M13. Stenting of right ventricular outflow tract as palliation for patient with right ventricular outflow tract obstruction with ventricular shunt physiology: a systematic review and meta-analysis

Aims

Right ventricular outflow tract (RVOT) stenting is emerging as an effective alternative to surgical palliation in selected patients. We aim to assess the outcome of RVOT stenting in patients suffered from RVOT obstruction with ventricular shunt physiology such as tetralogy of Fallot (ToF) and other type of lesions, also to compare its clinical outcomes with modified Blalock-Taussig shunt (mBTS) procedure.

Method and Results

A systematic review and meta-analysis was conducted according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement. We systematically searched the relevant studies from date of inception to June 2021. Outcomes of interest were pulmonary artery (PA) growth and oxygen saturation after palliation. Eleven retrospective studies (384 patients) were included for qualitative analysis, and four studies (193 patients) were eligible for meta-analysis. From our study, RVOT stenting can be accomplished safely and effectively in severe cyanosis or high risk patients with ToF physiology. Right PA z-score and oxygen saturation post RVOT stenting was significantly higher compared with post mBTS (MD 0.50; 95% CI 0.06 – 0.93, p = 0.03 and MD 3.46; 95% CI 1.42 – 5.49, p = 0.0009 respectively). Our analysis shows no significant difference of left PA z-score after palliation between two groups (MD -0.05; 95% CI -0.89 – 0.79, p = 0.90).

Conclusion

RVOT stenting effectively improves oxygen saturation and promotes proper pulmonary artery growth in patients with ToF physiology. The larger and randomized-controlled studies are required to better evaluate the efficacy of RVOT stenting and its superiority compared to mBTS.

M17. The usefulness of brain natriuretic peptide measurement in pediatric patients with cardiovascular disease: a systematic review and meta-analysis

Background and Aims

The use of brain natriuretic peptide (BNP), a common cardiac biomarker, has traditionally been limited to adult populations for heart failure assessment. In children, less is known about the diagnostic value of BNP. Emerging evidence suggests they might be useful in diagnosis of children with cardiovascular disease. We aim to evaluate the use of BNP in children with cardiovascular disease.

Methods and Results

We performed a systematic review of literatures on online databases for studies evaluating level of BNP in children with cardiovascular disease from inception to July 26, 2021. A total number of 8 studies comprising 1304 patients were included in the meta-analysis. All articles included in the meta-analysis had high quality according to the GRADE approach. From our analysis, higher BNP was found in patients with congenital heart disease (CHD) compared with healthy subjects (SMD 2.88 [0.21-5.56], p = 0.03; I2 99%). Higher BNP was also found in children with heart failure (HF) compared with patients without HF (SMD 1.21 [0.73-1.69], p < 0.0001; I2 0%), and higher in CHD patients with pulmonary hypertension (PH) compared with CHD patients without PH (SMD 1.76 [0.02-3.51], p = 0.05; I2 95%).

Conclusion

Significantly higher level of BNP was found in CHD patients, CHD-PH, and HF patients. Therefore, BNP measurement might be used for screening of CHD, PH in CHD populations and HF in pediatric populations. Further study is required to determine diagnostic accuracies and cut-offs within age groups.

OR37. Factors associated with in-hospital mortality in patients hospitalized with acute coronary syndrome

Background and Aims

Acute coronary syndrome (ACS) remains a source of high mortality worldwide, therefore it is important to determine factors associated with worse outcomes to better develop strategies to reduce the burden of disease. This paper aims to describe the characteristics of patients admitted with ACS to Kediri General Hospital and factors associated with in-hospital mortality.

Methods and Result

In this study, 117 patients admitted with ACS to Kediri General Hospital between January and June 2020 were included. Data were collected retrospectively from medical records and analysed using SPSS software v25. The median age was 60 (36-93) years old, 64 (54,7%) were male. They were presented either with STE-ACS (41%) or NSTE-ACS (59%). During hospitalization, 18 (15,4%) died. The bivariate analysis showed the patients who died were predominantly female (22,6% vs 9,4%, p = 0.048); had higher prevalence of Killip IV (38,9%, p = 0,003); higher prevalence of clinical signs of heart failure (23,7% vs 6,9%, p = 0,012); lower admission systolic blood pressure (117 ± 26,0 vs 137 ± 37,0, p = 0,036); lower admission diastolic blood pressure (70,6 ± 20,6 vs 81,5 ± 20,5, p = 0,04); and higher heart rate (104 ± 24 vs 91 ± 22, p = 0,026). From multivariable analysis, variables significantly associated with in-hospital mortality were decreased consciousness (OR 11, 95% CI 1.327-92.4, p = 0.026) and Killip class IV (OR 9.558, 95% CI 2.016-45.317).

Conclusion

Decreased consciousness and Killip class IV were significant independent predictors of in-hospital mortality in ACS.

OR60. The acef (age, creatinine, ejection fraction) score predicts major adverse cardiac events in patients hospitalized for acute coronary syndrome

Background and Aims

Age, Creatine, and Ejection Fraction (ACEF) score is a simple model for predicting mortality in patients undergoing elective cardiac surgery. However, the ability of ACEF score to predict other outcomes, such as major adverse cardiac events (MACE) in patients hospitalized with ACS, is less established.

Method and Result

In this study, 71 patients who were admitted with ACS to Kediri General Hospital between January and June 2020 with echocardiography data were included. The follow-up period to observe MACE was 6 months. The ACEF score was calculated using the following formula: age (years)/left ventricular ejection fraction (%) + 1 (if baseline serum creatinine was > 2 mg/dl). The median ACEF score was 1.15 (0.6-5.08). A higher ACEF score was linked with higher SGOT, the presence of diabetes mellitus, anaemia, and left bundle branch block (LBBB) on admission. ACEF score's predictive performance was then evaluated. Receiver-operating characteristic (ROC) curve analysis was used to assess the ability of ACEF score to predict MACE. The observed AUC was 0.8 (95% CI 0.6-0.98). Using ACEF score cut-off of 1.79, the sensitivity was 85.7% and the specificity was 82.8% to predict future MACE. The AUC in this study was higher than that in previous studies. Kristic et al (2021) found AUC of 0.63 (0.55-0.7) for ACEF score in predicting MACE in NSTE-ACS.

