group. 
Conclusion: Results suggest that Nicorandil facilitates the recovery of left ventricular 
contractile force in AMI pabents who underwent repeffusion therapy within 6 hours after 
the onset. 
40s 
2w 3td tycnr 4 prc 2w 3h4 tY=r 
1174-195 Is Insulin Resistance Associated With One-Year Target 
Vessel Revascularization Rates Results From CREDO 
IRS? 
Steven Marso, Ellen S. McErlean, Eric J. Topol, Steven R. Stelnhubl, Mid America Heart 
Institute, Kansas City, MO 
Insulin Resistance Syndrome (IRS) has been linked with increased neointimal prolifera- 
tion and target vessel revascularization rates in animal models and small human studies. 
CREDO IRS sought to compare one-year target vessel revascularization rates among 
non-diabetic patients undergoing PCI stratified by Homeostasls Model Assessment 
(HOMA). CREDO is a prospective multi-center randomized controlled trial enrolling 
patients undergoing PCI. Patients were randomized to a standard therapy: loading dose 
of placebo and aspirin 325 mg 3.24 hours prior to PCI, 75 mg of clopidogtel within 1 hour 
of PCI. aspirin and clopidogrel 2-26 days, placebo and aspirin 29-365 days, or an 
aggresswe regimen: a loading dose of clopidogrel 300 mg and aspirin 325 mg, 3-24 
hours prior to PCI. 75 mg of clopidog.el within 1 hour of PCI, aspirin and clopidogrel 2- 
365 days. CREDO-IRS was a prospectively designed sub-study. Fasting levels of insulin 
and glucose where measured. Insulin resistance was determined by HOMA tertles. The 
primary endpoint for CREDO-IRS was the need for l-year target vessel revasculawa- 
tion. Other endpoints included the combined’rate of death, MI or revascularization. There 
were 726 patients without a history of type 2 DM eligible for comparison within CREDO 
IRS. These patients were stratified, based on HOMA tertiles. The 26.day events are 
depicted in the table below. The one-year results will be available for presentation. 
JACC March 19,2003 
28.Day Events - HOMA Tertiles 
cl.69 1.89-3.36 >3.38 P-value 
N 242 242 242 
DeathlMliUTVR (%) 9.5 7.4 6.3 0.72 
Death (all cause. %) 0.4 0.0 0.0 
Myocardial Infarction (%) 7.4 6.6 7.4 
QMI (%) 1.2 0.8 1.2 
NQM (%) 6.2 5.6 6.2 
Urgent TVR (%) 1.7 0.6 0.8 
1174-196 Temporal Trends of One-Year Reinfarction and Mortality 
Rates Following Primary Angioplasty in High-Risk 
Acute Myocardial Infarction Patients 
Beth A. Bartholomew, Kishore J. Harjai. Judith A. Boura, Srinivas Dukkipati, Michael W. 
Yerkey, Lorelei L. Grines, Bruce R. Brodie, David Cox, Gregg W. Stone, William W. 
O’Neill, Cindy L. Grines, William Beaumont Hospital, Royal Oak, Ml 
Background: The use of primary angioplasty as treatment for acute myocardial infarction 
(AMI) is well established and use has tripled over the last decade. Numerous therapeutic 
advances have been introduced. However, no data exists regarding trends in adverse 
events and long term outcomes for high nsk AMI patients. Methods: Of the 3755 AMI 
patients who had PCI enrolled in the Primary Angioplasty in Myocardial Infarction (PAMI) 
studies from 1990-‘99, 1867 were high risk: heart rate >lOO, anterior infarct, LBBB, sys- 
tolic BP<100 and age over 70. The patients were grouped into 2 ttme periods: ‘90.‘94 
(n=607) and ‘95-‘99 (n=1364). Comparisons of 1 year reinfarction (1 yr reMI) and death 
rates were made between the 2 periods. Reinfarction was defined as recurrent symp- 
toms with any increase in creatine klnase MB fraction above its previous nadir. Multivari- 
ate regression analysis evaluating age >70, gender, EF, Kill@ class >l, systolic BPclOO, 
prior MI, stent use. final stenosis, final dissection, 3 vessel disease, smoking status and 
year enrolled, was used to determine the strongest predictors of 1 yr reMI. Results: 1 yr 
reMl and mortality rates are shown in the table. Year prior to 1995(p<O.O001. OR 3.96) 
and three vessel disease (p-zO.0029, OR 2.06), but not stent use, were independent pre- 
dictors of 1 yr reMI. Conclusions: High risk AMI patients treated with PCI have had a 3 
fold reduction in 1 yr reMl without change in mortality. This is likely attributable to 
improved secondary prevention strategies. 
Reinfarction 
Modality 
‘90.‘94 
9.7% 
6.9% 
‘95.‘99 
2.8% 
8.x 
P value 
<0.0001 
0.12 
POSTER SESSION 
1175 Predictors of Restenosis 
Tuesday, April 01, 2003, Noon-P:00 p.m. 
McCormick Place, Hall A 
Presentation Hour: Noon-l :00 p.m. 
1175-178 Preinterventional Levels of C-Reactive Protein and 
Platelet Function in Patients With Stable Angina 
Nicolas van Beckerath, Olga Gorchakova, Meinrad Gawaz. Julinda Mehilli, Alban Dibra, 
Albert Schomig, Adnan Kastrati, TU Miinchen, Munich, Germany 
Background: Elevated plasma levels of C-reactive protein (CRP) are associated with an 
increased risk of cardiovascular events. Recently, it has been shown that this is alsO true 
for patients with acute coronary syndromes undergoing percutaneous coronary revascu- 
larization. In vitro studies have shown that CRP itself may influence platelet function. 
Methods: Citrated blood samples from 305 consecutive patients with stable angina were 
obtained from the arterial sheath before coronary stenting. All patients had received aspi- 
rin and a loading dose (600 mg) of clopidogrel. CRP plasma levels were determined with 
a high sensitivity assay. Platelet aggregation !n response to ADP, collagen and throm- 
bine activating peptide (TRAP) was measured with lumi-aggregometry, surface expres- 
sion of membrane receptors with flow-cytometry. 
Results: Patients were divided in two groups: CRP > 5 mg/L (n=144) and CRP 6 5m& 
(n=l61). Maximum aggregation (maximum Increase of light transmissvx) in response to 
ADP (5 and 20pM). collagen and TRAP did not differ between the two groups (P values 
0.54, 0.90, 0.40 and 0.83 respectively). In addition, elevated CRP levels were not associ- 


Temporal trends of one-year reinfarction and mortality rates following primary angioplasty in high-risk acute myocardial infarction patients 

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Temporal trends of one-year reinfarction and mortality rates following primary angioplasty in high-risk acute myocardial infarction patients

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