M. Ekinci

Rosuvastatin versus atorvastatin to prevent contrast induced nephropathy in patients undergoing primary percutaneous coronary intervention (ROSA-cIN trial).

Aim We aimed to compare the incidence of contrast-induced nephropathy (CIN) between atorvastatin versus rosuvastatin in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary coronary angioplasty. Methods One hundred ninety-two consecutive patients, who underwent primary percutaneous intervention (p-PCI) with the diagnosis of STEMI, were included in the study. The patients were randomized to take atorvastatin 80 mg (n = 98) or rosuvastatin 40 mg (n = 94) before the procedure. Biochemical and complete blood count measurements were done at baseline and at 48 hours following admission. Results The incidence of CIN was 8.9% (n = 17) in the entire groups. The analysis performed between the statin groups revealed no statistical difference in any of the renal dysfunction indicators [baseline creatinine, baseline estimated glomerular fi ltration rate (eGFR), creatinine at 48 h, eGFR at 48 h, diff erence between baseline and 48 h creatinine, the per cent increase in the creatinine at 48 hours relative to basal creatinine]. In STEMI patients undergoing primary PCI, only the amount of the contrast agent administered was determined to be an independent predictor for CIN (OR and 95% CI: 1.08 (1.03- 1.13), P ≤ 0.001). Left ventricular ejection fraction exhibited borderline statistical signifi cance (OR and 95% CI: 0.88 (0.77-1.01), P= 0.07). Conclusion Atorvastatin and rosuvastatin had similar effi cacy in preventing CIN in patients with STEMI undergoing P-PCI.

Relation of the metabolic syndrome with proarrhythmogenic electrocardiographic parameters in patients without overt diabetes.

OBJECTIVES We aimed to observe the relationship of the metabolic syndrome and proarrythmogenic ECG parameters and to evaluate a possible correlation of these parameters to the metabolic syndrome score in patients without overt diabetes mellitus. METHODS The study population consisted of 142 patients with the metabolic syndrome and 170 age- and gender-matched control subjects. In the ECG recordings, resting heart rate, QRS duration, corrected QT duration and corrected QT dispersion were measured. Patients were classified into three groups based on number of fulfilled metabolic syndrome criteria: group 1 (three metabolic syndrome criteria), group 2 (four metabolic syndrome criteria) and group 3 (five metabolic syndrome criteria). RESULTS Patients with the metabolic syndrome had a higher increased resting heart rate, QTcd, prolonged QRS and QTc duration. Resting heart rate increases significantly parallel to the increase in the metabolic syndrome score across the groups, whilst QRS duration remained unchanged. QTc duration and QTc dispersion were significantly higher in groups 2 and 3 when compared to group 1. However, no significant differences were observed between groups 2 and 3. CONCLUSION We demonstrated that the metabolic syndrome and its score related with increased resting heart rate and prolonged repolarization durations in patiens without overt diabetes mellitus. These pro arrhythmogenic parameters could be used in the development of risk stratification schemes for sudden cardiac death in patients with the metabolic syndrome.

PP-221 THE RELATION OF SERUM GAMMA-GLUTAMYL TRANSFERASE LEVELS WITH CORONARY LESION COMPLEXITY AND LONG-TERM OUTCOME IN PATIENTS WITH STABLE CORONARY ARTERY DISEASE

a b s t r a c t Background: Relation of serum gamma-glutamyl transferase (GGT) levels with extent, severity, and complexity of coronary artery disease has not been adequately studied. Therefore, we evaluated the rela- tionship between GGT levels and coronary complexity, severity and extent assessed by SYNTAX score and long-term adverse events. Methods: We enrolled 442 consecutive patients with stable angina pectoris who underwent coronary angiography. Baseline serum GGT levels were measured and SYNTAX score was calculated from the study population. Median follow-up duration was 363 days. Endpoints were all cause mortality and any revascularization. Results: GGT levels demonstrated an increase from low SYNTAX tertile to high tertile. In multivariate analysis serum GGT, diabetes mellitus, HDL-cholesterol, eGFR and ejection fraction were found to be independent predictors of high SYNTAX score. The survival analysis showed that long-term revascular- ization rates were comparable between the GGT groups (for 36 U/l cut point) of the overall population (7.7% vs 8.6% logrank, p = 0.577), whereas long-term all cause mortality rate was higher in the GGT ≥ 36 U/l group (3.6% vs 11.6% logrank, p = 0.001). In Cox proportional hazards regression model, GGT ≥ 36 U/l group was found to be an independent predictor of long-term all cause mortality in the unadjusted (HR 2.54, 95% CI 1.17-5.48, p = 0.018) and age- and gender-adjusted (HR 2.58, 95% CI 1.19-5.58, p = 0.016) models. Conclusion: Serum GGT level was independently associated with coronary complexity and long-term mortality in patients with stable coronary artery disease.

Mean Platelet Volume is Associated with Inadequate Reperfusion Detected by Angiography in Patients with Successful Fibrinolytic Therapy

Mailing Address: Mehmet Eyuboglu 4025 Sokak Camlik Girisi, N:38. Postal Code: 35170. Karabaglar, Izmir – Turkey E-mail: mhmtybgl@gmail.com Mean Platelet Volume is Associated with Inadequate Reperfusion Detected by Angiography in Patients with Successful Fibrinolytic Therapy Abdurrahman Arslan1, Mehmet Eyuboglu2, Omer Senarslan3, Mehmet Akif Ekinci4, Mustafa Aytek Simsek5, Onder Kirimli6 Bartın State Hospital1, Avrupa Medicine Center2, Sifa University Hospital3, Alfakalp Medicine Center4, Dokuz Eylul University Hospital5, Dokuz Eylul University Hospital6 – Turkey

