Kwan Yong Lee

PS 02-10 Relationship of brachial-ankle pulse wave velocity and coronary atherosclerosis in asymptomatics: Evaluation by coronary CT angiography

Objective: We investigated the association of arterial stiffness, assessed by pulse wave velocity (PWV) with the prevalence, extent, and severity of coronary atheroma burden using coronary computed tomography angiography (CCTA) in community-dwelling Korean adults without chest pain. Design and Method: We analyzed 749 individuals without known or suspected coronary artery disease (CAD) undergoing CCTA. Participants were divided into two groups according to the mean value of PWV: 1455 cm/sec. Obstructive CAD, as measured by CCTA, was defined as maximum intra-luminal stenosis ≥ 50%. We compared the prevalence, extent, and severity of coronary atheroma burden, including coronary artery calcium score (CACS), atheroma burden obstructive score (ABOS), segment involvement score (SIS), and segment stenosis score (SSS) between groups. Multivariable logistic regression analysis was also performed to identify independent predictors of CAD. Results: Individuals with higher PWV possessed higher obstructive CAD (p < 0.001). Higher PWV was associated with greater degrees of CACS, ABOS, SIS, and SSS on CT scans (p < 0.001 for all). Multivariable analyses adjusted for conventional cardiovascular risk factors, including age, sex, and diabetes mellitus revealed that higher PWV was an independent predictor of obstructive CAD (odds ratio 2.694, confidence intervals 1.382–5.252, p = 0.004). Conclusions: Arterial stiffness assessed by PWV was associated with higher prevalence, extent, and severity of coronary atherosclerosis as well as increased risk of obstructive CAD in asymptomatics. Figure. No caption available.

Prognostic importance of mitral regurgitation complicated by acute myocardial infarction during a 5-year follow-up period in the drug-eluting stent era.

BackgroundMitral regurgitation (MR) is a frequent complication of left-ventricular dysfunction, with an incidence ranging from 13 to 59% after acute myocardial infarction (AMI), which is associated with poor clinical outcome. The aim of this study was to assess the clinical and angiographic characteristics associated with MR, the incidence and predictors of MR, and the outcomes of MR after AMI in those who were successfully treated with primary percutaneous coronary intervention (PCI) using a drug-eluting stent. MethodsWe analyzed a multicenter all-comer AMI registry and identified 4748 patients between January 2004 and December 2009. Of these, 1894 patients were treated with PCI using a drug-eluting stent and had MR. The association between MR and the composite of major adverse cardiac and cerebrovascular events (MACCE; all-cause death, recurrent nonfatal myocardial infarction, stroke, and any revascularization) was examined. ResultsPatients with MR after the index PCI showed significantly higher cumulative incidence of MACCE compared with no-MR patients over the 5-year survival period (P=0.002). When the MR groups were compared on the basis of the severity of MR, ranging from mild to severe grades, a higher grade of MR was found to be associated with a higher incidence of MACCE (P<0.001). Multivariate Cox proportional hazard analysis revealed that no reflow, left-ventricular ejection fraction less than 50%, and anemia, in addition to MR, were consistently associated with increased all-cause death during the 5-year period (adjusted hazard ratio 1.408, 95% confidence interval 1.052–1.884, P=0.021). ConclusionMR after AMI in patients successfully treated with primary PCI was associated with poor long-term outcome regardless of ST-segment elevation at diagnosis during the drug-eluting stent era.