Sarkis Kiramijyan

Impact of coronary artery calcium progression and statin therapy on clinical outcome in subjects with and without diabetes mellitus.

Coronary artery calcium (CAC) is a marker of atherosclerosis, and CAC progression is independently associated with all-cause mortality in the general population but not convincingly in subjects with diabetes mellitus (DM). The aim of this study was to ascertain the differences in the rates of CAC progression, the effect of statin therapy, and all-cause mortality in subjects with and without DM. The study group consisted of 296 asymptomatic subjects with type 2 DM and 300 controls (mean age 59 ± 6 years, 29% women) who underwent baseline and follow-up CAC scans within a 2-year interval. Absolute annual CAC score change, percentage annual CAC progression(ΔCAC%), event-free survival, and the effect of statin therapy on survival were all assessed. The mean follow-up duration was 56 ± 11 months. Absolute annual CAC score change was 81 ± 10 in subjects with DM and 34 ± 5 in controls (p = 0.0001). Percentage annual CAC progression was 29 ± 9% in subjects with DM and 10 ± 7% in controls (p = 0.0001). The hazard ratios of death in 3 groups of subjects with DM compared to controls without DM were 1.88 (95% confidence interval [CI] 1.51 to 2.36, p = 0.0001) for ΔCAC of 10% to 20%, 2.29 (95% CI 1.56 to 3.38, p = 0.0001) for ΔCAC of 21% to 30%, and 6.95 (95% CI 2.23 to 11.53, p = 0.0001) for ΔCAC >30%, all compared to ΔCAC <10%. The adjusted hazard ratios of all-cause mortality in subjects receiving compared to those not receiving statin therapy were 0.29 (95% CI 0.13 to 0.56, p = 0.001) in those without DM and without CAC progression, 0.51 (95% CI 0.21 to 0.73, p = 0.001) in those with DM and without CAC progression, and 0.71 (95% CI 0.25 to 0.91, p = 0.003) in those without DM and with CAC progression, with all 3 groups compared to 1.0 (reference) in those with DM, with CAC progression and without statin therapy. In conclusion, CAC progression was greater and event-free survival lower in patients with DM compared to controls in proportion to the extent of CAC progression. These results suggest that CAC progression is an independent predictor of all-cause mortality in patients with DM.

The adjunctive use of Angio-Seal in femoral vascular closure following percutaneous transcatheter aortic valve replacement.

AIMSnThe objective of this study was to describe and evaluate the adjunctive technique of Angio-Seal (AS) use to augment the dual Perclose ProGlide (PP) in achieving haemostasis in patients undergoing transfemoral percutaneous transcatheter aortic valve replacement (TAVR).nnnMETHODS AND RESULTSnAll patients who underwent TAVR from May 2007 to January 2015 via a planned transfemoral percutaneous approach with a dual PP pre-close strategy were retrospectively analysed. This cohort was divided into two groups: dual PP versus dual PP with adjunctive AS (PP+AS) use based on the specific status of intraprocedural haemostasis. The baseline and procedural characteristics and in-hospital outcomes were prospectively collected and retrospectively compared. Overall, a total of 387 consecutive patients (55% male, mean age 83 years) with dual PP (n=179) vs. dual PP+AS (n=208) were evaluated. There were no statistically significant differences between the dual PP vs. dual PP+AS groups with regard to the in-hospital Valve Academic Research Consortium-2 (VARC-2) primary endpoints of major vascular complications (8.0% vs. 6.6%, p=0.592), minor vascular complications (18.4% vs. 13.7%, p=0.218), life-threatening or disabling bleeding (5.1% vs. 3.0%, p=0.291), major bleeding (1.7% vs. 1.5%, p=1.000), and minor bleeding (14.4% vs. 10.6%, p=0.271).nnnCONCLUSIONSnThe adjunctive Angio-Seal technique to augment the dual PP pre-close strategy for patients undergoing percutaneous femoral closure following TAVR is feasible and safe and may be considered as a bail-out or an alternative strategy when the dual PP closure technique fails to obtain complete haemostasis.

