WCIM 2014 SEOUL KOREA 57
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0043 Cardiology
The Predictive Value of Aortic Arch Calcifi cation on Chest X-Ray for Cardiovascular Events in Comparison with the Coronary Artery Calcium Score and the Fram- ingham Risk Score
Unjoo LEE1, Jongshin WOO1, Weon KIM1, JinBae KIM1, SooJoong KIM1, WooShik KIM1, Kwonsam KIM1, SeHwan KIM2
Department of Internal Medicine, Kyung Hee University Medical Center, Korea1, Department of Radiolo- gy, Kyung Hee University Medical Center, Korea2
Background: The coronary artery calcium (CAC) and aortic arch calcifi cation (AoAC) are individually associated with cardiovascular disease and outcome. This study in- vestigated the predictive value of AoAC compared with CAC and the Framingham risk score (FRS) in coronary artery disease (CAD) and for the associated adverse events.
Methods: A total of 2,018 stable angina patients who underwent chest X-ray and cardiac multi-detector computed tomography were followed up for 4 years to assess adverse events, which were categorized as cardiac death, stroke, myocardial infarction, or repeated revascularization. The extent of AoAC on chest X-ray was graded on a scale from 0–3.
Results: During the 4 years of follow-up, 620 patients were treated by coronary stenting and 153 (7%) adverse events occurred. A progressively higher grade of AoAC was associated with a higher CAC score or FRS. Cox regression showed that the FRS (odds ratio [OR] 2.08, 95% confi dence interval CI [1.89–2.29]) and CAC score (OR 1.00, 95% CI 1.00–1.01), but not AoAC, were associated with adverse events. In patients with a FRS < 20 or a CAC score < 400, AoAC showed an additive predictive value for detecting signifi cant CAD. A gradual increase in the risk of adverse events was noted if AoAC was present in patients with similar CAC score or FRS (Figure).
Conclusions: Although the CAC score is a powerful predictor of adverse events, eval- uation of AoAC could be valuable for predicting signifi cant CAD in low- to intermedi- ate-risk patients assessed by FRS.
PS 0044 Cardiology
Platelet Reactivity in Patients with End Stage Renal Disease Receiving Clopidogrel Compared with Ticagr- elor: Results of Platelet Inhibition Sccording to Novel Drug in Patients with End Stage Renal Disease (Piano-3 ESRD) Randomized Cross Over Study
Unjoo LEE1, Weon KIM1, WooShik KIM1, JongShin WOO1, JinBae KIM1, KwonSam KIM1, TaeWon LEE1, KyungHwan JEONG1, JuHee CHO1, ChunGyoo IHM1
Kyung Hee University Medical Center, Korea1
Background: Patients with ESRD on maintenance hemodialysis are poor responders to clopidogrel. The aim of this study was to assess the functional impact of ticagrelor in end stage renal disease (ESRD) patients receiving maintenance hemodialysis.
Methods: In a single-center, prospective, randomized, crossover study, 25 ESRD pa- tients on hemodialysis were assigned to receive ticagrelor (180 mg loading, 90 mg twice daily for maintenance dose) or clopidogrel (300 mg loading, 75 mg once daily for maintenance dose) for 14 days, and after a 14-day washout period, crossover treatment assignment for another 14 days. Platelet function was evaluated before and after antiplatelet therapy via light transmittance aggregometry and VerifyNowTM P2Y12 assay, and genotyping was performed for CYP2C19*2 status.
Results: Higher inhibition of platelet aggregation (IPA) at both 5 and 20 μmol/L ADP stimuli occurred with ticagrelor than with clopidogrel at 1, 5, and 48 hours, and 2 weeks after loading (Figure). By 5 hours after loading, a greater proportion of patients in the ticagrelor group than in the clopidogrel group achieved IPA >50% (75% versus 12%, respectively, p < 0.05), and IPA >70% (44% versus 0%, respectively, p < 0.05).
The rates (slope) of onset and offset of the antiplatelet effect were faster in patients on ticagrelor than on clopidogrel (P<0.05). Regardless of status of CYP2C19*2 allele, the ticagrelor group showed signifi cantly lower P2Y12 reaction units at all times after loading and during maintenance.
Conclusions: Ticagrelor achieved more rapid and greater platelet inhibition than clopi- dogrel did in ESRD patients on hemodialysis.
