S60 J O U R N A L O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y , V O L . 7 1 , N O . 1 6 , S U P P L S , 2 0 1 8

TCTAP A-155

Clinical Impact of Periprocedural Myocardial InfarctionAccording to Various Definitions in Patients UnderwentPercutaneous Coronary Intervention with Drug-eluting Stent.

Yong-Hoon Yoon,1 Sang Yong Om,1 Minsoo Kim,1 Hanbit Park,1

Sang-Cheol Cho,1 Osung Kwon,1 Kyusup Lee,1 Do-Yoon Kang,1

Jung-Min Ahn,1 Duk-Woo Park,1 Soo-Jin Kang,1

Seung-Whan Lee,1 Young-Hak Kim,1 Cheol Whan Lee,1

Seong-Wook Park,1 Seung-Jung Park11Asan Medical Center, Korea (Republic of)

BACKGROUND This study aims to evaluate the clinical impact ofperiprocedural myocardial infarction(PMI) according to variousdefinitions after coronary intervention with drug-eluting stent(DES).METHODS Out of a total of 17,557 patients who underwent percuta-neous coronary intervention (PCI) in a prospective IRIS-DES registry,11,208 patients were selected for the analysis after exclusion ofpatients with ST elevation myocardial infarction(MI) or baselineelevation of CK-MB before intervention. The primary endpoint wasthe composite of cardiovascular death, MI or target-vessel revascu-larization (TVR). PMI was defined as the elevation of CK-MB �10, �5or �3 x URL after PCI.RESULTS During 5 years of follow-up, PMI occurred in 184, 393 and689 patients according to different definitions. After multivariableadjustment, only PMI defined as CK-MB �10 x URL was significant riskof the composite of cardiovascular death, MI or TVR. (Adjusted hazardratio [HR] 2.5, p<0.001 for CK-MB �10 x URL, adjusted HR 1.2, p¼0.390for CK-MB �5x URL, adjusted HR 1.2, p¼0.218 for CK-MB �3 x URL). Alldefinitions were related significantly with the occurrence of cardio-vascular death (adjusted HR 4.2, p<0.001 for CK-MB �10 x URL,adjusted HR 2.1, p¼0.021 for CK-MB�5x URL, adjusted HR 2.0, p¼0.013for CK-MB �3 x URL PMI. Only CK-MB �10 x URL PMI was the risk ofTVR (adjusted HR 1.7, p¼0.030). Any definition could not predict theoccurrence of MI for follow-up period in multivariate analysis.CONCLUSION Among all definitions, PMI defined as CK-MB �10x URLwas the best prognostic predictor for major adverse cardiovascularoutcomes after PCI with DES.

TCTAP A-162

Comparative Effectiveness of Different ContemporaryDrug-eluting Stents in Routine Clinical Practice: MultigroupPropensity-Score Analysis Using Data from the Stent-Specific,Multi-Center, Prospective Registries

Osung Kwon,1 Se Hun Kang,2 Jung-Bok Lee,3 Sun Hack Lee,1

Sangwoo Park,1 Tae-Oh Kim,1 Yong-Hoon Yoon,1

Sang Yong Om,1 Hanbit Park,1 Sang-Cheol Cho,1 Ungjeong Do,1

Jung Ae Hong,1 Kyusup Lee,1 Do-Yoon Kang,1 Chulhyun Lee,1

Pil Hyung Lee,1 Jung-Min Ahn,1 Soo-Jin Kang,1

Seung-Whan Lee,1 Young-Hak Kim,1 Cheol Whan Lee,1

Seong-Wook Park,1 Duk-Woo Park,1 Seung-Jung Park11Asan Medical Center, Korea (Republic of); 2CHA BundangMedical Center, CHA University, Korea (Republic of); 3Divisionof Biostatistics, Center for Medical Research and Information,Asan Medical Center, Univers, Korea (Republic of)