Fragmented QRS for Risk Stratification in Patients Undergoing First Diagnostic Coronary Angiography

Background Only a small proportion of patients referred for coronary angiography with suspected coronary artery disease (CAD) have the diagnosis of obstructive CAD confirmed by the exam. For this reason, further strategies for risk stratification are necessary. Objective To investigate the relationship of the presence of fragmented QRS (fQRS) on admission electrocardiogram with angiographically detected CAD and CAD severity in patients without known vascular diseases and myocardial fibrosis, undergoing first diagnostic coronary angiography. Methods We enrolled 336 consecutive patients undergoing coronary angiography for suspected CAD. The patients were divided into two groups according to the presence or absence of fQRS on admission. We compared the groups regarding the presence and severity of CAD. Results Seventy-nine (23.5%) patients had fQRS on admission. There was not a statistically significant difference between patients with fQRS (41.8%) and non-fQRS (30.4%), regarding the presence of CAD (p = 0.059). However, there was a statistically significant difference between patients with fQRS and non-fQRS regarding the presence of stenotic CAD (40.5% vs. 10.5%, p<0.001) and multi vessel disease (25,3% vs. 5.1%, p<0.001). The frequency of fQRS was significantly higher in patients with SYNTAX score >22 compared to patients with SYNTAX score ≤22. Conclusions Our findings suggest that fQRS may be an indicator of early-stage myocardial damage preceding the appearance of fibrosis and scar, and may be used for risk stratification in patients undergoing first diagnostic coronary angiography

Clinical importance of hyperemic coronary blood flow (thrombolysis in myocardial infarction-intravenous flow) after primary percutaneous coronary intervention.

We aimed to investigate clinical, demographic and angiographic factors associated with hyperemic coronary blood flow (HCBF) and the relation of HCBF with mortality at 30 days. Our study included 809 consecutive patients with acute ST-segment elevation myocardial infarction who underwent primary percutaneous coronary intervention (PCI). We divided corrected thrombolysis in myocardial infarction (TIMI) frame count (TFC) values into three tertiles: less than 14, 14–28 and more than 28. Corrected TFC less than 14 was defined as HCBF or TIMI intravenous flow. The primary end-point of the present study was all-cause mortality within 30 days. Among the HCBF group (n = 58), the patients with poor myocardial perfusion demonstrated the highest mortality rate within the 30-day follow-up period (33%). Low TIMI myocardial perfusion grade, history of no smoking, left ventricular ejection fraction (LVEF), and high Killip status and low LVEF were found to be independently associated with 1-month all-cause mortality.The present study showed that HCBF after primary PCI has a high 30-day mortality when associated with impaired reperfusion.

OP-215 RELATION OF LEFT VENTRICULAR END-DIASTOLIC PRESSURE WITH LEFT VENTRICULAR MECHANICS

controls (p < 0.0001 for all). However, passive emptying fraction was significantly lower in prehypertensives than controls (45.7±5.6 vs. 48.6±4.1, p = 0.006) and the minimum LA volume of the two groups were similar. Conclusions: The main finding of this study was; despite LA volume and LA active systolic functions were significantly increased in prehypertensive people, there was a reduction in passive LA systolic functions when compared with the controls. These parameters may be important in showing hemodynamic and structural changes formed by prehypertensives in cardiac tissue.

OP-147 RELATION OF RED CELL DISTRIBUTION WIDTH WITH PRESENCE AND SEVERITY OF ISOLATED CORONARY ARTERY ECTASIA

OP-146 A COMPARISON OF DIRECT VERSUS CONVENTIONAL STENTING IN PATIENTS UNDERGOING PRIMARY ANGIOPLASTY FOR ST ELEVATION MYOCARDIAL INFARCTION T. Isik, E. Ayhan, H. Uyarel, M. Ergelen, G. Cicek, D. Osmonov, C. Turkkan, A. Turer, B. Ghannadian, I.H. Tanboga, M. Kurt, M. Eren. Department of Cardiology, Balikesir University, School of Medicine, Balikesir, Turkey; Department of Cardiology, Bezmialem Vakif University, School of Medicine, Istanbul, Turkey; Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Center, Istanbul, Turkey; Department of Cardiology, California University School of Medicine, San Diego, USA; Department of Cardiology, Erzurum Region Education and Research Hospital, Erzurum, Turkey

PP-321 IS ROUTINE ECHOCARDIOGRAPHY NECESSARY AFTER CATHETER ABLATION OF ATRIOVENTRICULAR NODAL RE-ENTRANT TACHYCARDIA?

BACKGROUND The aim of this study was to investigate whether pericardial effusion (PE) detected by transthoracic echocardiography (TTE) was clinically significant and whether routine echocardiography was necessary after catheter ablation of atrioventricular nodal re-entrant tachycardia (AVNRT). METHODS A total of 202 patients with AVNRT were included in the study from three centers. The patients received basic electrophysiology-guided therapy, followed by radiofrequency ablation (RFA). All patients underwent TTE before and after RFA therapy. RESULTS The mean age of the study population was 46.2 ± 17.9 and 30.7% of the patients were male. Of these patients, six (3%) had postoperative PE, as detected by TTE. However, none of them had cardiac tamponade (CT). Four patients had minimal PE, while two had mild PE. Repeated TTE at one to three months showed resolved PE. No significant difference was seen among the patients with and/or without PE in terms of age, gender, the number of RFA applications, or RFA duration; however, significantly prolonged duration of fluoroscopy exposure was observed in the patients with PE. CONCLUSIONS PE was detected in 3% of the patients by TTE and associated with prolonged duration of fluoroscopy exposure. However, no patients with moderate or large PE or cardiac tamponade were found in the study. In conclusion, we suggest that TTE should only be performed in the presence of clinical indications following ablation of AVNRT.