TY - JOUR
AB - ACVC Essentials 4 You - ePublications Acute Heart Failure: Imaging 19 https://esc365.escardio.org/Presentation/216453/abstract Lung ultrasound predicts in-hospital mortality in acute heart failure D Araiza Garaygordobil,1 P Martinez-Amezcua,2 R Gopar-Nieto,1 A Cabello-Lopez,3 CP Paredes-Paucar,1 A Luna-Herbert,1 E Lerma-Landeros,1 V Reynier-Garza,1 FM Gutierrez-Gonzalez,1 B Salas-Teles,1 D Sierra-Lara,1 JL Briseno-De La Cruz,1 H Gonzalez-Pacheco,1 H Rodriguez-Zanella1 and A Arias-Mendoza1 1National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico 2Johns Hopkins University of Baltimore, Baltimore, United States of America 3UMAE Centro Medico Nacional Siglo XXI IMSS, Mexico City, Mexico Background: lung ultrasound (LUS) assessed B-lines have been associated with adverse clinical outcomes in patients with heart failure. Whether B-lines may predict in-hospital mortality in patients with acute HF is still undetermined. Purpose: we sought to independently relate point-of-care LUS findings with in-hospital mortality in patients admitted with acute HF. Methods: hand-held LUS was used to examine patients with acute HF admitted to a tertiary cardiovascular center (median age 59, 68.1% men, median LVEF 30%). LUS was performed in eight chest zones with a pocket ultrasound device. The association between B-lines and in-hospital mortality was assessed using Cox regression models. Patients were divided in tertiles: tertile 1 (0-1) & tertile 2 (2-12) constituted the reference group, and tertile 3 (>12 B-lines) constituted the "congestive" group. B-lines count, and outcome adjudication was blind. Results: in 119 patients with adequate LUS images, the sum of B-lines ranged 0-50 (median 5) and showed bi-modal distribution. ROC-AUC for B-lines and in-hospital mortality was 0.76. Age, gender, LVEF and NTproBNP were similar among both groups (Table 1). Patients in the congestive group showed increased risk for in-hospital mortality (HR 3.36, 95% CI [1.25-9.04]) p=0.016 (Figure 1). After multivariate analysis, only B-lines remained significantly associated with in-hospital mortality (HR 2.89, 95% CI [1.04-8.01]) p=0.04. Table 1. Baseline characteristics. Variable . Overall, N= 119 . B-Lines 0-12, n= 86 . B-Lines ≥13, n=33 . p value . Age, mean years ± SD 59.86 ± 1.51 60.48 ±1.82 58.19 ±2.73 0.50 Females, n (%) 38 (31.9) 28 (32.6) 10 (30.3) 0.81 LVEF<35%, n (%) 50 (51.6) 35 (50.7) 15 (53.6) 0.79 NT pro BNP >9000 pg/mL, n (%) 59 (50) 38 (44.71) 21 (63.64) 0.07 Creatinine >2.0 mg/dL, n (%) 18 (15.2) 13 (15.3) 5 (15.2) 0.99 Variable . Overall, N= 119 . B-Lines 0-12, n= 86 . B-Lines ≥13, n=33 . p value . Age, mean years ± SD 59.86 ± 1.51 60.48 ±1.82 58.19 ±2.73 0.50 Females, n (%) 38 (31.9) 28 (32.6) 10 (30.3) 0.81 LVEF<35%, n (%) 50 (51.6) 35 (50.7) 15 (53.6) 0.79 NT pro BNP >9000 pg/mL, n (%) 59 (50) 38 (44.71) 21 (63.64) 0.07 Creatinine >2.0 mg/dL, n (%) 18 (15.2) 13 (15.3) 5 (15.2) 0.99 LVEF: Left ventricular ejection fraction. Open in new tab Table 1. Baseline characteristics. Variable . Overall, N= 119 . B-Lines 0-12, n= 86 . B-Lines ≥13, n=33 . p value . Age, mean years ± SD 59.86 ± 1.51 60.48 ±1.82 58.19 ±2.73 0.50 Females, n (%) 38 (31.9) 28 (32.6) 10 (30.3) 0.81 LVEF<35%, n (%) 50 (51.6) 35 (50.7) 15 (53.6) 0.79 NT pro BNP >9000 pg/mL, n (%) 59 (50) 38 (44.71) 21 (63.64) 0.07 Creatinine >2.0 mg/dL, n (%) 18 (15.2) 13 (15.3) 5 (15.2) 0.99 Variable . Overall, N= 119 . B-Lines 0-12, n= 86 . B-Lines ≥13, n=33 . p value . Age, mean years ± SD 59.86 ± 1.51 60.48 ±1.82 58.19 ±2.73 0.50 Females, n (%) 38 (31.9) 28 (32.6) 10 (30.3) 0.81 LVEF<35%, n (%) 50 (51.6) 35 (50.7) 15 (53.6) 0.79 NT pro BNP >9000 pg/mL, n (%) 59 (50) 38 (44.71) 21 (63.64) 0.07 Creatinine >2.0 mg/dL, n (%) 18 (15.2) 13 (15.3) 5 (15.2) 0.99 LVEF: Left ventricular ejection fraction. Open in new tab Conclusion: in patients admitted with acute HF, point-of-care LUS measurements of pulmonary congestion (B-lines) are associated with in-hospital mortality. Open in new tabDownload slide B-lines and in-hospital mortality. Acute Heart Failure: Biomarkers 21 https://esc365.escardio.org/Presentation/217410/abstract Assessment of circulating biomarkers levels in heart failure patients with restored ejection fraction: an explorative proteomic-based approachSupported by UCSC- FPG- IRCCS A Bonanni,1 A D’aiello,1 C Lucci,1 D Pedicino,1 R Vinci,1 E Pisano,1 M Ponzo,1 P Ciampi,1 G Angelini,1 F Canonico,1 A Severino,1 LM Biasucci,1 G Marenzi,2 G Liuzzo1 and F Crea1 1Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy 2Cardiology Center Monzino IRCCS, Milan, Italy Background/Introduction: Heart Failure (HF) is a multifactorial, progressive syndrome that affects 60 millions of patients worldwide, characterized by elevated risk of adverse outcomes. Therefore, despite the novelties coming from the latest clinical trials, the scientific knowledge needs to be quickly improved. Recently the clinical interest has shifted on the novel sub-phenotype of HF patients with recovering of left ventricular ejection fraction (HFrecEF). Purpose: Aim of this study was to profile a complex pattern of 102 extracellular signalling molecules among chemokines, cytokines and growth factors, in patients with a diagnosis of HF who recovered the left ventricular function compared to those who did not recover it, in order to explore the molecular peculiarities underling the two pathophysiologic mechanisms. Methods: We performed a human proteome array on two groups of pooled sera, one from HF patients with recovered ejection fraction (HFrecEF n = 10) and the other one from patients without recovery (HFno-recEF n = 6). Results: Our data displayed several differences in protein levels of broad number of extracellular signalling molecule between HFrecEF and HFno-recEF. However, four protein levels, e.g. hepatocyte-growth factor (HGF) (p = 0.0005), sex-hormone binding protein (SHBG) (p = 0.0010), growth hormone (GH) (p = 0.0011) and osteopontin (OPN) (p = 0.0011) were top expressed in HFrecEF group. Meanwhile, HFno-recEF showed an increased expression of three protein levels, e.g angiopoietin 1 (ANGPT1) (p = 0.005), RANTES (or CCL5) (p = 0.036) and epidermal growth factor (EGF) (p = 0.046) (Figure B). Open in new tabDownload slide Conclusion(s): In HF, the detection of prognostic biomarkers together with the recognition of the anticipatory clinical signs might ameliorate the final patient outcome. Among the HF clinical group, the HF category of patients who experienced an improvement of LVEF (HFrecEF) recently caught the attention of the scientific community. The preliminary results of this study led us to focus on four proteins that have never been studied before in the context of HFrecEF but that might open the way towards attractive biological networks and molecules such as those ones related to steroid bioavailability (i.e. SHBG) or to pro-angiogenic factors and pro-survival factors (HGF, GH and OPN). The HFno-recEF counterpart was not far behind, presenting as unique statistically significant protein levels three molecules related with tissue repair and recovery mechanisms, such as fibrosis (EGF), remodelling (ANGPT1) and both acute and chronic inflammation (RANTES). Our explorative data could enable the medical society to surmount the limited information concerning this novel sub-phenotype of HF patients by allowing the scientific community to discover new cellular and molecular missing targets in patients presenting with chronic HF. 22 https://esc365.escardio.org/Presentation/217606/abstract TLR-4 expression predicts mortality in patients with acute heart failure M Lenz,1 KA Krychtiuk,1 K Huber,2 C Hengstenberg,1 J Wojta,1 G Heinz1 and WS Speidl1 1Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria 2Wilhelminen Hospital, 3rd Department of Internal Medicine, Cardiology and Emergency Medicine, Vienna, Austria Background: Inflammation is regarded as an important trigger for disease progression in heart failure (HF) and was implicated in the pathophysiology of acute heart failure (AHF). Toll-like receptors (TLRs) play an important role in acute inflammatory processes in critically ill patients by binding to pathogen associated molecular patterns (PAMPs) and danger associated molecular patterns (DAMPs). However, it is not known whether the expression patterns of TLRs on neutrophils and monocytes are associated with outcome in patients with severe AHF requiring intensive care unit (ICU) admission. Purpose: The aim of this prospective, observational study was to analyze whether TLR-expression on monocytes or neutrophils is associated with 30-day survival in patients with severe AHF. Methods: We included 90 patients with severe AHF admitted to our cardiac ICU. Blood was taken on admission and mean fluorescence intensity (MFI) of TLR-2, TLR-4 and TLR-9 on monocytes and neutrophils was analyzed by flow cytometry. Results: Median age was 65 (IQR 49-74) years and 76.8% of patients were male. Median NT-proBNP was 4941 (IQR 1298-12273) pg/mL and 30-day mortality was 36%. TLR-4 expression on monocytes in survivors (740 IQR 694-854) was significantly lower than in non-survivors (871 IQR 723-979; p<0.05). TLR-2 and TLR-9 expression on monocytes and TLR expression on neutrophils was not associated with survival. TLR-4 expression on monocytes was significantly associated with survival independent of age, sex, creatinine and NT-proBNP levels. Of interest, monocyte subset distribution 72 hours after admission towards an increase in the intermediate subset with a consecutive decrease in classical monocytes was associated with 30-day mortality. Discussion: Monocyte TLR-4 expression predicts mortality in patients admitted to a cardiac ICU for severe AHF. This suggests that activation of the innate immune system by TLR-binding of DAMPs may play a significant role in critically ill AHF patients. Acute Heart Failure - Clinical 24 https://esc365.escardio.org/Presentation/216472/abstract Terminally ill heart failure patients in intensive cardiac care unit and anticipated directives. A Sacco,1 N Morici,1 V Lusona,1 S D’elia,2 J Sun,3 G Viola,1 P Meani,1 L Forni4 and FG Oliva1 1ASST Grande Ospedale Metropolitano Niguarda, “De Gasperis” Cardio Center, Milano, Italy 2Università della Campania “Luigi Vanvitelli”, Scuola di Specializzazione in Malattie dell’Apparato Cardiovascolare, Napoli, Italy 3Università Milano-Bicocca, Scuola di Specializzazione in Malattie dell’Apparato Cardiovascolare, Milano, Italy 4Università Milano-Bicocca, School of Law, Milano, Italy Background: Terminally ill heart failure (HF) patients have significant Intensive Cardiac Care Unit (ICCU) resource utilization near the end of life. For chronic HF identifying when life expectancy is <6 months is daunting: the decision to consider hospice care is based largely on judgment, clinical assessment, and most importantly should be based on patient preferences. In December 2017 Italian Legislator brought in the provisions regarding the end-of-life choices, including indications for withdrawing and withholding life-sustaining therapies, corroborating the principle of the patient’s therapeutic self-determination. Purpose: To better understand the management of terminally ill HF patients in a single center ICCU in the light of the new Italian provisions regarding end-of-life. Methods and results: We retrospectively identified a sample of adults with acute decompensated HF who died at our ICCU between March 2018 to March 2019. Continuous variables were reported as median and interquartile range, whereas categorical ones as number and percentages. Out of 29 deaths, 21 were represented by an acute relapse on chronic HF. Mean age was 73 (62-80). The treatments at death time were as it follows: 38% i.v. morphine, 9% midazolam, 29% both morphine and midazolam; 19% and 29% propofol and dexmedetomidine respectively on top of morphine. The approach for pain and sedation evaluation and management was not protocol-based. 62% patients were prescribed inotropes/ vasopressors, 52% antibiotics, 14% blood transfusions, 62% oral therapy (23% statins and 43% double antiaggreagant therapy and anticoagulation). 5% of patients were supported by IABP, 14% renal replacement therapy, 29% mechanical ventilation and 57% non invasive ventilation. 24% of patients were resuscitated within 72 hours from death. Anticipated directives were recorded only in 1 case and only in 10 cases medical charts reported indications for withdrawing and withholding life-sustaining therapies. Moreover, even though, our population was represented by chronic HF patients no medical chart reported previous documentation of physician communication regarding life-sustaining interventions during hospitalizations and/or outpatient clinic check-up. Conclusions: We observed that in our ICCU the management of terminally ill HF patients is often in conflict with the recommendations of the main intensive care scientific societies and also with the Italian legislation. The reasons behind these contrasts and the lack of documentation of physician communication regarding life-sustaining interventions during the index and previous hospitalizations may relate to discomfort by physicians in broaching this topic, prognostic uncertainty, or patient and family unwillingness to discuss this sensitive issue. Our data suggest that in our center there is an unmet need to develop communication tools/support in order to improve communication between patients, family members and health care professionals. 25 https://esc365.escardio.org/Presentation/221292/abstract Predicting non-invasive ventilation failure in acute heart failure patients presenting in the emergency department DA Candeias Faria,1 D Roque,1 J Ferreira,1 M Beringuilho,1 I Fialho,1 J Augusto,2 A Soares1 and C Morais1 1Hospital Prof Fernando da Fonseca EPE, Cardiologia, Amadora, Portugal 2University College London, London, United Kingdom of Great Britain & Northern Ireland Background: The majority of patients with acute heart failure (AHF) present with some degree of respiratory insufficiency due to pulmonary congestion. Non-invasive ventilation can avoid the need for invasive mechanical ventilation (IMV) in some settings. However, it can also delay the time to orotracheal intubation and IMV, which worsens the short-term prognosis. Purpose: To provide a sumple and easy-to-perfom score base on clinical and analytical parameters quickly obtainable at admission and to access its performance to predict NIV failure. Methods: In a retrospective, observational, single-center, case-control study, a total of 516 patients were admitted for AHF in the emergency room of a large urban hospital. All patients had data collected regarding demographics, clinical and laboratorial markers at admission. We followed-up patients to access NIV failure and in-hospital mortality. Multivariate analysis was performed to identify predictors of NIV failure. Discriminative power was accessed by receiver operating characteristic (ROC) curve. Results: A total of 516 patients were included in the final analysis. Of those, 134 patients (25.9%) were treated with NIV and 16 of those (11.9%) had NIV failure with progression to IMV. In-hospital mortality was 8.9% (n=46). Univariate and multivariate analysis are illustrated in Table 1.Stratified analysis was based on the approximate cut-off value for the last quartile. Based on the similar beta coefficient values for each variable, we attributed 1 point in the presence of each following conditions: arterial lactate concentration>2.5 mmol/L, PaO2/FiO2<250, blood pH<7.30, heart rate >140 bpm, with a total score range 0-4. Our model yielded a good performance in predicting NIV failure using ROC analysis (AUC 0.802, 95% CI, 0.754-0.833, p<0.001). A score of 1 or above had a sensitivity of 94% and a specificity of 53% in predicting NIV failure. Conclusions: Our predictive model proved to be a simple and accessible tool with good to predict NIV failure in patients admitted for AHF. Open in new tabDownload slide Table and ROC curve. Acute Heart Failure – Diagnostic Methods 26 https://esc365.escardio.org/Presentation/217420/abstract The effect of myocardial inflammation on subpopulation of macrophages in virus-positive patients with ADHF E Kruchinkina,1 YV Rogovskaya,2 RE Batalov1 and VV Ryabov3 1Cardiology Research Institute Tomsk National Research Medical Center Russian Academy of Sciences, Tomsk, Russian Federation 2National Research Tomsk State University, Tomsk, Russian Federation 3Siberian State Medical University, Tomsk, Russian Federation Background: Macrophages play a key role in the inflammatory cascade and are the main source of both pro- and anti-inflammatory cytokines than underlies the pathogenesis of heart failure. Aim: To study the subpopulation of macrophages depending on myocardial inflammation in virus-positive patients with acute decompensation of ischemic heart failure (ADHF). Methods: This open-label, nonrandomized, single-center, prospective trial was registered at clinicaltrials.gov (#NCT02649517). This trial included 25 patients (84% men, left ventricular ejection fraction of 29.17±9.4%) with ADHF, ischemic systolic dysfunction, and the presence of cardiotropic viruses (human herpes virus type 1, 2, and 6; adenovirus; enterovirus; Epstein-Barr virus; and parvovirus B19). Inclusion criteria were ADHF not earlier than six months after optimal surgery (percutaneous coronary intervention or/and coronary artery bypass graft) and optimal drug treatment for ADHF according to ESC guidelines. All patients underwent invasive angiography and endomyocardial biopsy with immunohistochemistry (n=25) and by double immunofluorescent analysis (n=21). Immunohistochemical criteria of myocarditis were at least 14 leukocytes per sq. mm in the myocardium including up to 4 monocytes and 7 or more CD3+ T lymphocytes per sq. mm. We used CD68 as a marker of the cells of the macrophage lineage; CD80 was considered a biomarker of M1-like macrophages; CD163, CD206, and stabilin-1 were considered biomarkers of M2-like macrophages. Results: Based on data of immunohistochemical analysis, viruses in myocardial tissue were detected in 14 cases. After all these patients were divided into two groups: group 1 enrolled virus-positive patients with the signs of viral inflammation 43% (n=9), and group 2 enrolled virus-positive patients without signs of myocardial inflammation 22% (n=5). CD163+CD206-, CD163-CD206+, CD163+CD206+, CD68-CD 163+, CD68+CD 163-, CD68+ CD163+, CD 68+CD80-, CD68-CD80+, CD68+CD80+, CD68+CD stabilin-1-, CD68+CD stabilin-1+, CD 68- CD stabilin-1-, CD 68- CD 206+, CD68+CD206+, CD68+CD206- of M2-like macrophages in patients with ADHF were identified. In group 1 there was an increasing tendency in a number of CD68-CD80+ macrophages among other subpopulations in group 1 (59.50[24.00;74.00], p=0.0562). Whereas, in group 2 there was an increasing tendency in a number of CD68+CD163- macrophages (66.00[56.50;68.50], p=0.5254). In addition, an increased number of macrophages CD68+CD163+ was observed (19.00[10.00;26.00]) in group 1 compared to group 2 (11.00[7.50; 20.50]) by 63% (p=0.0421). Conclusions: We observed a regular tendency to increase M1-like macrophages in group 1 and M2-like macrophages in group 2 in this study. In support of this, a significant increase in the number of M2-like macrophages (CD68 + CD163 +) was observed in patients with viral inflammation that can indicate the stage of recovery of the myocardium. Acute Heart Failure: Pharmacotherapy 27 https://esc365.escardio.org/Presentation/221531/abstract The real life rate of inadequate up-titration in guideline-directed medical therapy in patients with heart failure with reduced ejection fraction U Kocabas,1 M Altinsoy,2 S Ustundag,3 F Ozyurtlu,4 U Karagoz,5 A Karakus,6 OD Urgun,7 UY Sinan,8 I Mutlu9 and S Pehlivanoglu1 1Baskent University Istanbul Hospital, Cardiology, Istanbul, Turkey 2Ataturk Education and Research Hospital, Cardiology, Ankara, Turkey 3Mengucek Gazi Training and Research Hospital, Cardiology, Erzincan, Turkey 4Special Grand Medical Hospital, Cardiology, Manisa, Turkey 5Izmir Katip Celebi University Ataturk Training and Research Hospital, Cardiology, Izmir, Turkey 6Besni State Hospital, Cardiology, Adiyaman, Turkey 7Kozan State Hospital, Cardiology, Adana, Turkey 8Istanbul University Cardiology Institute, Cardiology, Istanbul, Turkey 9Tepecik Training and Research Hospital, Cardiology, Izmir, Turkey Background: Current heart failure guidelines recommend the use of medical therapy including renin–angiotensin system (RAS) blockers, beta-blockers, mineralocorticoid antagonists (MRAs) at maximally tolerated dosages to improve outcomes. Despite the evidence-based recommendations, patients with heart failure with reduced ejection fraction (HFrEF) are rarely up-titrated to target doses. Purpose: The aim of this study was to determine the rate of use of target doses of medical therapy in patients with HFrEF (left ventricular ejection fraction ≤40%). Methods: This study is a prospective, multicenter, cross-sectional and observational study conducted in 24 cardiology centres from Turkey between January 2019 – June 2019. Results: The study included 1462 outpatients (male: 70.1%, mean age: 67 ± 11 years, mean LVEF: 30 ± 6%) with HFrEF. The proportion of patients receiving target doses were 24.6% for RAS blockers, 9.9% for beta-blockers and 10.5% for MRAs. The most common reasons for not using the target doses of RAS blockers were symptomatic hypotension, still in up-titration and worsening of renal function. Reasons for not using the target doses of beta-blockers were bradyarrhythmia or reaching target heart rate, still in up-titration, symptomatic hypotension and reasons for not using the target doses of MRAs were still in up-titration, hyperkalemia and worsening of renal function. The ‘real rate of inadequate up-titration’ –in other words that is absence of clear medical reason– may be given as 46.8, 48.3, and 59.8%, respectively, for the RAS blockers, beta-blockers, and MRAs. Conclusions: Our study shows that, nearly half of the eligible outpatients with HFrEF did not receive target doses of guideline-directed medical therapy. Strategies are needed in order to achieve uptitration of recommended medical therapies. Management of Out of Hospital Cardiac Arrest 29 https://esc365.escardio.org/Presentation/216458/abstract Metabolomics profiles of ventricular fibrillation versus asphyxial cardiac arrest D Varvarousis,1 K Polytarchou,2 E Locci,3 A Noto,3 A Chalkias,4 N Iacovidou,5 CH Staikou,5 M Stocchero,3 A Papalois,6 E D’aloja3 and T Xanthos7 1General Hospital of Nikea-Piraeus Agios Panteleimon, Piraeus, Greece 2Evangelismos Hospital, Cardiology Department, Athens, Greece 3University of Cagliari, Cagliari, Italy 4Tzaneio General Hospital of Piraeus, Pireas, Greece 5Aretaieio Hospital, Athens, Greece 6Experimental-Research Center ELPEN, Athens, Greece 7European University Cyprus, Nicosia, Cyprus Background/Introduction: Sudden dysrhythmic cardiac arrest (CA) due to ventricular fibrillation (VF) differs significantly from asphyxial CA with regard to pathogenetic mechanisms, response to therapy and post-resuscitation organ dysfunction. The underlying pathophysiology is not clearly defined yet. Novel metabolomics analyses, like proton nuclear magnetic resonance (1HNMR/metabolomics) could be extremely useful in the clarification of CA pathophysiological mechanisms. Purpose: Aim of this study was to define and investigate the metabolic alterations occurring during VF and asphyxial CA, as well as during