The utilisation of the cardiovascular automated radiation reduction X-ray system (CARS) in the cardiac catheterisation laboratory aids in the reduction of the patient radiation dose

AIMSnThe radiation exposure resulting from cardiovascular procedures may increase the risk of cancer, and/or cause skin injury. Whether the novel cardiovascular automated radiation reduction X-ray system (CARS) can help reduce the patient radiation dose in daily clinical practice remains unknown. The aim of this study was to evaluate the reduction in patient radiation dose with the use of CARS in the cardiac catheterisation laboratory (CCL).nnnMETHODS AND RESULTSnThis study retrospectively analysed 1,403 consecutives patients who underwent a cardiac catheterisation with coronary angiography (CA) and/or a percutaneous coronary intervention (PCI) in the Brest University Hospital over the course of one year. Patient radiation doses (dose area product and air kerma) were collected and compared between the CCL with (new CCL) and without (control CCL) CARS. Additionally, the patient radiation doses according to femoral versus radial access, procedural complexity and body mass index were compared. The radiation lesion position on the skin was assessed by automatically optimising the X-ray source to image distance (SID) and subsequently generating a radiation Dose-Map for those procedures exceeding 3 Gray of exposure. Overall, 447 patients underwent procedures in the control CCL and 956 in the new CCL. Baseline patient and procedural characteristics were similar between the two groups, with the exception of male gender and primary PCI, which were more prevalent in the new CCL group. Compared to the control CCL, the utilisation of the CARS in the new CCL resulted in a reduction of dose area product by 46% for CA, 56% for PCI alone and 54% for CA and PCI during the same procedure. Of note, radial access generated a higher radiation dose than femoral access (p<0.001). In this study, seven patients had an air kerma exceeding 3 Gray; however, only one patient had a skin dose greater than 3 Gray.nnnCONCLUSIONSnThe utilisation of the CARS resulted in a significant reduction in patient radiation doses compared to the control equipment. A real-time Dose-Map may help the operator change the projection during complex procedures to reduce the patient skin dose.

The relation of low levels of bone mineral density with coronary artery calcium and mortality

SummaryOsteoporosis and atherosclerosis are two prevalent major healthcare concerns that frequently coexist. The clinical outcome of 5590 consecutive subjects who underwent coronary artery calcium (CAC) scanning and thoracic bone mineral density (BMD) measurement was assessed. A significant link between low BMD levels and CAC with increased risk of mortality in both genders across ethnicities noted.IntroductionWhile a relation of CAC with lower levels of BMD reported previously; it is unclear whether low levels of BMD would be an independent risk factor for CAC and mortality. This study investigated the relation of BMD levels with CAC and mortality in both genders across ethnicities.MethodsThis study consisted of 5590 consecutive at-risk subjects without known coronary artery disease (CAD), age 57u2009±u200912, and 69% male, who underwent non-enhanced cardiac computed tomography, and were followed for mean of 8xa0years. The subjects’ CAC (Agatston score) and thoracic BMD levels (mg/cm3) were measured. CAC stratified based on the severity to CAC 0, 1–100, 101–400, and 400+. Low-BMD levels defined as BMD levels below median (180xa0mg/cm3). Physician verified that all-cause mortality was assessment hard-endpoint. Multivariate regression analysis, adjusted for age, gender, and other cardiovascular risk factors, was used to assess the relationship between BMD and CAC.ResultsThe BMD levels were proportionally lowering with the severity of CAC in both genders, especially in postmenopausal women (pu2009<u20090.05). The risk of each standard deviation reduce in BMD levels increased with the severity of CAC, as compared to CACu2009=u20090 across ethnicities (pu2009<u20090.05). Low BMD levels were an independent predictor of mortality and event-free survival rate decreased from 99% in those within normal BMD levels to 93% in those with low BMD levels (pu2009=u20090.0001). Furthermore, a significant link between low BMD levels and CAC >u20090 with increased risk of mortality was noted (pu2009=u20090.0001). The relative risk of death was 2.8, 5.9, and 14.3-folds higher in CAC 1–100, 101–400, and 400+ with low BMD levels, compared to CACu2009=u20090 and within normal BMD levels, respectively (pu2009<u20090.05).ConclusionsThe lower BMD levels are independently associated with the severity of CAC that predicts mortality.

