Special Feature

Select abstracts from Cardiovascular Research Technologies (CRT) 2012,February 4–7, Washington, DC

Intracoronary administration of abciximab via an intracoronaryperfusion catheter in patients with a thrombotic coronaryocclusion—a single center experienceChristian Roth, Georg Delle-Karth, Irene Lang, Gerhard Kreiner,Clemens Gangl, Rudolf Berger, Thomas NeunteuflMedical University of Vienna, Vienna, Austria

Aims: At concentrations superior to those achieved with thestandard intravenous dose for coronary procedures, abciximab hasan active dethrombotic effect by displacing platelet-bound fibrino-gen. This analysis investigates whether administration of abciximabby local intracoronary infusion through the ClearWay (CX) RXperfusion catheter improves coronary blood flow (TIMI flow) byreducing thrombus burden.Methods and Results: This retrospective study included 68 patientswho presented with an acute coronary syndrome due to anintracoronary thrombus between May 2009 and April 2011. Theprimary endpoint was defined as improvement in Thrombolysis InMyocardial Infarction (TIMI) flow after intracoronary application ofabciximab via the ClearWay (CW) RX perfusion catheter. Thepopulation (mean age 58±11 years) consisted of 54 patients (79%)with an ST-elevation myocardial infarction and 14 patients (21%)with a non-ST-elevation myocardial infarction. The balloon-diameterof the perfusion catheter was 1 mm in 25 (37%), 1.5 mm in 23 (34%),2.0 mm in 14 (20%), and 3.0 mm in 6 patients (9%), respectively.Successful positioning of the balloon within the thrombus was notpossible in 4 patients (6%). After infusion of abciximab using theperfusion catheter TIMI flow improved by one grade in 17 patients(25%), by two grades in 9 patients (13%), and by three grades in 7patients (10%), TIMI flow remained unchanged in 21 patients (31%),and even worsened by one grade in 4 patient (6%) (χ2 test, Pb.001).The procedure was complicated by an air embolization in 5 patients(7%). Air embolization occurred using a 2 mm balloon (threepatients) or a 3 mm balloon (two patients), but not using a 1 mmor 1.5 mm balloon (χ2, Pb.003). After the use of the perfusioncatheter in these patients TIMI flow improved by one degree in 2 ofthese patients, was unchanged in 2 of these patients and worsened byone grade in one patient. After additional treatment with throm-bectomy (54 patients, 79%), initial balloon dilatation (46 patients,68%), direct stenting (22 patients, 32%), and stent implantation (64patients, 94%), the final TIMI flow was TIMI 3 in 57 patients (84%),TIMI 2 in 4 patients (6%), TIMI 1 in 6 patients (9%), and TIMI 0 in 1patient (1%).Conclusion: The intracoronary infusion of abciximab using theClearWay (CX) RX perfusion catheter helps to improve myocardial

perfusion in patients with acute coronary syndrome due to anintracoronary thrombus. The use of perfusion catheters with aballoon ≥2 mm can be associated with air embolism.

doi:10.1016/j.carrev.2012.01.012

Combined treatment of thrombotic coronary occlusions bythrombectomy and by intracoronary administration of abciximabvia an intracoronary perfusion catheter—which treatment first?Christian Roth, Georg Delle-Karth, Irene Lang, Gerhard Kreiner,Clemens Gangl, Rudolf Berger, Thomas NeunteuflMedical University of Vienna, Vienna, Austria

Purpose: Thrombectomy and intracoronary administration of abci-ximab via an intracoronary perfusion catheter have been demon-strated to reduce thrombus burden. We analyzed two differenttreatment strategies: (1) first thrombus-aspiration to reduce throm-bus size, then lysis of the rest-thrombus by locally administered abci-ximab via the ClearWay (CW) RX perfusion catheter versus (2) firstpharmacological thrombus-reduction by locally administered abci-ximab, then, if necessary, thrombus-aspiration of the rest-thrombus.Methods: This retrospective study included 68 patients who pre-sented with an acute coronary syndrome due to an intracoronarythrombus between May 2009 and April 2011. Thrombus-aspirationfirst strategy was performed in 39 patients, abciximab first strategy in29 patients. The primaryendpointwas defined as final improvement inThrombolysis In Myocardial Infarction (TIMI) flow.Results: Before treatment TIMI flow was similar between the twotreatment groups (TIMI flow 0 in 28 and 21 patients (72/72%), 1 in 6and 1 patients (15/4%), 2 in 2 and 4 patients (5/14%), 3 in 3 and 3patients (8/10%), n.s.). In the thrombus-aspiration first group localabciximab administration improved TIMI flow by one stage in 26% ofpatients, by two stages in 3% of patients, and by three stages in 5% ofpatients, and did not improve TIMI stage in 46% of patients. In thisgroup TIMI improvement was not documented in 8 patients (20%). Inthe abciximab first group local abciximab administration improvedTIMI flow by one stage in 24% of patients, by two stages in 28% ofpatients, and by three stages in 17% of patients, and did not improveTIMI stage in 24% of patients. In this group TIMI improvement was notdocumented in 2 patients (7%). In the abciximab first group additionalthrombus aspiration was performed in 15 patients (52%), whereas inthe thrombus-aspiration first group all patients were additionallytreated with local abciximab administration (χ2, Pb.007). Final TIMIflow was significantly better in the abciximab first group (TIMI flow 0

