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S256 Abstract
Method: We analysed 1,292 consecutive patients undergo-
ing PCI at our institution from September 2009 to December
2011. Clinical outcomes were measured by the occurrence
of major adverse cardiac events [MACE, including death,
myocardial infarction, and ischaemia-driven target lesion
revascularisation (TLR)]. EuroQol-5D (EQ-5D) health survey
was used to measure quality-of-life at baseline, 6-, 12- and
24-months. Incremental cost-effectiveness ratios (ICER) per
quality-adjusted life year (QALY) gained, per TLR and MACE
avoided were calculated to determine cost-effectiveness of
DES from a healthcare provider perspective.
Results: Patients who received DES (62.4%, n=804) com-
pared to BMS (37.7%, n=462) had higher socioeconomic
status, more complex (Type B2/C) coronary lesions and left
main coronary artery interventions (all p<0.01). There were
significantly lower mortality (6.8% vs. 12.5%, p<0.01), TLR
(1.5 vs. 3.3%, p=0.03) and MACE (11.1 vs. 20.0%, p<0.01) rates
in patients receiving DES vs. BMS, respectively. Incremental
QALY gained with DES vs. BMS was 0.0149. Higher index
procedural costs with DES compared with BMS (US$11,586
vs. $10,051) were off-set by lower follow-up costs (US$3,019
vs. US$4727) resulting in cost saving of US$173 at 24-months.
DES was the dominant strategy (i.e. more effective and less
costly) compared BMS for QALY gained, TLR and MACE
avoided.
Conclusion: In this ‘real world’ registry, DES was consid-
ered cost-effective compared with BMS at 2-years in terms of
QALY gained, TLR and MACE avoided.
http://dx.doi.org/10.1016/j.hlc.2015.06.340
340
30-day Outcomes From The UK Hybrid
CTO Registry
W. Wilson1,∗, S. Walsh 2, C. Hanratty 2,H.
Douglas 2, M. McEntegart 3, K. Oldroyd 3,A.
Bagnall 4, M. Egred 4, J. Irving 5, E. Smith 6,J.
Strange 7, J. Spratt 8
1Royal Melbourne Hospital, Melbourne, VIC,
Australia
2Belfast Health and Social Care Trust, Belfast,
UK
3Golden Jubilee National Hospital, Glasgow, UK
4Freeman Hospital, Newcastle, UK
5Ninewells Hospital, Dundee, UK
6London Chest Hospital, London, UK
7Bristol Heart Institute, Bristol, UK
8Royal Infirmary Edinburgh, Edinburgh, UK
Background: We sought to review the outcomes after CTO-
PCI performed by ‘hybrid approach’ trained operators in the
United Kingdom.
Methods: The UK Hybrid CTO registry comprises 1524
consecutive CTO PCIs (in 1289 patients) from 7 centres, per-
formed between January 2012 and March 2015. The primary
(hierarchical) composite endpoint was 30-day cardiac death,
myocardial infarction (MI) or target vessel revascularisation
(TVR).
Results: Mean age of the cohort was 65.4±9.1 years. 79%
were male. Lesion complexity was high with a mean J-CTO
score of 2.6+-1.4.
Initial strategy was antegrade wiring escalation (AWE) in
66%, antegrade dissection-reentry (ADR) in 11%, Retrograde
wiring (RW) in 11% and retrograde dissection re-entry (RDR)
in 12%. The final strategy was AWE (44%), ADR (24%), RW
(8%) and RDR (24%). Average number of strategies used was
1.5 ±0.7.
Technical success rate per procedure (TIMI 3 flow and <30%
stenosis) was 80%. Per patient success rate was 93%, high-
lighting the value of an ‘investment’ procedure.
Procedural time was short (mean 109±48minutes). Con-
trast dose (mean 312±123ml) and radiation exposure (mean
skin dose 2.3±1.5Gy and DAP 13897±9751cGycm2) were rel-
atively low. Major complication rate was 2.3%.
30-day outcomes were favourable: primary endpoint 1%
(death 0.2%, MI 0.8% and TVR 0.3%). All TVR (n=5) were for
stent thrombosis.
Conclusions: A hybrid approach to CTO-PCI is associated
with high success rates and low complication rates in the treat-
ment of complex CTOs. Divergent strategies are often needed
for complex cases. Investment procedures can increase clini-
cal success.
http://dx.doi.org/10.1016/j.hlc.2015.06.341
341
A case study on platypnoea-orthodeoxia
following abdominal surgery and previous
PFO closure
D. Barrett ∗, J. Roy, J. Weaver, G. Youssef
Cardiology Department St George Hospital
Sydney, NSW, Australia
A 65-year-old woman presented with hypoxia soon
after discharge following laparoscopic adrenalectomy for
an ACTH-secreting tumour. Background included percu-
taneous Patent Foramen Ovale (PFO) closure 8 years ago
with an Amplatzer PFO 25mm device for recurrent transient
ischaemic attacks. The Amplatzer device was found to have
embolised 6 years post- implantation lodging in the distal
abdominal aorta, was asymptomatic and not extracted.
CT pulmonary angiogram excluded pulmonary embolism
or other lung pathology. Her right hemi-diaphragm was
raised.
Oxygenation on room air dropped significantly on stand-
ing. SaO290.9% (pO257.6mmHg) to 78.1% (pO240.4mmHg).
Transoesophageal echocardiogram (Figure 1) showed a
very mobile atrial septum, an atrial septal aneurysm (excur-
sion 20mm) and a large PFO > 10mm diameter. The ascending
aorta was dilated with a short aortic limbus <9mm. A bub-
ble study was positive without provocation in the supine
position and strongly positive in the semi-upright (45
degrees) position (on transthoracic echocardiogram). Atrial
and pulmonary artery pressures were normal on right heart
catheterisation.
Given concerns of previous percutaneous device failure,
minimal aortic limbus and aortic dilatation, surgical closure
was undertaken with rapid clinical improvement.
