350 Improving outcome in coronary artery disease

350
Improving outcome in coronary artery disease
1946 | BEDSIDE
Short-term statin therapy for prevention of contrast induced-acute
kidney injury in patients with diabetes and chronic kidney disease
Minjoz, Department of Cardiology, Besancon, France; 8 University Hospital of
Toulouse, Toulouse, France; 9 AP-HP - Hospital Saint Antoine, Clinical Research
Unit (URC) - Est, Paris, France
Y.L. Han 1 , G.Y. Zhu 2 , B. Xu 3 , R. Mehran 4 , Y. Huo 5 . 1 Shenyang Northern
Hospital, Department of Cardiology, Shenyang, China, People’s Republic of;
2 Asian Heart Hospital, Wuhan, China, People’s Republic of; 3 Cardiovascular
Institute & Fuwai Hospital, Beijing, China, People’s Republic of; 4 Mount Sinai
Medical Center, New York, United States of America; 5 No. 1 Hospital affiliated to
Beijing Medical University, Beijing, China, People’s Republic of
Background and aim: Recent evidence suggests that overweight is not associated with increased risk of premature death in the general population. We assessed 5-year mortality in AMI hospital survivors according to body mass index
(BMI) category and waist circumference (WC).
Methods: FAST-MI is a French nationwide registry of STEMI and NSTEMI patients included at the end of 2005 in 223 institutions (60% of all institutions taking
care of AMI patients). Of 3,670 patients enrolled, 3,463 were discharged alive, of
whom 3102 had BMI and 1647 WC recorded. BMI was categorized into 5 groups
(<22, 22-25, 25-30, 30-35 ≥35 kg/m2 ) and the upper quartile of WC was calculated within each BMI category. 5-year follow-up was available in 95%. Cox
multivariate analyses included baseline characteristics, in-hospital management
and complications, and discharge medications.
Results: Five-year mortality was lowest (21%) in the 25-30 kg/m2 category and
highest in the < 22 (35%) and ≥ 35 (27%) groups (P<0.001). Likewise, being in
the upper WC quartile was associated with increased 5-year mortality (40% vs
21%). Adjusted Hazard Ratios for 5-year death, compared with the 25-30 kg/m2
category, are displayed in Figure; upper quartile of WC was also an independent
correlate of 5-year death (HR 1.40; 1.14-1.73, P=0.002).
Background: Contrast-induced acute kidney injury (CIAKI) is an important complication after contrast media injection. While small studies have shown positive
results with statin therapy, the role of statin therapy in prevention of CIAKI remains
unknown. The aim of this study was to evaluate the safety and efficacy of rosuvastatinin preventing CIAKI in patients with diabetes mellitus (DM) and chronic
kidney disease (CKD).
Methods and results: We randomized 2,998 patients with type 2 DM and concomitant CKD who were undergoing coronary/peripheral arterial angiography with
or without percutaneous intervention to rosuvastatin 10 mg/day (n=1,498) for five
days (two days before, three days post procedure) or standard-of-care (n=1,500).
Renal function was assessed at baseline, 48, and 72 hours aftercontrast mediaexposure. The primary endpoint of the study was the development of CIAKI,
which was defined as an increase in serum creatinine concentration ≥0.5 mg/dL
(44.2μmol/L) or ≥25% above baseline at 72 hours after exposure to contrast
media. Patients randomized to the rosuvastatin group had a significantly lower incidence of CIAKI compared to controls (2.3% vs 3.9%;P=0.01; OR=0.58, 95% CI
0.38, 0.89). There was no significant difference in the rate of major adverse cardiac events (MACE) except worsening heart failure, which was significantly lower
in patients treated with rosuvastatin (2.6% vs 4.3%;P=0.02).
Conclusion: Rosuvastatin significantly reduced the risk of CIAKI in patients with
DM and CKD undergoing arterial contrast media injection.
A. Gille 1 , S. Wright 2 , R. Easton 2 , C. Shear 2 . 1 CSL Limited, Parkville, VIC,
Australia; 2 CSL Behring, King of Prussia, PA, United States of America
Purpose: The ability of HDL to promote cholesterol efflux from atherosclerotic
plaque is thought to underpin its potential for cardioprotection. CSL112 is apoA-I,
the active component of HDL, purified from human plasma and reconstituted to
form HDL-particles suitable for infusion. CSL112 is in development for the treatment of ACS, and this study measures the ability of CSL112 to promote cholesterol movement.
