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Basal characteristics, group A and B, respectively n (%): age 61,6�11,2 vs 59�14,5;masculine sex 28(85) vs 18(86); diabetes 9(27) vs 7(33); prior infarct 7(21) vs 5(24); priorrevascularization 5(15) vs 3(14); LVEF 39,6�16 vs 46,5�21; anterior infarct 10(30) vs9(43); anterior descending artery affected 18(54) vs 19(90); presence of collateral circu-lation 10(30) vs 3(14); use of IABP 11(33) vs 3(14); use of GP IIbIIIa 10(30) vs 2(9); use oftromboaspiration 3(9) vs 2(9); millimeters of stent implanted 46�32 vs 71,5�32; implantof drug eluting stents 5(15) vs 8(38); dye material 263,1�121 vs 305,2�93 ml; time offluoroscopy 25,3�21,5 vs 23,7�16,4 minutes.Results: Group A and B n (%), respectively: mortality intrahospitalary 7(21) vs 2(9); rein-farct 0 vs 2 (9); early occlusion coronary 1(3) vs 2(9); renal insufficiency pos PCI 0 vs 1(5).In the average follow-up to 20 months of the 96% population there demonstrated, group

A and B n (%), respectively: total mortality to 6 months 10(30) vs 4(19); cardiac mortalityto 6 months 10(30) vs 2(9) p¼0,05; reinfarct 1(4) vs 0; need of coronary revascularization7(27) vs 1(5) and events combined of cardiac death, reinfarct and new revascularization18(54) vs 5(21) p¼0,02.Conclusion: The complete coronary revascularization in the same session in STEMI andcardiac failure and MVD, demonstrated to be more favorable in terms of total mortality andadverse major combined events that the PCI only of the culprit vessel.Disclosure of Interest: None Declared

PT143

Outcomes of oral Anticoagulation management post Anterior STEMI in the PrimaryPCI era

Damon K. Jackson*1, Louise Roberts1, Andrew Teh1, David J. Clark2, Philippa Loane3,Chin Hiew4, Hariharan Sugumar1, David Eccleston5, Gishel New1, Melanie Freeman11Cardiology, Eastern Health, Box Hill, 2Cardiology, Austin Hospital, Heidelberg, 3Cardiology,CCRET - Monash University, Melbourne, 4Cardiology, Barwon Health, Geelong, 5Cardiology,Royal Melbourne Hospital, Parkville, Australia

Introduction: Left ventricular (LV) thrombus is a well known complication of anteriorSTEMI occurring in up to 18% of patients and is more common in those with reducedejection fraction <40%. Anticoagulation is used to prevent thromboembolic complicationsin Anterior STEMI, however little data exist in the primary PCI era.Objectives: To evaluate the use of warfarin therapy in preventing thromboembolic com-plications following primary PCI for anterior STEMI, utilizing a large Australian registry.Methods: We analysed 365 patients who underwent primary PCI for Anterior STEMI dueto proximal LAD occlusion between 2005 and 2011. Baseline characteristics, proceduraldata and clinical outcomes were compared between those patients on warfarin (n¼98) andthose not on warfarin at 30 days following PCI (n¼267).Patients with atrial fibrillation,previous valvular surgery, or previous revascularisation were excluded. Patients who died<30 days were also excluded.Results: Patients treated with warfarin were younger (59�13 vs 63�12years p¼0.005)and had lower mean LV ejection fraction (41�10% vs 49�12% p<0.001). There were nosignificant differences in gender, diabetes, BMI or past history of cerebrovascular disease.Cardiogenic shock (14% vs 8% p¼0.07) or out of hospital cardiac arrest (10% vs 8% p ¼0.4) did not differ between the two groups, however the warfarin group were more likely torequire IABP insertion (18% vs 9% p ¼ 0.01). There were no differences in glycoproteinIIbIIIa and dual antiplatelet therapy use between the two groups. Drug eluting stent usewas similar between the two groups (26% vs 36% p¼0.2) and there were no differences indual antiplatelet therapy between the 2 groups. Those on warfarin were more likely to havedeveloped in-hospital bleeding complications (10% vs 4% p¼0.02). There were no sig-nificant differences in in-hospital stroke (1% vs 0% p¼0.1) or 12-month death (0% vs0.4% p¼0.5), stroke (1% vs 0.4% p¼0.5) and MACE (8% vs 6% p¼0.6). Ejection fractionless than 40% was not a predictor of 12-month MACE (OR 1.5 95% CI 0.66-3.8).Conclusion: In this small sample of patients who underwent primary PCI for AnteriorSTEMI, treatment with warfarin did not appear to reduce 12-month stroke or majoradverse cardiac events, however those treated with warfarin were more likely to have in-hospital bleeding complications. The benefit of anticoagulation in this subset requiresfurther investigation.Disclosure of Interest: None Declared

