B. Tyrrell

THE APPLICATION OF THE JAPANESE CHRONIC TOTAL OCCLUSION (J–CTO) SCORE TO TAILOR APPROACHES AND PREDICT SUCCESS IN CHRONIC TOTAL OCCLUSION PERCUTANEOUS CORONARY INTERVENTIONS (CTO PCI)

In the J–CTO model, angiographic variables of blunt entry, calcification, lesion length >20mm, angle>45o and previous PCI attempt are independent predictors of CTO PCI failure. While the use of bilateral injections and retrograde approach during CTO PCI remain operator dependent, these strategies

Transcatheter Mitral Valve Intervention for Chronic Mitral Regurgitation: A Plethora of Different Technologies

Chronic mitral regurgitation (MR) remains a common cardiovascular condition resulting in significant morbidity and mortality. With an aging population, increasing trends for both primary (degenerative) and secondary (functional) MR have become apparent. Although the gold standard remains surgical intervention with mitral valve repair/replacement, comorbid conditions have steered the development of less invasive technologies to mitigate perioperative surgical risk. Transcatheter mitral valve repair using a percutaneous edge-to-edge technique is the most widely available choice at present. However, other transcatheter mitral valve repair techniques such as annuloplasty and chordal implantation are notable alternatives. Moreover, emerging technologies in transcatheter mitral valve replacement are rapidly establishing their roles in the field of chronic severe MR therapy. Hence, it is imperative to understand the indications and limitations of these various transcatheter mitral valve interventions to provide the best and most up-to-date clinical care for patients. This review will outline current evidence and patient selection criteria for such device-based therapies.

DEFERRED STENTING - AN ALTERNATIVE STRATEGY FOR THE INVASIVE MANAGEMENT OF STEMI PATIENTS WITH SIGNIFICANT THROMBUS BURDEN

myocardial infarction (STEMI). Despite this, there is a lack of data in this high-risk patient population. The purpose of the study is to characterize the baseline characteristics, culprit lesions and outcomes of patients with previous CABG and STEMI. METHODS AND RESULTS: We retrospectively reviewed a database of all patients undergoing emergency percutaneous coronary intervention (PCI) of which 95.8% of patients had electrocardiographic evidence of STEMI at a single-centre in British Columbia between January 2009 and December 2013. There were 94 (2.9%) patients with a prior history of CABG in a total of 3231 patients. The prior CABG group was significantly older and had a significantly greater incidence of hypertension, dyslipidemia, diabetes, previousMI, previous heart failure, and previous PCI. There was a significantly greater length of stay in the CABG population, but no difference when comparing in hospital mortality. The infarct-related vessel in the CABG group was a bypass graft in 44 patients (48.9%), native coronary artery in 36 patients (40.0%), was not identifiable in 10 patients (11.1%) and 4 patients had missing data. We further stratified previous CABG patients by the time between emergency PCI and index CABG. There were 79 patients (84.0%) who had CABG more than five years from emergency PCI. There were no significant differences in baseline characteristics, culprit lesions and 30-day mortality between CABG more than five years and less than five years from emergency PCI. CONCLUSION: Emergency PCI for STEMI after previous CABG is associated with more comorbidities when compared with patients that did not undergo previous CABG. However, there were similar outcomes in short-term mortality. Furthermore, there were no significant differences in baseline characteristics and short-term mortality between the timing from initial CABG to emergency PCI. Further data analysis is needed to characterize longer-term outcomes.

297 The Application of an Angiographic Scoring System to Tailor Approaches And Predict Success In Chronic Total Occlusion Percutaneous Coronary Interventions (CTO PCI)

minimum lumen diameter (MLD) and area (MLA), and lesion length (LL) were recorded from the C7XR console. Diameter stenosis (DS%) and area stenosis (AS%) were calculated. RESULTS: The median of OCT parameters was not significantly different between Non-ACS (MLD 1.35; MLA 2.24; LL 11.5; DS% 53; AS% 68) and ACS groups (MLD 1.36; MLA 2.26; LL 9.5; DS% 43; AS% 64). OCT parameters showed modest correlation to FFR in the Non-ACS group (MLD 0.65; MLA 0.66; LL -0.57; DS% -0.56; AS% -0.53) but not in the ACS group. Stepwise logistic regression of OCT parameters found DS% an independent predictor of FFR 0.80 (p 0.03) in NonACS only, correctly classifying 76% of lesions (ROC optimal cut-off DS% 55%; sensitivity 61%, specificity 100%, AUC 0.87). CONCLUSION: OCT parameters correlate with FFR in NonACS presentations and OCT diameter stenosis independently predicts FFR 0.80. However, OCT in ACS does not correlate with or predict FFR.