cardiopulmonary resuscitation, using a metabolomics approach. Methods: We have used a validated swine model of VF and asphyxial CA (n=10 animals for each group). Plasma samples were collected at baseline and every minute during the experimental phases: asphyxial pre-arrest phase (only for the asphyxial CA group), 5-minute untreated CA phase, resuscitation phase and return of spontaneous circulation. All samples were analyzed by 1HNMR spectroscopy and liquid chromatography mass spectrometry, coupled by univariate and multivariate statistical analysis. Results: A total of 380 plasma samples were analyzed. The metabolomics profile of VF CA differed significantly from asphyxial CA during the arrest (no-flow) phase and the resuscitation (low-flow) phase, Figure 1 shows orthogonal partial least square discriminant analysis (OPLS-DA) models for asphyxial and VF CA plasma samples. Major metabolic perturbations were evident in the asphyxial CA group during the arrest phase, and included significant increases in hypoxanthine, in tricarboxylic acid cycle intermediates (succinate, malate), anaplerotic replenishing of the cycle (alanine, aspartate) and in urea cycle intermediates (ornithine, citrulline, argininosuccinate). For the VF CA group, these metabolic alterations occurred shifted, at the resuscitation phase. Figure 1 Open in new tabDownload slide Conclusions: The two most common causes of CA, VF and asphyxia, are characterized by different metabolic profiles, during the peri-arrest period and resuscitation. More research is needed to further elucidate completely the underlying pathophysiological mechanisms. However, our findings may be useful in the research field of cardiopulmonary resuscitation and in identifying diagnostic/prognostic biomarkers, like succinate or hypoxanthine. Ventricular Arrhythmias and SCD - Clinical 30 https://esc365.escardio.org/Presentation/221288/abstract Efficacy of urgent ultrasound-guided unilateral stellate ganglion block for management of hemodynamic unstable patients with ventricular tachycardia storm M Sramko,1 P Stojadinovic,1 P Peichl1 and J Kautzner1 1Institute for Clinical and Experimental Medicine (IKEM), Department of Cardiology, Prague, Czechia Background: Ultrasound-guided stellate ganglion block (SGB) has recently emerged as a simple bedside procedure that can suppress ventricular tachycardias (VT). However, the role of SGB in acute management of VT storm is still unclear. Purpose: This study investigated efficacy of urgent unilateral SGB in hemodynamically unstable patients with VT storm. Methods: We prospectively evaluated 10 consecutive patients with advanced heart failure who underwent urgent SGB for VT storm at our ICU between December 2018 and January 2019 (all men, age: 66±9 years, ischaemic/non-ischaemic aetiology: n = 6/4, left ventricular ejection fraction: 20±5%). All the patients had sustained or incessant monomorphic VTs (cycle lengths of 390 to 545 ms), despite treatment by intravenous amiodarone, deep sedation wtih mechanical ventilation, and overdrive pacing at 100-110 bpm. Left-side SGB was performed by a single operator with a bolus of 8ml of 0.5% of bupivacaine, under real-time ultrasound visualization with a linear probe (Vivid i, GE Healthcare). The operator’s procedural skills were verified on a parallel group of 9 consecutive patients who underwent SGB for refractory non-revascularizable angina pectoris (AP) during the same period (female gender: n=4, age: 74±7 years). Results: No SGB-related permanent complications were observed in any of the patients. Temporary Horner’s syndrome developed in 2 patients with VT storm (20%) compared to 9 patients with AP (100%). In one patient with refractory VT storm despite catheter ablation, the arrhythmias disappeared within a few minutes after SGB. The effect lasted for two weeks until he underwent a successful stereotactic radioablation for the VT. In another three patients with persistent VT storm despite catheter ablation, the arrhythmias waned during 2-4 days after SGB, and the effect lasted for up to 3 months. However, the individual contribution of the SGB could not be clearly distinguished from the effect of concomitant introduction of amiodarone, sedation and overdrive pacing. Finally, in one patient, the VT burden decreased shortly after SGB by >50%, which helped to stabilize him until a successful epicardial catheter ablation. In the remaining five patients with VT storm (50%), SGB had no apparent effect on the arrhythmia burden. In contrast, 7 of 9 patients with AP (78%) reported significant relief of angina symptoms, with the effect lasting up to 3 weeks after SGB. Conclusion: Ultrasound navigated SGB is a safe and feasible bedside procedure that can help at the ICU in acute management of VT storm in hemodynamically unstable patients. Future research is needed to identify optimal responders to the therapy. 31 https://esc365.escardio.org/Presentation/216491/abstract Succinate plasma concentration during ventricular fibrillation and asphyxial cardiac arrest D Varvarousis,1 K Polytarchou,2 E Locci,3 A Noto,3 A Chalkias,4 N Iacovidou,5 CH Staikou,5 M Stocchero,3 E D’aloja3 and T Xanthos6 1General Hospital of Nikea-Piraeus Agios Panteleimon, Piraeus, Greece 2Evangelismos Hospital, Cardiology Department, Athens, Greece 3University of Cagliari, Cagliari, Italy 4Tzaneio General Hospital of Piraeus, Pireas, Greece 5Aretaieio Hospital, Athens, Greece 6European University Cyprus, Nicosia, Cyprus Background/Introduction: Ventricular fibrillation (VF) and asphyxia are the two most common causes of cardiac arrest (CA). Sudden VF CA differs significantly from asphyxial CA with regard to metabolic perturbations. Succinate is a tricarboxylic acid cycle intermediate, accumulating in circulating blood in conditions of progressive tissue hypoxia, due to mitochondrial dysfunction. This metabolite has been linked to the severity of the hypoxic insult. Purpose: To investigate succinate plasma concentrations during VF and asphyxial CA. Methods: A validated swine model of VF and asphyxial CA was used (n=10 animals for each group). Plasma samples were collected at baseline and every minute through the experimental phases: asphyxial pre-arrest phase, 5-minute untreated CA phase, cardiopulmonary resuscitation, return of spontaneous circulation (ROSC), and every hour during a 4-hour post-ROSC period and at 24h. Metabolic alterations were investigated using proton nuclear magnetic resonance (1H NMR) spectroscopy and liquid chromatography mass spectrometry, coupled by univariate and multivariate statistical analysis. Results: Succinate increased during the asphyxial pre-arrest period (asphyxial CA group). As a result, significantly higher succinate plasma levels were found during the arrest phase of asphyxial versus VF CA, and during resuscitation. During untreated VF CA, there were even no changes in its plasma levels, until resuscitation initiation. Figure 1 shows an overview of succinate plasma levels during the different experimental phases (asterisks indicate statistical significance regarding the comparison between asphyxial and VF CA groups). Figure 1 Open in new tabDownload slide Conclusions: Succinate is associated with progressive tissue hypoxia and may be useful as a diagnostic biomarker for differentiating the cause of CA, VF or asphyxia. Arrhythmias, General – Treatment 32 https://esc365.escardio.org/Presentation/221523/abstract Incidence and characteristics of tachyarrhythmias in patients presented with acute myocarditis A Gkouziouta,1 A Kostopoulou,1 E Fountas,1 D Miliopoulos,1 I Armenis,1 E Livanis1 and N Kogerakis1 1Onassis Cardiac Surgery Center, Athens, Greece Purpose: Acute myocarditis may be associated with life threatening tachyarrhythmias and a poor outcome. The purpose of our study was to define the incidence and clinical characteristics of tachyarrhythmias in young patients with acute myocarditis. Methods: We retrospectively reviewed all patients under 25 years of age who received a clinical or biopsy proven diagnosis of acute myocarditis from October 2002 to December 2018 at a tertiary care institution. Clinically significant tachyarrhythmias (CSTs) were defined as requiring treatment with antiarrhythmic medications and/or defibrillation. Results: Seventy patients met the inclusion criteria (76% male, 22.4 ± 3.5 years). The diagnosis of myocarditis was made clinically with 43% (n=30) confirmed with biopsy. Eighteen patients required intubation and 38 were treated with inotropes. There were 18 patients with CSTs (4 supraventricular, 3 non-sustained VT, 11 sustained VT/VF). Cardioversion or defibrillation was required in 10/18 (55%). Patients with CSTs were more likely to have been treated with inotropes (16/18, 89%) than those without tachyarrhythmias. Twenty patients required mechanical support (IABP,n=16,ECMO n=3,Impella n=1). Patients with CSTs were more likely to require mechanical support as compared to patients without. Twenty-two patients were transplanted and five died . Patients with CSTs were more likely to experience death or transplant as compared to patients without CSTs. When controlling for age and ejection fraction, CSTs remain a predictor of death or transplant. Left ventricular ejection fraction was an independent predictors of CSTs, while gender, CRP, ESR, and troponins were not. Conclusion: Patients with acute myocarditis have a considerable incidence of clinically significant tachyarrhythmias. The morbidity and mortality is significantly higher in patients with tachyarrhythmias. Pulmonary Embolism 33 https://esc365.escardio.org/Presentation/216483/abstract Right ventricular adaptation in acute pulmonary embolismAarhus University, the Laerdal Foundation for Acute Medicine, Soester and Verner Lipperts Foundation, Holger and Ruth Hesse’s Memorial Foundation MD Lyhne,1 JG Schultz,1 AK Hansen,1 CS Mortensen,1 A Andersen1 and JE Nielsen-Kudsk1 1Aarhus University Hospital, Skejby, Department of Cardiology & Institute of Clinical Medicine, Aarhus, Denmark Background: Right ventricular (RV) function is essential for risk stratification in acute pulmonary embolism (PE). Patients with RV dysfunction may require more aggressive therapy or closer observation until improvement in RV function. However, the time course of RV dysfunction following large, central acute PE is unknown. Purpose: The present study aimed to describe cardiovascular changes in the prolonged phase 12 hours after central, acute PE. Methods: The Danish Animal Research Inspectorate approved the study. Twelve pigs were randomized to administration of autologous, large PE (n=6) until mean pulmonary arterial pressure (mPAP) was doubled or sham (n=6). We used bi-ventricular pressure-volume loop recordings and invasive pressure measurements for repeated evaluation hourly for 12 hours after PE. We used two-way ANOVA analysis to compare PE vs sham in overall analysis and post-hoc hierarchical testing to control power in multiple comparisons. Results: mPAP increased significantly (p<0.0001) and stayed elevated throughout 12 hours in the PE group compared to sham (13.9±2.3 vs 25.5±2.9mmHg, p<0.0001 at 12h). Despite maintained high pulmonary pressure, pulmonary vascular resistance (PVR) and RV arterial elastance were only transiently increased in the PE group (p<0.01 for both). The arterial elastance (RV afterload, see figure) was only significantly increased through the first 6 hours after PE. Open in new tabDownload slide Right ventricular function and afterload. RV ejection fraction and stroke volume were reduced in the PE group compared to sham (p<0.01 and p=0.06, respectively) for the first 4-8 hours after PE before returning to sham values (see figure). RV ventriculoarterial coupling was significantly reduced for the first 6 hours following PE (p<0.05), but not throughout all 12 hours. Total RV mechanical work was significantly increased in the PE-group (p<0.01) but only during the first 6 hours. Conclusions: Physiological evaluation of the natural history of large, central PE shows that the increased RV afterload causes RV dysfunction despite increased RV mechanical work. However, the PVR and afterload normalize after approximately 6 hours, where also RV function was improved despite a maintained elevated pulmonary pressure. The data suggest that the first 6 hours after acute PE might be the most critical period in patients with acute PE showing manifest RV dysfunction whereas RV seems to adapt and improve in the more prolonged phase. 36 https://esc365.escardio.org/Presentation/217418/abstract Usefulness of PESI score to predict clinical outcomes among intermediate risk pulmonary emboli patients SS Natanzon,1 S Shlomi,1 O Goitein,1 L Kaufman,1 N Shlomo,1 F Chernomordik,1 I Mazin,1 S Ben-Zekry,1 A Grupper,1 R Herscovici1 and R Beigel1 1Chaim Sheba Medical Center, Lev and Olga Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel, Tel Hashomer, Israel Background: Intermediate risk pulmonary embolism (PE) patients pose a therapeutic dilemma. On the one hand, they are hemodynamic stable on presentation while on the other hand they are at increased risk of recurrent VTE, hemodynamic compromise and death. Purpose: We aimed to evaluate the usefulness of PESI score to predict clinical outcomes among intermediate risk PE patients with signs of right ventricular (RV) dysfunction admitted to Intensive care cardiac unit (ICCU) Methods: We evaluate 203 consecutive intermediate risk PE patients admitted to ICCU with signs of RV dysfunction. Patients were stratified to Low (PESI class<3) and high (PESI class≥3) score. Clinical outcomes were defined as one or several of the following: the need for reperfusion therapy (both surgical and thrombolysis), ionotropic agents, mechanical ventilation, hemodynamic instability and in-hospital as well as 30 days mortality Results: Patients with higher PESI score were older (72.4±11.1 vs 57±17.4, p<0.001) had higher prevalence of malignancy (31.8% vs 3.2%, p<0.001), hypertension (57.1% vs 44.3%, p-0.087) and lower body mass index (28.55±6.22 vs 31.08±7.37, p-0.017). Upon, Echocardiography, no difference was observed in right ventricular dysfunction and/dilation as well as systolic pulmonary artery pressure (SPAP)>35 mmhg. The higher risk groups had higher prevalence of hemodynamic instability (10.2% vs 0, p-0.006), need of mechanical ventilation (6.5% vs 0, p-0.026), and a trend towards higher rate of acute kidney injury (10.2% vs 3.2%, p-0.089). No significant difference was found in need for reperfusion therapy, in-hospital and 30 days mortality. Conclusion: Admission PESI score predicted a more complicated clinical course among intermediate risk pulmonary embolism patients with signs of RV dysfunction Open in new tabDownload slide Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure: Pharmacotherapy 37 https://esc365.escardio.org/Presentation/221291/abstract Inhaled nitric oxide has pulmonary vasodilator efficacy both in the immediate and prolonged phase of acute pulmonary embolismThe Novo Nordisk Foundation; The Laerdal Foundation; Eva og Henry Frænkels Mindefond; Direktør Emil og Hustru Inger Hertz’ Fond; Ringgård-Bohns Fond A Hansen,1 CS Mortensen,1 JS Schultz,1 MD Lyhne,1 A Andersen1 and JE Nielsen-Kudsk1 1Aarhus University Hospital, Aarhus, Denmark Background: Inhaled nitric oxide (iNO) effectively reduces right ventricular afterload when administered in the immediate phase of acute pulmonary embolism (PE) in preclinical animal models. Purpose: In a porcine model of intermediate-risk PE, we aimed to investigate whether iNO has pulmonary vasodilator efficacy both in the acute and prolonged phase of acute PE. Methods: Prior to the potential administration of autologous emboli, 18 pigs were randomized into three subgroups. An iNO-group (n=6) received iNO at 40 ppm at one, three, six, nine and 12 hours after onset of PE. Vehicle animals (n=6) received PE, but no active treatment. Finally, a third group of sham animals (n=6) received neither PE nor treatment. Animals were evaluated using intravascular pressures, respiratory parameters, biochemistry and intracardiac pressure-volume measurements. Results: Administration of PE increased mean pulmonary artery pressure (mPAP) (vehicle vs. sham; 33.3 vs. 17.7 mmHg, p<0.0001), pulmonary vascular resistance (vehicle vs. sham; 847.5 vs. 82.0 dynes, p<0.0001) and right ventricular arterial elastance (vehicle vs. sham; 1.2 vs. 0.2 mmHg/ml, p<0.0001). Significant mPAP reduction by iNO was preserved at 12 hours after the onset of acute PE (Vehicle vs. iNO; 0.5 vs. -3.5 mmHg, p<0.0001). However, this response was attenuated over time (p=0.0313). iNO did not affect the systemic circulation. Conclusions: iNO is a safe and effective pulmonary vasodilator both in the immediate and prolonged phase of acute PE in an in-vivo porcine model of intermediate-risk PE. Open in new tabDownload slide Mean Pulmonary Arterial Pressure. Acute Coronary Syndromes: Tako-Tsubo Cardiomyopathy 76 https://esc365.escardio.org/Presentation/221094/abstract Coronary slow flow is associated with a worse clinical outcome in patients with takotsubo syndrome RA Montone,1 MC Meucci,1 L Galiuto,1 MG Del Buono,1 F Vergni,1 M Camilli,1 T Sanna,1 D Pedicino,1 A Buffon,1 C Trani,1 G Liuzzo,1 AG Rebuzzi,1 G Niccoli1 and F Crea1 1Catholic University of the Sacred Heart, Rome, Italy Background: Patients with Takotsubo syndrome (TTS) present an acute microvascular dysfunction that leads to an impaired myocardial perfusion and, in more severe forms, to an impaired epicardial flow. However, clinical relevance of a delayed epicardial coronary flow, the so-called coronary slow flow (CSF), in these patients has never been investigated. Purpose: To evaluate the incidence, the clinical correlates and the prognostic value of CSF occurring in the acute phase of TTS. Methods: This is an observational cohort analysis with a prospective clinical follow-up, including consecutive patients presenting with a diagnosis of TTS from January 2014 to September 2018. Median follow-up time is of 22.6 ±17.5 months. Occurrence of intrahospital complications (composite of acute heart failure, respiratory failure, life-threatening arrhythmia, cerebrovascular event and death from any cause) was examined. The incidence of death from any cause and major adverse cardiovascular events (MACE), defined as the composite of TTS recurrence, cardiac rehospitalization, cerebrovascular events and death from any causes, was assessed at follow-up. CSF was defined as angiographically non-obstructive coronary arteries with Thrombolysis In Myocardial Infarction (TIMI) 2 flow. Results: We enrolled 101 TTS patients [mean age 71.0±11.1 years, 86 (85.1%) female]. CSF occurred in 18 (17.8%) patients. At admission, patients with CSF presented more frequently with Killip class III/IV, with moderate-to-severe left ventricle systolic dysfunction and right ventricle dysfunction compared with patients with normal coronary flow (NCF). During the index admission CSF patients had a higher rate of intra-hospital complications [12 (66.7%) vs. 28 (33.7%), p=0.01]. At long-term follow-up, CSF patients had a significantly higher occurrence of death from any causes [9 (50%) vs. 19 (22.9%), p=0.011] and a numerically higher rate of MACE [10 (55.5%) vs. 27 (32.5%), p=0.06] compared with NCF. Of interest, the cause of death was non-cardiac in the large part of patients (89.3%). At multivariable Cox regression, CSF and a pre-existing neurologic disorder were independently associated with death from any causes. Conclusions: Coronary slow flow is an independent predictor of poor short- and long-term clinical outcomes demonstrating a potential role for prognosis stratification of Takotsubo patients. Open in new tabDownload slide Kaplan–Meier curves for death. Table 1. Endpoint . Total population (n=101) . Normal coronary flow (n=83) . Coronary slow flow (n=18) . P . Intra-hospital complications, n(%) 40 (39.6) 28 (33.7) 12 (66.7) 0.01 MACE at follow-up, n(%) 37 (36.6) 27 (32.5) 10 (55.5) 0.06 All-cause mortality at follow-up, n(%) 28 (27.7) 19 (22.9) 9 (50) 0.01 Endpoint . Total population (n=101) . Normal coronary flow (n=83) . Coronary slow flow (n=18) . P . Intra-hospital complications, n(%) 40 (39.6) 28 (33.7) 12 (66.7) 0.01 MACE at follow-up, n(%) 37 (36.6) 27 (32.5) 10 (55.5) 0.06 All-cause mortality at follow-up, n(%) 28 (27.7) 19 (22.9) 9 (50) 0.01 Kaplan-Meier analysis for survival. Open in new tab Table 1. Endpoint . Total population (n=101) . Normal coronary flow (n=83) . Coronary slow flow (n=18) . P . Intra-hospital complications, n(%) 40 (39.6) 28 (33.7) 12 (66.7) 0.01 MACE at follow-up, n(%) 37 (36.6) 27 (32.5) 10 (55.5) 0.06 All-cause mortality at follow-up, n(%) 28 (27.7) 19 (22.9) 9 (50) 0.01 Endpoint . Total population (n=101) . Normal coronary flow (n=83) . Coronary slow flow (n=18) . P . Intra-hospital complications, n(%) 40 (39.6) 28 (33.7) 12 (66.7) 0.01 MACE at follow-up, n(%) 37 (36.6) 27 (32.5) 10 (55.5) 0.06 All-cause mortality at follow-up, n(%) 28 (27.7) 19 (22.9) 9 (50) 0.01 Kaplan-Meier analysis for survival. Open in new tab Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome 77 https://esc365.escardio.org/Presentation/216729/abstract Incidence and prognostic relevance of new-onset atrial fibrillation in acute myocardial infarction and its relationship with renal function. J Campodonico,1 N Cosentino,1 M Ballarotto,1 V Milazzo,1 M Moltrasio,1 M De Metrio,1 C Lucci,1 K Celentano,1 M Rubino,1 I Marana,1 M Grazi,1 G Lauri1 and G Marenzi1 1Cardiology Center Monzino IRCCS, cardiology, Milan, Italy Introduction: Atrial fibrillation (AF) is a frequent complication of acute myocardial infarction (AMI) and is associated with a worse prognosis. Patients with chronic kidney disease are more likely to develop AF. Whether the association between AF and renal function is also true in AMI has never been investigated. Purpose: The aim of the study was to assess the incidence of new-onset AF according to renal function, estimated at hospital admission, and its relationship with short-term outcome and long-term all-cause mortality in a large real-world cohort of AMI patients. Methods: We prospectively enrolled 2,445 AMI patients. New-onset AF was recorded during hospitalization. Glomerular filtration rate (eGFR) was estimated at admission and patients were grouped according to their renal function (group 1 [n=1,887]: eGFR>60; group 2 [n=492]: eGFR 60-30; group 3 [n=66]: eGFR<30 ml/min/1.73m2). The primary endpoint was AF incidence. In-hospital and long-term (median 5 years) all-cause mortality were the secondary endpoints. Results: The AF incidence in the whole population was 10% and it was associated with a higher in-hospital (5% vs. 1%; P<0.0001) and long-term mortality (34% vs. 13%; P<0.0001). The AF incidence was 8%, 16%, 24% in groups 1, 2, 3, respectively (P<0.0001). In each group, in-hospital mortality was higher in AF patients (3.5% vs. 0.5%, 6.5% vs. 3.0%, 19% vs. 8%, respectively; P<0.0001). A similar trend was observed for long-term mortality (20% vs. 9%, 51% vs. 24%, 81% vs. 50%, respectively; P<0.0001). The higher risk for in-hospital and long-term mortality associated with AF in each group was confirmed also after adjustment for major confounders. Conclusions: The study demonstrates that the incidence of new-onset AF during AMI, as well as its associated in-hospital and long-term mortality, increases in parallel with the severity of renal dysfunction assessed at hospital admission. 