PT145

Primary Utilization of EECP In Chronic Stable Angina Patients With Left VentricularDysfunction and Long Time Follow Up

Pratiksha Gandhi*1, Ramasamy Subramanian2, Monica Mittal11Cardiology, IPC Heart Care Centre, Mumbai, 2Cardiology, CHENNAI HEART FAILURECLINIC, Chennai, India

Introduction: Enhanced external counter pulsation (EECP) is shown to be effective inChronic stable angina patients refractory to medical therapy and revascularization. Thetreatment work similar to intra aortic balloon pump except it increases the venous return,as the cuffs in the lower limb compress both arterial and venous compartment.Objectives: We examined the effect of EECP therapy in chronic stable angina patient withleft ventricular dysfunction and follow them up to 3.5 years.Methods: We Investigated 637 patients enrolled, who have chronic stable angina treatedby EECP therapy during 2005-2009. All the patients were subjected to exercise tolerancetest with modified Bruce protocol and Echocardiography assessment of LVEF by M-Modemethod pre and post EECP. The patients were followed up by telephone consultationsResults: The patients with a mean age of 60.65� 8.69, 82% of them are male with baselineLV ejection fraction (LVEF) 54.43 �.08. 93% are candidate for either PTCA or CABG buttaken EECP treatment as alternative due to their personal preference. Demography includes

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39% had prior MI, 71% HT, 47% DM, 20% chronic smokers, 56% had family history, 56%had TVD, 23% had DVD,52 % at least have one vessel proximal lession,7% had priorCABG and 11% had prior PTCA. 92% of the patient had at least one class decrease inCanadian Cardiovascular society (CCS) functional class. The exercise treadmill timeincreased from baseline 6.68�3.36 minutes pre-EECP to 9.63 � 3.37 minutes post-EECP(p<0.0001). The mean LVEF increased from 53.95�8.0% at baseline to 58.01 � 6.94 %post-EECP (p<0.0001). The patients are followed up for a mean period 3.5 yrs. There were21.66% patients lost during follow up, 66.4% of the patients retained their EECP treatmentbenefit, 4.23% underwent CABG, 1.88% underwent PTCA and 5.18% expired. The sur-vival rate is 95%.Conclusion: EECP is effective and safe in enhancing the exercise capacity, ejection fractionand functional class in angina patients with moderate to normal LVEF and these benefitssustained up to a mean of 3.5 yearsDisclosure of Interest: None Declared

PT146

Myocardial Contrast Echocardiography Map - A New Noninvasive Gate Way ToDetect Coronary Artery Disease

Ri-Ichiro Kakihara*1, Chinatsu Naruse1, Yoshiko Moutai11Department of Cardiology, Private Kakihara Clinic, Toyohashi, Japan

