The effect of extracorporeal shockwave myocardial revascularization therapy to myocardial perfusion and function in indicated CABG-stable angina pectoris patients: case series

OBJECTIVE

Many studies have found a beneficial effect of Extracorporeal Shockwave Myocardial Revascularization (ESMR) therapy for refractory angina patients. However, clinical studies ESMR therapy for indicated coronary artery bypass grafting (CABG)-stable angina pectoris (SAP) patients are limited.

PATIENTS AND METHODS

Four indicated CABG-SAP patients CCS class I-III reviewed in this study. All patients refuse to CABG procedure. Data of myocardial perfusion and function from medical records were collected.

RESULTS

After ESMR therapy, summed rest score was improved in patient 1 from 14 to 8, Patient 2 from 10 to 5, and Patient 3 from 6 to 4. Summed stress score was improved in patient 1 from 31 to 19. Left ventricular ejection fraction was improved in patient 1 at rest from 59 to 67% and stress from 39 to 57%. The global longitudinal strain was improved in patient 1 from -16 to -20.9 and Patient 3 from -14.8 to -18.2. Diastolic dysfunction severity was improved in patient 2 and patient 3 from grade 2 to grade 1.

CONCLUSIONS

In our case series, ESMR therapy for indicated CABG-SAP patients might improve myocardial perfusion and function, especially for patients with a high ischemic burden.

OR8. Appropriateness of percutaneous coronary intervention procedure in Indonesia

Background and Aims

There is a possibility of the high variability of the appropriateness of PCI performed in Indonesia. It is assumed that appropriate PCI tends to have clinical outcomes than other categories. This study aimed to evaluate the appropriateness of the percutaneous coronary intervention (PCI) procedure in Indonesia.

Method and Results

We assigned appropriateness ratings to 214 acute coronary syndromes (ACS) and 191 stable ischemic heart disease (SIHD) records that underwent PCI in four hospitals from 2017 - 2018. The included hospitals consist of one public and three private hospitals, two cardiovascular centers, and two general hospitals with the most performed PCI procedures on 2016 - 2018 and accessible to the researchers. The PCI appropriateness was adjudicated using 2016/2017 ACC/AHA guidelines of the Appropriate Use of Care (AUC) for coronary revascularization in ACS and SIHD. The results were categorized into “appropriate”, “maybe appropriate”, and “rarely appropriate”.  

The result from this study demonstrated that in ACS patients, 76.0% and 24.0% of PCI were appropriate” and “maybe appropriate”. While, in SHID patients, 68.7%, 28.7%, and 2.6% of PCI were “appropriate”, “maybe appropriate”, and “rarely appropriate”. In ACS patients, “appropriate” PCI is more commonly found in ST-elevation myocardial infarction (STEMI) cases (62.6%). In SIHD patients, 54.0% and 46.0% of left-main diseases patients underwent “maybe appropriate” and “rarely appropriate” PCI. 

Conclusion

The majority of PCI performed in ACS and SIHD patients from the studied hospitals are “appropriate”. 

OR13. Cardiac Arrythmias on COVID19 Patients: Characteristics, Correlated Risk Factors and Associated Outcomes

Background

Arrythmias in COVID19 patients were often found. This study was aimed to investigate characteristic, risk factors, and outcome of arrhythmic COVID19 patients.

Methods

This was a single-centered study. All confirmed COVID19 patients admitted from May 2020 until March 2021 were included. Data were obtained from medical records. Patients with no ECG or incomplete medical record were excluded. Bivariate analysis through Chi Square was used to define association between arrhythmia risk factors, and outcomes.

Results

374 patients were included, ranged from 2 until 85 years old (mean 52.5 ± 15, median 54). Mostly were males (53.7%) with 10 days median hospice care. Fifty eight patients (15.50%) had arrhythmia, which were mainly sinus tachycardia, supraventricular tachycardia, ventricular extra systole (3.7% each) and atrial fibrillation (3.5%). Congestive heart failure (CHF) (31.9%) and hypertension (28.7%) were the main comorbid. Bivariate analysis was conducted. CHF increased risk of arrhythmia by two times (RR: 2.15, CI 95%: 1.21 – 3.83, p < 0.008) and chloroquine use by 1.17 times (RR: 1.17, CI 95%: 1.05 – 1.11, p < 0.04). Arrhythmia events increased mortality risk by 2.5 times (RR: 2.52, CI 95%: 1.41–4.48, p < 0.001). Eighteen patients (31.03%) with arrhythmia died, especially those with atrial fibrillation (7 patients).

Conclusion

Sinus tachycardia, supraventricular tachycardia, ventricular extra systole, and atrial fibrillation were the most arrhythmia found. CHF and the use of chloroquine increased risk of arrhythmia. Arrythmia itself, especially atrial fibrillation, should be monitored as it increased mortality.