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184 J KARDIOL 2008; 15 (5–6)

ÖKG-Jahrestagung – Abstracts

NSTEMI: 12 %). 52 % of elective patients had an indication for

antithrombotic triple therapy (atrial fibrillation, mechanical valve

replacement) and 38 % had planned non cardiac surgery.

Lesion classification was B2/C in 44 %, the LAD was treated in

40.8 % of patients (ACS: 38 % vs elective 47 %, p = n. s.) and LM

in 2 % (ACS 1 and elective 1). Mean lesion length was 18 ± 7.9 mm

with mean reference vessel diameter of 3.2 ± 0.6 mm.

All patients were followed by telephone contact after 1 year and

angiography was performed in 36 % of patients after median 199

days (range 48 to 408 days).

During FUP (median 360 days, range 24 to 770 days):

Overall mortality rate was 7.1 % (ACS: 3 % vs elective 15.6 %;

p = 0.036), cardiac death occurred in 4.1 % (ACS: 3 % vs elective

6 %; p = n. s.), myocardial infarction occurred in 1 % (1 patient

with STEMI due to another culprit vessel, no stentthrombosis)

(ACS: 1 % vs elective 0 %; p = n. s.), target lesion revascularization

(TLR) was performed in 9.2 % of patients (ACS: 10.6 % vs elective

6.3 %; p = n. s.) or 6.9 % of implanted stents (ACS: 8.1 % vs elec-

tive 4.7 %; p = n. s.).

Overall MACE rate including 3 coronary artery bypass graft opera-

tions (2 in ACS patients, 1 in elective patient) was 19 % (ACS:

16.7 % vs elective 25 %; p = n. s.).

Statin therapy was prescribed in 87 % of patients (ACS: 89 % vs.

elective 81 %; p = n. s.) at discharge. There was a statistical not sig-

nificant trend towards higher MACE rates in patients without statin

therapy: TLR 15.4 vs 8.2 %, mortality 15.4 vs 5.9 %, overall MACE

30.8 vs 17.6 %. Dual antiplatelet therapy was prescribed in ACS

patients for 12 months, in elective patients for 4 weeks. Subacute

stent thrombosis occurred in1 ACS patient (on day 7), but no inci-

dence of late stent thrombosis was observed.

Conclusion Genous

stent implantation appears safe and effec-

tive with low rates of TLR and no late stentthrombosis in selected

higher risk patients, especially with ACS and STEMI. Statin therapy

might reduce MACE rates after Genous

stent implantation. The

higher non cardiac mortality in our elective patient cohort reflects

the higher comorbidity in this selected patient group.

Comparison of Percutaneous Coronary Intervention

with Implantation of Drug-Eluting Stents (Taxus

)

versus Endothelial Progenitor Cell Capture Stents

(Genous

) during ST Elevation Myocardial Infarction:

A Non-Randomized Single Center Experience 117

S. Winkler, M. Heidinger, I. M. Lang, G. Kreiner, G. Christ, M. Gyöngyösi, D. Glogar

Division of Cardiology, Department of Internal Medicine II, Medical University of

Vienna

Background Although recent data suggest that percutaneous

coronary intervention (PCI) with drug-eluting stent implantation

(DES) in ST elevation myocardial infarction (STEMI) provides bet-

ter clinical outcomes compared to bare-metal stenting, there still

exist concerns about DES safety issues in this patient population.

The Genous

Bio-engineered R stent is coated with an antibody (an-

tihuman CD 34) that captures endothelial progenitor cells (EPCs) to

accelerate the natural healing process including reendothelialisation

and seems therefore of potential benefit in this patient population.

Objectives This study evaluated the clinical outcomes of con-

secutive STEMI patients after PCI with DES (Taxus

) or EPC cap-

ture stent (Genous

) implantation.

Methods From November 2005 to August 2007, 256 consecutive

STEMI patients were treated with Taxus

(n = 202) or Genous

(n = 54) stent implantation. Stent choice was left to the discretion of

the operator.

Results High-risk patients (cardiogenic shock or cardio pulmo-

nary resuscitation) comprised 16 % of the Taxus

group and 19 % of

the Genous

group (p = 0.68). Mean age in the Taxus

group was

59 ± 13 years, 76 % male, LAD involvement in 48 % (LM 2 %) and

in the Genous

group 60 ± 13 years, 77 % male, 44 % LAD treat-

ment (LM 2 %) (p = n. s., in all cases).

