Impact of Three Different Glycoprotein IIb/IIIa Antagonists on Glycoprotein IIb/IIIa Platelet...

AB

ST

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S

S106 Heart, Lung and CirculationAbstracts 2009;18S:S1–S286

was not significant (p = 0.23). There were 15 deaths in eachgroup (p = 0.70).

Conclusions: Although the primary end-point of CHAT(Packer composite) was not met, TS significantly reducedthe number of HF patients hospitalised amongst a ruraland remote cohort. These data suggest that TS maybe an effective (and potentially cost-effective) approachto improve clinical outcomes in rural and remote HFpatients.

doi:10.1016/j.hlc.2009.05.239

238EFFICACY OF CALENDAR BASED ICD CHECKS: CON-VENTIONAL VS. REMOTE MONITORING FOLLOW-UP IN THE TRUST TRIAL

N. Varma 1, A. Epstein 2, A. Irimpen 3, L. Gibson 4, C.Love 5

1 Cleveland Clinic, Cleveland, OH, United States2 University of Alabama Medical Center, Birmingham, AL,United States3 Tulane University Medical Center, New Orleans, LA, UnitedStates4 BIOTRONIK, Inc., Lake Oswego, OR, United States5 Davis Heart & Lung Research Institute, Columbus, OH, UnitedStates

Background: Extension from the recommended 3 monthfollow-up (FU) to longer is not evidence-based. Adher-ence and problem detection rate is unknown, and effect ofreplacement of clinic visits (CV) with remote monitoringtechnology (RMT), which differs operationally, is unclear.TRUST, a multicenter prospective trial, tested these pointswith RMT performing daily checks.

Methods: 1312 patients were randomized post ICDimplant 2:1 to remote monitoring (RM) or to conventional(C) groups. 3 month FU was scheduled (S) in all patients:CV in C and remotely in RM. ICDs triggered event noti-fications (EN) for arrhythmias and system integrity issuesbetween S FU. CVs resulting from EN, and actionability(reprogramming, change in anti-arrhythmic therapy, orsystem revision) of CV were tracked.

Results: RM and conventional patients were similar(average 63-year-old male).

Causes of actionability were typically reprogramming(75%) and medication changes (27%). In RM, 54% of ENdriven CV (n = 102) occurring between 3 monthly S wereactionable. Median time to event evaluation was <3 dayscompared to >30 days in C.

Conclusions: Adherence to S CV deteriorates rapidly inC but RMT based evaluation remains consistently high.However, actionability is similarly low in both indicatingthat simple replacement with RMT does not affect detec-tion. However, EN driven evaluations are prompt andhighly actionable. The data question the efficacy of calen-dar based ICD monitoring and support RMTs providingautomatic daily surveillance with rapid event notifications.

3 months S 6 months S 9 months S 12 months S

Adh Act Adh Act Adh Act Adh Act

RM 88 13.0% 90* 16.7% 88* 12.0% 84 8.5%C 91 12.1% 78 9.2% 73 11.0% 65 10.0%

Adh = adherence/Act = actionability.

doi:10.1016/j.hlc.2009.05.240

239IMPACT OF THREE DIFFERENT GLYCOPROTEINIIB/IIIA ANTAGONISTS ON GLYCOPROTEIN IIB/IIIAPLATELET RECEPTOR INHIBITION, TISSUE LEVELPERFUSION AND CLINICAL ENDPOINTS

Rohan Gupta 1, Patrick Diu 2, Tuan Nguyen 2, KishorKadappu 2, Saissan Rajendran 1, Sidney Lo 1,2, DominicLeung 1,2, John French 1,2, Craig Juergens 1,2

1 University of New South Wales, Sydney, NSW, Australia2 Liverpool Hospital, Sydney, NSW, Australia

Background: There are no randomised control trialscomparing abciximab, high-dose tirofiban and double-bolus eptifibatide on level of platelet function inhibition,effect on tissue level perfusion and clinical endpoints,in Acute Coronary Syndrome (ACS) patients undergoingPercutaneous Coronary Intervention (PCI).

Methods: Patients with high-risk ACS undergoing PCI,in whom a Glycoprotein IIb/IIIa Inhibitor (GPI) was used,were randomised to one of three GPIs. Platelet inhibitionwas measured at 10 min, 1, 8 and 24 h after commence-ment of therapy using the Ultegra Rapid Platelet FunctionAssay (Accumetrics). Epicardial and myocardial flow wereassessed using Thrombolysis in Myocardial Infarction(TIMI) flow grade, corrected TIMI Frame Count (cTFC)and TIMI Myocardial Perfusion Grade (TMPG) before andimmediately following PCI. Major adverse cardiac eventswere monitored for 30-days post-procedurally.

Results: Based on 25 patients enrolled to-date, therewas no significant difference in platelet inhibition betweenthe three treatments at 10 min, 1 and 8 h. At 24 h,platelet inhibition was significantly better with abcix-imab (77 ± 14%) versus tirofiban (26 ± 23%; p < 0.001) oreptifibatide (36 ± 24%; p = 0.002). There was no significantdifference with respect to epicardial blood flow and tissuelevel perfusion. There was no difference in adverse clinicaloutcomes between groups.

Conclusion: In this preliminary study, high-dosetirofiban was equivalent to double-bolus eptifibatide andabciximab in regards to platelet inhibition at 10 min, 1 and8 h. However, consistent with its biological effect, abcix-imab was more effective than high-dose tirofiban anddouble-bolus eptifibatide in relation to platelet inhibition24 h after PCI.

doi:10.1016/j.hlc.2009.05.241