79 https://esc365.escardio.org/Presentation/216494/abstract The association of B-lines in lung ultrasound with mortality in ST-elevation myocardial infarction C Jackson,1 R Gopar-Nieto,1 A Gallardo-Grajeda,1 C Dattoli-Garcia,1 L Baeza-Herrera,1 R Pohls-Vazquez,1 M Martinez-Ramos,1 G Raymundo-Martinez,1 A Loaisiga-Saenz,1 A Villalobos-Flores,1 I Delgado-Cruz,1 A Alonso-Vazquez,1 D Araiza-Garaygordobil1 and A Arias-Mendoza1 1National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico Background: Lung ultrasound (LUS) based on B-lines measurement has been proposed as an effective tool for the assessment of pulmonary congestion in patients with decompensated heart failure. Decompensated heart failure is often recognized in a very late stage and clinical congestion can be explored earlier with LUS. In myocardial infarction, the early diastolic dysfunction can correlate with pulmonary congestion, nevertheless the association of B lines in LUS with in-hospital mortality in ST-elevation myocardial infarction (STEMI) remains unexplored. Purpose: Association between B-lines assessed by lung ultrasound and mortality in STEMI Methods: Cohort study. Included patients with STEMI treated with PCI or thrombolysis from April 2018 to October 2019 in our city. A 4-site LUS protocol was performed during the first 24 hours of hospitalization after diagnosis of STEMI. To estimate sensitivity, specificity and likelihood ROC analysis was used. A Cox univariate regression model was performed to predict the association of B lines with in-hospital mortality. Results: We included 329 patients, with no previous pulmonary pathology. In the ROC analysis, the presence of >=3 lines showed 50% sensitivity, 93.46% specificity, 7.64 +LR and 0.53 –LR. In a univariate Cox-regression model, >3 B-lines were associated with higher mortality (HR 7.99, 95%IC 1.98-32.13) a survival analysis showed differences in mortality (p=0.00). Conclusion(s): The use of LUS can be used to predict mortality in ST-elevation myocardial infarction. Table 1. . n . % . Men 292 88.8 Diabetes Mellitus 109 33.1 Hypertension 143 43.5 Dyslipidemia 58 17.6 Current Smoking 155 47.1 n Median (IQR) Age (years) 329 59 (50.5-66) Heart Rate (bpm) 329 77 (69-90) Systolic Blood Pressure (mmHg) 329 127 (112-145) Diastolic Blood Pressure (mmHg) 329 80 (70-90) GRACE Score 329 123 (99-149) TIMI Score 329 4 (2-5) Ejection fraction (%) 329 46 (35-55) . n . % . Men 292 88.8 Diabetes Mellitus 109 33.1 Hypertension 143 43.5 Dyslipidemia 58 17.6 Current Smoking 155 47.1 n Median (IQR) Age (years) 329 59 (50.5-66) Heart Rate (bpm) 329 77 (69-90) Systolic Blood Pressure (mmHg) 329 127 (112-145) Diastolic Blood Pressure (mmHg) 329 80 (70-90) GRACE Score 329 123 (99-149) TIMI Score 329 4 (2-5) Ejection fraction (%) 329 46 (35-55) Baseline characteristics of STEMI patients. Open in new tab Table 1. . n . % . Men 292 88.8 Diabetes Mellitus 109 33.1 Hypertension 143 43.5 Dyslipidemia 58 17.6 Current Smoking 155 47.1 n Median (IQR) Age (years) 329 59 (50.5-66) Heart Rate (bpm) 329 77 (69-90) Systolic Blood Pressure (mmHg) 329 127 (112-145) Diastolic Blood Pressure (mmHg) 329 80 (70-90) GRACE Score 329 123 (99-149) TIMI Score 329 4 (2-5) Ejection fraction (%) 329 46 (35-55) . n . % . Men 292 88.8 Diabetes Mellitus 109 33.1 Hypertension 143 43.5 Dyslipidemia 58 17.6 Current Smoking 155 47.1 n Median (IQR) Age (years) 329 59 (50.5-66) Heart Rate (bpm) 329 77 (69-90) Systolic Blood Pressure (mmHg) 329 127 (112-145) Diastolic Blood Pressure (mmHg) 329 80 (70-90) GRACE Score 329 123 (99-149) TIMI Score 329 4 (2-5) Ejection fraction (%) 329 46 (35-55) Baseline characteristics of STEMI patients. Open in new tab Open in new tabDownload slide Kaplan-Meier analysis for survival. 80 https://esc365.escardio.org/Presentation/216486/abstract Sex gaps in optimal care delivery after acute coronary syndromes in a tertiary center in europe: (not) me too07/03/2020 17:30 C Montalto,1 M Walker,1 A Repetto,2 F Fortuni,1 M Portolan,2 R Camporotondo,2 FM Dionisio,1 R Totaro,2 L Arzuffi,1 B Marinoni,2 M Ferlini,2 G Crimi,2 M Gnecchi,1 L Oltrona-Visconti2 and S Leonardi1 1University of Pavia, Pavia, Italy 2Policlinic Foundation San Matteo IRCCS, Division of Cardiology, Pavia, Italy Introduction: Acute coronary syndromes (ACS) outcome and management may vary according to sex. Purpose: We sought to examine possible sex disparities in optimal medical therapy (OMT) prescription at discharge in the context of ACS and its impact on survival. Methods: Between 2015 and 2017 consecutive patients with an initial diagnosis of ACS were enrolled in the Clinical Governance Program, a single-center prospective quality improvement initiative in all comers ACS patients. OMT was defined as a patient-level binary all-or-none composite Quality Indicator (QI) according to 2016 ACCA QIs on Acute Myocardial Infarction, including: optimal dual antiplatelet therapy; optimal secondary prevention; appropriate in-hospital fondaparinux administration only in eligible Non-ST Elevation ACS patients. Results: We enrolled a total of 1,524 patients with ACS, including: 471 (30,9%) women and 1052 (69.1%) men. Women presented with higher bleeding (CRUSADE score 21 vs. 12, p<0.001) and mortality risk (GRACE score 66 vs. 53, p<0.001) and less frequently presented with STEMI (48% vs. 41%, p<0.001); other baseline characteristics are in Figure 1A. Figure 1 Open in new tabDownload slide Overall, a significantly lower proportion of women with ACS received OMT at discharge (55.3% vs. 63.9%, p=0.003). When individual ACCA QIs were explored, women were less likely to receive adequate statin and aspirin at discharge (p<0.05). Finally, women were less likely to receive non-contraindicated invasive management than men (70.9% vs. 83.2%, p<0.001) but door-to-balloon time was similar for STEMI patients. During a mean follow-up of 264 days after index ACS we observed 166 (10.9%) deaths. Kaplan-Meier analysis showed that women experienced an excess long term mortality (log rank p=0.008; Figure 1B) but a similar rate of intra-hospital death was observed (7.5% vs. 5.2%, p=0.12). Cox regression multivariable analysis showed that receiving OMT was independently associated with less all-cause death (Hazard Ratio 0.53; 95% Confidence Interval 0.33-0.85; p=0.01) after adjustment for sex, age, prior ACS, left ventricular ejection fraction, renal function, anemia, cancer and type of ACS (Figure 1A). Finally, female sex was a univariate predictor of 1-year death but did not retain a multivariable independent prognostic value. Conclusions: In a contemporary cohort of consecutive ACS patients women experienced increased rate of death after ACS and were less likely to receive optimal medical therapy at discharge. As OMT is a strong, independent predictor of survival further research efforts should be invested to understand these potential sex-related disparities. Coronary Intervention: Primary and Acute PCI 82 https://esc365.escardio.org/Presentation/216432/abstract Experience in emergent percutaneous coronary interventions in pediatric population in a congenital cardiac disease centre. L Fernandez Gonzalez,1 F Ballesteros Tejerizo,2 A Rodriguez Ogando,2 A Sobrino Baladron,2 JL Zunzunegui Martinez,2 E Gutierrez Ibanes,3 R Sanz Ruiz3 and JM Gil-Jaurena4 1Hospital de Cruces, Baracaldo, Spain 2University Hospital Gregorio Maranon, Pediatric Cardiology, Madrid, Spain 3University Hospital Gregorio Maranon, Interventional Cardiology, Madrid, Spain 4University Hospital Gregorio Maranon, Pediatric Cardiac Surgery, Madrid, Spain Background: Percutaneous coronary interventions (PCI) is much less frequent than in adult population and usually is limited to an isolated cases with the limitation of the size of vessels. Atheriosclerotic coronary disease in pediatrics is extremely rare, the etiology of coronary disease include a wide spectrum; congenital coronary anomalies, Kawasaki disease, cardiac allograft vasculopathy, coronary extrinsic compression by right ventricle outflow conducts and cardiac surgery with coronary manipulation (Jatene arterial switch, Ross intervention…) Methods and Results: Unicentric retrospective registry of emergent PCI procedures in patients under 18 years since 2005 to 2018 in an specific pediatric congenital cardiac disease centre. We made a total of 9 procedures in 9 patients. Mid age 3,6 years (6 days - 14 years) with 4 patients under 1 year and 6 under 10 kilograms. 7 patients underwent to recent cardiac surgery inmediate postoperative period (2 Jatene arterial switch with Lecompte maniover, 4 Ross intervention and one of them coronary reinsertion), 1 patient to percutaneous aortic valvuloplasty and the last one had Kawasaki vasculitis affecting coronary arteries. In 8 of them the clinical presentation was cardiogenic shock needing extracorporeal membranous oxygenation (ECMO). All procedures were performed under general anesthesia by femoral access in 8 of them and axilar access in a patients with complete ilio-femoral axis obstruction. Most lesions affected ostial segments being more frequently involved ostial right coronary segments specially in case of surgery with coronary manipulation. Procedures were performed with 5F and 6F guiding catheters and 0,014 hidrofilic guidewires, in 90% predication with non compliant and cutting balloons were needed in order to obtain optimal stent aposition. We implanted 8 coronary stents (3 BMS, 4 DES and 1 BVS) in 7 patients, 2 of them only were treated with simple angioplasty due to the small vessel size. Postdilation was necessary in 2 cases because of stent underexpansión. Procedure success was defined as residual stenosis less than 30% of vessel lumen without complications. Neither procedure complications nor mortality was achieved. We followed up all patients, in 6 patients after the procedure ECMO could be stopped with optimal recovering. In hospital mortality was 22,2% (2 of 9) being both patients in cariogenic shock with multi-organ failure. Conclusions Although the small size of population studied, we could conclude that percutaneous coronary interventions in pediatric patients are feasible and safe procedures specially in experimented operator hands. It is really important to take into account acute coronary lesions in patients that undergone to cardiac surgery that include coronary manipulation. Diagnosis and treatment must be fast in order to avoid future complications and reduce mortality rates. Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome 84 https://esc365.escardio.org/Presentation/216452/abstract Long-term prognostic value of soluble urokinase plasminogen activator receptor in acute coronary syndromes OM Peiro Ibanez,1 G Cediel,2 G Bonet,1 S Rojas,1 V Quintern,1 A Carrasquer,1 M Gonzalez-Del-Hoyo,1 E Sanz1 and A Bardaji1 1Hospital Universitario Joan XXIII, Cardiology, Tarragona, Spain 2Germans Trias i Pujol Hospital, Badalona, Spain Introduction: Soluble urokinase plasminogen activator receptor (suPAR) is a low-grade inflammatory biomarker. In patients affected by an acute illness, chronic kidney disease and cardiovascular disease, elevated concentrations of suPAR have been related to adverse outcomes. However, there are limited data about the prognostic value of suPAR in the setting of an acute coronary syndrome (ACS). Purpose: To study the long-term prognostic value of suPAR in ACS. Methods: We included patients with an ACS who underwent coronary angiography and plasma suPAR concentration was measured. Patients were classified into two groups: low suPAR concentrations (<2.6ng/mL) and high suPAR concentrations (≥2.6ng/mL) and long-term events were evaluated. suPAR prognostic value was assessed beyond a clinical model that included age, GRACE score, estimated glomerular filtration rate, cardiac troponin I peak and left ventricular ejection fraction<40%. Results: A total of 340 patients were included; 194 (<2.6ng/mL) and 146 (≥2.6ng/mL). The median (IQR) age was 65 (56–74) years and 28.2% were female. Of all patients, 62.35% were admitted with non-ST-elevation myocardial infarction, 22.65% with ST-elevation myocardial infarction and 15.00% with unstable angina. Higher values of suPAR were consistently associated with an increased prevalence of cardiovascular risk factors. During a maximum follow-up of 5 years (median 4.9 [IQR 4.1-5.0]) 53 patients died. Of those patients, 13 (6.7%) had values of suPAR <2.6ng/mL and 40 (27.4%) ≥2.6ng/mL. After adjustment for potential confounders, suPAR ≥2.6ng/mL was independently associated with all-cause death (HR 2.5; 95% CI 1.2–5.2; p=0.011) and major adverse cardiovascular events (MACE) which were identified as all-cause death, non-fatal myocardial infarction and heart failure (HR 1.8; 95% CI 1.1–2.8; p=0.013). For long-term all-cause death a significant improvement of the net reclassification improvement (0.656; 95% CI 0.358–0.954; p<0.001) and integrated discrimination improvement (0.029; 95% CI 0.009–0.049; p=0.004) was seen after addition of suPAR to the clinical model. Of 16 events of heart failure, 13 occurred in patients with suPAR ≥2.6ng/mL. A multivariate competing risk model showed a significant association between suPAR ≥2.6ng/mL and incidence of heart failure (SHR 4.9; 95% CI 1.4–17.6; p=0.014) but non-significant association were found for myocardial infarction. Conclusions: In the setting of an ACS suPAR is associated with long-term all-cause death, MACE and heart failure and provides incremental prognostic value beyond traditional risks factors in the long-term all-cause death. Open in new tabDownload slide Cumulative survival and incidence. Acute Coronary Syndromes: Pharmacotherapy 86 https://esc365.escardio.org/Presentation/216745/abstract Ticagrelor versus clopidogrel in elderly patients with myocardial infarction: a real-life experience AR Pereira,1 A Marques,1 S Alegria,1 A Briosa,1 D Sebaiti,1 I Rangel,1 R Cale,1 AC Martins1 and H Pereira1 1Hospital Garcia de Orta, Cardiology, Almada, Portugal Introduction: Dual anti-platelet therapy (DAPT) with ticagrelor is recommended in patients (pts) with myocardial infarction (MI), due to its long-term benefit over clopidogrel. Elderly pts have both higher risk of recurrent ischemic events and higher risk of bleeding but there is few evidence for this cohort of pts. Objectives: To compare the short-term safety profile of DAPT with ticagrelor versus (vs) clopidogrel in elderly pts treated with percutaneous coronary intervention (PCI) after MI. To determine the evolution of this therapy prescription over the last years. Methods: From a retrospective multicenter national registry, pts with MI treated with PCI, between January 2011 and October 2018, were selected. These pts were divided according to age (< 75 vs ≥ 75 years). A detailed comparison between DAPT with ticagrelor vs clopidogrel was performed in the elderly group. Pts under triple antithrombotic therapy at hospital discharge were excluded. The safety profile was evaluated by the occurrence of major hemorrhage, need for red blood cell transfusion and all-cause death during hospital stay. Results: Of a total of 5847 pts, 1332 (22.8%) were age ≥ 75 years (mean age 81±4 years; 61.1% male). In both groups (figure), there was a progressive increase in ticagrelor prescription over the years. However, the interception point of the prescription curves occurred 1 year later for elderly pts and the highest prescription proportion (observed in 2018) was significantly lower in this group (88% vs 69%, p <0.01). Non-ST segment MI diagnosis (OR 0.9, 95%CI 0.5-0.9, p = 0.01), dyspnea as predominant initial symptom (OR 0.35, 95%CI 0.1-0.9, p = 0.02) and previous vascular peripheral disease (OR 0.5, 95%CI 0.3-0.9, p = 0.03) were independent predictors for clopidogrel prescription in the elderly group. No other factors influenced the DAPT choice, such as, previous kidney disease or bleeding, creatinine or hemoglobin values and the number or type of vessels with coronary disease. Regarding safety profile, there were no differences between clopidogrel and ticagrelor [in major hemorrhage (p =0 .56), need for transfusion (p = 0.11) and death (p > 0.99)]. Open in new tabDownload slide Conclusions: In this real-life context, there was a significantly lower prescription of ticagrelor in elderly group. Several clinical factors, not related to predictors of validated bleeding risk scores, influenced the DAPT choice in this subgroup. No difference was observed in short-term safety profile between the 2 drugs. Thus, prescription of ticagrelor in elderly should be rethought, in order to provide them with the best long-term benefit already demonstrated by large randomized trials. Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome 91 https://esc365.escardio.org/Presentation/221511/abstract Acute coronary syndromes with transient ST elevation: should we look closer? T Faria Da Mota,1 P Azevedo,1 R Fernandes,1 J De Sousa Bispo,1 H Costa,1 W Santos,1 J Mimoso1 and I Jesus1 1Algarve University Hospital Centre - Faro Hospital, Faro, Portugal Introduction: Some of the patients admitted for Acute Coronary Syndromes (ACS) present with transient ST segment elevation (tSTE-ACS). Current guidelines categorize such events as Non-ST Elevation ACS (NSTE-ACS), abstaining from any specific and directed recommendations. Methods: The authors present an observational, retrospective, descriptive and analytical study including all patients admitted for ACS in a country’s Cardiology Departments between the 1st of October 2010 and the 9th of January 2019. Patients with pacemaker rhythm or Left Bundle Branch Block at admission were excluded. A 1-year (1y) follow-up (f-up) was made through registry consultation and phone call by a Cardiologist. Patients were divided in three groups: STEMI, tSTE-ACS or NSTE-ACS and baseline demographic and clinical characteristics, risk factors and hospitalization data, as well as 1y outcomes, were compared between the groups. The authors performed multivariate statistical analysis of 1y mortality and re-admission rate, using SPSS 24,0. Results: A total of 17627 patients were included, of which 4637 (26,3%) were female, with a mean age of 65±13 years; 7804 patients (44,27%) were admitted for STEMI, 543 (3,08%) for tSTE-ACS and 9280 (52,65%) for NSTE-ACS. Regarding CV risk factors, smoking was less frequent in tSTE-ACS than STEMI patients, but hypertension, diabetes and dyslipidaemia were more frequent (p<0,001). Additionally, previous coronary events and interventions were also more common in tSTE-ACS patients, as was medication with anti-platelets, anticoagulants, beta-blockers, ACEi and statins (p<0,001). tSTE-ACS patients arrived at the hospital by their own means more frequently (48,3% vs 39,4%, p<0,001), and recurred less to pre-hospital emergent medical assistance (17,2% vs 27,1%, p<0,001). 4,4% of these patients were directly admitted at the Cath Lab, but most of them went to Acute Cardiac Care Units (58,3%). Time between onset of symptoms and hospital admission was significantly higher in tSTE-ACS patients (median: 232 vs 177 min.) mainly due to longer times between first medical contact and admission. These patients presented less heart failure NYHA class ≥II symptoms (10,1% vs 14,1%), specially for cardiogenic shock (0,2% vs 3,6%), but presented more frequently with atrial fibrillation (7,6% vs 5,3%). These patients’ angiograms more oftenly had no significant lesions (13,4% vs 2%) or non-identified culprit lesions (12% vs 4,7%). After multivarite analysis, all in-hospital complications apart from AF and mechanical complications, and including death, were more frequent in STEMI patients. On the other hand, no sigificant differences were observed between tSTE-ACS and NSTE-ACS patients. Regarding f-up data, 1y mortality was significantly higher in STEMI patients (6,1% vs 3,5%, p=0,022), but these had less hospital re-admissions (10,9 vs. 13,7%, p<0,001). Besides, ST-T changes didn’t prove to be a significant predictor of earlier death or re-admission on 1y f-up. Acute Coronary Syndromes: Biomarkers 93 https://esc365.escardio.org/Presentation/221096/abstract Fast prehospital rule-out using a high-sensitivity cardiac troponin T assay in a low-prevalence population for acute coronary syndrome (OUT-ACS)The Norwegian Research Fund for General Practice, The Norwegian Medical Association’s fund for quality improvement and patient safety TR Johannessen,1 OM Vallersnes,1 AC Larstorp,2 I Mdala,3 D Atar4 and S Halvorsen4 1Oslo Accident and Emergency Outpatient Clinic, City of Oslo Health Agency and University of Oslo, Department of General Practice, Oslo, Norway 2Oslo University Hospital Ulleval, Department of Medical Biochemistry and Section of Cardiovascular and Renal Research, Oslo, Norway 3University of Oslo, Department of General Practice, Oslo, Norway 4Oslo University Hospital Ulleval, Department of Cardiology and Institute of Clinical Medicine, University of Oslo, Oslo, Norway Background: In Norway, many patients with acute chest pain initially present to primary care emergency outpatient clinics, which serves to triage them to hospitals. Purpose: The diagnostic utility of the 0/1-hour algorithm for high-sensitivity cardiac troponin T (hs-cTnT) has been validated in large emergency department cohorts. This study aimed to validate the diagnostic and prognostic performance of the algorithm in a primary care setting, among patients not directly hospitalised, hence with a lower pre-test probability for acute coronary syndrome. Methods: This single-centre, prospective cohort study included 1750 patients with acute non-specific chest pain from November 2016 to October 2018, at a primary care emergency outpatient clinic in Norway. Hs-cTnT was measured after 0, 1 and 4 hours, before a decision of rule-out, rule-in, or further observation was taken, according to the current European Society of Cardiology guidelines on non-ST-elevation myocardial infarction. Acute myocardial infarction (AMI) diagnoses were adjudicated by two independent cardiologists. Information on new incidents of AMIs or deaths the following 90 days were collected from all consenting patients. Results: Among the 1711 patients remaining for analysis, median age was 56 years (IQR 45-68), 47.7% were females, and 3.6% were diagnosed with AMI. By applying the algorithm, 76.6% of the patients were assigned to rule-out, among whom 40.1% were directly ruled out by a single hs-cTnT. Patients directly ruled out were younger, 47 years (IQR 38-56), and more often female (58.6%). Only 3.9% of the patients were triaged toward rule-in, and 334 (19.5%) patients were assigned to further observation. Conclusions: The 0/1-hour algorithm for hs-cTnT seems safe, efficient, and applicable for an accelerated assessment of patients with non-specific chest pain in a primary care emergency setting, especially for a fast rule-out of AMI. Prehospital implementation may reduce the need for hospitalization of these patients in the future, and hence decrease health care expenditure. Acute Heart Failure: Biomarkers P98 https://esc365.escardio.org/Presentation/216431/abstract Exhaled breath acetone as a marker for acute heart failure in patients presenting with breathlessnessTemporary doctoral fellowship mandate from the university of Antwerp M Vanden Eede,1 G Koppen,2 G Slingers,2 K Lamote,1 J Van Meerbeeck,3 K Monsieurs,4 P Jorens1 and M Claeys5 1University of Antwerp, Antwerp-Wilrijk, Belgium 2Flemish Institute for Technological Research, Bio-health, Mol, Belgium 3Antwerp University Hospital, Pulmonology, Edegem, Belgium 4Antwerp University Hospital, Emergency, Edegem, Belgium 5Antwerp University Hospital, Cardiology, Edegem, Belgium