Relationship of PRECISE-DAPT and DAPT scores with mortality in patients admitted with acute coronary syndrome who undergo coronary stent implantation

Introduction

International guidelines recommend using risk score tools that allow us to assess the risk of bleeding and ischemia when deciding on DAPT. In our research, we aimed to examine the mortality relationship of new risk scores, DAPT and PRECISE-DAPT scores.

Method

Between 2013–2014, 948 patients admitted to our clinic with ACS were included in our study. We excluded 688 patient (no contact number,CABG, medical treatment, use of oral anticoagulation, active malignant cancer). 260 patients admitted with acute coronary syndrome (58%, 8 STEMI, 35%, 4 non-STEMI, 5%, 4 Unstable angina pectoris) who undergo coronary stent implantation were included in the study. We aimed to focus on the patients who undergo percutaneous coronary intervention and their risk of mortality. The patients' records were retrospectively analyzed through the hospital information system and archive records. Laboratory results, echocardiography and CAG reports of the patients, disease histories were obtained from the information recorded through the system. With these data, PRECISE-DAPT and DAPT scores of patients were calculated.

Results

The number of patients with a PRECISE-DAPT Score ≥25 was 62 (23.8%). The number of patients with DAPT Score ≥2 was 193 (74.2%). Mortality occurred in 49 (18.8%) patients. Patients with PRECISE-DAPT ≥25 and those with PRECISE-DAPT <25 were compared in terms of mortality and mortality was significantly higher in the high-scoring group [P <0.001 OR 6.94 C (3.53–13.62)]. The patients were divided into 4 groups (PRECISE-DAPT 25 and DAPT ≥2, PRECISE-DAPT ≥25 and DAPT ≥2, PRECISE-DAPT 25 and DAPT 2, PRECISE-DAPT ≥25 and DAPT 2) according to PRECISE-DAPT and DAPT score. Mortality was significantly higher regardless of DAPT score in patients with high PRECISE-DAPT scores (p<0.001). We evaluated the relationship between PRECISE-DAPT score and major bleeding and all bleeding. Compared to the group there was no significant difference in all bleeding events (P=0.56) and major bleeding events (P=0.23). The relationship between bleeding events and mortality was evaluated. There was no significant difference in mortality (p=0.689) with all bleeding events; but mortality was significantly increased in patients with major bleeding [P=0.025 OR 6.16 (1,33–28,49)].

Conclusion

In our study, we observed that the patient group with a high PRECISE-DAPT score had a high mortality rate regardless of the DAPT score. The PRECISE-DAPT score is a useful tool in determining the group with high long-term mortality in patients who present with acute coronary syndrome and undergo percutaneous coronary intervention. The clinician should use the PRECISE-DAPT score when deciding on the duration of dual antiplatelet therapy in this patient group and these patients with high scores need to be monitored more closely. The data we have obtained from our study is retrospective and these results need to be supported by prospective and large studies.

Funding Acknowledgement

Type of funding sources: None.

Telemedicine-based early rule out and followup ECG algorithm for COVID-19 patients

Funding Acknowledgements

Type of funding sources: None.

Background

Drugs with the potential to prolong QT are used in the treatment of coronavirus 19 (COVID-19) pneumonia. We have developed a telemedicine-based corrected QT (QTc) follow-up algorithm that allows early rule out for follow up.

Aims

In this study, we investigated the availability and safety of the algorithm.

Study design

Retrospective cohort

Methods

Consecutive patients; administered hydroxychloroquine (HCQ) for COVID-19 pneumonia were enrolled into digital ECG recording program which includes QTc follow-up algorithm.

Results

Patients were classified into three groups as those, excluded promptly from the QTc follow-up based on two consecutive ECG findings (early rule out, n = 92) and those, for whom the follow-up was continued (n = 12) and usual care group (n = 68). Of note, 237 ECG tracings were performed in our algorithm population contrary to standard practice of daily recommended ECG monitoring which could have yielded 975 ECG tracings along with accompanied risks of exposure. This way; we ended in 738 (75.7%) fewer ECG tracings. Sustained ventricular arrhythmia or sudden cardiac death was not observed in the entire patient population.

Conclusions

It is safe to rely on telemedicine-based early rule out algorithm in COVID-19 patients, receiving hydroxychloroquine treatment. This algorithm abolished the need for further ECG in majority of patients without increased risk during follow up. These algorithms can significantly reduce the healthcare worker exposures by eliminating the need for ECG follow-up promptly.

P1734 Surprising image in the aortic root, is it zebra ?

CASE

80 year old-man patient was admitted our emergency department with dyspnea and chest pain. Transthoracic echocardiography (TTE) was performed.Ejection fraction was %60.Severe tricuspid regurtation was observed and pulmonary artery pressure was 55 mmHg.TTE showed mobile, hyperdense, flap-like appearance (Figure 1-A) Thorax computerized tomography (CT) angiography scan was performed with the suspicion of aortic dissection.CT angiography showed that there is no aortic dissection.(Figure 1-B) Transesophageal echocardiography (TEE) was planned. TEE showed an appearance consistent with the prosthetic material extending from the ascending aorta to the left main coronary artery.(Figure 1-C,D) When the patient"s history was investigated in detail, it was learned that the patient underwent coronary angiography six months ago.The patient was recommended bypass surgery, but he refused bypass surgery. Due to his rejection of bypass surgery, percutaneous intervention was attempted to the left anterior descending artery. Percutaneous coronary intervention was unsuccessful due to the severely calcified lesions. After learning this information, it was decided to perform imaging with fluoroscopy and chest CT without contrast.Because the image mimicking aortic dissection was thought to be the material related to previous unsuccesfull percutaneous coronary intervention. CT showed linear, hyperdense metallic densities that mimicked aortic dissection,extending form the left main coronary artery orifice to the ascending aorta. (Figure 1-E) The patient underwent imaging under fluoroscopy. In the imaging of the patient under fluoroscopy, it was observed that the image was consistent with the stent extending from the aorta to the left main coronary. (Figure 1-F) The mystery was solved and it was understood that during the unsuccessfull percutaneous coronary intervention the stent was removed from the balloon in the ascending aorta.

CONCLUSİON

In patients presenting with shortness of breath and chest pain, differantial diagnoses should always be life-threatening conditions such as aortic dissection, myocardial infarction and pulmonary embolism. When you hear hoofbeats, think of horses not zebras as taught in the early years of medical schools. Everything is never as it seems.Sometimes the sound of hoofbeats may also belong to the zebras.It is very important to evaluate the patient and medical history together with different perspectives.

Abstract P1734 Figure.

P699 Atrial septum tearing due to balloon sizing in percutaneous closure of ASD

CONCLUSION

In this case, we tried to present the rupture of the interatrial septum, which is a rare complication that may develop when using sizing balloon, and successful percutaneous closure of ASD in the same session.

Abstract P699 Figure.