Comparison of Platelet Reactivity in Black Versus White Patients With Acute Coronary Syndromes After Treatment With Ticagrelor

Ticagrelor, a potent platelet inhibitor, has primarily been studied in white patients. Platelet reactivity among black patients with acute coronary syndrome (ACS) on ticagrelor, however, is unknown. Our objective was to compare platelet reactivity in black versus white patients with ACS treated with ticagrelor. We conducted a prospective, pharmacodynamic study of 29 black patients with ACS treated with ticagrelor. Platelet reactivity was assessed at 1, 4, and 8xa0hours after a loading dose of ticagrelor 180xa0mg and at 30xa0days on a maintenance dose of ticagrelor 90xa0mg twice daily. Assays included light transmission aggregometry, VerifyNow P2Y12, and vasodilator-stimulated phosphoprotein. We provided comparison with a historical white cohort. Platelet reactivity among blacks with ACS on ticagrelor was similar to that in whites, except that blacks had lower values at 4xa0hours, 8xa0hours, and on maintenance therapy for light transmission aggregometry with 20xa0μmol/L adenosine diphosphate. Among blacks, high-on-treatment platelet reactivity for all 3 assays was uncommon at 1xa0hour and nonexistent at 4xa0hours, 8xa0hours, and while on maintenance therapy. Blacks preloaded with clopidogrel (nxa0= 17) had significantly lower results of VerifyNow (64 ± 65 vs 198 ± 86, p <0.001) and vasodilator-stimulated phosphoprotein (12.8 ± 21.6 vs 58.9 ± 19.9, p <0.001) at 1xa0hour compared with those with no clopidogrel preload. In conclusion, among patients with ACS receiving ticagrelor, levels of platelet reactivity in blacks are similar to that in whites. This suggests that the cardiovascular benefits of ticagrelor observed in the platelet inhibition and patient outcomes (PLATO) trial are likely to be observed in blacks and whites.

TCT-295 Percutaneous Coronary Intervention in Chronic Total Occlusions: A Single Center Experience on the Impact and Efficacy of Using Contemporary Techniques

Withdrawn

TCT-269 Impact of Incomplete Revascularization in Diabetes Mellitus Patients with Multivessel Disease Treated with Percutaneous Coronary Intervention

TCT-267 Clinical outcomes of diabetic patients treated with an amphilimus-eluting stent and a short duration of dual antiplatelet therapy in routine clinical practice: first results of the Utrecht Cre8 (U-Cre8) Registry Rik Rozemeijer, Mera Stein, Michiel Voskuil, Adriaan Kraaijeveld, Leo Timmers, Ramon Rodríguez-Olivares, Saskia Rittersma, Pieter Stella UMC Utrecht, Utrecht, Netherlands; Utrecht, Netherlands; UMC Utrecht; UMC Utrecht, Leiden, Netherlands; The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai; ErasmusMC, Rotterdam, Netherlands; University Medical Center Utrecht; University Medical Center Utrecht, Utrecht, Netherlands

TCT-478 Within a High-Bleeding Risk population which factors drive Stent Choice the most?

Patients who present with percutaneous coronary intervention (PCI) with high bleeding risk (HBR) are often treated with bare metallic stents (BMS) to mitigate the need for long-term dual antiplatelet therapy (DAPT). The aim of this study is to examine which HBR risk factors are more strongly

TCT-445 Does the Risk of Bleeding Impacts Selection of Stent Type during Percutaneous Coronary Intervention?

Patients undergoing percutaneous coronary intervention (PCI) with Drug eluting stents (DES) are subject to prolonged dual antiplatelet therapy (DAPT) which can lead to increase in bleeding rate in high bleed risk (HBR) population. Patients with HBR are often treated with bare metallic stents (BMS).

TCT-734 Evolution of Clinical Outcomes in Patients with Aortic stenosis treated with Transcatheter Aortic Valve Replacement Across Generation of Devices.

METHODS A systematic review was conducted of randomized control trials (RCTs) and observational studies comparing TAVR versus SVR in low-intermediate risk patients included in MEDLINE, EMBASE, CINAHL and Cochrane databases. The outcomes of interest were allcause mortality, cardiovascular mortality (CVM), myocardial infarction (MI), stroke, major bleeding, acute kidney injury (AKI), new atrial fibrillation, major vascular complications, moderate-severe paravalvular regurgitation (PVR) and new permanent pacemaker (PPM) implantation. Pooled analyses were performed using random-effects model and treatment effects were reported as risk ratios (RR) with 95% confidence intervals (CI).