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Cardiovascular Revascularization Medicine

1553-8389/$ – see front matterdoi:10.1016/j.carrev.2012.01.007

Cardiovascular Revascularization Medicine 13 (2012) e3–e19

in 1 patient and TIMI flow 3 in 28 patients) than in the thrombus-aspiration first group (TIMI flow 1 in 6 patients, 2 in 4 patients, 3 in 29patients) (χ2, Pb.021).Conclusion: Improvement of TIMI flow by local abciximab adminis-tration is more effective when using the abciximab first strategycompared to using thrombus-aspiration first strategy. The abciximabfirst strategy seems to be more effective to achieve optimal final TIMIflow than the thrombus-aspiration first strategy.

doi:10.1016/j.carrev.2012.01.013

The true incidence of atrial fibrillation after an atrial flutterablation with continuous monitoringJeffrey Snow, Nikolai A. Snow, Joseph Germano, Sameer P. ParekhWinthrop University Hospital, Garden City, NY, USA

Background: The reported incidence of atrial fibrillation (AF) aftersuccessful ablation of typical isthmus dependent right atrial flutter(AFl) has been variably reported. Some authors have reported thisincidence to be as high as 68% for patients with known AF pre-ablation, to as little as 21.5% of patients with no known AF prior toablation. Given that monitoring in these follow-up studies wasvariable and rarely continuous, the true incidence of post-ablation AFmay be significantly higher than previously reported. Patients withAFl who also have dual chamber devices (pacemakers or defibrilla-tors); however, are continuously monitored for arrhythmia with nearperfect accuracy. Here, we report the true incidence of AF postablation of typical flutter in an ambulatory private practice setting.Methods: Our database was queried for all patients who underwentsuccessful AFl ablation in the past 8 years in whom a device had beenimplanted prior to the flutter ablation. Of 287 total AFl ablations, 23patients with previously placed devices were identified. From thesepatients, we found 14 in whom no AF was noted prior to the ablation.Results: Of these 14 patients 4 (28.6%) developed AF in a meanfollow-up of 19 months. The mean age of these patients was 71 years(range 58–83). The mean CHADS2 score was 1.9. In comparison, weidentified 9 patients who had known AF pre-ablation. Seven of these9 (77.8%) had AF post-ablation in a mean follow-up of 32 months.

The demographics of this group were otherwise similar with a meanage of 73 years (range 53–81), and a mean CHADS2 score of 1.8.Conclusions: The true incidence of AF post-AFl ablation is substantial,even in patients who have no history of AF prior to ablation.Furthermore, AFl ablation is unlikely to cure AF.

doi:10.1016/j.carrev.2012.01.014

Impact of glycemic control and hypoglycemic agents on theclinical outcome in diabetic patients with percutaneous coronaryintervention: from the FU-registryAmane Ikea, Kazuyuki Shiraib, Hiroaki Nishikawaa, Akira Kawamuraa,Atsushi Iwataa, Eiji Yahiroa, Yoshinari Ueharaa, Shin-ichiro Miuraa,Keijiro SakuaaFukuoka University, Fukuoka, JapanbHakujyuji Hospital, Fukuoka, Japan

Background: It is not yet clear whether glycemic control andhypoglycemic agents used affect the clinical outcome of percutaneousintervention (PCI) in diabetic patients.Methods and Results: Among 1809 patients who underwent PCI andreceived stent placement (FU-registry), we selected 774 DM patients,then divided them into 2 groups: a poor-glycemic-control group, whoshowed greater than 6.9%HbA1c at the time of PCI (Pre-HbA1c) (“≥6.9group”, n=357) and a good-glycemic-control group, who showed lessthan b6.9% at Pre-HbA1c (qb6.9 groupq, n=417). The patients in the≥6.9 group were further divided into two groups for furthercomparisons: a qDM control groupq and a qPoor control groupq. Atfollow-up (300 days), therewas no difference inmajor adverse cardiacevent (MACE) between the b6.9 group and ≥6.9 groups, as well asbetween the DM control group and Poor control group. In amultivariate analysis, therewas no relationship between the incidenceof MACE and Pre-HbA1c, Pre- HbA1c ≥6.9% or the HbA1c diffe-rence (Pre-HbA1c − HbA1c at follow-up), however, patients treatedwith insulin (OR:2.23, 95% CI: 1.50–3.30) or thiazolidine (OR:1.9, 95%CI: 1.07–3.41) positively related to MACE, while biguanide (OR:0.17,95% CI: 0.03–0.59) negatively related to MACE. Insulin treated DMpatients with HbA1c b6.5% tended to have increased MACE (Fig. 1).

Fig. 1.

e4 Abstracts / Cardiovascular Revascularization Medicine 13 (2012) e3–e19