Introduction: Exhaled breath contains volatile end products of systemic metabolic processes, called Volatile Organic Compounds (VOC), that can be measured and quantified. Observational studies have described increased concentrations of exhaled acetone and pentane in patients with Acute Heart Failure (AHF) compared to healthy controls, as well as decreased concertations of isoprene. We hypothesized that in patients with AHF, the concentrations of these exhaled breath compounds also differ from patients with pulmonary diseases, when presenting to the Emergency Department (ED) with shortness of breath. Purpose: To evaluate the feasibility of exhaled breath testing for differentiating AHF from lung diseases in patients presenting to the ED with breathlessness. Table 1. Mean exhaled VOC concentrations. . AHF group Mean (IQR), ppb . Lung diseases group Mean (IQR), ppb . p-valuea . N 5 6 Isoprene 51.1±29 (36.4) 21±11.4 (11.5) 0.082 Pentane 166±33.4 (40.2) 174±88.7 (21.9) 0.537 Acetone 2814±873 (1265) 555±257 (238) 0.004 . AHF group Mean (IQR), ppb . Lung diseases group Mean (IQR), ppb . p-valuea . N 5 6 Isoprene 51.1±29 (36.4) 21±11.4 (11.5) 0.082 Pentane 166±33.4 (40.2) 174±88.7 (21.9) 0.537 Acetone 2814±873 (1265) 555±257 (238) 0.004 a: Mann-Whitney U test; IQR: InterQuartile Range; ppb: Parts Per Billion Open in new tab Table 1. Mean exhaled VOC concentrations. . AHF group Mean (IQR), ppb . Lung diseases group Mean (IQR), ppb . p-valuea . N 5 6 Isoprene 51.1±29 (36.4) 21±11.4 (11.5) 0.082 Pentane 166±33.4 (40.2) 174±88.7 (21.9) 0.537 Acetone 2814±873 (1265) 555±257 (238) 0.004 . AHF group Mean (IQR), ppb . Lung diseases group Mean (IQR), ppb . p-valuea . N 5 6 Isoprene 51.1±29 (36.4) 21±11.4 (11.5) 0.082 Pentane 166±33.4 (40.2) 174±88.7 (21.9) 0.537 Acetone 2814±873 (1265) 555±257 (238) 0.004 a: Mann-Whitney U test; IQR: InterQuartile Range; ppb: Parts Per Billion Open in new tab Methods: This pilot study enrolled 11 selected patients (mean age 75±8.9Y) with distinctive heart failure or pulmonary disease, presenting to the ED with breathlessness. Patients with acute heart failure (N=5) included 3 patients with left ventricular dysfunction (mean left ventricular ejection fraction 23±4.2%) and two patients with right ventricular dysfunction, all in decompensated phase. Patient with pulmonary diseases (N=6) included 5 community-acquired pneumonias and 1 chronic obstructive pulmonary disease. Exhaled breath was sampled using a commercially available sampler device and analysed using selected ion flow tube mass spectrometry in multiple ion monitoring mode for acetone, pentane and isoprene. Results: Of the measured exhaled compounds, only acetone was significantly elevated in patients with AHF (Mean: 2814±873 ppb, IQR: 1256 ppb) when compared to patients with pulmonary diseases (Mean: 555±257 ppb, IQR: 238 ppb). Receiver operating characteristics identified an optimal cut-off value of 864 ppb of exhaled acetone to diagnose AHF with an area under the curve of 1.0. Acetone showed poor correlation with glucose (R = -0.118) and time of last meal (R = -0.004). Acetone did moderately correlated with NT-proBNP (R = 0.53), although this did not reach statistical significance (p = 0.4232). Conclusion(s): Exhaled breath analysis is feasible and shows promise as a rapid diagnostic tool for AHF. Further evaluation is needed in a large unselected population of patients presenting to the ED with breathlessness. P99 https://esc365.escardio.org/Presentation/217218/abstract High venous to arterial CO2 gap is related to cardiovascular death in cardiogenic shock T Lopez-Sobrino,1 A Gazquez Toscano,1 M Soler Silva,1 N Romeu Mirabete,1 M Parellada Vendrell,1 M Casado Pena,1 C Ruiz Falques,1 A Fernandez Valledor,1 S Vazquez Calvo,1 N Rojo Prieto,1 L Izquierdo Montilla,1 G Lopez Domenech,1 I Velasco Ortiz,1 R Andrea Riba1 and JT Ortiz Perez1 1Hospital Clinic de Barcelona, Barcelona, Spain Background: Venous to arterial CO2 gap (CO2gap) is calculated by subtracting partial pressure of arterial CO2 to central venous partial pressure of CO2 (ScvCO2). This marker has been studied in septic shock and indicates hypoperfusion when exceeds 6mmHg. Its kinetics and applicability in cardiogenic shock (CS) are unclear, being mixed/central venous saturation and lactate more commonly used. Purpose: The objective of the study is to describe CO2gap kinetics in patients with CS. Secondary objective is to analyze if CO2gap is as marker of prognosis in CS. Table 1. CO2gap and cardiovascular mortality. Time from shock onset . Cardiovascular death (n=7) . No cardiovascular death (n=33) . Sig.(p value) . Admission 10.97 (± 0.6) mmHg 8.17 (± 4.21) mmHg 0.007 6 h 9.65 (± 4.04) mmHg 5.25 (± 8.31) mmHg 0.068 12 h 9.24 (± 7.27) mmHg 7.37 (± 3.29) mmHg 0.529 24 h 8.38 (± 1.69) mmHg 6.93 (± 4.72) mmHg 0.191 48 h 4.77 (± 5.86) mmHg 6.26 (± 4.92) mmHg 0.579 Time from shock onset . Cardiovascular death (n=7) . No cardiovascular death (n=33) . Sig.(p value) . Admission 10.97 (± 0.6) mmHg 8.17 (± 4.21) mmHg 0.007 6 h 9.65 (± 4.04) mmHg 5.25 (± 8.31) mmHg 0.068 12 h 9.24 (± 7.27) mmHg 7.37 (± 3.29) mmHg 0.529 24 h 8.38 (± 1.69) mmHg 6.93 (± 4.72) mmHg 0.191 48 h 4.77 (± 5.86) mmHg 6.26 (± 4.92) mmHg 0.579 Differences in CO2gap during first 48 hours from shock onset related to cardiovascular mortality. Open in new tab Table 1. CO2gap and cardiovascular mortality. Time from shock onset . Cardiovascular death (n=7) . No cardiovascular death (n=33) . Sig.(p value) . Admission 10.97 (± 0.6) mmHg 8.17 (± 4.21) mmHg 0.007 6 h 9.65 (± 4.04) mmHg 5.25 (± 8.31) mmHg 0.068 12 h 9.24 (± 7.27) mmHg 7.37 (± 3.29) mmHg 0.529 24 h 8.38 (± 1.69) mmHg 6.93 (± 4.72) mmHg 0.191 48 h 4.77 (± 5.86) mmHg 6.26 (± 4.92) mmHg 0.579 Time from shock onset . Cardiovascular death (n=7) . No cardiovascular death (n=33) . Sig.(p value) . Admission 10.97 (± 0.6) mmHg 8.17 (± 4.21) mmHg 0.007 6 h 9.65 (± 4.04) mmHg 5.25 (± 8.31) mmHg 0.068 12 h 9.24 (± 7.27) mmHg 7.37 (± 3.29) mmHg 0.529 24 h 8.38 (± 1.69) mmHg 6.93 (± 4.72) mmHg 0.191 48 h 4.77 (± 5.86) mmHg 6.26 (± 4.92) mmHg 0.579 Differences in CO2gap during first 48 hours from shock onset related to cardiovascular mortality. Open in new tab Methods: Prospective observational study that included patients admitted for CS in the Acute Cardiovascular Care Unit of a tertiary hospital. Gasometric samples were obtained at admission, 6, 12, 24 and 48 hours from the onset of shock. In-hospital mortality was registered. Results: We included 40 patients with CS during 1 year. Most patients were male (80%), average age was 68 years. There was a high incidence of cardiac arrest (58%), most frequent cause of CS was STEMI (45%), in-hospital mortality was 45%, most cases from non-cardiovascular causes (61%). Refractory shock was frequent (28%). Average lactate peak was 6.02 mmol / L. CO2gap kinetics consisted in a peak at admission (8.8mmHg), valley at 6h (3.9mmHg), new peak at 12h (7.5mmHg) and plateau at 24 (6.7mmHg) and 48h (7.5 mmHg). Significantly, higher CO2gap values at admission (10.97mmHg vs 8.16mmHg, p = 0.007) and as a trend at 6 hours (9.65mmHg vs 5.2mmHg, p = 0.068) were predictors of cardiovascular mortality. Lactate values at 6, 12 and 48 hours were also predictors of cardiovascular mortality, as well as ScvO2 at admission. Conclusions: Patients with CS present with high CO2gap values during first hours of admission. The kinetics of this marker consists in two peaks at admission and 12 hours from CS onset, a valley at 6 hours and a plateau at 24 and 48 hours. Its determination at admission is associated with cardiovascular mortality. We suggest the potential benefit of combining this marker, along with lactate and ScvO2 values, to guide management of patients with CS. Open in new tabDownload slide P100 https://esc365.escardio.org/Presentation/217223/abstract Prognostic approach of natriuretic peptides in acute heart failure H Costa,1 T Silva,1 A Quiterio,1 A Baptista1 and M Lazaro1 1Algarve University Hospital Center, Faro, Portugal Introduction: Heart failure (HF) is a highly prevalent clinical syndrome associated with high morbi-mortality. The usefulness of cardiac biomarkers in HF has been widely studied in the last decades, aiding not only the diagnosis but also the prognostic impact. In acute HF (AHF) natriuretic peptides (NP) can estimate the patient’s blood volume and an adequate decongestive therapy, indirectly reflecting cardiac filling pressures. Concentrations after treatment have prognostic significance, since lower values or greater relative reductions at discharge are predictors of lower mortality and 1-year rehospitalizations. Purpose: Primary Outcome: To determine the number of AHF patients admitted to a central hospital in a single day, characterize the ejection fraction (EF) and check NT-proBNP values upon admission and if were performed at discharge. Verify the distribution of NT-proBNP values depending on HF-EF. Secondary Outcome: Verify if patients with a significant relative reduction (SRR) of NT-proBNP at discharge have shorter hospital stays, as well as mortality. Methods: Retrospective observational study with descriptive analysis. Created 2 groups: NTDD-proBNP - NT-proBNP Double Dosing; NTSD-proBNP - NT-proBNP Single Dosing. NTDD-proBNP is defined as patients with an NT-proBNP measurement at admission in emergency department (ED) and at least another near discharge. NTSD-proBNP is defined as patients with NT-proBNP measurement only at admission. Disease characterization assessed by echocardiographic: HFpEF-preserved EF (≥50%); HFmEF-moderated EF (40-49%); HFrEF-reduced EF (<40%); HFuEF- unknown FE. NT-proBNP SRR is considered if > 30% reduction. Short term hospitalization is defined when ≤ 15 days. Elevated NT-proBNP values at admission were defined as > 3500pg /ml. For this purpose it was verified the clinical and death records. Results: Identified 36 patients (N174), mean 83 years old, 55% male. 25% HFpEF; 15% HFrEF; 2% HFmEF; 58% HFuEF. 55% HFpEF had lower NT-proBNP values at admission versus 60% of HFrEF and 72% of HFuEF with higher values. 33% NTDD-proBNP and 67% NTSD-proBNP. 33% NTDD-proBNP - 50% with NT-proBNP SRR and 100% these had short-term hospitalization. 67% NTSD-proBNP - 42% with short-term hospitalization. There were 11 deaths, 36% of HFpEF, 18% HFrEF, 46% HFuEF and 72% NT-proBNP > 3500pg/ml at admission. Conclusions: 20% of hospitalized patients have a primary diagnosis of AHF. Only 33% of patients are NTDD-proBNP, despite their proven prognostic value. Of these, 50% had short-term hospitalization and SRR NT-proBNP. Of the characterized HF, most were HFpEF with lower NT-proBNP values at admission but with higher mortality. 72% of deaths have a higher NT-proBNP at admission. Most patients remain uncharacterized, although they showed higher mortality and NT-proBNP values. P101 https://esc365.escardio.org/Presentation/216397/abstract Troponin T predicts cardiogenic shock requiring mechanical circulatory support in patients with valve diseaseStatutary work at Institute of Cardiology, Warsaw, Poland P Duchnowski,1 M Kusmierczyk,2 M Kozma1 and T Hryniewiecki1 1Institute of Cardiology in Anin, Department of Acquired Cardiac Defects, Warsaw, Poland 2Institute of Cardiology in Anin, Department of Cardiosurgery and Transplantology, Warsaw, Poland Background: Cardiogenic shock is a very serious postoperative complication in patients undergoing heart valve surgery. Mechanical circulatory support is a recognized method of treating patients with this complication. The aim of the presented study was to assess the usefulness of selected biomarkers in predicting the occurrence of postoperative cardiogenic shock requiring mechanical circulatory support. Methods: This prospective study was conducted on a group of 712 patients undergoing heart valve surgery. The primary end-point at the intra-hospital follow-up was postoperative cardiogenic shock requiring mechanical circulatory support. Results: The postoperative cardiogenic shock requiring mechanical circulatory support occurred in 20 patients. The statistically significant predictors of postoperative cardiogenic shock requiring mechanical circulatory support at univariate analysis are presented in Table 1. At multivariate analysis high-sensitivity Troponin T measured immediately after surgery (hs-TnT I)(OR 1.006; 95% CI 1.002-1.013; p 0.009) remained independent predictor of the primary end point. The area under receiver operator characteristic curve for primary end-point for hs-TnT I is 0.880 (95% CI 0.853-0.903)(Figure 1). Figure 1. Open in new tabDownload slide Conclusions: The postoperative hs-TnT can be used to predict a postoperative cardiogenic shock requiring mechanical circulatory support. Acute Heart Failure: Imaging P102 https://esc365.escardio.org/Presentation/216473/abstract Predictores of early cardiotoxicity induced by anthracyclines CC Oliveira,1 I Bernardo,2 M Coelho,2 I Campos,1 P Medeiros,1 C Pires,1 P Medeiros,1 R Flores,1 F Mane,1 C Braga,1 VH Pereira1 and J Marques1 1Hospital de Braga, Braga, Portugal 2University of Minho - Life and Health Sciences Research Institute (ICVS), Braga, Portugal Introduction: The increasing use of anthracyclines and the increasing survival of cancer patients, motivates the need to monitor the toxic effects of these drugs. Normally, monitoring is done by assessing the Left Ventricular Ejection Fraction (LVEF), which requires significant myocardial damage. Therefore, it is important to study earlier markers for cardiotoxicity so that monitoring can be adjusted and for the implementation of cardioprotective strategies can be earlier in order to improve the prognosis of this risk group. Objective: To identify the early markers of cardiotoxicity caused by anthracycline therapy. Methods: We performed a systematic review. Our research was performed on 3 databases (Pubmed, Embase and Medline) using a combination of terms (anthracyclines and cardiotoxicity and predictors and early detection), including articles from 2000 to May 2019. Selection criteria: The inclusion criteria used were human only studies, anthracycline therapeutic regimens in any dosage or formulation for treatment of any type of cancer and only full versions and articles written only in Portuguese and English were included. Data collection and analysis: We extracted information about the study population, intervention and results, using a data extraction platform specifically designed for this review. Results: According to the evaluated studies, GLS, 2D and 3D, and the biomarkers of cardiac dysfunction and overload (TnT, hs-TnT, TnI, hs-TnI) shown to be good predictors for early detection of anthracycline provoked cardiotoxicity. LVEF, LA volume, E/A ratio and NTproBNP values were not statistically significant and could not be used as predictors. Conclusions: This systematic review confirms the importance of monitoring echocardiographic deformation parameters and biomarkers of injury and cardiac overload for early detection of cardiotoxicity in patients receiving chemotherapy containing anthracyclines. P103 https://esc365.escardio.org/Presentation/217217/abstract Chest ultrasound for the differential diagnosis of acute cardiogenic dyspnoea among patients admitted to an intensive care unit: a comparison with natriuretic peptides L Graca Santos,1 T Elias,2 R Assis,2 I Coelho,2 L Franca,2 A Real,2 A Araujo,2 T Pereira,2 L Pessoa2 and N Catorze2 1Hospital Santo Andre, Cardiology, Leiria, Portugal 2Centro Hospitalar do Médio Tejo, Intensive Care Unit, Abrantes, Portugal Introduction: N-terminal pro B-type natriuretic peptide (NT-proBNP) is a useful tool for the diagnosis of heart failure (HF) and a well-established and independent marker of worse prognosis. NT-proBNP seems less useful from a diagnostic perspective in the context of critical illness, while chest ultrasonography (CUS) allows rapid determination of cardiac function, intravascular volume status, and presence of pulmonary oedema. Aim: To compare the accuracy of CUS and NT-proBNP for predicting HF among patients with acute dyspnoea. Methods: We prospectively evaluated 26 patients admitted in our intensive care unit (ICU) due to acute dyspnoea, between January and March 2018. In the first 12 hours, CUS was performed and NTproBNP levels were assessed in each patient. The ultrasound protocol included lung (B-lines) and cardiac evaluation (left ventricular ejection fraction (LVEF), diastolic filling (E/é) and inferior vena cava collapsibility index (IVCi)). A positive exam was defined according to the presence of ≥3 bilateral B-lines plus 2 of 3 of the following: LVEF <50%; E/eé>14; IVCi <25%. Two independent physicians, blinded to CUS and NT-proBNP findings, reviewed all the medical records to establish the aetiologic diagnosis of dyspnoea. Patients who survived hospital admission were additionally followed for 180 days. Results: Overall, mean age was 71.7±14.7 years and 52.0% (N=12) were female. Cardiogenic dyspnoea was diagnosed in 58.3% (N=14) of the patients and the remaining (N=12) were clinically diagnosed with non-cardiac dyspnoea. Mortality risk scores at admission did not differ between groups: APACHE II score was 22.6±6.9 vs 23.6±8.8, p=0.765; and SAPS II 46.9±12.8 vs 46.6±20.1, p=0.975. Accordingly, in-hospital and 180-day mortality rates did not differ according to the aetiology of the acute dyspnoea (28.6 vs 18.2%, p=0.661 and 35.7 vs 18.2%, p=0.407 respectively). The results from CUS evaluation and NT-proBNP levels among each aetiologic group is depicted in the table. NT-proBNP did not correlate with a positive CUS (r=0.263, p=0.214). Receiver operating characteristic analysis showed an area under the curve of 0.821 (95% confidence interval (CI): 0.650-0.993) for positive CUS and of 0.686 (95%CI 0.435-0.937) for NT-proBNP in predicting the cardiac origin of dyspnoea. Conclusions: In this small cohort of patients presenting with acute dyspnoea and admitted to an ICU, mean NT-proBNP levels did not differ between cardiac and non-cardiac aetiology. The accuracy of CUS, a combination of lung and cardiac ultrasound parameters, in predicting the cardiac origin of dyspnoea was high and it was also superior to the discriminative power of NT-proBNP. Open in new tabDownload slide Table picture. P104 https://esc365.escardio.org/Presentation/217226/abstract The importance of baseline lung ultrasound scanning in stable patients with heart failure. A Ioannidis1 1Thessaloniki General Hospital ‘G. Gennimatas’, Thessaloniki, Greece Background: Lung ultrasound (LUS) is a quick, reliable, and easy-to-use point-of care exam that can facilitate the management of heart failure patients. Quantification of B-lines (vertical artifacts that result from an increase in interstitial density) has been shown to be useful for the diagnosis, monitoring, and risk assessment of patients with known or suspected acute heart failure. Moreover, pleural effusions can be detected more accurately by LUS than chest x-rays. Purpose: The aim of this study was to assess the range of the baseline LUS findings in stable patients with known heart failure, with special focus in features that would, otherwise, most probably lead to the admission of the patients if they had reported deterioration of their condition. Methods: Patients with known heart failure, with purported stable condition, attending an outpatient clinic were invited to participate in the study. An ultrasound experienced cardiologist-intensivist performed the LUS following the 8 zones plan recommended by the ILC-LUS and clips were blindly randomly interpreted afterwards (Picture). A positive point was defined as the presence of at least three B-lines in a given scanning site. Unfortunately, measurement of natriuretic peptides was not available. Results: In total 53 LUS scans were completed. Almost half of the patients had a positive scan at lower lateral right zone (Table). One third of the patients showed bilateral lower lateral positive points which are the expected pattern of patients in pulmonary oedema. Furthermore, 7 (13.2%) of those 18 patients had a ≥1 cm pleural effusion (uni- or bi-laterally). Conclusions: Presumably stable heart failure patients can manifest a range of LUS features, with a pulmonary oedema compatible pattern revealed to up to one third of them. The already irregular, baseline LUS findings may limit the usefulness of LUS in those heart failure patients. Further research is warranted to confirm the aforementioned results. Table 1. Positive points in scanning zones (n, %). RIGHT SIDE LEFT SIDE LATERAL ANTERIOR ANTERIOR LATERAL 8 (15.1) 4 (7.6) UPPER 3 (5.7) 6 (11.3) 25 (47.2) 13 (24.5) LOWER 11 (20.8) 18 (34.0) RIGHT SIDE LEFT SIDE LATERAL ANTERIOR ANTERIOR LATERAL 8 (15.1) 4 (7.6) UPPER 3 (5.7) 6 (11.3) 25 (47.2) 13 (24.5) LOWER 11 (20.8) 18 (34.0) Open in new tab Table 1. Positive points in scanning zones (n, %). RIGHT SIDE LEFT SIDE LATERAL ANTERIOR ANTERIOR LATERAL 8 (15.1) 4 (7.6) UPPER 3 (5.7) 6 (11.3) 25 (47.2) 13 (24.5) LOWER 11 (20.8) 18 (34.0) RIGHT SIDE LEFT SIDE LATERAL ANTERIOR ANTERIOR LATERAL 8 (15.1) 4 (7.6) UPPER 3 (5.7) 6 (11.3) 25 (47.2) 13 (24.5) LOWER 11 (20.8) 18 (34.0) Open in new tab Open in new tabDownload slide 8 zone LUS. P106 https://esc365.escardio.org/Presentation/217409/abstract A new strategy to guide VA ECMO weaning. Provisional results of a pilot study.ESC Research Grant A Gambaro,1 A Vazir,2 N Lees,2 R Fisher,3 A Rosenberg,2 A Hurtado,2 E Galiatsou,2 R Garda,2 J Doyle,2 S Ledot,2 M Passariello,2 R Trimlett,2 J Pepper,2 F Ribichini1 and S Price2 1University of Verona, Verona, Italy 2Royal Brompton and Harefield NHS Foundation Trust, London, United Kingdom of Great Britain & Northern Ireland 3King’s College Hospital, London, United Kingdom of Great Britain & Northern Ireland Introduction: Venoarterial extracorporeal membrane oxygenation (VA ECMO) is a type of mechanical support device (MCS) used as bridge to heart transplant, long term MCS or recovery. The decision to wean a patient from VA ECMO has not universally agreed criteria. Cardiac output (CO), Ejection Fraction (EF), Mean Arterial Pressure (MAP) are the most used parameters. Speckle tracking is a promising imaging technique which can be used to evaluate the contractility of the heart. Purpose: To assess whether speckle tracking parameters can give additional information in identifying patients who develop adverse outcomes (cardiovascular death, heart transplant, long term ventricular assist device, necessity of new MCS within 1 year) post VA ECMO weaning (removal not for palliation). Methods: all patients admitted to intensive care unit for cardiovascular shock and supported by VA ECMO were screened. If there was a high probability of VA ECMO weaning, the patients were recruited. Exclusion criteria were: presence of Impella, decision not to attempt VA ECMO weaning, left ventricle outflow tract velocity time integral (LVOT VTI) < 10 cm. During the VA ECMO weaning procedure a transoesophageal echocardiogram was performed. At every change of ECMO flow, the mid-esophageal 4 chamber view and the trans-gastric view at the level of papillary muscles were recorded together with LVOT VTI, and the drugs used. The speckle tracking analysis was performed on the recorded images. Non parametric tests were used to compare the echocardiographic and speckle tracking results of the group of patients developing the outcome of interest with the results of the group of participants not experiencing any outcomes. A multivariate analysis using generalized estimating equations with an exchangeable correlation structure has been used to assess the relationship between echocardiographic measures of cardiac function measured by LV EF and strain (Longitudinal (LS) and circumferential (CS)) and its association with CO, stroke volume (SV) and LVOT VTI. Results: Over 10 months 52 patients were screened. 