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Cardiovascular Journal of Africa • ABSTRACTS – SA HEART
®
CONGRESS 2019
S19
AFRICA
The leading aetiology was tuberculous-pericarditis (81.0%); iatrogenic cardiac catheterisation-related effusions comprised 1.3%. Overall, EGPP procedural
success rate was 95% and 6-month survival was 98% (95% CI: 95 - 99), with a total procedure-related complication prevalence of 6.5% (95% CI: 4.5 - 8.9%);
(major: 1.7%; minor: 4.8%), compared to a complication rate of 4.7% (major: 1.2%; minor: 3.5%) in the largest series from the Mayo Clinic. The preferred site of
access, as per ultrasound-guidance, was the trans-apical route (55%). After adjusting for confounding variables in a multivariate analysis, multiple punctures
were associated with procedure-related complications [odds ratio 7.0 (95%) confidence interval (CI): 3.30 -14.90].
Conclusion:
Tuberculosis is the leading cause of pericardial disease and is associated with significant mortality. EGPP is associated with a low prevalence of
complications in our centre, with major procedure related complication prevalence comparable to that of a leading centre from a high-income country. After
adjusting for confounders in a multivariate analysis, multiple punctures were highly associated with an increased risk of procedure-related complications.
Thrombus aspiration in combination with glycoprotein IIb/IIIa inhibitors with, or without, stent implantation in patients
presenting with STEMI and high thrombus burden
Konstantinos Kintis, Emmanouel Papadakis, Dionisis Antonatos, Christos Mantis, Charis Armonis, Konstantinos Thomopoulos,
Michael Koutouzis, Ioannis Tsiafoutis, Areti Poulianitou, Kyriakos Dimitriadis and Sotiris Patsilinakos
Konstantopoulio General Hospital, lNea Ionia, Greece
Introduction:
High thrombus burden is an independent risk factor for death and complications, including no reflow, during primary percutaneous coronary
intervention (PCI) for STEMI. The aim was to investigate whether a strategy of thrombus aspiration in combination with glycoprotein IIb/IIIa inhibitors without
stent implantation is associated with a reduced incidence of slow- or no-reflow, and other thrombotic complications compared with stenting in patients with
high thrombus burden.
Methods:
A total of 210 patients with STEMI and high thrombus burden (thrombolysis in myocardial infarction thrombus grade ≥3) treated with thrombus
aspiration in combination with glycoprotein IIb/IIIa inhibitors with or without stent implantation. Patients were divided into 2 groups: non-stent PCI group
(deferred stenting, n=105) and stent PCI group (immediate stenting, n=105). A new catheterisation and deferred stent implantation was performed 48
- 72 hours after primary PCI. The end points were a myocardial blush grade of 0 or 1 (defined as absent or minimal myocardial reperfusion, respectively)
and the postprocedural frequencies of a TIMI flow grade of 3, complete resolution of ST-segment elevation immediately after primary PCI, target vessel
revascularisation, reinfarction, death and the combination of major adverse cardiac events by 30 days after randomisation.
Results:
A myocardial blush grade of 0 or 1 occurred in 26.3% of the patients in the stent PCI group and in 17.1% of those in the non-stent PCI
group (p<0.05). Complete resolution of ST-segment elevation occurred in 86.6% and 78.2% of patients, respectively (p=0.35). At 30 days, the rate of death
in the stent PCI group and non-stent PCI group was 1.7% and 1.0%, respectively (p=0.33) and the rate of adverse events was 12.1% and 2.2%, respectively
(p<0.01).
Conclusions:
Thrombus aspiration, in combination with glycoprotein IIb/IIIa inhibitors without immediate stenting, is an applicable and effective method in
a large majority of patients with myocardial infarction with ST-segment elevation and a high thrombus burden.
Factors affecting radiation exposure during transradial diagnostic coronary angiography
Konstantinos Kintis, Emmanouel Papadakis, Dionisis Antonatos, Christos Mantis, Charis Armonis, Konstantinos Thomopoulos,
Michael Koutouzis, Ioannis Tsiafoutis, Areti Poulianitou, Kyriakos Dimitriadis and Sotiris Patsilinakos
Konstantopoulio General Hospital, lNea Ionia, Greece
Introduction:
The transradial approach during diagnostic cardiac catheterisation is being increasingly adopted as the preferred vascular access, although it
is associated with increased radiation exposure when compared to the femoral access. The aim was to evaluate the factors affecting radiation exposure using
the transradial approach including: radial side, catheter size and clinical determinants.
Methods:
Our population consisted of 1 021 consecutive patients without a previous history of CABG (673 males, aged 66 years) which underwent
diagnostic coronary angiography. Cardiac catheterisations performed via right or left radial approach using 5 or 6 French (Fr) diagnostic catheters.
The primary end-points of the study were: procedural success, fluoroscopy time (FT), dose-area product (DAP), air kerma (AK) and amount of
contrast agent.
Results:
In the total population, FT was negatively related to height (r=-0.100, p<0.001) and positively associated with age (r=0.111, p<0.001). Dose-area
product was positively associated with weight (r=0.424, r<0.001), height (r=0.222, r<0.001), BMI (r=0.361, r<0.001) and BSA (r=0.418, r<0.001). Independent-
samples t-test indicated that the male sex, compared to the female sex, was characterised by increased DAP (30 221 ± 9 543 vs. 23 208 ± 5 651mGycm
2
,
p<0.001), increased AK (458 ± 59 vs. 352 ± 53mGy, p<0.001), but decreased FT (2.88 ± 1.00 vs. 3.18 ± 0.79 minutes, p<0.05). The group of 6 Fr, compared to the
group of 5 Fr, was characterised by increased DAP (29072 ± 9 387 vs. 25 825 ± 4 861mGycm
2
, p<0.001) and AK (441 ± 61 vs. 392 ± 49mGy, p<0.001). Finally,
the left radial grouped when compared to the right radial group was characterised by an increased FT (3.27 ± 0.80 vs. 2.86 ± 0.73 minutes, p<0.01).
Conclusions:
In patients undergoing transradial diagnostic coronary angiography, radial side, catheter size and clinical characteristics are factors of radiation
exposure and FT in patients. These findings imply that operators seem to be less familiar with the left side approach.
Coronary artery ectasia, an independent predictor of high thrombus burden in patients presenting with ST-elevation
myocardial infarction
Konstantinos Kintis, Emmanouel Papadakis, Dionisis Antonatos, Christos Mantis, Charis Armonis, Konstantinos Thomopoulos,
Michael Koutouzis, Ioannis Tsiafoutis, Areti Poulianitou, Kyriakos Dimitriadis and Sotiris Patsilinakos
Konstantopoulio General Hospital, lNea Ionia, Greece
Introduction:
High thrombus burden is an independent risk factor for death and complications, including no reflow, during primary percutaneous coronary
intervention (PCI) for ST-elevation myocardial infarction (STEMI). The aim of this study was to determine the potential association between coronary artery
ectasia (CAE) and high thrombus burden during primary PCI.