Conclusion

ACEF score may serve a simple way to predict risk of future MACE in patients hospitalized for ACS.

OR68. The impact of coronavirus disease 2019 pandemic on acute coronary syndrome hospitalizations, treatments, and outcomes: a dual-center observational study

Background and Aims

Since March 2020, transmission of coronavirus disease 2019 (COVID-19) in Indonesia have led to substantial decline in non-COVID-19 hospitalizations and healthcare services. We ought to determine the impact of COVID-19 pandemic on acute coronary syndrome (ACS) hospitalizations, treatments, and outcomes.

Methods and Results

We conducted a dual-center observational study in Bogor City General Hospital and Kediri General Hospital, Indonesia. We included all ACS patients between January-June 2020. Subjects were divided into two groups: pandemic period (admitted in March-June 2020) and pre-pandemic period (admitted in January-February 2020). 279 subjects were involved (107 pandemic vs 172 pre-pandemic). Monthly average ACS admissions reduced by 68.6% during pandemic period compared to pre-pandemic period. Proportion of STEMI subjects was significantly higher during pandemic compared to pre-pandemic (56.1% vs 38.4%; p = 0.004). Proportion of Killip 3-4 subjects was also significantly higher during pandemic compared to pre-pandemic (26.2% vs 14.5%; p = 0.016). However, reperfusion therapy (PCI or fibrinolytic) proportion for STEMI subjects was significantly lower during pandemic compared to pre-pandemic (16.7% vs 31.8%; p = 0.049), although there was no significant difference in onset time of ACS symptoms before hospitalization (p = 0.793). In-hospital mortality rate was significantly higher during pandemic compared to pre-pandemic (15.9% vs 8.1%; p = 0.045).

Conclusion

There was a significant decline in ACS hospitalizations, increased proportion of STEMI and KILLIP 3-4 patients, and higher in-hospital mortality rate in the pandemic period compared to pre-pandemic period. Paradoxically, reperfusion therapy proportion in STEMI patients has reduced significantly during pandemic period.

OR49. Predictor of prolonged length of stay in patients hospitalized with acute coronary syndrome

Aims

Acute coronary syndrome (ACS) is responsible for high rates of hospital admission with high cost burden. Knowing patients with projected prolonged length of stay (LOS) could enable clinicians to do early interventions and better preparations. This study aims to identify factors associated with prolonged LOS in ACS patients at the time of admission.

Method and Result

We included 237 ACS patients admitted to Kediri General Hospital and Bogor General Hospital between January and June 2020. Patients who died during hospitalization or discharged by their own will were excluded. Data were collected retrospectively and analyzed using SPSS v25. Prolonged LOS was defined as LOS more than 6 days. The mean age was 57.5±0.7 years, majority was male (65.8%) and had diagnosis of NSTE-ACS (56.5%). The median LOS was 5 days (2-23), and the prevalence of prolonged LOS was 18.1%. On bivariate analysis, factors associated with prolonged LOS were high risk age (men > 40 years and women > 50 years) (p = 0.01), hypotension (p < 0.01), decreased consciousness (p = 0.004), sign of shock (p = 0.002), tachycardia (p = 0.001), and higher Killip class (p = 0.002). After multivariable adjustment and stepwise elimination, hypotension was found to be significant independent predictor for prolonged LOS (OR 38.512 [95% CI 4.5-328], p = 0.001). The area under the receiver operating characteristic curve (AUC) was 0,704 (95% CI 0.614-0.794) which showed acceptable discrimination, and calibration was good (Hosmer-Lemeshow test: p = 0.96).

Conclusion

Hypotension was found to be strong independent predictor for prolonged LOS in ACS patients.

OR78. The utility of shock index, modified shock index and age shock index to predict in-hospital mortality and icu admission in patients hospitalized with acute coronary syndrome

Aims

The shock index (SI), the modified shock index (MSI), and the age shock index (ASI) are simple scales which can be obtained bedside. These scales have been studied to predict outcomes in various diseases. We aimed to evaluate the use of SI, MSI and ASI in patients hospitalized with acute coronary syndrome (ACS).

Method and Result

In this cross-sectional study, 102 patients who were admitted with ACS to Kediri General Hospital between January and June 2020 were included. Patients who presented with shock were excluded. We calculated for each patient the admission SI (defined as heart rate/systolic blood pressure), MSI (heart rate/mean arterial pressure), and ASI (age × SI). The mean SI was 0.70 ± 0.20, MSI was 0.95 ± 0.23 and ASI was 42.33 ± 14.17. Receiver-operating characteristic (ROC) curve analysis was used to assess the ability of SI, MSI and ASI to predict in-hospital mortality and ICU admission. The observed AUC of SI was 0.706 (95% CI 0.572-0.840), MSI was 0.705 (95% CI 0.58-0.83), and ASI was 0.687 (95% CI 0.540-0.834) in predicting in-hospital mortality. The cut-off point for SI was 0.75 with sensitivity of 69.2% and specificity of 67.4% in predicting in-hospital mortality. MSI demonstrated better C-statistics (0.665, 95% CI = 0.565 - 0.765) in predicting ICU admission.

Conclusion

SI had the best predictive value for in-hospital mortality compared with MSI and ASI, while MSI could predict ICU admission in patients with ACS.