13 patients were recruited and analysed. The median follow up time was 5 months (IQR 3 to 7 months). 2 patients experienced the outcome of interest. The CS and the EF were more impaired in the patients experiencing the outcome of interest compared to those not experiencing any outcomes (CS -5.62%(IQR -5.89 to -5.36); -14.46 %(IQR -16.54 to -12.18), p Value 0.03; EF 23.43% (IQR 23.21 to 23.66); 45.77%(IQR 36.55 to 60.31), p Value 0.03). According to the multivariate analysis, CS and EF had a significant association with CO, SV and LVOT VTI (Figure). Figure. Open in new tabDownload slide Conclusions: according to our preliminary results, CS appears to be a promising parameter to discriminate patients who are going to develop cardiovascular failure after VA ECMO removal. Further, LV EF and LV CS are significantly associated with CO and SV. These results need to be confirmed in a larger group. Acute Coronary Syndromes – Pathophysiology and Mechanisms P108 https://esc365.escardio.org/Presentation/216717/abstract Intracardiac thrombosis and early remodeling in stemi patients associated with pro-inflammatory profile ofmonocytes subpopulation O Dovhan,1 A Parkhomenko,1 A Parkhomenko,1 T Talayeva,1 T Talayeva,1 I Tretyak,1 I Tretyak,1 A Shumakov1 and A Shumakov1 1Strazhensku Cardiology Institute, Kyiv, Ukraine The inflammation underlying atherosclerosis and ACS is strongly associated with monocytes and their subpopulations. Different subpopulation of monocytes can play different roles in the formation and destabilization of atherosclerotic plaque and healing of damaged myocardial tissue. There are classical CD14hiCD16- (representing up to 90% of the blood monocytes), intermediate CD14++CD16+ and patrolling CD14+CD16++ monocytes. The highest levels of CD14++CD16- cells are observed on day 3 of AMI, then they should decrease, while CD16+ monocytes reached a peak on day 7. Сlassicаl monocytes have high pro-inflammatory activity, while the non-classical are involved in repair and angiogenesis. Aim of the study was to analyze the content of different subpopulation of monocytes in the blood of STEMI pts and the development of early complications of the disease. Methods: The composition of individual subpopulations of monocytes in the peripheral venous blood was evaluated in 50 pts with STEMI and primary PCI at admission in the hospital and on day 7. Dynamic cardiac echocardiography was performed at the same time frame. All patients were divided into 2 groups depending on the increase (1 group - 21 pts) or decrease (2 group-29 pts) of “classical” monocytes (CD14hiCD16-) subpopulation in the dynamics of FU period. Early thrombotic and mechanical complications were assessed (intracardiac thrombosis, LV remodeling). Results: Research findings indicate that the increase in classical monocytes in dynamics and the decrease in non-classical monocytes is associated with the development of more complications (tab1). Conclusion: The growth of classical monocytes subpopulation, with a decrease in intermediate and patrolling, within 7 days of follow-up period in STEMI pts is associated with the development of more complications (pathological remodeling, intracardiac thrombosis) with risk of heart failure and thromboembolism development. Table 1. Tab1. Monocytes subpopulations during fo. . 1st group (n=21) . P . 2nd group (n=29) . P . Day1 (%) Day 7 (%) Day 1 (%) Day 7 (%) CD14+CD16- (classical) 85.44±1.3 89.04±1.2 0.01 90.42±0.8 83.44±1.2 <0.0001 CD14hiCD16+ (intermediate) 8.25±0.7 5.77±0.5 0.001 5.80±0.5 7.97±0.5 0.002 CD14dimCD16++ (patrolling) 5.94±0.7 5.65±0.6 0.3 3.68±0.4 8.52±0.9 <0.0001 Intracardiac thrombosis 23.76% 7.14% 0.049 LV dilatation 57.0% 7.0% <0.0001 Reduction of the LVEF 43.0% 10.3% <0.0001 . 1st group (n=21) . P . 2nd group (n=29) . P . Day1 (%) Day 7 (%) Day 1 (%) Day 7 (%) CD14+CD16- (classical) 85.44±1.3 89.04±1.2 0.01 90.42±0.8 83.44±1.2 <0.0001 CD14hiCD16+ (intermediate) 8.25±0.7 5.77±0.5 0.001 5.80±0.5 7.97±0.5 0.002 CD14dimCD16++ (patrolling) 5.94±0.7 5.65±0.6 0.3 3.68±0.4 8.52±0.9 <0.0001 Intracardiac thrombosis 23.76% 7.14% 0.049 LV dilatation 57.0% 7.0% <0.0001 Reduction of the LVEF 43.0% 10.3% <0.0001 LV - left ventriculeLVEF-left ventricular ejection fraction. Open in new tab Table 1. Tab1. Monocytes subpopulations during fo. . 1st group (n=21) . P . 2nd group (n=29) . P . Day1 (%) Day 7 (%) Day 1 (%) Day 7 (%) CD14+CD16- (classical) 85.44±1.3 89.04±1.2 0.01 90.42±0.8 83.44±1.2 <0.0001 CD14hiCD16+ (intermediate) 8.25±0.7 5.77±0.5 0.001 5.80±0.5 7.97±0.5 0.002 CD14dimCD16++ (patrolling) 5.94±0.7 5.65±0.6 0.3 3.68±0.4 8.52±0.9 <0.0001 Intracardiac thrombosis 23.76% 7.14% 0.049 LV dilatation 57.0% 7.0% <0.0001 Reduction of the LVEF 43.0% 10.3% <0.0001 . 1st group (n=21) . P . 2nd group (n=29) . P . Day1 (%) Day 7 (%) Day 1 (%) Day 7 (%) CD14+CD16- (classical) 85.44±1.3 89.04±1.2 0.01 90.42±0.8 83.44±1.2 <0.0001 CD14hiCD16+ (intermediate) 8.25±0.7 5.77±0.5 0.001 5.80±0.5 7.97±0.5 0.002 CD14dimCD16++ (patrolling) 5.94±0.7 5.65±0.6 0.3 3.68±0.4 8.52±0.9 <0.0001 Intracardiac thrombosis 23.76% 7.14% 0.049 LV dilatation 57.0% 7.0% <0.0001 Reduction of the LVEF 43.0% 10.3% <0.0001 LV - left ventriculeLVEF-left ventricular ejection fraction. Open in new tab Acute Coronary Syndromes – Pathophysiology and Mechanisms P110 https://esc365.escardio.org/Presentation/221184/abstract Platelet HYAL2 enrichment in acute coronary syndrome patients: a bridge between the immune and the pro-thrombotic pathwaysThis work was supported by the Catholic University of the Sacred Heart (R4124500458 LINEA D.1 2016) and FPG-IRCCS, Rome (IT) R Vinci,1 D Pedicino,1 A D’aiello,1 A Bonanni,1 G Russo,1 E Pisano,1 M Ponzo,1 P Ciampi,1 A Ruggio,1 G Angelini,1 F Canonico,1 A Severino,1 LM Biasucci,1 G Liuzzo1 and F Crea1 1Catholic University of the Sacred Heart - Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy Background/Introduction: Acute Coronary Syndrome (ACS) patients display dysregulated hyaluronan (HA) catabolism that furthermore might promote the formation of monocyte-platelet complexes. Notably, Hyaluronidase 2 (HYAL2) enzyme, the key mediator of this HA catalysis, is increased on systemic mononuclear cells from ACS with an Intact Fibrous Cap (IFC) plaque. Purpose: Aim of our study was to investigate HYAL2 protein expression on platelet (pltHYAL2) of patients with Non-ST Elevation Myocardial Infarction (NSTEMI) and Stable Angina (SA) and its role on monocyte-platelet binding. Methods: We enrolled patients with chronic stable angina (SA) (n = 40) and ACS patients at their first diagnosis admitted to our coronary care unit with NSTEMI (n = 40). In order to assess the total functional response, we evaluated the integrated MFI (iMFI). We further compared pltHYAL2 within NSTEMI patients who underwent Optical Coherence Tomography (OCT) investigation with diagnoses of IFC (n = 5) or ruptured fibrous cap (RFC) (n = 8) plaques. Lastly, we investigated the HYAL2 role through an in vitro model setting of co-cultured CD14+ monocyte and CD42+ platelet not treated or treated with high- and low-molecular weight HA (HMW-HA and LMW-HA, respectively) and Escherichia Coli-lipopolysaccharide (LPS), in presence or in absence of HYAL2 primary antibody. Results: The iMFI analysis assessed that NSTEMI patients had a robust increase of functional pltHYAL2 with respect to SA patients (p = 0.006) (Figure 1A). Analyses of the NSTEMI subgroup that underwent OCT investigation displayed, although not significant, a trend of increased pltHYAL2 surface protein expression and amount of HYAL2 positive cells in patients with IFC plaques. Noteworthily, our in vitro model made evident that co-cultured cells from NSTEMI patients considerably reduced the percentage of monocyte-platelet binding following the incubation with HYAL2 primary antibody, only in presence of the pro-inflammatory stimulus of LMW-HA (Figure 1B). Conclusions: The innate immune system of ACS patients is unequivocally involved in ECM degradation and HA dyshomeostasis through the commitment of molecule such as monocyte HYAL2. Our data markedly demonstrated, for the first time, that patients presenting with unstable atherosclerotic lesions such as NSTEMI have a relevant systemic enrichment of functional platelet expressing HYAL2 when compared to patients with stable plaques. The systemic chronic inflammatory status might be the product of a never-ending stress response secondary to a synergic approach between monocyte and platelet, as proven by our monocyte-platelet in vitro model. Within this pathological milieu, HYAL2 might be the bridge between elements historically belonging to the immune system, such as monocytes, and elements belonging to the haemostasis and thrombotic system, such as platelets, representing the novel target to bet on in pharmacotherapy personalization. Acute Myocardial Ischemia P111 https://esc365.escardio.org/Presentation/216711/abstract Familial hypercholesterolemia prevalence between early-onset coronary artery disease patients in Lithuania and influence of known cardiovascular risk factors N Dauksaite,1 G Valteryte,1 R Jurgaitiene2 and D Zaliaduonyte2 1Lithuanian University of Health Sciences, Kaunas, Lithuania 2Hospital of Lithuanian University of Health Sciences, Kaunas, Lithuania Introduction Familial hypercholesterolemia (FH) is a common genetic disorder of cholesterol metabolism. Beginning at the tender age, sustained exposure of the arterial wall to elevated LDL-C levels accelerates cholesterol deposition and vascular inflammation, developing premature coronary artery disease (CAD). Purpose: To find the prevalence of familial hypercholesterolemia in patients with premature CAD and to evaluate the influence to patient’s condition of known cardiovascular risk factors. Methods: The study was conducted in tertiary care center in the Department of Cardiology. 7397 patients were attended to the hopital for diagnostic or therapeutic angiography. There were 1641 patients with early-onset CAD. A total of 159 patients with early-onset CAD and LDL-C above 4,5mmol/L were assessed for FH using the Dutch Lipid Clinical Network (DLCN) criteria. Other CV risk factors known to cause CAD were also recorded. The statistical analysis was performed by IBM SPSS Statistics (version 23.0). Results: The sample consisted of 35 (22.00%) women and 124 (78.00%) men. The average age of subjects was 54.67±5.38 years. 109 (68.55%) of all patients were diagnosed acute CAD and 50 (31.45%) with chronic ischemic heart disease. In the sample of 159 of patients with early-onset CAD and LDL-C above 4.5 mmol/L there were 8 (5.03%) definite FH cases, 69 (43.39%) probable, 39 (24.53%) possible and 43 (27.04%) unlikely FH cases. Distribution of clinical profiles and CAD risk factors of four groups are summarized in the Table. Conclusions: Men were three times more likely to have early-onset CAD, however, the percentage of women in groups relatively grew as the DLCN criteria score increased. Moreover, patients in definite FH group were younger comparing to the rest of the patients, their CAD was not accompanied by higher BMI or DM. The frequency of familial history of premature CAD was significantly higher in definite FH group. Table 1. Distribution of clinical profiles. . All n=159 . Definite FH n=8 . Probable FH n=69 . Possible n=39 . Unlikely n=43 . p value . Female 35 (22%) 3 (37.5%) 18 (26.1%) 10 (25.6%) 4 (9.3%) 0.031 Male 124 (78%) 5 (62.5%) 51 (73.9%) 29 (74.4%) 39 (90.7%) 0.031 Age* 54.67±5.37 52.62±7.92 53.85±4.89 52.92±6.21 57.72±4.10 <0.001 Statins at admission 14 (8.8%) 1 (12.5%) 2 (2.9%) 7 (17.9%) 4 (9.3%) 0.259 Diabetes mellitus 15 (9.4%) 0 (0.0%) 7 (9.1%) 6 (15.4%) 2 (4.7%) 0.759 BMI* 29.30±5.45 26.19±2.06 29.06±5.69 29.42±6.78 30.17±0.57 0.278 LDL-C* 5.56±1.04 7.60±2.68 5.69±0.73 5.46±0.49 5.03±0.80 <0.001 Family history of premature CAD 62 (39.0%) 7 (87.5%) 44 (63.8%) 7 (17.9%) 4 (9.3%) <0.001 . All n=159 . Definite FH n=8 . Probable FH n=69 . Possible n=39 . Unlikely n=43 . p value . Female 35 (22%) 3 (37.5%) 18 (26.1%) 10 (25.6%) 4 (9.3%) 0.031 Male 124 (78%) 5 (62.5%) 51 (73.9%) 29 (74.4%) 39 (90.7%) 0.031 Age* 54.67±5.37 52.62±7.92 53.85±4.89 52.92±6.21 57.72±4.10 <0.001 Statins at admission 14 (8.8%) 1 (12.5%) 2 (2.9%) 7 (17.9%) 4 (9.3%) 0.259 Diabetes mellitus 15 (9.4%) 0 (0.0%) 7 (9.1%) 6 (15.4%) 2 (4.7%) 0.759 BMI* 29.30±5.45 26.19±2.06 29.06±5.69 29.42±6.78 30.17±0.57 0.278 LDL-C* 5.56±1.04 7.60±2.68 5.69±0.73 5.46±0.49 5.03±0.80 <0.001 Family history of premature CAD 62 (39.0%) 7 (87.5%) 44 (63.8%) 7 (17.9%) 4 (9.3%) <0.001 * (mean(±SD)). Open in new tab Table 1. Distribution of clinical profiles. . All n=159 . Definite FH n=8 . Probable FH n=69 . Possible n=39 . Unlikely n=43 . p value . Female 35 (22%) 3 (37.5%) 18 (26.1%) 10 (25.6%) 4 (9.3%) 0.031 Male 124 (78%) 5 (62.5%) 51 (73.9%) 29 (74.4%) 39 (90.7%) 0.031 Age* 54.67±5.37 52.62±7.92 53.85±4.89 52.92±6.21 57.72±4.10 <0.001 Statins at admission 14 (8.8%) 1 (12.5%) 2 (2.9%) 7 (17.9%) 4 (9.3%) 0.259 Diabetes mellitus 15 (9.4%) 0 (0.0%) 7 (9.1%) 6 (15.4%) 2 (4.7%) 0.759 BMI* 29.30±5.45 26.19±2.06 29.06±5.69 29.42±6.78 30.17±0.57 0.278 LDL-C* 5.56±1.04 7.60±2.68 5.69±0.73 5.46±0.49 5.03±0.80 <0.001 Family history of premature CAD 62 (39.0%) 7 (87.5%) 44 (63.8%) 7 (17.9%) 4 (9.3%) <0.001 . All n=159 . Definite FH n=8 . Probable FH n=69 . Possible n=39 . Unlikely n=43 . p value . Female 35 (22%) 3 (37.5%) 18 (26.1%) 10 (25.6%) 4 (9.3%) 0.031 Male 124 (78%) 5 (62.5%) 51 (73.9%) 29 (74.4%) 39 (90.7%) 0.031 Age* 54.67±5.37 52.62±7.92 53.85±4.89 52.92±6.21 57.72±4.10 <0.001 Statins at admission 14 (8.8%) 1 (12.5%) 2 (2.9%) 7 (17.9%) 4 (9.3%) 0.259 Diabetes mellitus 15 (9.4%) 0 (0.0%) 7 (9.1%) 6 (15.4%) 2 (4.7%) 0.759 BMI* 29.30±5.45 26.19±2.06 29.06±5.69 29.42±6.78 30.17±0.57 0.278 LDL-C* 5.56±1.04 7.60±2.68 5.69±0.73 5.46±0.49 5.03±0.80 <0.001 Family history of premature CAD 62 (39.0%) 7 (87.5%) 44 (63.8%) 7 (17.9%) 4 (9.3%) <0.001 * (mean(±SD)). Open in new tab Open in new tabDownload slide Distribution of LDL-C in patient groups. Thrombosis, Platelets, and Coagulation P112 https://esc365.escardio.org/Presentation/217411/abstract ATRIA score predicts survival in the first year after stent implantation in patients with atrial fibrillation D Bras,1 R Guerreiro,1 M Carrington,1 AR Rocha,1 B Picarra,1 P Semedo,1 J Aguiar1 and ON Behalf Of Portuguese Registry On Acs1 1Hospital Espirito Santo de Evora, Cardiology, Evora, Portugal Introduction: Oral anticoagulation (OAC) coupled with doble antiplatelet therapy (DAPT) increases the risk of bleeding complications in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) with stent implantation. The ATRIA score is one of the most widely used for haemorrhagic risk stratification in patients with AF under OAC. Purpose: The authors intend to investigate the predictive ability of the ATRIA score for intrahospital death, 1-year mortality and bleeding complications in patients with AF undergoing PCI with stent implantation. Methods: This retrospective study is composed of a sample of 514 patients, derived from a national multicentre registry, that were admitted with acute myocardial infarction (AMI) and underwent PCI. The ATRIA score is defined as follows: Anemia: 3p; Severe renal disease/dialysis (eGFR <30mL/min): 3p; Age ≥ 75 years: 2p Stroke History: 1p Prior haemorrhage: 1p Hypertension: 1p The following outcomes were adressed: intrahospital death, 1-year mortality and bleeding complications during hospitalization (blood transfusion or major bleeding). After population characterization, we have performed a ROC curve analysis between the outcomes and ATRIA score, reporting AUC, optimal c-statistic and its epidemiological data. We also have performed a multivariate analysis reporting OR with plausible variables. Figure 1. Open in new tabDownload slide Results: The mean age is 73 ± 11 years and it is composed by 73% of males. Hypertension was present in 81%, anemia in 18% and stroke history in 13%. Only 2% had previous haemorrhage. The mean serum creatinine at admission was 1.2 ± 1mg/dL and eGFR 54 ± 20mL/min. The mean ATRIA score was 4.2 ± 2.4 points. The ROC curve analysis between ATRIA and intrahospital death have performed poorly (c-statistic 0.528). As for the composite endpoint of bleeding complications, it performed fairly (c-statistic 0.647). The predictive capacity for 1-year mortality had performed better, revealing a c-statistic of 0.747, with an optimal cut-off point of 4.5p (specificity 67%, sensitivity 83%, negative predicting value 97%, positive predicting value 25%). Multivariate analysis included the variables ATRIA ≥5p, Killip >1 and discharge VKA/DOAC. An OR of 7 (95% CI 2.2 – 20.0; p=0.001) for the variable ATRIA ≥5p was obtained. The other variables were non significant. Conclusion: We conclude that the ATRIA score is a good test to predict which patients will survive 1-year after discharge, in our population of patients with AMI and AF submitted to PCI, as it is shown by its very high negative predicting value at optimal cut-off point (97%). A ATRIA ≥ 4.5 is the optimal cut-off point to predict the studied outcome and represents an increased risk of 7 times. The calculation of the ATRIA score in this setting could inform the clinician of patients that at low-risk of death within the first year after discharge and may also help guiding triple antithrombotic duration. P113 https://esc365.escardio.org/Presentation/216467/abstract Peculiarities of clotting and endogenous fibrinolysis in patients with a history of spontaneous reperfusion of infarct-related artery. O Dukhin,1 A Kalinskaya,1 H Uzhakhova,1 A Shpektor1 and H Vasilieva1 1Moscow State University Of Medicine And Dentistry, Moscow, Russian Federation Background: Spontaneous reperfusion (SR) of infarct-related artery (IRA) in ST-elevation myocardial infarction (STEMI) patients is associated with better clinical outcome and long-term prognosis. SR is the result of an interaction of the processes of clot formation and endogenous fibrinolysis. What happens with this interaction in long term period after MI with SR remains unknown. Purpose: The aim of our research was to investigate the process of clot formation and endogenous fibrinolysis in patients with ST-elevation MI in deferred period. Methods: 57 patients with a history of STEMI (median - 35 months) were enrolled in our study. 20 patients had a spontaneous reperfusion of IRA during index event, 27 - total occlusion of IRA. The clot formation process and endogenous fibrinolysis were assessed using native tromboelastometry and Thrombodynamics assay. The platelet aggregation was assessed using multiple electrode aggregometry. Endothelial function as a major regulator of the clot formation process and endogenous fibrinolysis was analyzed using the flow-mediated dilation test (FMD-test) of the brachial artery. Results: The clot formation remains much more active patients with total occlusion of IRA (V um/min 28,2 vs 31,5 (p=0,012); Vi um/min 56,8 vs 60,6 (p < 0,01); Vst um/min 28,35 vs 31,6 (p < 0,05)). Moreover, the clot size in patients with occlusion was significantly larger (СS, um 1187,0 vs 1302,0 (p < 0,01). There was no significant difference in the level of fibrinolysis activity and collagen-induced and thrombin-induced platelet aggregation. The endothelium function in deferred period was better among patients with spontaneous reperfusion of IRA during index event compared to patients with total occlusion (FMD 17,4% vs 11.5 %, p < 0.01). Conclusion: The process of clot formation remains much more active in patients with a history of total occlusion compared to patients with SR of infarct-related artery. The worse endothelial function in this group of patients may contribute to this finding. Open in new tabDownload slide Thrombodynamics study. P114 https://esc365.escardio.org/Presentation/216421/abstract Coronary artery ectasia, an independent predictor of high thrombus burden in patients presenting with ST-elevation myocardial infarction K Kintis,1 CHR Mantis,1 E Papadakis,1 D Antonatos,1 K Thomopoulos,2 M Koutouzis,3 CH Armonis,1 I Tsiafoutis,3 A Poulianitou,1 V Kyriakopoulos,1 K Dimitriadis4 and S Patsilinakos1 1Konstantopoulio General Hospital, Athens, Greece 2General-Maternity District Hospital Elena Venizelou, Athens, Greece 3Hellenic Red Cross Hospital, Cardiology, Athens, Greece 4Hippokration General Hospital, Cardiology, Athens, Greece Background/Introduction: High thrombus burden is an independent risk factor for death and complications, including no reflow, during primary percutaneous coronary intervention (PCI) for ST-elevation Myocardial Infarction (STEMI). Purpose: The aim of this study was to determine the potential association between coronary artery ectasia (CAE) and high thrombus burden during primary PCI. Methods: A case control study was performed based on a prospective cohort of STEMI patients from January 2010 to December 2018. Thrombus burden was classified by investigator prior to wire crossing based on the Thrombolysis In Myocardial Infarction (TIMI) thrombus grade (higher thrombus grade, greater thrombus burden). Thrombus burden (grade ≥3 or <3) was pre-specified as the primary subgroup analysis. Control subjects were two consecutive STEMI patients after each case, with low thrombus burden (grade <3). CAE was defined as dilatation of an arterial segment to a diameter at least 1.5 times that of the adjacent normal coronary artery. Results: In the high thrombus burden group, frequency of CAE was significantly higher (23.8% vs 3.9%, p < 0.01) compared to the control group. After multivariate analysis, CAE remained a strong and independent predictor of high thrombus burden (OR 13.9, CI 4.7 – 41.2, p < 0.01). Conclusions: CAE is a strong and independent predictor of high thrombus burden during primary PCI for STEMI. Future studies should assess optimal treatment. Vulnerable Plaque P117 https://esc365.escardio.org/Presentation/216727/abstract PLIN2 protein expression is an age dependent regulator of plaque instability in ST-elevation myocardial infarction D D’amario,1 F Canonico,1 C Pidone,1 A Restivo,1 R Vergallo,1 RA Montone,1 M Galli1 and F Crea1 1Polyclinic Agostino Gemelli, Rome, Italy Background: Accumulation of Lipid Droplets (LDs) leads to alteration of macrophages into foam cells, and is considered a key factor in the pathogenesis of atherosclerosis. The main LD-coating protein in macrophages and foam cells is PLIN2. PLIN2 upregulation leads to cytoplasmic LD accumulation. Chaperone-mediated autophagy (CMA) selectively degrades the LD-proteins such as PLIN2 from the LD surface. Aims: The main purpose of this study was to evaluate PLIN2 protein expression and its correlation with the age of patients with ST-elevation myocardial infarction (STEMI). Secondary aims were to investigate the underlying mechanisms the PLIN2 degradation, such as CMA and Proteasome activity. Methods: We enrolled 120 prospective, consecutive, symptomatic patients with following conditions: stable angina (SA) and STEMI. Peripheral blood mononuclear cell (PBMCs) were obtained from whole blood samples by standard gradient centrifugation over Ficoll-Hypaque. A positive selection of CD14+ cells was performed. PBMCs were incubated with mAbs anti-CD14, anti-ABCA1 and anti-CD36. For intracellular analysis, PBMCs