F. Gobeil

One-Year Safety Analysis of the COMPARE-AMI Trial: Comparison of Intracoronary Injection of CD133 Bone Marrow Stem Cells to Placebo in Patients after Acute Myocardial Infarction and Left Ventricular Dysfunction.

Bone marrow stem cell therapy has emerged as a promising approach to improve healing of the infarcted myocardium. Despite initial excitement, recent clinical trials using non-homogenous stem cells preparations showed variable and mixed results. Selected CD133+ hematopoietic stem cells are candidate cells with high potential. Herein, we report the one-year safety analysis on the initial 20 patients enrolled in the COMPARE-AMI trial, the first double-blind randomized controlled trial comparing the safety, efficacy, and functional effect of intracoronary injection of selected CD133+ cells to placebo following acute myocardial infarction with persistent left ventricular dysfunction. At one year, there is no protocol-related complication to report such as death, myocardial infarction, stroke, or sustained ventricular arrhythmia. In addition, the left ventricular ejection fraction significantly improved at four months as compared to baseline and remained significantly higher at one year. These data indicate that in the setting of the COMPARE-AMI trial, the intracoronary injection of selected CD133+ stem cells is secure and feasible in patients with left ventricle dysfunction following acute myocardial infarction.

Contained Rupture of the Aortic Annulus After Transcatheter Aortic Valve Implantation: Uncommon Presentation of a Rare Complication

We report the case of a contained rupture of the aortic annulus after transcatheter aortic valve implantation. The landing zone tear extended cranially to the aortic root and caudally into the perimembranous septum, creating a restrictive ventricular septal defect and severe paravalvular regurgitation into both ventricles, but no pericardial effusion or hemodynamic collapse. We elected conservative management, which proved to be a reasonable option.

The first case of takotsubo cardiomyopathy associated with sodium tetradecyl sulphate sclerotherapy

The present article describes the case of a 70-year-old woman who developed a classic type takotsubo cardiomyopathy after receiving cosmetic sclerotherapy for varicose veins of the legs with sodium tetradecyl sulphate (STS) injections. The patient was in her usual state of health before the injections, and described no apprehension leading up to the procedure and no pain during the procedure. However, a few minutes after the completion of the procedure, the patient had severe chest pain of sudden onset and an electrocardiogram highly suggestive of ST elevation myocardial infarction. The patient was referred for emergent coronary angiography, which was normal. Subsequent ventriculography confirmed the suspected apical ballooning typical of takotsubo cardiomyopathy. Ventricular function returned to near-normal within three days of presentation. The present article describes what is believed to be the first case of takotsubo cardiomyopathy associated with the use of STS. A review of adverse events ascribed to STS revealed visual disturbances and transient ischemic attacks, suggesting the possibility of a common underlying vasospastic pathophysiology and an under- recognized vasoactive potential of STS that merits further investigation. In the interim, the present case advocates for the recommendation of universal pretreatment test dosing.

APPROPRIATENESS OF CORONARY ARTERY BYPASS GRAFTING BASED ON FRACTIONAL FLOW RESERVE LESIONS ASSESSMENT

Background: Fractional Flow Reserve (FFR) is currently validated as an important tool in the hemodynamic evaluation of coronary stenosis. Some studies reported that Coronary Artery Bypass Graft (CABG) on lesions with normal FFR arteries might result in early graft patency compromise. However, the

Adult Congenital Heart Disease Intervention: The Canadian Landscape

Once considered a childhood disease, the number of adults living with congenital heart disease (CHD) has now exceeded the number of pediatric patients. The landscape of percutaneous intervention for adult congenital heart disease (ACHD) has evolved over the past decade and has yet to be characterized in Canada. The aim of this study was to begin to understand the current infrastructure underlying ACHD interventions in Canada and to characterize the type and number of interventions being carried out across the country. A cross-sectional national survey was distributed by e-mail to all cardiac catheterization laboratory directors in 2015. All Canadian laboratories involved in ACHD interventions responded, encompassing 19 institutions spanning 69 cardiac catheterization laboratories. A total of 1451 percutaneous interventions were recorded. Nationwide, the most common simple ACHD interventions were for atrial septal defect and patent foramen ovale closures. The most common ACHD interventions of increased complexity were for coarctation stenting and transcatheter pulmonary valve implantation. There was a marked clustering of procedures in Ontario, Québec, British Columbia, and Alberta in keeping with Canadas population-density distribution. A total of 23 ACHD operators were identified, half of whom had ACHD-specific fellowship training. These data can be used as a starting point to inform the present state of affairs in the area and lay the groundwork for further work to assess resource allocation and human resource planning for the care of patients with ACHD in Canada.