BACKGROUND Previous clinical trials and meta-analyses have inves-tigated the relative efficacy and safety profiles of different drug-elutingstents (DES). However, data on the comparative effectiveness ofcontemporary DES in the unrestricted, real-world setting are limited.OBJECTIVES We investigated the long-term effectiveness and

safety of contemporary DES by means of multiple treatment pro-pensity score weighting.METHODS From 7 stent-specific, prospective DES registries conduct-ed between July 2007 and July 2015, we evaluated 17,196 patientswho received several contemporary DES and first-generation DES:3,053 treated with cobalt-chromium EES (CoCr-EES), 2,985 withplatinum-chromium everolimus-eluting stents (PtCr-EES),2,922 withResolute zotarolimus-eluting stents (Re-ZES), 789 with biomatrixbiolimus-eluting stents (Bi-BES), 1,907 with Nobori biolimus-elutingstents (No-BES), 1,970 with Xience Prime cobalt-chromium ever-olimus-eluting stents (Pr-CoCr-EES), and 3,570 with sirolimus-elutingstents (SES). The primary outcome was target-vessel failure (acomposite of cardiac death, target-vessel myocardial infarction,or target-vessel revascularization).RESULTS The observed 3-year rates of target-vessel failure were notsignificantly different among different second-generation DES andSES (CoCr-EES 9.8%,PtCr-EES 9.5%, Re-ZES 9.3%, Bi-BES 9.8%,No-BES 7.7%, Pr-CoCr-EES 10.4%, SES10.2%; overall p¼0.07). In

multiple treatment propensity-score analysis, adjusted hazard ratios(HR) for target-vessel failure were similar in between-group compar-isons of several contemporary DES, except for Re-ZES vs. CoCr-EES(reference) (HR, 1.26; 95% confidence interval, 1.06–1.50, P¼0.009)and No-BES vs. Re-ZES (reference) (HR, 0.76; 95% confidence interval0.61–0.94, p¼0.01).

CONCLUSION In this comparative effectiveness research using stent-specific, clinical-practice registries involving unrestricted use ofseveral contemporary DES, we found that there were no significantbetween-group differences in the 3-year rates of target-vessel failure,except that Re-ZES was associated with a higher risk of primaryoutcome as compared with CoCr-EES and No-BES.

STRUCTURAL HEART DISEASE: VALVULAR HEARTDISEASE (AORTIC, MITRAL, ETC.) (TCTAP A-110 TOTCTAP A-116, TCTAP A-156 TO TCTAP A-161)

TCTAP A-110

ABSTRACT WITHDRAWN

TCTAP A-111Comparison of Early Clinical Outcomes of Transcatheter AorticValve Replacement Between Low to Intermediate and HighSurgical Risk Patients with Severe Aortic Stenosis

Hyungdon Kook,1 Cheol Woong Yu,1 Han Saem Jeong,1

Duck-Hyun Jang,1 Seung Hun Lee,1 Hyung Joon Joo,1

Jae Hyoung Park,1 Soon Jun Hong,1 Seung Hyuk Choi,2

Kiyuk Chang,3 Young Jin Choi,4 Do-Sun Lim1

1Korea University Anam Hospital, Korea (Republic of); 2SamsungMedical Center, Korea (Republic of); 3The Catholic University ofKorea, Seoul St. Mary’s Hospital, Korea (Republic of); 4SejongGeneral Hospital, Korea (Republic of)