were fixed and permeabilizedand then incubated with fluorochrome-conjugated mAbs anti-ADFP, Alexafluor-488 and anti-LAMP-2a. The Proteasome Activity was analyzed with the Proteasome Activity Assay Kit according to manufacturer’s protocol. Results: A positive correlation of PLIN2 expression with age was found in STEMI patients (mean±standard deviation 0,95±0,2; P=0,003) and in SA patients (0,77±0,1; P=0,01), but only in STEMI patients an increased expression of PLIN2 was observed. A key step during foam cells formation is the binding of oxidized LDL to macrophage surface scavenger receptors such as CD36. Importantly, CD36 expression was augmented with age in STEMI patients (6,65±2,3; P=0,03), together with the expression of Adipocyte ATP-binding Cassette A1 (ABCA1) that promotes cholesterol efflux from monocytes. ABCA1 expression was inversely associated with age in STEMI patients (2,14±1,3; P=0,004) while LAMP-2a expression is inversely correlated with age (1,92±0,7; P=n.s.) . The presence of multi-vessel disease appears to be proportionally associated with PLIN2 expression both in STEMI and in SA patients. PLIN2 upregulation was inversely correlated with Trombolysis In Myocardial Infarction (TIMI) Grade Flow before percutaneous coronary intervention (PCI) and post-PCI. Conclusion: Our data showed in a large cohort of consecutive STEMI patients an increase of PLIN2 expression with age, compared with SA, highlightening the role in plaque instability. We also demonstrated a pathofisological mechanism related to the proteasome acitivuty and lipid accumulation, that was associated with a highly significantly differnece of hemodynamic and procedural data. Reperfusion and Reperfusion Injury P119 https://esc365.escardio.org/Presentation/216707/abstract Clinical associations of intramyocardial haemorrhage and microvascular obstruction in primary myocardial infarction with ST-segment elevationPresidential grant Y Alekseeva,1 EV Vyshlov,1 OV Mochula,2 VY Ussov,2 VV Ryabov1 and VA Markov1 1Cardiology Reseach Institute, Tomsk National Reseach Medical Centre, Russian Academy of Scince, Emergency cardiology, Tomsk, Russian Federation 2State Research Institute of Cardiology of Tomsk, Tomsk, Russian Federation Background: The success of coronary reperfusion therapy in ST-segment–elevation myocardial infarction (MI) is commonly limited by failure to restore microvascular perfusion. Intramyocardial haemorrhage (IMH) and microvascular obstruction (MVO), or no-reflow phenomenon, represent components of reperfusion injury. Cardiac magnetic resonance (CMR) imaging can be used to identify IMH and MVO in patients with ST-segment elevation myocardial infarction (STEMI). Following acute myocardial infarction, MVO and IMH adversely affect both left ventricular remodeling and prognosis. Purpose: The purpose of the study was to evaluate the predictors and the prevalence of IMH and MVO in patients with primary STEMI by CMR. Materials and methods: The study included 60 patients with primary STEMI admitted within the first 12 hours after the onset of disease who had undergone different reperfusion techniques. Exclusion criteria: pulmonary edema, cardiogenic shock, estimated glomerular filtration rate <30 mL/min/1,73 m2 or dialysis, severe comorbidity, acute psychotic disorders and inability to undergo or contra-indications for CMR. Each patient included in the study underwent CMR imaging at day 2 post-STEMI. MVO and IMH were assessed using late gadolinium enhancement and T2-weighted CMR imaging. The study was registered at ClinicalTrials.gov, with identification number NCT03677466. Results: MVO was detected in 34 patients (56,7%) with primary STEMI while IMH – of 28 patients (46,7%). Patients with diabetes (18,3% vs 1,6%; p=0,07) and oncological process (21,4% vs 5,6%; p=0,08) tended to develop both IMH and MVO more frequently. The combination of this phenomena was associated with the larger infarct size (9% [8-18] vs 21% [15-39] p=0,03). Then we compared the prevalence of IMH and MVO in patients after different modes of reperfusion therapy: pharmaco-invasive approach (n-39), where fibrinolysis was performed during the pre-hospital ambulance delivery, and primary PCI (n=21). Among patients with different reperfusion strategies, IMH and MVO were more prevalent in the group of primary PCI (57,1% vs 66,6%; p=0,09 and 35,8% vs 48,7%; р=0,08, respectively). Combination of IMH with MVO was present in 21 of our patients (35%): 10 (25,6%) in the group of pharmaco-invasive approach and 11 (52,3%) in the group of primary PCI (p=0,03). Conclusion: IMH and MVO were common findings in patients with primary STEMI who had underwent different reperfusion strategies. Сombination of MVO and IMH was associated with larger infarct size. Сombination of IMH with MVO occured more frequently in patients treated with primary PCI. Left Ventricular Remodeling P120 https://esc365.escardio.org/Presentation/216449/abstract Left ventricular remodeling in low and intermediate risk Non-STEMI pacients: immediate versus delayed reperfusion. A Surev,1 L Ciobanu,1 M Abras1 and A Grib1 1Institute of Cardiology, Interventional Cardiology, Chisinau, Moldova (Republic of) Background: A consensus has been reached in the global scientific community regarding the treatment of high risk Non-STEMI patients. Urgent revascularization is the gold standard for such cases. The situation with intermidiate and low risk patients is not so obvious. Emergency operations are accompanied by an increased risk of developing complications such as distal embolization, coronary dissection or stent thrombosis. All of these complications ultimately affect short- and long-term outcomes. Purpose: To compare six months left ventricular remodeling in low and intermediate risk Non-STEMI pacients after immediate versus delayed revascularisation. Methods: The study included two groups of 126 patients with Non-STEMI and score GRACE below 140 who underwent revascularization: I group in the first 72 hours from the onset of symptoms, II group in the interval 72 hours - 30 days. Echocardiography was performed one day after revascularization and six months later. During the observation, patients were on optimal medical treatment. Two patients from I group died. Results: Left ventricular end-diastolic volume in I group in six months increased from 148,341 ml. up to 150,210 ml. an average of 2,742 ml. (m=1.028; p<0,01), in II group from 144,016 ml. up to 144,96 ml., an average of 0,944 ml. (m=1,128; p>0,05). Differences between groups in increasing of end-diastolic volume were not observed (p> 0.05). Left ventricular end-sistolic volume in I group grew by an average of 1.048 ml. (m=1,08; p> 0.05) with 75.294 ml. on the first day after revascularization up to 75.419 ml. six months later, in II group the value fell on average by 5.556ml. (m = 0.615; p <0.001) with 70.627 ml. up to 65.071 ml. Difference between groups in end-systolic volume changes was statistically significant (p <0.001). Ejection fraction in I group increased on average by 1.734% (m = 0.58; p <0.01) from 47.063% to 48.992%. In II group, the growth was more significant (p <0.001) and amounted to 5.238% (m = 0.36; p <0.001) from 48.754% to 53.992%. Conclusion(s): Delayed myocardial revascularization (more than 72 hours from the onset of symptoms) contributes to a more favorable remodeling of the left ventricle with an increase of ejection fraction due to a decrease of end-systolic volume. Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome P124 https://esc365.escardio.org/Presentation/216501/abstract Total Ischemic Burden score based on st-segment deviations from the 12-lead ECG predicts mortality among patients with ischemic cardiomyopathy and reduced LVEF D J Dzikowicz,1 J A Fallavollita2 and M G Carey1 1University of Rochester, Rochester, United States of America 2University of Buffalo, Buffalo, United States of America Background: Ischemic cardiomyopathy due to coronary artery disease leads to chronic myocardial ischemia and reduced ejection fraction (EF). Twelve lead electrocardiography (ECG) is able to detect myocardial ischemia, yet there is no measure of total ischemic burden (TIB). Purpose: The purpose of this abstract is to develop a TIB score based on ST-segment deviations in all 12-leads of a resting ECG. Methods: This was a secondary data analysis of Prediction of Arrhythmic Events with Positron Emission Tomography (PARAPET) study which recruited ischemic cardiomyopathy with reduced EF patients. TIB=(duration of ST-segment deviation (minutes) * [summation of ST-segment deviation (mm) in each lead per coronary region/ number of leads per major coronary region])/ (the total number of ischemic events). Major coronary regions included lateral (I, aVL, V5, V6); inferior (II, III, aVF); septal (V1, V2); and, anterior (V4, V5). Additionally, myocardial ischemia was categorized as diagnostic when ST-segment deviations >1mm. The outcome of this study was SCD, arrhythmic death, and cardiac death. Participants were followed for approximately 4 years at 3-month intervals. Nonparametric statistical analyses were performed due to a small sample size. Mann-Whitney U Tests were used to compare demographic and TIB between outcome groups; ROC curve analysis and crosstabulation analysis used to assess predictive and association values; and, bivariate Spearman correlations conducted to demonstrate convergent validity with other mortality risk factors including age, body mass index (BMI), and EF. Results: Nineteen (10%) of the original sample was included. The sample was 100% white males, mean age 66 (+11.0) years, mean BMI 27.4 kg/m2 (+3.5 kg/m2), and mean EF 27% (+9.3%). Diagnostic myocardial ischemia was measured in 2 leads among 52.6% (n=10), 3 leads among 31.6% (n=6), and >4 leads among 15.8% (n=3) of patients. Nearly half (42.1%, n=8) experienced the outcome. TIB scores were different between those outcome groups (p=0.02), but no statistically significant differences based on age, BMI, or EF. The AUC was 0.818 (p=0.02, 95%CI: 0.593-0.993; cutoff: >-47969570; sensitivity=87.5%, specificity=54.5%, overall accuracy= 68.4%) compared to age (AUC=0.48, p=0.9), BMI (AUC=0.13, p=0.3), and EF (AUC=0.15, p=0.9). TIB at the cutoff demonstrated trending significance for the association with the outcome (X2= 3.5 p=0.06; LR= 3.8 p=0.05; Cramer V= 0.43 p=0.06; RR=4.1 p=0.14). Logistic regression for the prediction of the outcome was also trending significance (OR=8.4 p=0.08 95%CI 0.76- 93.3). TIB correlated with lead ST-deviation in lead V5 (ρ=−0.659; p=0.002), lead V6 (ρ=−0.450, p=0.04), sum of all 12-lead ST-segment deviations (ρ=0.609; p=0.006), and number of affected leads (ρ=0.514; p=0.024). Conclusions: In this small, homogenous sample of ischemic cardiomyopathic men, a TIB score was predictive of SCD, arrhythmic death, and cardiac death. P125 https://esc365.escardio.org/Presentation/216423/abstract CRUSADE score and age: which is hot and which is not for bleeding prediction in acute coronary syndromes JP Sousa,1 L Reis,1 JG Lopes,1 C Lourenco1 and L Goncalves1 1University Hospitals of Coimbra, Coimbra, Portugal Introduction: Bleeding may complicate acute coronary syndrome (ACS), exerting important implications in both short-term and long-term outcomes (including ischemic ones). The CRUSADE score stands out as a simple-to-use and robust bleeding risk model, despite not including one of the finest hemorrhage predicting variables: age. Aim: To quantify the bleeding prediction ability of both the CRUSADE score and age and to determine whether they can be of incremental value to each other in the setting of an ACS. Methods: Retrospective single-center study comprising patients consecutively admitted into a Cardiac Intensive Care Unit, presenting with ACS, in whom the CRUSADE score was calculated. Outcome measures were those of total and major bleeding. The latter was defined by means of the GUSTO criteria as moderate-to-severe. Logistic regression analysis targeting these outcomes was performed as follows: CRUSADE score as model 1; age as model 2; CRUSADE score plus age as model 3. Model accuracy was evaluated through the C-Statistic parameter and compared via the DeLong Test. Results: 1034 patients were included between February 2009 and March 2012. Mean age was 68.0 ± 13.5 years and 31.5% were female; 38.8% presented with ST-elevation myocardial infarction. Mean CRUSADE score was 32.2 ± 16.5. Bleeding occurred in 5.6%, with 3.5% classified as major. Both age and the CRUSADE score effectively predicted bleeding: p 0.007, with Hosmer and Lemeshow (HL) p 0.478, and p <0.001, with HL p 0.186, respectively, for total bleeding; p <0.001, with HL p 0.342, and p <0.001, with HL p 0.584, respectively, for major bleeding. For total bleeding, C-Statistics were as follows: 0.616 (p 0.002) for model 1, 0.665 (p <0.001) for model 2 and 0.663 (p <0.001) for model 3. No statistical significant differences were found in their pairwise comparisons. For major bleeding, the following C-Statistics were obtained: 0.725 (p <0.001) for model 1, 0.881 (p <0.001) for model 2 and 0.883 (p <0.001) for model 3. Model 3 accuracy was higher than that of model 1 (p <0.001) but similar to that of model 2 (p 0.634). Conclusion: Older age and a high CRUSADE score efficiently stratify hemorrhage risk in ACS patients. The CRUSADE score is not superior to age alone in predicting total bleeding, whereas meritoriously dismisses age for major bleeding estimation. Open in new tabDownload slide P126 https://esc365.escardio.org/Presentation/216708/abstract Concomitant chronic total occlusion (CTO) as a prognostic factor for the immediate and long-term prognosis of patients with myocardial infarction with ST-elevation (STEMI) I Bayraktarova,1 E Naseva,2 E Trendafilova,1 A Alexandrov,1 H Mateev,1 A Bankova,1 G Vladimirov,1 G Hristova,1 E Kostova,1 E Dimitrova,1 V Grigorov,1 B Georgiev1 and N Gotcheva1 1National Heart Hospital, Cardiology Department, Sofia, Bulgaria 2Medical University of Sofia, Department of Public Health, Sofia, Bulgaria Introduction: The presence of a CTO is not a rare finding during primary PCI for STEMI. And while multivessel disease in this patient population is an established predictor of worse long-time prognosis, the additional significance of a concomitant CTO remains debatable. Purpose: We aimed to evaluate the frequency of CTO during primary PCI in a Bulgarian tertiary-centre population of STEMI patients, and the effects of the finding on the immediate and extended prognosis of the patients. Methods: We performed retrospective analysis of 265 consecutive patients with STEMI (mean age 64.0±12.1 years, 32.8% female). Patients with single-vessel disease were excluded from further analysis. Two-vessel disease was found in 89 patients (33.6%), and three-vessel disease – in 80 patients (30.2%). Results: In 39 patients (21.9% of the 169 multi-vessel disease patients) there was a concomitant CTO. There was no significant difference in the frequencies of standard risk factors between patients with and without CTO. Patients with CTO more often had an already established ischaemic heart disease (р=0.01) and peripheral artery disease (р=0.025), but not ischaemic brain disease. Patients with CTO had more complex coronary artery – as demonstrated by a higher frequency of three-vessel disease (67.6 vs 41.7%, p=0.04) and left main disease (50 vs 19%, p=0.009). Patients with CTO had a higher frequency of heart failure during the index hospitalization, but no difference in other complications during the hospital stay, including inhospital death. Patients with CTO were more frequently referred for urgent coronary surgery (р=0.001), but were less often referred for staged interventional revascularisation (р=0.05) or received complete staged interventional revascularisation (р=0.033). During a follow up of 1280 (33-1626) days, 34 patients died, with a median survival of 1408 days. Despite similar median GRACE values at admission, patients with CTO had worse survival according to the Kaplan-Meier curves, regardless of the comparable frequencies of registered ischemic events. Cox regression analysis found CTO to be a significant predictor of worse long-term prognosis, independent of the presence of concomitant left main or triple-vessel disease. Conclusion: The presence of CTO in STEMI patients seems to significantly influence the long-term survival in this population and should therefore be routinely considered as part of the risk stratification at the time of the index event. P127 https://esc365.escardio.org/Presentation/216714/abstract Impact of concomitant chronic total occlusion (CTO) on the immediate and long-term prognosis of patients with myocardial infarction without ST-elevation (NSTEMI) I Bayraktarova,1 E Naseva,2 E Trendafilova,1 A Alexandrov,1 H Mateev,1 A Bankova,1 G Vladimirov,1 G Hristova,1 E Kostova,1 E Dimitrova,1 V Grigorov,1 B Georgiev1 and N Gotcheva1 1National Heart Hospital, Cardiology Department, Sofia, Bulgaria 2Medical University of Sofia, Department of Public Health, Sofia, Bulgaria Introduction: The presence of a CTO is a frequent finding in PCI-treated NSTEMI patients. And while multivessel disease in this population is an established predictor of worse long-time prognosis, the additional significance of a concomitant CTO remains a matter of some debate. Purpose: We aimed to evaluate the frequency of CTO during PCI in NSTEMI patients treated at a Bulgarian tertiary centre, and its effects on the immediate and extended prognosis of the patients. Methods: We performed retrospective analysis of 138 consecutive patients with NSTEMI (mean age 68.5 ± 10.2 years, 26.1% female). Two-vessel disease was found in 48 patients (34.8%), and three-vessel disease – in 59 (42.8%). Results: In 50 patients (46.7% of the 107 multi-vessel disease patients) there was a concomitant CTO. There was no significant difference in the frequencies of standard risk factors between patients with and without CTO, with the exception of arterial hypertension (р=0.043). There was no difference in the frequency of established coronary artery disease or other localised atherosclerotic vessel disease either. Patients with a CTO suffered more frequently from a triple-vessel disease (64.4 vs 25.5%, p<0.0001), but no such correlation was found with respect to left main disease. Presence of CTO was not associated with differences in the course of the index hospital stay, including the median length of stay and the occurrence of inhospital death. There were no therapeutic differences during the index hospitalisation, the frequency of urgent coronary surgery or planned staged interventional revascularisation between the groups. Despite that, when followed up three months after the index NSTEMI, patients with a CTO had received significantly less often complete staged revascularisation (р=0.039), both interventional (р=0.037), and surgical (р=0.017). Consistent with comparable median GRACE values at index admission, during a follow up of median 1026 (22-1893) days, patients with a CTO had no significant difference in the frequency of ischaemic events by types and in survival in general, according to Kaplan-Meier curves, regardless of the degree of revascularisation reached. Presence of CTO remained a statistically insignificant independent predictor for worse prognosis after correction for the presence of left main or triple-vessel disease. Cox regression analysis wielded the same results. Conclusion: Presence of CTO in NSTEMI did not seem to influence the immediate and long-term survival in our patient population. P128 https://esc365.escardio.org/Presentation/216507/abstract Very low LDL-C: insights from the real world D De Campos,1 C Saleiro,1 J Lopes,1 L Puga,1 J M Ribeiro,1 R Gomes,1 A Botelho,1 R Teixeira1 and L Goncalves1 1University Hospitals of Coimbra, Coimbra, Portugal Background: The association of a low LDL cholesterol (LDL-C) and an acute coronary syndrome (ACS) is not uncommon. Methods: We retrospectively assessed consecutive patients admitted for an ACS in a single center coronary unit from 2009 to 2016. Patients were stratified according to LDL-C (cut-off of 70mg/dL): LDL-C ≤70 mg/dl (N=260) and LDL-C>70mg/dL (N=1188). The primary end-point was five year all-cause death and readmission for a new ACS. Results: In 1448 patients (70.2% males, 67.78±13.16 years old) followed for a median of 35 months, 420 deaths and 197 new ACS occurred. The majority (62.9%) was admitted for a non-ST elevation ACS. Mean LDL-C was 111.75±130.70mg/dL. LDL-C ≤70 mg/dl patients were older. A significant association between low LDL-C and chronic kidney disease and previous revascularization was remarkable. During their hospital stay, LDL-C ≤70 mg/dl patients were more frequently diagnosed with clinical heart failure, had a higher NTproBNP although left ventricular ejection fraction was similar. Low LDL-C patients had more frequently multivessel coronary artery disease albeit not considered amenable for revascularization. Low LDL-C was an independent predictor of the primary endpoint (HR 0.75, 95%CI 0.68-0.82, P=0.000). Compared with LDL-C <100 mg/dL, LDL-C ≤70 mg/dl was associated with a significantly higher risk of all-cause death and new ACS (event-free survival 54.2% vs 69.4%, Log Rank P=0.000). In statin-naïve patients, low LDL-C was also found to be an independent predictor of the primary endpoint (HR 0.62, 95%CI 0.46-0.85, P=0.003) and these patients had a worse 5-year outcome (event-free survival 61.5% vs 83.4%, Log Rank P=0.002). In pretreated statin patients, low LDL-C was not a predictor of the primary endpoint. Conclusions: In a high risk cohort with long-term follow-up and among statin-naïve patients, LDL-C ≤70 mg/dL was independently associated with all-cause death and new ACS and conferred a worse prognosis. In statin pretreated patients, admission LDL-C had no significance in predicting future events. These findings may have implications for future cholesterol treatment paradigms. Figure 1. Open in new tabDownload slide Kaplan-Meier curves. P129 https://esc365.escardio.org/Presentation/217598/abstract Predictors of coronary artery disease severity in non-ST segment elevation myocardial infarctionnone H Santos,1 H Miranda,1 M Santos,1 I Almeida,1 C Sousa,1 L Almeida,1 J Chin,1 S Almeida,1 C Sa,1 L Santos1 and J Tavares1 1Hospital N.S. Rosario, Cardiology, Barreiro, Portugal Introduction: Non-ST segment elevation myocardial infarction (NSTEMI) is frequently associated with other comorbidities. First assessment of patient’s can reveal important data on the prediction of severe coronary disease and with that plan our intervention. Objective: Evaluate the impact of cardiovascular previous history and clinical signs at admission in the prediction of coronary stenosis severity in NSTEMI patients. Methods: Single-centre retrospective study, engaging patients hospitalized for NSTEMI between 1/04/2016-31/10/2018. Epidemiological, clinical data at admission and angiography results were collected. Patients were divided in two groups: A - no stenosis or single vessel stenosis, and B - multiple vessel disease (≥ 2 vessel). Cardiovascular risk factors (CVRF) included the traditional ones, and previous history of acute coronary syndrome (ACS), stroke, valvular heart disease and angina. Chi-square, Fisher and T-student tests were used to compare categorical and continuous variables. Multiple linear regression was performed to assess the coronary artery stenosis’ severity based on the cardiovascular history and clinical signs at admission. Results: 229 patients were included, mean age 67.27±11.78 years, with 62.4% males. Group A (92 patients) and group B (137 patients) were similar regarding gender, body mass index, arterial hypertension, dyslipidemia, previous ACS, arterial pressure (systolic and diastolic) at admission, as well on the heart rate and Killip classification. On the other hand, group B were older (68.79±11.05 vs 65.01±12.53 years, p=0.017), had higher prevalence of diabetes (51.8 vs 30.4%, p=0.001), history of angina (22.6 vs 6.5%, p=0.001), previous stroke (15.3 vs 4.3%, p=0.009) and valvular heart disease (10.2 vs 2.2%, p=0.019). Active smoking status was more frequent in group A (40.2 vs 24.8%, p=0.014). Multiple linear regression revealed diabetes, previous stroke and history of angina as predictors of multivessel disease with an R2a of 0.106 – Table 1. Table 1. Independent Variables .  (95% CI) . P value . Diabetes 0.190 (0.064-0.311) 0.003 Previous stroke 0.141 (0.025-0.418) 0.027 Previous history of angina 0.195 (0.094-0.426) 0.002 Independent Variables .  (95% CI) . P value . Diabetes 0.190 (0.064-0.311) 0.003 Previous stroke 0.141 (0.025-0.418) 0.027 Previous history of angina 0.195 (0.094-0.426) 0.002 Multiple linear regression models for prediction of coronary stenosis severity in NSTEMI. Kaplan-Meier analysis. Open in new tab Table 1. Independent Variables .  (95% CI) . P value . Diabetes 0.190 (0.064-0.311) 0.003 Previous stroke 0.141 (0.025-0.418) 0.027 Previous history of angina 0.195 (0.094-0.426) 0.002 Independent Variables .  (95% CI) . P value . Diabetes 0.190 (0.064-0.311) 0.003 Previous stroke 0.141 (0.025-0.418) 0.027 Previous history of angina 0.195 (0.094-0.426) 0.002 Multiple linear regression models for prediction of coronary stenosis severity in NSTEMI. Kaplan-Meier analysis. Open in new tab Conclusions: Diabetes, previous stroke and previous history of angina were predictors of multivessel coronary stenosis (10,6% of the cases) in this population. P130 https://esc365.escardio.org/Presentation/216728/abstract High-sensitivity C-reactive protein and acute kidney injury in patients with acute myocardial infarction. J Campodonico,1 N Cosentino,1 C Lucci,1 V Milazzo,1 M Moltrasio,1 K Celentano,1 M De Metrio,1 M Rubino,1 I Marana,1 M Grazi,1 G Lauri1 and G Marenzi1 1Cardiology Center Monzino IRCCS, cardiology, Milan, Italy Introduction: Acute kidney injury (AKI) is a frequent complication of acute myocardial infarction (AMI), and it is associated with increased short-term and long-term morbidity and mortality. Accumulating evidence suggests that inflammation plays a key role in AKI pathogenesis and progression. Purpose: The aim of this study was to explore the relationship between high-sensitivity C-reactive protein (hs-CRP), a marker of systemic inflammation, and AKI in AMI. Methods: We prospectively included 2,063 AMI patients in whom hs-CRP was measured at hospital admission. The following endpoints were considered: AKI incidence and a clinical composite of in-hospital death, cardiogenic shock, and acute pulmonary edema. AKI was defined applying the Acute Kidney Injury Network (AKIN) classification according to the maximum creatinine increase recorded between baseline (hospital admission) and the first 72 hours. Results: Two-hundred-thirty-four (11%) patients developed AKI. Levels of hs-CRP were higher in patients with AKI than in those without (45±87 vs. 16±41 mg/L; P<0.0001). The incidence and severity of AKI, as well as the rate of the composite endpoint, increased in parallel with hs-CRP quartiles (P for trend <0.0001 for all comparisons). A significant correlation was found between admission hs-CRP values and subsequent maximal increase of serum creatinine (R=0.23; P<0.0001). At ROC analysis, the AUC of hs-CRP for AKI prediction was 0.69 (95% CI 0.65-0.73; P<0.001). At reclassification analysis, addition of hs-CRP allowed to properly reclassify 14% of patients when added to creatinine and 8% of patients when added to a clinical model. Conclusions. In AMI patients, admission hs-CRP is closely associated with AKI development and severity, and with in-hospital outcomes. Future research should focus on whether prophylactic renal strategies in patients with high hs-CRP values may prevent AKI and improve clinical outcome. P131 https://esc365.escardio.org/Presentation/216459/abstract Mortality associated to acute coronary syndromes: a retrospective analysis of the last 5-years I Almeida,1 H Miranda,1 H Santos,1 M Santos,1 J Chin,1 C Sousa,1 S Almeida1 and J Tavares1 1Hospital N.S. Rosario, Barreiro, Portugal Introduction: Although mortality associated to acute coronary syndromes (ACS) has been decreasing due to more fast and efficient interventions, it is always a devastating consequence and our best efforts should be used to combat it. Purpose: Evaluation of predictor factors of death in patients with ACS. Material and methods: Retrospective analysis of data patients admitted with ACS included in a multicentric registry between 2012-2017. We compared the impact of dual antiplatelet therapy strategy – clopidogrel (CLOPI) versus ticagrelor (TICA) – and evaluation of the endpoint death. Results: 10156 patients with ACS were admitted, 3% of which died (p <0.001) during hospitalization. 59.3% of male gender. The patients who died had a higher average age (78±11 years vs 65±13, p<0.001). The most prevalent comorbidities were hypertension (72.1%), dyslipidaemia (50.2%) and diabetes (37.2%). The majority of patients who died arrived to the hospital by an ambulance without a doctor or their own transport (72.4% on total, p<0.001) with 46.3% (p 0.088) of the cases admitted in hospitals without hemodynamic department. In 57.3% the diagnosis was of ST elevation myocardial infarction, in 63.4% of anterior location (p <0.001). 54.5% of the patients presented in a Killip Kimball class higher than I. 3.2% of the patients medicated with CLOPI (86.6% of the total patients) died versus 1.5% of the patients under TICA (p <0.001, odds ratio 0.45, 95% confidence interval 0.29-0.72). In 81% of the performed coronarographies, the involved coronary artery was the anterior descendent and in 74.1% there was multivessel disease (p <0.001). There was dead of 51.3% of the patients who performed angioplasty. Average ejection fraction 35±12 vs 52±12 % (p <0.001). There was necessity of non-invasive mechanic ventilation in 26.3%, invasive mechanic ventilation in 20.7%, temporary pacemaker in 15% and intra-aortic balloon in 4.7% (p <0.001). A logistic regression was performed to evaluate the prognostic impact of demographic and clinical predictors of patients medicated with TICA vs CLOPI on death. There was verified that age (≥75 years), the presence of right bundle branch block pattern, hypotension (systolic blood pressure <90mmHg), Killip Kimball class higher than I, persistent ST elevation or depression and an ejection fraction less than 50% were independent predictors of death. Conclusion: Although mortality associated to acute coronary syndromes is currently rare, the authors reinforce the importance of recognize the presence of clinical and electrocardiographic markers of gravity and decrease further mortality. P132 https://esc365.escardio.org/Presentation/216436/abstract Glycaemic status in ST elevation myocardial infarction and long-term mortality: prediabetes and controlled diabetes mellitus two sides of the same coin? C Vila Cha Vaz Saleiro,1 D Campos,1 R Teixeira,1 J Lopes,1 JP Sousa,1 L Puga,1 J Ribeiro,1 A Gomes,1 C Lourenco,1 M Costa1 and L Goncalves1 1University Hospitals of Coimbra, Coimbra, Portugal Background: The association between diabetes mellitus and cardiovascular (CV) risk is well known. Prediabetic patients are also at increased risk of composite CV events and all-cause mortality. The actual impact of prediabetes diagnosis, diabetes with good glycaemic control or uncontrolled diabetes in the context of a ST elevation myocardial infarction (STEMI) remains to be determined. Purpose: To assess the differences on long-term all-cause mortality between non-diabetic, prediabetic and diabetic patients admitted with STEMI. Methods: 485 STEMI patients admitted to a single coronary care unit between 2009 and 2016 were included. Clinical, laboratorial and echocardiographic data were evaluated. Four groups were created based on the glycaemic status and HbA1c level: Group A (non-diabetic patients, HbA1c ≤5.6%) N= 150; Group B (prediabetic patients, HbA1c between 5.7-6.4%) N=167; Group C (diabetic patients with HbA1c ≤7.4%) N=81 and Group D (diabetic patients with HbA1c ≥7.5%) N=87. The primary endpoint was long-term all-cause mortality at 72-months of follow-up. Survival analysis was performed according to the Kaplan-Meyer. A Cox regression was elaborated targeting all-cause mortality. Results: The groups were similar regarding gender, dyslipidaemia, previous coronary artery disease and left ventricular (LV) systolic function. However, non-diabetic patients were younger (60±14 vs 67±15 vs 69±12 vs 67±13 years old, P<0.001), had a lower prevalence of chronic kidney disease (CKD) and hypertension and were less likely to have heart failure. 117 patients met the primary outcome. Kaplan-Meyer curves showed a decreased survival in the prediabetic and diabetic groups (62.3% vs 56.5% vs 54.2% vs 47.2%, Log Rank P=0.001 – Figure 1). The survival rates of prediabetic and diabetic patients with HbA1c ≤7.4% were similar (Log Rank P=0.36). After adjustment for age, CKD, heart failure and LV systolic function, uncontrolled diabetes (HbA1C ≥7.5%) remained associated with increased mortality (HR 1.82, 95% CI 1.00-3.23, P=0.049). No association was documented for prediabetic patients or diabetics with HbA1c ≤7.4% with the primary outcome after adjustment. In this model, age, heart failure diagnosis and impaired LV function remained associated with the outcome, regardless of glycaemic status. Open in new tabDownload slide Conclusion: The risk of prediabetic patients after STEMI was similar to the controlled diabetic patients, suggesting that the prediabetic state should also be regarded as a high-risk group. P133 https://esc365.escardio.org/Presentation/221293/abstract STEMI outcomes in XXI century, are there still benefits with a reperfusion network? 28-days and one-year mortality C Garcia-Garcia,1 C Labata,1 F Rueda,1 T Oliveras,1 M Ferrer,1 S Montero,1 N El Ouaddi,1 J Serra,1 H Resta,1 A Borrellas,1 J Andres1 and A Bayes-Genis1 1Germans Trias i Pujol University Hospital, Barcelona, Spain Background/Introduction: Acute myocardial infarction (AMI) Code with a reperfusion network improves reperfusion therapy in ST elevation AMI (STEMI) patients. Although would be interesting to analyze short- and long-term prognosis of these patients in real life. Purpose: Analyze shot-term prognosis and one-year all-cause mortality of STEMI patients in the XXI century, before and after the onset of a reperfusion network (AMI Code). Methods: Single-centre prospective registry of STEMI patients admitted in a University hospital from January 2000 and December 2017. Depending on the year of admission, patients were classified in two groups: Pre-Code (years 2000-2009), before the onset of AMI Code; Post-Code (years 2010-2017), after the onset of AMI-Code. We analyze reperfusion therapies, in-hospital prognosis, 28-day case-fatality and one-year all-cause mortality between both periods. Results: A total of 5,292 consecutive STEMI patients were included, Pre-Code: =2,206, Post-Code: n=3,086. Mean age was 62.3 years (SD 12.9) and were men 79.2 of them. Post-Code patients had higher prevalence of smoking history, hypertension and hypercholesterolemia, but less diabetes and previous AMI. Reperfusion therapies increase in Post-Code period (91.1% vs 67.6%, p<0.001), primary percutaneous coronary intervention (pPCI) was performed in 98.4% of Post-Code patients. In Pre-Code period, pPCI was performed in 55.9% of cases while 44.1% of patients received thrombolytics. Killip-Kimball class was lower in Post-Code, class III-IV in 8.7% vs 12.5% of patients in Pre-Code, p>0.001. Moreover, 28-day case fatality was similar in both periods (6.0 Pre-Code vs 5.7% post-Code, p= 0.55). All-cause one-year mortality did not differ between periods (9% Pre-Code vs 8.4% Post-Code, p=0.24). After multivariable adjustment, 28-day case-fatality (HR:0.88, IC95%:0,70-1,10; p=0,26) and one-year mortality (HR:0.99, IC95%:0,78-1,25; p=0,91) remain without reduction in Post-Code period compared to Pre-Code. Conclusions: The onset of the AMI-Code increases reperfusion therapies in STEMI patients in XXI Century, improving some in-hospital complications, although 28-day and one-year mortality remain without significant changes. P134 https://esc365.escardio.org/Presentation/216738/abstract Sex-differences in the baseline characteristics, treatment and mortality of young patients with acute myocardial infarction according to Estonian myocardial infarction registryEstonian Research Council (PRG435) M Blondal,1 P Loiveke,1 T Ainla,2 T Marandi,3 A Saar,1 G Veldre4 and J Eha5 1University of Tartu, Faculty of Medicine, Department of Cardiology, Tartu, Estonia 2North Estonia Medical Centre, Centre of Cardiology, Tallinn, Estonia 3North Estonia Medical Centre, Quality Department, Tallinn, Estonia 4Tartu University Hospital, Estonian Myocardial Infarction Registry, Tartu, Estonia 5Tartu University Hospital, Department of Cardiology, Tartu, Estonia Background: Previous observational studies have demonstrated conflicting results on the sex-differences in the baseline characteristics, treatment and prognosis of young patients with acute myocardial infarction (AMI). Purpose: To describe the sex-differences in the baseline characteristics, clinical presentation, existence of obstructive coronary artery disease, treatment as well as 30-day and 1-year mortality in a non-selected cohort of young patients with AMI in Estonia. Methods: We included 18-55-year old AMI patients hospitalized during 2012-2017 according to the Estonian Myocardial Infarction Registry (EMIR), which is a national registry collecting data on all hospitalized AMI cases (International Classification of Diseases 10th version, codes I21-I22). Submitting data online via a specific form is mandatory and the annual case-coverage is over 95%. The registry provided data on baseline characteristics, current AMI episode, coronary angiography and revascularization, as well as medications used during hospitalization and recommended for outpatient use. Mortality data was obtained through the linkage with the Causes of Death Registry. Statistical analysis was done using Stata 10 and a p-value of under 0.05 was considered statistically significant. Results: Out of 1777 patients hospitalized during the study period, 217 (12.2%) were female and 1560 (87.8%) were male. In both study groups the rate of current smokers was strikingly high and there were more smokers among males (57.2% vs 40.2%). Females had more often diabetes (20.0% vs 12.9%), a family history of coronary heart disease (35.0% vs 28.5%) and presented with atypical symptoms (26.5% vs 19.3%). During hospitalization there were no major differences in the use of medications, except for glycoprotein IIb/IIIa inhibitors which were less often prescribed for females (16.6% vs 23.0%). A similar proportion of females (88.9%) and males (90.3%) underwent coronary angiography. Females were more often found to have non-obstructive coronary artery disease (7.8% vs 2.8%). Out of those who underwent coronary angiography a lower rate of females (82.9%) than males (88.7%) received percutaneous coronary intervention. For outpatient treatment females were less often prescribed P2Y12 inhibitors and angiotensin-converting-enzyme inhibitors and/or angiotensin II receptor blockers. The mean 30-day and 1-year mortality rates were 4.1% and 5.4% respectively and there were no major differences between the study groups neither in crude nor in baseline-adjusted analysis. Conclusions: Based on a nationwide registry with a high case-coverage we found sex-differences in the baseline characteristics, clinical presentation, existence of obstructive coronary artery disease and treatment among young AMI patients. Our study highlights the need to address the high rates of modifiable risk factors among young AMI patients and the need for further research on the mechanisms of AMI among females. P135 https://esc365.escardio.org/Presentation/216400/abstract Acute coronary syndrome in the setting of multimorbidity B Morawiec,1 M Gorzko,1 P Muzyk,1 W Zaleski,1 M Zdebska,1 J Godziek,1 E Nowalany-Kozielska,1 A Tomasik1 and D Kawecki1 12nd Department of Cardiology, Medical University of Silesia, Zabrze, Poland Background: Multimorbidity, as the coexistence of two or more chronic conditions, is a growing health challenge that affects significantly the course of acute cardiac conditions. The model of single-disease seems to be outdated and, according to personalized approach to the patient, should be modified to deal with rising burden of multimorbidity. Purpose: To examine the prognosis of patients with cardiovascular (CV) and non-cardiovascular (NCV) multimorbidity (MMB) after acute coronary syndrome (ACS). Methods: This study included patients from a prospective registry of patients suspected of ACS between July 2015 and June 2016, for whom a 2-year follow-up period was completed. Based on the medical history we defined CV_MMB_Index as a combination of coronary heart disease, congestive heart failure, peripheral artery disease, cerebrovascular disease, diabetes, arterial hypertension, and NCV_MMB_Index as a combination of cancer, chronic obstructive pulmonary disease, gastrointestinal bleeding, inflammatory systemic disease, chronic renal disease and liver disease. Total_MMB_Index was a combination of CV and NCV risk factors. Multivariable adjusted Cox proportional models were built to assess the 2-year risk of major adverse cardiovascular and cerebral events (MACCE), defined as mortality and non-fatal myocardial infarction, urgent percutaneous coronary intervention or stroke and, secondary, all-cause mortality alone. The final model was adjusted for biometric variables (age, gender, and body mass index). Results: From the total of 196 patients included for analysis 162 patients (83%) had CV risk factors. Cox proportional hazard ratio analysis identified CV_MMB_Index as a significant risk factor for 2-year MACCE (HR 1.43 95%CI [1.04-1.97], p=0.026). The analysis of increasing cut-off for CV_MMB_Index revealed increasing risk for each additional risk factor with significantly highest risk for CV_MMB_Index 5 or higher (HR 5.63 95%CI 1.33-23.93], p=0.019). These results were confirmed in Kaplan-Meier analysis (Figure). Neither NCV_MMB_Index nor Total_MMB_Index were significant risk factors for 2-year MACCE. Open in new tabDownload slide Kaplan-Meier analysis. Secondary analysis for 2-year mortality showed similar outocome for CV_MMB_Index (HR 1.75 95%CI 1.04-2.95], p=0.035) and for CV MMB 5 or higher (HR 18.35 [95%CI 3.78-89.38], p<0.001). Single NCV_MMB_Index was not a significant risk factor in Cox analysis, however Total_MMB_Index significantly increased risk for 2-year mortality with HR 5.65 (95%CI 1.17-27.25), p = 0.031. Adjustment for biometric parameters did not change the outcome of CV_MMB_Index significantly, with only slight decrease in hazard ratio for prognosis of 2-year MACCE. Conclusions: In patients suspected of ACS, cardiovascular risk factors defined as CV_MMB_Index, increase the risk of MACCE in long-term follow-up with the highest rise with the fifth risk factor. In this group, NCV risk factors are of less influence on long-term events. P136 https://esc365.escardio.org/Presentation/217412/abstract Gender influence in prediction of cardiogenic shock after an acute coronary syndrome. IR Martinez Primoy,1 JC Garcia Rubira,1 RJ Hidalgo Urbano,1 T Seoane Garcia,1 J Carmona Carmona,1 DF Arroyo Monino,1 MJ Cristo Ropero,1 FJ Cortes Cortes,1 B Olivares Martinez,1 A Gomez Gonzalez,1 MP Ruiz Garcia,1 B Lorenzo Lopez,1 M Hidalgo Velastegui,1 A Recio Mayoral1 and M Almendro Delia1 1UNIVERSITY HOSPITAL VIRGEN MACARENA, Seville, Spain Introduction: Cardiogenic shock (CS) is the main cause of death in patients suffering from an acute coronary syndrome (ACS). Early revascularization has proved to be the most effective maneuver in reducing this high mortality. Prognosis factors of ACS have been evaluated repeatedly, although we have failed to obtain a defined list of them. In this context, many predictive models have been tested in order to detect patients with higher risk of developing CS, each one of those contains different factors and is submitted equally to men and women. Purpose: Our purpose is to analyse gender differences in clinical characteristics in patients that suffer from an ACS, in order to detect sex-based independent predictors of CS. Methods: Retrospective, observational study of patients admitted in a Coronary Unit due to an ACS from June 2011 to July 2018. 70 variables were registered and compared in men and women. Data was analysed using the Chi2 Test and U Mann-Whitney in univariate analysis and logistic regression in multivariate analysis. Differences with p-value<0.05 were considered significant. Results: 1858 patients were included, 73.7% were men (1370) and 26.3% women (488). In descriptive analysis of admission characteristics, 61.6% were admitted due to ACS with ST elevation (STEMI) and 38.4% due to ACS with non ST elevation (NSTEMI), no difference between sexes were found. 