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Conclusion: There was an 11.4% trend towards reduced TAR and 21.4% reduction inbilateral radial artery use in patients who underwent radial access angiography. This studywas limited by its sample size and ongoing dataset expansion will provide more robuststatistical analysis. Given TAR is proposed as having greater long-term graft patency thenthere may be a need to review current practice. Further studies on graft patency outcomesin patients who have had radial artery grafting after RA will provide important clinicalinformation.Disclosure of Interest: None Declared

PW134

Nicotine exacerbates myocardial ischemia-reperfusion injury by aggravatingoxidative stress and neutrophil activation

Anand Ramalingam*1, Satirah Zainalabidin1, Siti Balkis Budin1, Norsyahida M. Fauzi21Program of Biomedical Science, School of Diagnostic and Applied Health Sciences, Faculty ofHealth Sciences, 2Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur,Malaysia

Introduction: Long term exposure to cigarette smoke, either active or passive increases therisk of coronary heart disease. Cigarette smoke exposure to animal models increasedsensitivity of heart to ischemia-reperfusion (I/R) injury, with indication of free radicalmechanisms. However, the direct effects of nicotine, a potent free-radical generator intobacco, have not been studied against myocardial tolerance to I/R injury except thatprenatal exposure to nicotine exacerbates I/R injury.Objectives: To investigate tolerance to experimental I/R injury in isolated heart of chronic-nicotine administered rats.Methods: Healthy male Sprague-Dawley rats were divided into three groups (n ¼ 8 pergroup). Rats were given either saline as control, 0.6 mg/kg nicotine as low-dose or 1.2 mg/kg nicotine as moderate dose (28 days, i.p.). Upon sacrifice, hearts were excised andperfused retrogradely using Langendorff technique. Upon stabilisation, hearts were sub-jected to 20 minutes ischemia and 60 minutes reperfusion. Coronary effluent and portionof heart tissues were kept frozen for biochemical analysis.Results: Post-ischemic recovery of rate-pressure product, indicator for myocardial work-load was significantly (p<0.05) lower in nicotine-administered rats (Low ¼ 48.2 � 3.4;Moderate ¼ 45.5 � 8.2%) than control group (62.4 � 5.1%). Similarly, recovery of leftventricle developed pressure, its derivatives (�dP/dt) and heart rate were reduced innicotine groups. Lactate dehydrogenase (LDH) leakage in coronary effluent, used as indexfor cell death was markedly elevated onset of reperfusion in nicotine groups (Low ¼ 36.5;Moderate ¼ 41.34 U/ml) compared to control (28.4 U/ml). Lipid peroxidation index washigher in nicotine groups, indicative of high degree of oxidative stress. Moreover, elevatedmyeloperoxidase (MPO) activity was seen, indicating aggravated neutrophil activationduring I/R injury.Conclusion: Chronic nicotine exposure increases myocardial sensitivity to I/R injury byaggravating oxidative stress and neutrophil-mediated cell injury.Disclosure of Interest: None Declared

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A dedicated program for PCI to Chronic Total Occlusions improves outcomes

Jeremy Knott*1, George Touma1, David Ramsay1, James Weaver11Cardiology, St George Hospital, Sydney, Australia

Introduction: Successful percutaneous coronary intervention (PCI) of chronic total oc-clusion (CTO) results in improved clinical outcomes. Yet, PCI is attempted in a minorityand success rates remain low using conventional methods. In February 2011, an institu-tional CTO-PCI strategy incorporating dedicated dual operators, retrograde PCI, pre-planning cases and specialised equipment was established after a visiting internationalmentorship.Objectives: To determine the rates of intervention, procedural success, radiation exposureand outcomes of PCI in patients with CTOs, before and after a dedicated CTO-PCI strategy.Methods: A retrospective database search was performed for CTOs and chronicityconfirmed by clinical and angiographic variables. Patients with a patent coronary bypassgraft (CABG) were excluded. Detailed clinical and procedural data was collected for eachcase. Follow-up for major adverse cardiac events (death, myocardial infarction, target vesselrevascularisation and CABG) was obtained by phone interview. Outcomes were analysedbased upon inclusion in the CTO dual operator program.

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

Results: Between January 2008 and July 2013, 889 CTOs were identified on 7363 an-giograms. PCI was recommended in 20% and CABG in 38%. Institution of a dedicatedCTO-PCI program increased PCI rates from 17.2% (88/511) to 23.3% (88/378) at theexpense of CABG (40.5% to 34.9%) (p¼0.016). Institutional PCI success rates improvedfrom 58.8% to 73.3% (p¼0.045) after mentorship. This was due to higher success rateswith dual operators performing anterograde and retrograde PCI (n¼31) compared to singleoperators (90% vs 58.5%, p<0.001). These improvements were associated with theretrograde approach (p¼0.034), dual arterial access (p<0.001), microcatheter use(p<0.001), intravascular ultrasound (p¼0.035) and planned cases (p<0.001). Thecomplication rate with dual operators (3%) was lower than single operators (17%).Contrast use was no different but radiation exposure was increased; Dose Area Product51043 vs 29831cGycm2 (p<0.001) and fluoroscopy time 59 vs 32min (p<0.001). At amedian follow-up of 2.47 years, those with successful compared with failed PCI had agreater improvement in angina (p¼0.002), less CABG (p¼0.026) and a trend towardslower MACE (8.9% vs 30%, p¼0.054).Conclusion: Chronic total occlusions are common and a dedicated CTO-PCI programimproves referral rates, procedural success and outcomes. This is associated with increasedradiation exposure. Methods of radiation minimisation are being explored.Disclosure of Interest: None Declared