Methods and results: We studied PK and biomarkers of cholesterol movement following a single infusion of 5 to 135 mg/kg CSL112 in 42 of 57 enrolled
healthy subjects, all other subjects received placebo (NCT01129661). We previously showed that infusion of CSL112 caused an immediate and large elevation
in serum cholesterol efflux capacity. Consistent with this finding, during the initial
24 h interval, HDL-cholesterol increased in a dose-dependent manner while nonHDL-cholesterol did not change. These observations demonstrate movement of
tissue cholesterol to HDL. Here, we investigated the fate of that HDL cholesterol.
During the first 24 h following the infusion we observed a progressive conversion
of unesterified cholesterol (UC) in HDL to esterified cholesterol (EC), indicating
the action of LCAT. The predominant clearance path for HDL EC involves transport to non-HDL cholesterol by CETP, an enzyme that removes HDL EC in exchange for triglyceride (TG). Two findings support the action of this pathway after
infusion of CSL112. In the first 24 h we observed a transient, dose-dependent increase in TG in the HDL-fraction. Second, we observed a transient rise in CETP
activity after the infusion of CSL112. Further studies showed that enhanced CETP
activity did not lead to an increase in non-HDL-cholesterol indicating that there
was no saturation of the hepatic LDL-receptor mediated catabolism of LDL.
Conclusion: Infusion of CSL112 caused an immediate rise in apoA-I, cholesterol
efflux capacity and exit of tissue cholesterol into plasma. Newly effluxed cholesterol appears to follow a normal route of clearance with passage to non-HDL
lipoproteins via CETP. CSL112 may thus provide a novel option to rapidly transport cholesterol from atherosclerotic plaque to the liver and reduce early recurrent
events following ACS.
HR for 5-year death according to BMI
Conclusion: In this real-world nationwide AMI registry, underweight (<22) and
severe obesity (≥35 kg/m2 ) were independent correlates of increased 5-year mortality beyond the hospital phase. In addition, high waist circumference was also
associated with increased risk. The lowest mortality was observed in the overweight category. Reducing weight, except in very obese patients, does not seem
to be an important health priority in patients having sustained an AMI.
1949 | BEDSIDE
Reperfusion arrhythmia bursts predict larger infarct size in STEMI
patients undergoing primary percutaneous coronary intervention
despite optimal epicardial and microvascular flow
K. Van Der Weg 1 , W.J. Kuijt 2 , K.T. Koch 2 , J.G.P. Tijssen 2 , J.D. Haeck 2 ,
C.L. Green 3 , M.W. Krucoff 3 , A.P.M. Gorgels 1 , R.J. Winter 2 . 1 University Hospital
Maastricht, Maastricht, Netherlands; 2 Academic Medical Center, University
of Amsterdam, Department of Cardiology, Amsterdam, Netherlands; 3 Duke
University Medical Center, Duke Clinical Research Institute, Durham, United
States of America
Background: Ventricular arrhythmia (VA) bursts are associated with larger infarct
size (IS) in patients presenting with ST elevation myocardial infarction (STEMI)
after achieving TIMI 3 flow with primary coronary intervention (pPCI). Inadequate
microvascular reperfusion, as determined by myocardial blush grade (MBG) ≤2,
has also been shown to be associated with larger IS. We hypothesized that VA
burst is a marker of an unfavorable response to reperfusion resulting in larger IS
in patients with optimal epicardial and optimal microvascular obstruction.
Methods: 144 STEMI patients from the PREPARE study were included with
24 hour continuous, 12-lead Holter monitoring, and who achieved brisk epicardial flow restoration (TIMI 3 and MBG 3) post pPCI (figure 1). Angiographic
1948 | BEDSIDE
Long-term prognostic impact of body mass index and waist
circumference in hospital survivors of acute myocardial infarction.
Data from the French FAST-MI 2005 registry
N. Danchin 1 , E. Puymirat 1 , M. Zeller 2 , P.G. Steg 3 , J. Machecourt 4 , N. Delarche 5 ,
P.V. Ennezat 6 , F. Schiele 7 , J. Ferrieres 8 , T. Simon 9 on behalf of FAST-MI
Investigators. 1 AP-HP - European Hospital Georges Pompidou, Paris, France;
2
University Hospital Center (CHU) Dijon, Dijon, France; 3 AP-HP - Hospital
Bichat-Claude Bernard, Department of Cardiology, Paris, France; 4 CHU,
Grenoble, France; 5 Hospital Francois Mitterand, Pau, France; 6 Eaux-Claires
Clinic, Grenoble, France;7 University Hospital of Besancon - Hospital Jean
Figure 1. Patient selection
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1947 | BEDSIDE
Infusion of CSL112, a novel formulation of human apolipoprotein
A-I, in healthy subjects removes tissue cholesterol and directs its
clearance