Impact of Paclitaxel-Eluting Balloons Compared to Second-Generation Drug-Eluting Stents for of In-Stent Restenosis in a Primarily Acute Coronary Syndrome Population

Background The place of drug-eluting balloons (DEB) in the treatment of in-stent restenosis (ISR) is not well-defined, particularly in a population of all-comers with acute coronary syndromes (ACS). Objective Compare the clinical outcomes of DEB with second-generation drug-eluting stents (DES) for the treatment of ISR in a real-world population with a high proportion of ACS. Methods A retrospective analysis of consecutive patients with ISR treated with a DEB compared to patients treated with a second-generation DES was performed. The primary endpoint was a composite of major adverse cardiovascular events (MACE: all-cause death, non-fatal myocardial infarction, and target lesion revascularization). Comparisons were performed using Cox proportional hazards multivariate adjustment and Kaplan-Meier analysis with log-rank. Results The cohort included 91 patients treated with a DEB and 89 patients treated with a DES (74% ACS). Median follow-up was 26 months. MACE occurred in 33 patients (36%) in the DEB group, compared to 17 patients (19%) in the DES group (p log-rank = 0.02). After multivariate adjustment, there was no significant difference between the groups (HR for DEB = 1.45 [95%CI: 0.75-2.83]; p = 0.27). Mortality rates at 1 year were 11% with DEB, and 3% with DES (p = 0.04; adjusted HR = 2.85 [95%CI: 0.98-8.32]; p = 0.06). Conclusion In a population with a high proportion of ACS, a non-significant numerical signal towards increased rates of MACE with DEB compared to second-generation DES for the treatment of ISR was observed, mainly driven by a higher mortality rate. An adequately-powered randomized controlled trial is necessary to confirm these findings.

TCT-689 Tailored Therapy in TAVI: Outcomes of a Device Selection Algorithm based on the Presence of Risk Factors for Paravalvular Regurgitation

Paravalvular regurgitation (PVR) negatively impacts prognosis after TAVI. Risk factors associated with PVR include eccentric shape of annulus, non-symmetric distribution of calcification and lack of oversizing. New generation transcatheter heart valves (THV) designed for PVR reduction has

717 Radial vs. femoral access in patients referred for primary percutaneous coronary intervention: Characteristics and clinical outcomes

versus 19.5, P 0.04). Patients in the PtDA group were also significantly more knowledgeable regarding the risks and benefits associated with each vascular access (mean knowledge score of 3.0/5 (95% confidence intervals (CI) 2.6-3.3) versus 2.0 (95% CI 1.7-2.3, P 0.01). Despite 76.3 % of patients actively selecting their vascular access route of choice in the PtDA group as compared to 39.2% in the control group (P 0.01), there were no significant differences in safety outcomes. CONCLUSION: A vascular access PtDA for eligible patients undergoing coronary angiography procedures significantly improves the patient’s knowledge of their health care options and reduces decisional conflict, without affecting safety outcomes. This study demonstrates the significant benefits of involving eligible patients in the decision process regarding vascular access for coronary angiography procedures. McMaster University, Dept of Medicine Internal Career Research Award and Division of Cardiology, AFP research competition grant

719 Incidence, predictors and long-term clinical outcomes of coronary perforation in the modern era

CONCLUSIONS: In fibrinolytic-treated STEMI patients undergoing a routine early invasive approach or receiving standard care, radial PCI was chosen in younger, less ill patients and was associated with a lower rate of bleeding compared to patients undergoing femoral PCI. The independent association between radial access and lower rates of major bleeding remained significant after adjusting for potential confounding variables.