The 30-day major adverse cardiac event (MACE) rate for Taxus

and Genous

was 7.9 % and 3.7 % (p = 0.28), respectively. 30 day

mortality was 5 % and 0 % (p = 0.09), subacute stentthrombosis

(ST) occurred in 1.5 % and 1.9 % (p = 0.85), coronary artery bypass

graft operation (CABG) was performed in 2.0 % and 1.9 % (p =

0.95). The mean follow-up was 444 ± 183 days in the Taxus

group

and 406 ± 195 days in the Genous

group (p = 0.33). The overall

long term MACE-free survival was 85 % in the Taxus

group and

82 % in the Genous

group (p = 0.51). The mortality rate after 30

days was 3.5 % and 5.6 % (p = 0.52), myocardial infarction oc-

curred in 1.1 % and 5.8 % (p = 0.04), late ST occurred in 0.5 % and

0 % (1 vs 0; p = 0.61) and target lesion revascularization (TLR) was

performed in 2.7 % and 7.7 % (p = 0.09) in the Taxus

group and

Genous

group, respectively.

Conclusion PCI with DES (Taxus

) implantation in acute STEMI

offers equivalent long term safety with higher efficacy compared to

Genous

stent implantation in an all comers population. The initial

observed higher 30 day MACE rate in the Taxus

group was statis-

tically not significant and seems attributable to the rather small

number of Genous

patients. Long term MACE rate was in favor

of Taxus

with lower rates of MI and TLR, despite one case of late

ST.

Our data do not support concerns that DES implantation in STEMI

might cause additional harm, however to draw final conclusions the

results of the worldwide randomized HORIZONS Trial should be

awaited.

Echokardiographische Bestimmung der koronaren

Flussreserve bei Patienten nach Ross-Operation und

mechanischen Aortenklappenersatz 086

Th. Wittlinger, F. Oezaslan, M. Doss, S. Matens, P. Kleine, F. Bakhtiary, A. Moritz

Klinik für Thorax-, Herz- und thorakale Gefäßchirurgie, Universitätsklinik Frankfurt/

Main

Hintergrund Die koronare Flussreserve (CFR) ist ein wichtiger

Parameter der Langzeitprognose bei Patienten nach Aortenklappen-

ersatz (AKE). Der AKE führt zu einer Verbesserung, aber nicht

vollständigen Normalisierung der CFR.

Eine reduzierte CFR kann Ursache für eine erhöhte kardiale Kom-

plikationsrate, höhere Mortalität und reduzierte linksventrikuläre

Funktion sein.

Ziel der Studie war die Bestimmung der CFR bei Patienten nach

Ross-Operation im Vergleich zu Patienten nach mechanischem

AKE.

Methodik Die CFR wurde bei 34 Patienten mit der transthoraka-

len Doppler-Echokardiographie (TTDE) im Mittel 7,5 Jahre nach

der Operation bestimmt.

Im Rahmen einer randomisierten Studie wurde zwischen 1999 und

2001 bei 16 Patienten ein mechanischer AKE (Gruppe A) und bei

18 Patienten eine Ross-Operation (Gruppe B) durchgeführt; 10 ge-

sunde Probanden (Gruppe C) dienten als Kontrollgruppe.

Die Bestimmung des Koronarflusses wurde in Ruhe und nach 5-mi-

nütiger Stresstestung mit Adenosin (140 mg/kg/min) durchgeführt.

Ergebnisse In Ruhe bestand kein signifikanter Unterschied be-

züglich der mittleren koronaren Flussgeschwindigkeit (CFV) zwi-

schen den Gruppen A vs. B vs. C.

Unter Stresstestung mit Adenosin zeigt sich ein signifikant ernied-

rigter Anstieg (p < 0,005) der CFV in der Gruppe A (24,4 ± 3,3 cm)

verglichen mit den Gruppen B (45,7 ± 6,1 cm) und C (51,4 ±

6,0 cm).

Die CFR war signifikant erniedrigt in der Gruppe A (1,56 ± 0,18;

p < 0,005) verglichen mit den Gruppen B (2,52 ± 0,2) und C (2,68 ±

0,16).

Schlussfolgerung Die CFR ist bei Patienten nach Ross-Opera-

tion signifikant erhöht gegenüber Patienten nach mechanischem

AKE. Die signifikant erhöhte CFR stellt eine mögliche Erklärung

für die bessere Langzeitprognose nach Ross-Operation gegenüber

mechanischem AKE da.

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