PW136

Criteria To The Beginning A Program Of Ambulatory Coronary Angioplasty

Ricardo A. Costantini*1, Juan M. Telayna1, Cristian S. García11Interventional Cardiology, Austral University Hospital, Pilar, Argentina

Introduction: The main reasons in elective PTCA that made necessary patients (pt) controlduring first night in hospital have been controlled and diminished.Objectives: To evaluate the safety of the selected criteria to do Ambulatory PTCA, withsame day procedure discharge.Methods: Two groups: GROUP B: PRE PTCA: 1-Allen negative. 2-PTCA urgent. 3-Impossibility to sign consent. 4-PTCA post 2pm. 5-LVEF minor 50%. 6-Non under-standing of the steps to follow in case of symptoms. 7-Absence of an adult at home. 8-Access to hospital post PTCA in more than 40 minutes. INTRA PTCA: 9-PTCA of the onlypermeable vessel. 10-LM not protected. 11-Cardiopulmonary resurge. 12-Persistentchanges in EKG. 13-Hemodynamic collapse during balloon inflation. POST PTCA: 14-Any degree of coronary dissection. 15-Suboptimal result. 16-Intracoronary thrombs. 17-Branch occlusion. 18-PTCA without stent. 19-Persistent angina post PTCA. 20-Vascularaccess: pain, edema, hematome or bleeding. GROUP A: pts not included in group B anddischarged after 4-6 hours of observation.Final Primary Point: cardiovascular events and related to vascular access within 24 hs

post PTCA (death, urgent CABG, myocardial infarction, rePTCA, pseudoaneurism, majorbleeding, AV fistule, and radial artery occlusion).POPULATION: 958 PTCA were done since sep 2009, 685 excluded for clinical reasons

or related to vascular access, 273 pts were chosen. 98 pts fulfilled criteria of selection forgroup A, 15 refused to participate and 2 pts had post PTCA symptoms. The PTCA will bemade only by radial access. Pts signed an informed consent previously approved by theHospital’s Ethics Committee.Baselines: group A and B n(%), respectively: age 60�9 vs 60�9; diabetes 34(35) vs

55(31); prior infarction 18(18) vs 46(26); test of effort 95(97) vs 150(86); silent ischemia57(58) vs 86(49); stable chronicle angina 11(11) vs 19(11); low risk unstable angina 31(31)vs 70(40); mean vessel diameter 3,4�1,2 vs 3,4�0,8; total mms of implanted stents 47�31vs 42�25; TIMI flow III final 98(100) vs 172(98).Results: Groups A and B n(%) respectively: cardiovascular events and related to vascularaccess within 24 hours 0 vs 8(4,5) p¼0,05; acute coronary occlusion 0 vs 0; infarction postPTCA 0 vs 6(3); intrahospital cardiac death 0 vs 1 (0,5); intrahospital non cardiac death0 vs 1 (0,5).Conclusion: The selected criteria to beginning a program of Ambulatory Angioplastyproved to be correct and safe. These parameters will allow a change in the paradigm of careof the PTCA in 36% of the procedures.Disclosure of Interest: None Declared

PW137

The Relationship Between Hba1c Level And Coronary Artery Stenosis Severity InDiabetic Patients With Coronary Artery Disease-An East Coast Malaysia Study

Seng Loong Ng*1, Nik Fathanah Nik Ali2, Wan Mohamad Wan Mohd Izani1, Zurkurnai Yusof11Department of Internal Medicine, Universiti Sains Malaysia, Kubang Kerian, 2Department ofInternal Medicine, Hospital Sultanah Ampuan Afzan, Kuantan, Malaysia

Introduction: The prevalence of Type 2 diabetes mellitus (DM) continues to rise around theworld and much of the global burden of this disease is expected to come from the Western-Pacific as well as the South-East Asia regions. Coronary artery disease is significantly asso-ciated with DM. Glycosylated haemoglobin (HbA1c) is used for monitoring diabetic controland reduction in levels has been associated with reduction in coronary events.Objectives: This study was done to evaluate the association between HbA1c level and thedegree of coronary artery stenosis. Other objectives include identifying modifiable riskfactors that can be associated with the severity of coronary artery stenosis lesions.Methods: This was a retrospective study where 124 adult patients with DM who under-went coronary angiogram between 1st January 2009 and 30th October 2011 in HospitalUniversiti Sains Malaysia (HUSM) were enrolled. This study was powered at 80% using 2proportion formula.Results: Fifty six point five percent (56.5%) of the study population had severe coronaryartery stenosis and 81.0% of them had HbA1c more than 7%. Univariate analysis

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