Introduction: Peak systolic strain map (SM) is used to detect angina pectoris (AP) bysegmental left ventricular wall (SLVW) dysfunction. SLVW dysfunction is not alwayscaused by myocardial ischemia. It could be more accurate and direct to observe whetherSLVW is ischemic.Therefore myocardial contrast echocardiography map (CM) was createdand was compared to SM to see which is more accurate to detect AP. All procedures wereperformed in accordance with Declaration of Helsinki of the World Medical Association.Objectives: 198 coronary arteries (CAs) of 66 patients with coronary angiography withinthe last three months were enrolled; informed consents were obtained. Among the 198CAs, 111 CAs were <50% stenosis; 36 were 50%; 32 were 75% and 20 were 90%�.Methods: The left ventricular wall of the figures of APLAX, AP2ch and AP4ch was dividedinto 17 segments (seg.s) in both CM and SM. Among them the middle-anterior seg.7 wasregarded as LAD, the middle-posterior seg.11 was regarded as LCX and the middle-inferiorseg.10 was regarded as RCA. Sonazoid� was employed as a contrast agent for CM. In theCM, differences of intensity value between the mid-point of the left ventricular cavity and ofeach seg. were shown, while in the SM strain values of the mid-point of each seg. wereillustrated. In both maps, sensitivity (SC), specificity (SP), diagnostic accuracy (DA) of eachCA stenosis were investigated by ROC. From the data, which map more accurately detectedCAD and its severity was concluded.Results: CM group: average intensity difference values <50% -8.9�2.9db, 50%-15.4�1.1db, 75% -18.8�1.9db, 90%� -21.7�2.2db. Cutoff values were 50% :-14.0db,75%:-16.0db and 90%�:-19.0. SC were 50% 1.000, 75% 1.000, 90%� 1.000. SP 50%0.902, 75% 0.984, 90%� 1.000. DA 50% 0.939, 75% 0.989, 90%� 1.000. Therewere significant differences between <50% and 50%, 50% and 75%, 75% and90%� (p<0.0001). SM group: average strain values <50% -20.7�3.9%, 50%-18.4�4.6%,75%-17.5�4.6%, 90%�-12.1�4.0%. Cutoff values were 50% -18.0%, 75% -17.0% and90%�-16.0%. SC were 50% 0.631, 75% 0.630, 90%�0.857. SP were 50% 0.689, 75%0.787, 90%� 0.869. DA were50% 0.667, 75% 0.739, 90%� 0.866. There was significantdifference between 75% and 90%� stenosis only (p <0.0002). There were significantdifferences between CM and SM in all 4 CA stenosis pairs (p<0.0001).Conclusion: Based on the results, CM accurately and directly detected myocardial ischemicextent and its severity at the same time, which SM suggested only.Disclosure of Interest: None Declared

PT147

Measuring Serum Vitamin D level as a part of evaluating patients presenting withAtypical Chest Pain

Syed Raza*11Cardiology, Awali hospital, Manama, Bahrain

Introduction: Chest pain is a leading cause of ambulatory visits to any hospital. Afterserious cardiopulmonary conditions are excluded, musculoskeletal causes of chest pain,including costochondritis, are commonly attributed to the final diagnosis .Although thereare a few reports of osteomalacia and vitamin D deficiency associated with chest pain, weare unaware of any literature where measurement of Vitamin D level forms a part ofevaluation in patients presenting with chest pain.Objectives: We conducted this study to explore the association of Vitamin D as a possiblecause of chest pain in patients who presented with atypical symptoms.Methods: We, over a period of one year prospectively studied 324 patients who presentedwith atypical chest pain and in whom more serious cardio-respiratory causes were excludedafter initial investigation. . A provisional diagnosis of musculo-skeletal pain was made inpatients in whom either chest pain was reproduced on twisting upper torso or chest walland sternal tenderness were appreciated on palpation. Vitamin D level was checked in allthese patients. If deemed appropriate Vitamin D was prescribed in appropriate doses andpatients were followed up after one week and two months.Results: .A provisional diagnosis of musculo-skeletal cause of chest pain was made in 194(60.4%) patients. Serum Vitamin D level was requested in all patients as per standardprotocol. 45(23.1%) patients had optimal serum Vitamin D level. 96 (49.4%) patients hadinsufficient while 53(27.3%) patients had deficient levels of serum Vitamin D level. 131patients attended the first follow up while only 94 patients came for the second .On thefirst follow up 54 (41.2%) patients reported improvement in symptoms or complete res-olution of chest pain. A similar trend was seen in 81 (86.1%) patients on second follow up.

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters