WCIM 2014 SEOUL KOREA 55
Poster Session
The Korean Journal of Internal Medicine Vol. 29, No. 5 (Suppl. 1)
PS 0036 Cardiology
Intra-Aortic Balloon Pump for Cardiogenic Shock with Resuscitation in Patients with Myocardial Infarction
Hyun Kuk KIM1, Myung Ho JEONG1, Youngkeun AHN1, Doo Sun SIM1, Shung Chull CHAE2, Young Jo KIM3
Chonnam National University Hospital, Korea1, Kyungpook National University Hospital, Korea2, Yeun- gnam University Hospital, Korea3
Background: The adjunctive use of intra-aortic balloon pump (IABP) has few convincing evidence of proven benefi t in cardiogenic shock with acute myocardial infarction (AMI).
We investigated the clinical effects of IABP in the group of patients hard to enroll randomized trials
Methods: Between November 2005 and April 2014, 49542 patients enrolled prospec- tive cohort study for AMI in Korea (KAMIR). Cardiopulmonary resuscitation (CPR) was performed in 1700 patients with cardiogenic shock. We exclude patients 1) who did not perform coronary angiogram, 2) performed extracorporeal membrane oxygenation (ECMO), 3) performed thrombolysis, and 4) presence of mechanical complications. The primary end point was 30-day all-cause mortality. A total of 883 patients in the IABP group and 476 in the control group were included.
Results: During the one-month follow-up, all-cause of death was occurred in 749 patients (55.1%). IABP group had higher a prevalence of male gender, ST-segment elevation MI (STEMI), and higher risk coronary lesion such as left main disease, three-vessel disease. Glycoprotein IIb/IIIa inhibitor was less used in non-IABP group.
In total population, IABP group showed worse outcomes in point of mortality rates after multivariate analysis [hazard ratio (HR) 1.22, 95% confi dence interval (CI) 1.02- 1.47, p=0.034] with similar rates of recurrent MI, stroke, and major bleeding. After propensity matching with a pair of 452 patients, there were no signifi cant differences in baseline characteristics and clinical outcomes (HR 1.21, 95% CI 0.93-1.57, p=0.158).
Conclusions: The use of IABP did not show clinical benefi ts in patients with acute deterioration cardiogenic shock complicating AMI for whom an early revascularization was planned. In contrary to expectation of clinician, poorer vital status of patients translated into decreasing benefi t of IABP.
PS 0037 Cardiology
Giant Left Descending Coronary Artery Aneurysm with Fistula to Double Chamber Right Ventricule.
Yasser HESSEIN ABDOU1, Maria Angeles PEREZ MARTINEZ2, Natalia PINILLA ECHEVARRI2, Maria Thiscal LOPEZ LLUVA2, Fernando LOZANO RUIZ-POVEDA2, Ignacio SANCHEZ PEREZ2, Miguel Angel RIENDA MORENO2
VALDEPEÑAS Hospital, Spain1, Ciudad Real Hospital, Spain2
A 36 year-old man was referred to our hospital for the evaluation of an abnormal shadow on the cardiac apex on a chest X-ray fi lm.He denied systemic disease such as hypertension or diabetes mellitus and had no history of specifi c conditions, such as Kawasaki’s disease, chest trauma or connective tissue disorder. He had no subjective symptoms. His blood pressure was 120/75 mmHg and pulse rate was 70 beats/min. On physical examination, continuous murmur of a grade II/VI was audible at 4th left in- tercostal space. The results of other physical examination and blood test were normal.
A Chest X-ray showed a radio-opaque shadow at the apex. An echocardiography was arranged and a round sac of 4x4 cm located in the apex, as well as a double-chamber right ventricle was observed Contrast echocardiography with Sonovue showed the fi lling of the vascular sac with contrast then partial fi lling of the distal RV apex. The abnormal vascular sac was connected from the left side to a vascular structure that looks to be coronary artery and from the right side to the distal part of a double right ventricle apex with a bi-directional shunt (fi stula). It also demonstrates the high ve- locity and centrifuge nature of blood fl ow in the vascular sac. Chest CT showed a LAD ectasia with a 4x4 cm saccular aneurysm at the distal portion of LAD Cardiac MRI revealed a giant left descending coronary artery distal aneurysm attached to a double apex right ventricle Coronary angiography revealed a dilated LAD with a huge saccular coronary aneurysm at its distal portion. The patient refused surgical correction for the coronary aneurysm and fi stula. He was discharged and has been followed up for more than 1 year without cardiovascular events.
PS 0038 Cardiology
Patterns of Ecg Changes During Occlusion of Left Cir- cumfl ex Coronary Artery
Mitsumasa OKANO1 Kitano Hospital, Japan1
Background: Despite of advances in high sensitivity troponin measurements and echocardiography, there are still diffi culties for the diagnosis of the acute coronary syndrome caused by the culprit lesion in left circumfl ex coronary artery. For examples, LCX is sometimes severely diseased with no signifi cant changes in ECG or minimal abnormalities in echocardiography.
Methods: We hypothesized that we could evaluate the ECG changes in the patients who underwent PCI for LCX during the occlusion of LCX by ballooning, for the better understanding of the ECG changes when LCX was occluded. We retrospectively ex- tracted ACS and Stable Angina Pectoris patients who underwent PCI for LCX in our hospital between April 2013 and February 2014. ECG before PCI and during the occlu- sion of LCX were compared. Patients with chronic total obstruction of LCX and other culprit lesions were excluded.
Results: A total of 23 patients were included for these analyses. Thirteen patients (57%) showed the changes in 1 and aVL leads. Nine patients (39%) showed the changes in 2, 3, and aVF leads. Eleven patients (48%) showed the changes in aVR leads, all of whom accompanied with the simultaneous changes in 1 and aVL leads, and 6 of whom ac- companied with additional changes in 2, 3, and aVF leads.
Conclusions: Balloon occlusion of LCX showed a variety of changes in ECG, not only typical ECG changes in lateral leads but also changes in inferior leads with changes in aVR leads.
