Intracoronary nitroprusside is the preferred vasodilator for fractional flow reserve

e23Abstracts / Cardiovascular Revascularization Medicine 12 (2011) e1–e46

numbers were 78–111 with a mean of 93 (GP-A) but were 68–94 with amean of 77 pre and 66-92 with a mean of 79 post gradual D/C (GP-B).Overall, 12/99 patients in GP-A had a significant increase in plateletaggregation post sudden D/C vs. 0/74 in Gp-B (Pb.01). Only one patient inGP-A had LST that occurred 6 days post D/C clopidogrel.Conclusion: Light transmission aggregometry determined platelet aggre-gation revealed an enhanced rebound aggregation post sudden D/Cclopidogrel that was not shown after gradual tapering of clopidogrel over2 weeks before complete stopping.

doi:10.1016/j.carrev.2011.04.303

Intracoronary nitroprusside is the preferred vasodilator for fractionalflow reserveSalvador Sancheza, Michael Benzb, Preet Randhawab, Cyndy Cruz c,Wojcek Rudzinskic, Jim Riley c, Marc Klapholz c, Edo KaluskidaUniversity Hospital Newark, NJ, University Hospital NJ Medical School,NJ, USAbUniversity Hospital Newark, UMDNJ, NJ, USAcUniversity Hospital Newark, Newark, NJ, USAdUniversity Hospital Newark, Florham Park, NJ, USA

Background and aim: Fractional flow reserve (FFR) is routinely used forcoronary lesion assessment. Maximal coronary vasodilatation can beaccomplished by intracoronary (IC) and intravenous (IV) adenosine (thegold standard), IC-nitroprusside (NTP) or IC-papaverine. We compared FFRresponse to IC-NTP vs. IV-adenosine.Methods: Nitroprusside 100 μg bolus was injected over b3 s (tworepeated injections 60 s apart). Sixty seconds after last NTP injection,continuous intravenous administration of adenosine (140 μg/kg/m) wasinitiated for 150 s. The FFR was measured using conventional FFR wire(Prime Wire, Volcano) and guiding catheters (6F Cordis guides with orwithout side holes).Results: Eighteen lesions were assessed. Time to maximal vasodilatationwas consistently under 20 s for NTP and varied between 50 and 120 s forintravenous adenosine. Second NTP injection did not provide additionalFFR reduction when compared to first injection. IC-NTP-induced FFR wasconsistently similar or lower than IV-adenosine-induced FFR and was notaffected by guiding catheter side holes. Five of the patients experiencedunpleasant sensation during adenosine infusion. The hypotensive effect ofNTP was short lived and did not result in any side effects. One patient had noFRR response to adenosine but responded to NTP.Conclusion: Nitroprusside 100 µg single intracoronary bolus results inexcellent and consistent coronary vasodilation within b20 s that appearsequal or superior to continuous intravenous adenosine. Since NTP isinexpensive, readily available, well tolerated and safe, it should be the agentof choice for FFR assessment.

doi:10.1016/j.carrev.2011.04.304

Correlation between VEGF and the severity of non-ST-elevation acutecoronary syndromeAhmed MowafyCairo University, Cairo, Egypt

Background: VEGF is a key regulator of angiogenesis. It is thought to beimplicated in the pathogenesis of atherosclerotic plaque neovascularizationand thus promotes its infiltration by inflammatory cells with sub-sequent destabilization.Aim: The aim was to investigate the level of the vascular endothelial growthfactor in patients with acute coronary syndrome and whether it is correlatedwith the severity of the disease and the short in-hospital prognosis.

Methods: The study was conducted on 78 patients with an average age of54.7±9 years. Patients were classified into group 1 (included 31 patients withunstable angina) or group 2 (included 26 patients who presented with non-ST-segment elevation myocardial infarction). A group of 21 patients withnormal coronary angiogram was used as a study control. All patients weresubjected to ECG, echocardiography, routine laboratory investigations andalso measurement of the serum VEGF by quantitative enzyme-linkedimmunosorbent assay. Extent and severity of CAD were graded using amodified Gensini score. During hospitalization, the major cardiovascularcomplications were assessed.Results: The serum level of VEGF was significantly higher in groups 1 and2 relative to control patients. The serum VEGF level did not show anysignificant difference between unstable angina patients and NSTEMIpatients. Also, there was no significant correlation between the serumlevel of VEGF and the extent and severity of CAD. Recurrent ischemicattacks were significantly higher in patients with higher serum VEGF levelcompared with those with low serum VEGF level. Regarding CHF, itoccurred more in patients with higher serum VEGF level compared withpatients with low serum VEGF level. However, there was no significantcorrelation between arrhythmias or development of cardiogenic shock andthe serum level of VEGF.Conclusion: VEGF serum level is higher in patients presenting with acutecoronary syndrome, and it may predict an adverse in-hospital prognosis, butthere was no correlation between VEGF serum level and angiographicallydefined disease severity and extent.

doi:10.1016/j.carrev.2011.04.305

Change of glycoprotein IIb/IIIa inhibitors strategies in percutaneouscoronary interventions and the rate of ischemic andbleeding complicationsJames Reillya, Dinora Matuteb, Cynthia Cruzb, Michael Benzb,Preet Randhawab, Ceyone Drakesb, Marc Klapholzb, Christine Gerulab,Edo KaluskibaUniversity Hospital Newark, Newark, NJ, USAbUniversity Hospital Newark, UMDNJ, NJ, USA

Background: Routine use of glycoprotein IIb/IIIa inhibitors (GPI) reducesischemic events during PCI, but this benefit appears to be negated byexcessive bleeding complication and thrombocytopenia and did not translateinto mortality benefit in any randomized clinical trial (RCT). In 2009, wealtered our protocol of GPI use. Via our continuous quality improvementprogram, we evaluated the effect of this intervention on clinical events.Methods: Commencing February 2009, the following strategies wereemployed: (a) Prior to GPI administration, patients were assessed forbleeding propensity. (b) Eptifibatide was the only GPI used. (c) Bolus onlyor bolus and abbreviated (b8 h) drip GPI were preferred over the traditional18-h administration. Both major ischemic and bleeding events as well asadjunctive therapy were recorded.Results: A total of 336 consecutive PCIs (89% stent based, 19%emergent, 33.3% urgent and 47.6% elective) were assessed. Only 2.38%of PCIs were done via the radial artery. GPI use was bolus only (3.87%),bolus and abbreviated drip (25.9%), bolus and N8-h drip (3.57%), while66.1% did not receive GPI. Adjunctive therapy included unfractionatedheparin and aspirin in all subjects and thienopyridines loading:clopidogrel 300 mg (15.2%) or ≥600 mg (81%) or prasugrel 60 mg(3.6%), administered mostly during (88%) or immediately post-PCI(10%). There were no events of stent thrombosis or acute vessel closure,two (0.6%) patients experienced in-hospital cardiovascular (pumpfailure) death, four (1.2%) experienced pseudoaneurysms, three patients(0.9%) experienced major bleeding complications requiring therapy andone patient (0.3%) experienced severe thrombocytopenia. The results ofthis study compare favorably with historic controls and with randomizedPCI trials and registries.