BACKGROUND Data regarding a comparison between low to inter-mediate and high risk patients underwent transcatheter aortic valvereplacement (TAVR) are lacking due to low volume and limited ex-periences of TAVR in Korea. This study compared early clinical out-comes of TAVR in severe aortic stenosis (AS) patients with low tointermediate versus high surgical risk at early learning period.METHODS Total of 138 patients treatedwith Sapien XT or 3 (Edwards Lifesciences, USA) in 4 medical centers from July 2010 to October 2017 werereviewed. Based on the Society of Thoracic Surgeons (STS) score, the studypopulation was classified into low to intermediate (STS<8) or high risk(STS�8). Primary endpoint was cardiovascular mortality at 30-day.RESULTS At baseline, patients with low to intermediate surgical risk(n¼78, STS 3.99 � 1.94) were younger (76.13 � 7.83 vs.80.72 �6.59 years,p<0.001), more likely to have higher creatinine clearance rate (52.26 �22.76 vs. 41.75 � 21.35 mL/min, p¼0.007) and lesser inoperable condi-tions (19, 24.4% vs. 36, 60.0%, p<0.001) than patients with high risk

J O U R N A L O F T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y , V O L . 7 1 , N O . 1 6 , S U P P L S , 2 0 1 8 S61

(n¼60, STS 13.72 � 7.07). At 30-day, cardiovascular mortality was low andsimilar between two groups (5.3% vs. 3.4%, Log-rank p¼0.615). Therewere no statistical differences in terms of all-cause mortality or stroke.Complications after TAVR including tamponade, permanent pacemakerimplantation and major bleeding were rare in both groups (1 event ineach group). One aortic dissection and 1 device embolization in high riskgroup and 1 annular rupture in low to intermediate risk group occurredduring TAVR procedure, resulting in conversion to surgery.CONCLUSION In this study, 30-day mortality and complication rate ofthe low to intermediate risk group were generally low and notdifferent from the high risk group in patients with severe AS under-went TAVR even at early learning period. TAVR can be safely per-formed in patients with severe AS, irrespective of surgical risk.

TCTAP A-112

Aorto-ventricular Angulation Does Not Impact on DeviceSuccess in Transcatheter Aortic Valve Replacements with theLotus Valve System

Hashrul Rashid,1 Ameera Amiruddin,1 Kim Be,2

Andrew Talman,2 Abdul Rahman Ihdayhid,1 Liam McCormick,1

Arthur Nasis,1 Ian T. Meredith AM,3 Robert Gooley11Monash Health and Monash University, Melbourne, Victoria,Australia; 2Monash Health and Monash University, Melbourne,Australia; 3Monash Medical Centre, Australia

BACKGROUND Aorto-ventricular Angulation (AA), defined as theangulation of the aortic valve on basal plane, may affect the deploy-ment of TAVR. The Lotus Valve System is fully repositionable and isdelivered on a pre-shaped catheter which may alter the impact of AAon its deployment. The effect of AA on procedural and clinical out-comes with the Lotus Valve is unreported.METHODS Consecutive patientswhounderwent transfemoral TAVRwiththe Lotus Valve System were analyzed. AA was determined on pre-pro-cedural MDCT imaging. Device success, procedural characteristics, andclinical events were assessed according to Valve Academic ResearchConsortium-2 (VARC2) definitions at day 30. Patients were later dividedinto two groups; low AA (below mean) and high AA (above mean).RESULTS 165 patientswere analyzed (48%male,mean age 84 years). Themean AAwas 47.8� with the aorto-ventricular angulation demonstrating anormal bell-curve distribution (Figure 1). Patientswere, therefore, dividedinto low AA (AA <48�, n¼78) or high AA (AA �48�, n¼87). Baseline char-acteristics were similar in both cohorts (Figure 2). Device success andprocedural outcomeswere also similar includingprocedure time, radiationdose and need to reposition (Figure 3). There was no difference in thedegree ofmoderate or greater paravalvular regurgitation (PVR) (0% vs 3%,p¼0.09). Clinical outcomes of death, stroke, myocardial infarction andother major VARC2 endpoints were similar.

CONCLUSION AA did not affect device success or clinical outcomewith the Lotus Valve system. The Lotus’ unique design features mayhave mitigated the impact of AA by improving the accuracy and easeof valve positioning and reducing PVR. To our knowledge, this is thelargest reported Lotus Valve analysis in Australia.