54 32nd World Congress of Internal Medicine (October 24-28, 2014) WCIM 2014
presence of Mets in obese patients was not an independent factor for predicting the adjusted MACE rate at one-month (HR 1.19, 95% CI 0.56-2.54, P=0.645), six-month (HR 1.48, 95% CI 0.94-2.32, P=0.088), and twelve-month (HR 1.10, 95% CI 0.75-1.61, P=0.622).
Conclusions: Obesity phenotype is not an independent prognostic factor for patients with STEMI who undergoing primary PCI. The risk stratifi cation by presence or absence of Mets is not useful in these patients.
PS 0034 Cardiology
Prognostic Impact of Bundle Branch Block in Diabetic Patients with Acute Myocardial Infarction
Doo Sun SIM1, Myung Ho JEONG1, Youngkeun AHN1, Young Jo KIM2, Shung Chull CHAE3, Taek Jong HONG4, In Whan SEONG5, Jei Keon CHAE6, Chong Jin KIM7, Myeong Chan CHO8, Seung Woon RHA9, Jang Ho BAE10, Ki Bae SEUNG11, Seung Jung PARK12
Chonnam National University Hospital, Korea1, Yeungnam University Hospital, Korea2, Kyungpuk National University Hospital, Korea3, Busan National University Hospital, Korea4, Chungnam National University Hospital, Korea5, Chunbuk National University Hospital, Korea6, Kyung Hee University Hospital, Korea7, Chungbuk National University Hospital, Korea8, Korea University Guro Hospital, Korea9, Konyang Univer- sity Hospital, Korea10, Catholic University Hospital, Korea11, Asan Medical Center, Korea12
Background: Prognostic implications of BBB in diabetic patients with acute MI have yet to be clarifi ed.
Methods: We analyzed 23,724 patients with acute MI from the Korea Acute Myocar- dial Infarction Registry and the Korea Working Group on Myocardial Infarction Registry.
Twelve-month clinical outcome was compared between patients with BBB and those without BBB according to the presence of DM.
Results: Patients with left BBB (n = 181) were older, more likely to be men, have hyperten- sion, DM, multi-vessel disease, left ventricular dysfunction, less likely to have chest pain at presentation and receive percutaneous coronary intervention (PCI) and beta blockers. All- cause mortality and the rate of major adverse cardiac events (MACE: all-cause mortality, MI, and repeat revascularization) were higher in patients with left BBB at 1 month and 12 months. Patients with right BBB (n = 494) were older, more likely to be men, have prior stroke, less likely to have chest pain at presentation and PCI. All-cause mortality and MACE were similar at 1 month, but higher in patients with right BBB at 12 months. Diabetics with left BBB, compared to diabetics without left BBB, had higher prevalence of multi-vessel disease (80% vs. 65%, p = 0.024), which was similar in non-diabetics regardless of the presence of left BBB. On multivariate analysis, left BBB was associated with 12-month all- cause mortality in diabetics (hazard ratio: 2.6; 95% confi dence interval: 1.25 to 5.25; p = 0.010), but not in non-diabetics, while right BBB was not an independent predictor of death regardless of diabetic status.
Conclusions: In patients with acute MI, BBB was associated with worse 12-month clinical outcome. Particularly in diabetics, left BBB was associated with more extensive coronary artery disease and higher mortality.
PS 0035 Cardiology
Impact of Renal Insuffi ciency on Outcomes After No-Refl ow Phenomenon of Patients with Acute Myo- cardial Infarction
Seunghun LEE1, Myungho JEONG1, Ju Han KIM1, Hyuk Jin PARK1, Yun Ah JEONG1, Joon Ho AHN1, Youngkeun AHN1, Jong Hyun KIM2, Shung Chull CHAE3, Young Jo KIM4, Seung Ho HUR5, In Whan SEONG6, Taek Jong HONG7, Donghoon CHOI8, Myeong Chan CHO9, Chong Jin KIM10, Ki Bae SEUNG11, Wook Sung CHUNG11, Yang Soo JANG8, Jeong Gwan CHO1, Jong Chun PARK1, Seung Jung PARK12
Chonnam National University Hospital, Korea1, Hanseo Hospital, Korea2, Kyungpook National University Hospital, Korea3, Yeungnam University Hospital, Korea4, Keimyung University Dongsan Medical Center, Korea5, Chungnam National University Hospital, Korea6, Pusan National University Hospital, Korea7, Yonsei University Severans Hospital, Korea8, Chungbuk National University Hospital, Korea9, Kyunghee University College of Medicine, Korea10, The Catholic University of Korea Hospital, Korea11, Asan Medical Center, University of Ulsan College of Medicine, Korea12
Background: The no-refl ow phenomenon (NR) has been known as an embarrass- ing event during percutaneous coronary intervention in patients with acute my- ocardial infarction (AMI). In these patients, impact of renal insuffi ciency (RI) has remained unclear. This study aims to investigate the correlation of RI and NR on clinical outcomes
Methods: We analyzed in-hospital mortality, complications, and major adverse cardiac events (MACE) of 1,121 patients who underwent NR in the Korea Acute Myocardial Infarction Registry from November 2005 to October 2010. NR was diagnosed when a signifi cant decreased of coronary fl ow (Thrombolysis in Myocar- dial Infarction [TIMI] fl ow grade<3) was revealed through the fi nal angiograms. RI was defi ned as estimated glomerular fi ltration rate (eGFR) < 60 ml/min by Cock- croft-Gault equation.
Results: RI group was composed of 531 patients (47.4%) and non-RI group 590 patients (52.6%). The patients with RI had higher incidence of in-hospital mor- tality (15.8% vs. 3.9%, P<0.001) and composite complications (23.2% vs. 15.6%, P=0.001) compared with non-RI patients. At one year, RI group showed signifi - cantly higher incidence of MACE and all-cause mortality (log-rank, P<0.001) (Fig.
1). By the multivariate Cox regression analysis, the presence of RI was still a strong indicator of poor prognosis at twelve month (adjusted HR 2.58, 95% CI 1.45-4.60, P=0.001).
Conclusions: The RI is an independent factor predicting poor clinical outcomes in patients with AMI undergoing NR.