54.2% of patients had one vessel lesion, and 8% had multivessel lesion, defined as 3 vessels disease or left main coronary artery disease. Normal coronary arteries (4.6% of patients) was found to be more frequent in female and multivessel lesions in male patients. The culprit artery was more commonly left anterior descending (56.5%). Male patients were, more often than women, active or past smokers. On the other hand, female patients had more likely to be older, with diabetes mellitus (DM), high blood pressure or previous history of heart failure (HF). In addition, women had higher shock index (SI) at admission, higher values of GRACE and CRUSADE scales, and Killip Kimbal II. Once in Hospital, male patients had more probability of underwent urgent revascularization than female. In contrast, women had longer hospitalizations and worst evolution, developing more CS (12.7%vs8.4%, p<0.05) and death (10.5%vs5.0%, p<0.001) compared with men. Independent predictors of CS in women were the age and the presence of DM, whereas in men were the age, being ex-smoker, HF history, STEMI and the SI. Conclusion: Patients admitted due to an ACS have clinical and demographic differences based on gender, which is translated into different in-hospital outcomes. Independent predictors of CS were found to be different in men and in women. Our study suggests that differential models based on sex should be developed in order to predict CS and, therefore, reduce the mortality. P138 https://esc365.escardio.org/Presentation/216489/abstract Spontaneous Coronary Artery Disease: a single center experience CC Oliveira,1 C Braga,1 I Campos,1 P Medeiros,1 C Pires,1 R Flores,1 F Mane,1 J Costa1 and J Marques1 1Hospital de Braga, Braga, Portugal Introduction: Though underestimated, myocardial infarction due to spontaneous coronary artery disease (SCAD) is an increasingly prevalent entity. Nevertheless, there is still a lack of evidence regarding treatment. Aim: To investigate the characteristics and prognosis of patients with SCAD. Methods: Single-center, retrospective study performed in patients hospitalized from January 2010 to December 2018 with diagnosis of SCAD (n= 52), regarding patient characteristics and outcomes (death, myocardial infarction, SCAD recurrence and stroke at discharge and during follow-up). Results: Patients with SCAD were mainly female (78.8%) with median age of 55.6 years. Predisposing factors were identified in 36.5% of patients and precipitating factors in 23.1%. Non-ST elevation myocardial infarction (NSTEMI) was the main form of presentation (65.4%). The left anterior descending artery (LAD) was the most commonly involved (34.5%) and 5 patients had compromise of 2 or more non-contiguous arteries. Type 2 dissection was the most prevalent angiographic pattern (73.1%). Ejection fraction was reduced in 30.8%. The majority of patients (69.2%) were managed medically and the remaining patients underwent percutaneous coronary intervention (PCI) with second generation drug-eluting stents. PCI were mainly due to re-infarction during hospitalization (n=4) or due to the nature of the territories involved (Left main or proximal LAD, n= 4). Eight patients re-infarcted while in the hospital and 5 during follow-up (SCAD was present in 4 patients: in 3 patients the event occurred in a coronary territory other than that of the index case, and in 1 patient it occurred in the previously affected territory). At discharge, 75% of patients were medicated with dual antithrombotic therapy. Over the period of follow-up, 3 patients develop heart failure and there were no registries of death or stroke. Fibromuscular dysplasia and inflammatory/ connective tissue diseases were not investigated in our population. We are currently implementing a protocol with Rheumatology to rule-out these predisposing factors for SCAD. Ten patients were already involved and, in at least 1 patient, an inflammatory disease was diagnosed. Conclusion: SCAD is mostly associated with young women with low cardiovascular risk. It is important to investigate predisposing factors since SCAD recurrence was not rare. Nevertheless, the prognosis of the disease in our population was good. P139 https://esc365.escardio.org/Presentation/216439/abstract Identification of a major bleeding predictive score in acute coronary syndrome R Menezes Fernandes,1 HA Costa,1 TF Mota,1 JS Bispo,1 D Bento,1 N Marques,1 J Mimoso1 and I Jesus1 1Faro Hospital, Cardiology, Faro, Portugal Introduction: In Acute coronary syndrome (ACS), major bleeding (MB) is a serious complication and is associated with a worse prognosis. Identification of high-risk patients is essential, but recent studies have questioned the applicability of CRUSADE score in specific populations of ACS. Purpose: This study pretends to determine a predictive score of MB in patients with ACS. Methods: We conducted a retrospective, descriptive and correlational study encompassing patients admitted with ACS in a Cardiology service from 1st October 2010 to 1st October 2018. Demographic factors, risk factors, antecedents and clinical characteristics were analyzed. The correlation between the categorical variables was performed by the Chi-square test, while the T-Student test was applied to the continuous variables, with a significance level of 95%. Independent predictors of MB were identified through a binary logistic regression analysis, considering p=0,05. Then, a discriminatory function was applied using the Wilks lambda test to determine the discriminant score of the analyzed groups. For statistical analysis, SPSS 24.0 was used. Results: A total of 4458 patients were admitted with ACS, and 86 (1,9%) had MB during the hospitalization. In this subgroup, 81,4% were over 65 years of age, 65,1% were males, 61,6% had acute myocardial infarction with ST-segment elevation (STEMI), 15,1% had hemoglobin (Hb) <10 g/dL and 36% were medicated with aspirin on an outpatient basis. The in-hospital mortality rate was 17,4%. Age >65 years (p=0,016), STEMI (p=0,019), hemoglobin <10 g/dL (p=0,027), and history of medication with aspirin (p<0,001) were independent predictors of MB. A predictive score of MB in patients with ACS was determined with the formula: - 1,238 + 1,166x(age>65) + 0,959x(STEMI) + 3,7x(Hb<10) + 0,504x(history of taking aspirin). In this equation, variables should be substituted by 1 or 0, depending on the presence of that condition. A cutoff of 0,51 was obtained with 60,5% sensitivity, 79,6% specificity and 79,2% discriminative power. Conclusion: In this population of patients admitted with ACS, 1,9% presented major bleeding. A predictive score of MB with a good discriminative power was determined, and included age >65 years, STEMI, hemoglobin <10 g/dL and previous medication with aspirin. By considering clinical variables, this score can be used at a very early stage of hospital admission, in order to stratify the hemorrhagic risk of each patient. It still needs validation to allow its application in clinical practice. P140 https://esc365.escardio.org/Presentation/216509/abstract Will my patient with acute coronary syndrome develop heart failure? R Menezes Fernandes,1 TF Mota,1 JS Bispo,1 HA Costa,1 D Bento,1 N Marques,1 J Mimoso1 and I Jesus1 1Faro Hospital, Cardiology, Faro, Portugal Introduction: Acute coronary syndrome (ACS) is one of the main precipitating factors of heart failure (HF), worsening the patient’s prognosis. Early identification of high risk of developing HF would hasten initiation of preventive strategies. Purpose: To determine a predictive score of developing HF in patients with ACS. Methods: We conducted a retrospective, descriptive and correlational study including patients admitted with ACS in a Cardiology service from 1st October 2010 to 1st October 2018. Demographic factors, risk factors, antecedents and clinical characteristics were analyzed. The correlation between the categorical variables was performed by the Chi-square test, while the T-Student test was applied to the continuous variables, with a significance level of 95%. Independent predictors of HF were identified through a binary logistic regression analysis, considering p=0,05. A discriminatory function was applied using the Wilks lambda test to determine the discriminant score of the analyzed groups. SPSS 24.0 was used for statistical analysis. Results: 4458 patients were admitted with ACS and 522 (11,7%) developed HF. Of these, 70,9% were over 65 years, 65,1% were male and 45,9% had diabetes mellitus (DM). In addition, 51,7% had acute myocardial infarction with ST-segment elevation, 31,9% had left ventricular ejection fraction (LVEF) <50% and 10,5% developed cardiogenic shock. The in-hospital mortality rate was 19,2%. Age>65 (p=0,04), DM (p=0,025), cardiogenic shock (p<0,001), absence of sinus rhythm at admission (p=0,029), BNP>100 pg/ml (p=0,008), LVEF<30% (p=0,003), LVEF<50% (p<0,001) and no previous medication with oral antidiabetic agents (OAA) (p=0,033) were independent predictors of HF development. We determined a predictive score of HF in patients with ACS, using the formula: 0,49 + 0,383x(Age>65) + 0,577x(DM) + 3,638x(cardiogenic shock) – 0,265x(sinus rhythm at admission) + 0,487x(BNP>100) + 1,475x(LVEF<30%) – 1,357x(LVEF>50%) – 0,310x(previous medication with OAA). In this equation, variables should be substituted by 1 or 0, depending on whether the condition is present or not. A cutoff of 0,49 was obtained with 68% sensitivity, 78,4% specificity and 77% discriminative power. Conclusion: HF is a frequent complication of ACS. We produced a predictive score of HF with a good discriminative power, including age over 65 years, DM, history of medication with OAA, rhythm on admission’s electrocardiogram, LVEF<30%/50%, BNP>100 pg/ml and cardiogenic shock. By considering clinical variables, it can be used at an early stage of the hospitalization, allowing stratification of the risk of developing HF. It still needs validation to be applied in clinical practice. P141 https://esc365.escardio.org/Presentation/216476/abstract Prognosis of patients hospitalized with STEMI: does BNP help in the stratification? I Almeida,1 M Santos,1 H Santos,1 H Miranda,1 J Chin,1 C Sousa,1 S Almeida1 and J Tavares1 1Hospital N.S. Rosario, Barreiro, Portugal Introduction: The prognostic value of brain natriuretic peptides (BNP) in ST elevation myocardial infarction (STEMI) has been extensively evaluated, however not fully stablished. Many studies have demonstrated the potential of BNP as a marker of hemodynamic stress, to give additional information to the traditional markers of ischemia in electro and echocardiography. Objective: Evaluation of prognostic impact of BNP levels in coronary anatomy, left ventricle ejection fraction (LVEF) and in-hospital outcomes in patients admitted with STEMI. Material and methods: Retrospective analysis of patients’ data admitted with STEMI at multicentric registry between October 2010 and January 2019. Patients were divided into three groups regarding BNP levels: < 100pg/ml in group 1 (39.0% of patients); 100 ≤ BNP < 400 pg/ml in group 2 (39.5%); and ≥ 400 pg/ml in group 3 (21.5%). Demographic and clinical characteristics were compared, and in-hospital outcomes were evaluated. Results: Admitted 1650 patients with STEMI. Group 1 patients were younger (58±11 vs 66±13 vs 72±12 years, p <0.001). Patients were mostly male in all groups (75.4%) and body mass index was not statistically different between groups (mean value 27.2±4.4 kg/m2). The percentages of patients with a previous diagnosis of heart failure were: 0.5 vs 1.8 vs 5.9%, p <0.001. Mean values of BNP at admission were: 43±26 in group 1 vs 208±81 in group 2 vs 1105±1073 pg/ml in group 3, p <0.001. All patients were submitted to coronary angiography: the anterior descendent was the artery most frequently involved in all groups (57.4 vs 66.9 vs 80.3%, p <0.001). The involvement of more than more coronary artery was more frequent between group 3 patients (34.4 vs 44.5 vs 51.3%, p < 0.001), however a smaller percentage of patients were submitted to percutaneous coronary angioplasty (95.8 vs 93.7 vs 86.6%, p < 0.001). A higher percentage, although not statistically different, was submitted to myocardial revascularization surgery (0.3 vs 1.5 vs 2.3%, p 0.017). Group 3 patients had lower mean left ventricle ejection fraction evaluated during hospitalization: 58±11 vs 53±12 vs 44±13 %, p <0.001. The in-hospital events evaluated were all more prevalent in group 3 patients: reinfarction rate (0.5 vs 0.6 vs 1.1%, p 0.447); acute heart failure (6.5 vs 16.7 vs 45.4%, p <0.001); cardiogenic shock (3.3 vs 5.1 vs 16.9%, p < 0.001), atrial fibrillation (3.0 vs 6.4 vs 16.9%, p <0.001), stroke (0.5 vs 0.6 vs 2%, p 0.032), sustained ventricular tachycardia (1.6 vs 3.7 vs 6.8, p < 0.001), blood transfusion (0.3 vs 1.8 vs 5.1%, p < 0.001) and death (1.2 vs 2.6 vs 8.5%, p 0.017). The need of non-invasive mechanical ventilation (0.2 vs 1.4 vs 6.8%, p < 0.001) and Swan-Ganz catheterization (0.0 vs 0.6 vs 5.6%, p < 0.001) was also more frequent in group 3 patients. Conclusion: In patients admitted with STEMI, higher BNP levels were associated with more complex coronary anatomy, lower LVEF and higher in-hospital morbimortality. P142 https://esc365.escardio.org/Presentation/216464/abstract Occluded culprit in non-ST-segment elevation myocardial infarction: characteristics and mortality C Marques Pires,1 P Medeiros,1 C Oliveira,1 I Campos,1 R Flores,1 G Mane,1 C Galvao Braga,1 J Costa,1 N Antunes1 and J Marques1 1Braga Hospital, Braga, Portugal Introduction: Coronary occlusion in non-ST-segment elevation myocardial infarction (NSTEMI) is relatively common, however limited data are available about features and outcomes of this population. Purpose: To evaluate the clinical and angiographic characteristics of coronary occlusion in NSTEMI patients (pts) and the in-hospital mortality impact. Methods: We analysed retrospectively 488 NSTEMI pts admitted without cardiogenic shock in our coronary care unit for two years. They were divided in two groups: group 1- NSTEMI pts with coronary occlusion (n=112, 22,95%); group 2-NSTEMI pts without coronary occlusion (n=376, 77,05%). For each group we evaluated the clinical and angiographic characteristics and the in-hospital mortality differences. Results: Group 1 pts were younger (61,3 ± 12,7 years vs 65,7 ± 12,0 years; p-0,001) and had a lower prevalence of some cardiovascular risk factors, as hypertension (50,9% vs 68,9%; p<0,001) and diabetes (21,4% vs 35,9%; p-0,004). There was also lower prevalence of previous myocardial infarction (9,8% vs 19,9%; p- 0,014) and coronary artery bypass grafting (0%vs 7,7%; p-0,002). There were not statistical significant differences regarding gender, body mass index, hypercholesterolemia, smoking habit, cerebrovascular disease and previous percutaneous coronary intervention (PCI). In concern to the time from hospital arrival to angiography it was significantly lower in group 1 (22,75± 41,9h vs 44,95±47,0h; p<0,001), however the time from symptoms onset to hospital arrival was not statistically different. The angiograms revealed that the culprit in the group 1 was most often located in the right coronary artery (41,1%), while in the group 2 it was most often seen in the left anterior descending artery (42,3%). Additionally, TIMI 3 after PCI was statistically more frequent in the NSTEMI pts without total occlusion (92,9% vs 98,1%; p-0,004). We observed a trend to higher in-hospital mortality in NSTEMI pts with total coronary occlusion, however this result was not statistically significant (2,7% vs 0,5%; p-0,082). Conclusions: In this studied the incidence of a totally occluded culprit lesion in NSTEMI pts was 22,95%. Pts in this group were younger, had less comorbidities and previous coronary disease, and the right coronary artery was the most frequent culprit vessel involved. There was no significant statistical difference of in-hospital mortality in this pts. P143 https://esc365.escardio.org/Presentation/216490/abstract ST-segment elevation myocardial infarction in women: later diagnosis, worst outcome? C Marques Pires,1 P Medeiros,1 P Medeiros,1 P Medeiros,1 C Oliveira,1 C Oliveira,1 C Oliveira,1 I Campos,1 I Campos,1 I Campos,1 R Flores,1 R Flores,1 R Flores,1 G Mane,1 G Mane,1 G Mane,1 C Galvao Braga,1 C Galvao Braga,1 C Galvao Braga,1 J Costa,1 J Costa,1 J Costa,1 N Antunes,1 N Antunes,1 N Antunes,1 J Marques,1 J Marques1 and J Marques1 1Braga Hospital, Braga, Portugal Introduction: There are gender-specific differences in the presentation and the outcomes of patients (pts) with ST-segment elevation infarction (STEMI). Although ischaemic heart disease develops on average 7 to 10 years later in women compare with men, it remains a leading cause of death in women and both genders must be managed in a similar way. AIM: To compare the time from symptoms onset to STEMI diagnosis, in-hospital mortality and one-year mortality between genders. Methods: We analysed retrospectively 1215 STEMI pts admitted in our coronary care unit from June 2011 to May 2016. They were divided in two groups: group 1- STEMI pts of the female gender (n=267, 21,97%); group 2-STEMI pts of the male gender (n=948, 78,03%). For each group we evaluated the clinical characteristics and we compared the time from symptoms onset to STEMI diagnosis. We also compared the in-hospital mortality and the one-year mortality between genders. Results: STEMI patients of the female gender were older (69,4± 13,8 years vs 59,7 ± 12,7 years; p<0,001), had a higher prevalence of some cardiovascular risk factors, as hypertension (62,6% vs 47,9%; p<0,001) and diabetes (31,4% vs 18,6%; p<0,001), and a lower prevalence of smoking habits (14,2% vs 64,3%, p<0,001). There were not statistically significant differences regarding body mass index, hypercholesterolemia, cerebrovascular disease and previous myocardial infarction. The time from symptoms onset to STEMI diagnosis was significantly higher in the female gender (126 ± 168 min vs 105±144 min; p-0,026). We observed a higher in-hospital mortality in STEMI pts of the female gender (10,1% vs 3,5%; p<0,001). However, when adjusted to the confounding factors the gender was not a predictor of in-hospital mortality (OR adjusted=1,054; p-0,882). In addition, we evaluated the one-year mortality after discharge and found no statistically significant difference among genders (7,1% vs 9,2%; p-0,296). Conclusion: In this STEMI population the time to diagnosis was significantly delayed in the female gender, making a lower clinical suspicion threshold probably advisable in women. Older age and a higher comorbidities burden can explain the higher in-hospital mortality in this group. P144 https://esc365.escardio.org/Presentation/221528/abstract Prognostic implications of previously known or newly diagnosed diabetes and hypovitaminosis D in patients with myocardial infarction A Aleksova,1 D Santon,2 E Stenner,2 G Gagno,1 C Francescut,3 L Padoan,1 AP Beltrami4 and G Sinagra1 1Azienda Sanitaria Universitaria di Trieste and University of Trieste, Department of Medical Surgical and Health Sciences, Cardiovascular Department, Trieste, Italy 2Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy 3University of Trieste, Trieste, Italy 4University of Udine, Udine, Italy Background: Vitamin D deficiency and diabetes mellitus are frequent among patients with acute myocardial infarction. Independently, both were associated with a worse prognosis after myocardial infarction (MI). However, it is unclear whether the risk of worse outcome, associated with diabetes mellitus, may be accentuated in presence of hypovitaminosis D. Purpose: We assessed if previously known or newly diagnosed diabetes is associated with worse outcome (major cardiovascular events) in combination with hypovitaminosis D in patients with acute MI. Methods and Results: Were enrolled 1004 patients with acute MI; 64.7% of them, had hypovitaminosis D and 37% were diabetic. We grouped our population by diabetic status: previously known diabetes (diagnosis of diabetes before MI, n=330; 32.9%); newly diagnosed diabetes (during hospitalization for MI, but no known diabetes at presentation, n=47;4.7 %); or no diabetes (n=627;62.5%). Hypovitaminosis D was more frequent among patients with previously known (70.2%) and newly diagnosed diabetes (73.3%), when compared to non diabetic patients (61.2%). During median follow-up of 15.6 months, patients with previously known and newly diagnosed diabetes had increased risks of major cardiovascular events (HR 1.72; 95% CI, 1.26 to 2.36. The risk of major events during the follow-up among diabetic patients, was further increased in presence of hypovitaminosis D (Figure 1). Figure 1. Open in new tabDownload slide Conclusions: The presence of both, previously known or newly diagnosed diabetes and hypovitaminosis D, in patients with MI is synergistically associated with a worse outcome. P145 https://esc365.escardio.org/Presentation/216739/abstract The features of acute coronary syndrome in senile patients and centenarians E Konstantinova,1 M Muksinova,2 M Gilyarov,3 YU Ryzhkova,3 E Kanareykina,3 M Atabegashvili,3 M Zheltoukhova,3 L Muradova3 and AV Svet3 1Pirogov Russian National Research Medical University, Moscow, Russian Federation 2FSBO National Medical research center of cardiology of the Ministry of healthcare, Moscow, Russian Federation 3City Clinical Hospital No 1 of N.I.Pirogov, Moscow, Russian Federation Background: The features of the acute coronary syndrome (ACS) in senile patients and centenarians have not been studied sufficiently. Purpose: The aim of the study was to conduct a comparative analysis of the features ACS in senile patients and centenarians in the real clinical practice. Methods: The retrospective study included 734 patients with ACS, who were treated in Clinical Hospital in our city and were hospitalized during the period from the 1st January 2015 to the 31st of December 2016. Patients were divided into two age categories: 75-89 years (senile age (cohort S) n = 662) and 90 years and older (centenarians (cohort C) n = 72). Depending on the type of ACS, each сohort consisted of two groups: I group - patients 75-89 years old with ACS without ST elevation (NSTEMI, n = 463), II group - patients 75-89 years old with STEMI (n = 199), III group - patients older than 90 years with NSTEMI (n = 49), group IV - patients older than 90 years with STEMI (n = 23). The reliability was determined by using confidence factors (p) under the c2 criterion. The significance level p <0.05 in the study was taken as statistical significance. Results: Patients in cohort S presented 90% of the total number of patients, patients in cohort C were 10%. In cohorts S and C, patients with STEMI were 30% and 32%, respectively. Women in both cohorts were 65% and 78%, respectively (p <0.05). Comorbid pathology in cohort S and C was observed with a frequency of: arterial hypertension - 97% in all patients; diabetes mellitus (DM) - 29% and 25% (p <0.05); previous myocardial infarction (MI) - 38% and 43%; previous acute cerebrovascular accident (stroke) - 17% and 11% (p = 0.1); atrial fibrillation (AF) - 30% and 50% (p <0.001); mean serum creatinine levels were 114 μmol / L and 131 μmol / L, respectively. The compliance of PCI in cohort S and C was 54% and 35% (p <0.001); death rates of 5% and 23%, respectively. MI was observed in the groups: I in 44% of cases, III - 53%, which was more often than in II - 28% and IV - 22% (p <0.05). DM in group IV was 17%, while in groups I, II, III - 29%, 30%, 29%, respectively. PCI was performed: group I - 48% and group III - 22%, which was less frequently than group II 67% and group IV - 61% (p <0.001). Conclusion: In the real clinical practice, centenarians conducted 10% of all patients old patients with ACS, with a predominance of female persons. Among centenarians transferred stroke, and DM were relatively less frequently observed (especially with STEMI), which harmed the prognosis of these comorbid diseases. Previous MI was associated with patients with ACS of senile age and centenarians more likely to develop NSTEMI. Centenarians, in comparison with people of senile age, were more often observe AF and CKD, they were less likely to have PCI (especially with NSTEMI), which was associated with a higher frequency of deaths in the hospital. P146 https://esc365.escardio.org/Presentation/217416/abstract Influence of daylight- saving time on myocardial infarction rate? Data from a regional myocardial infarction registry JU Roehnisch,1 B Maier,2 S Behrens,3 L Bruch,4 R Schoeller,2 H Schuehlen,5 M Stockburger6 and H Theres7 1Vivantes Hospital Hellersdorf, Berlin, Germany 2Berlin-Brandenburg Myocardial Infarction Registry, Berlin, Germany 3Vivantes Humboldt Klinikum, Berlin, Germany 4UKB Berlin, Berlin, Germany 5Vivantes Auguste-Viktoria Hospital, Berlin, Germany 6Havelland Klinik, Nauen, Germany 7Martin-Luther Hospital, Berlin, Germany Background: Health effects of daylight-saving time are currently under discussion. Therefore we analyzed, whether more patients with acute myocardial infarction (MI) are admitted to hospitals after clock shifts in spring or autumn with the data of our regional myocardial infarction registry. Method: Our Registry collects prospective data on hospital treatment of patients with MI since 1999. In this study we included data from 42,906 MI patients (1999-2017). The relative risk of MI patients admitted to a Hospital 1 week before vs. 1 week after the date of clock shift was calculated, pooled over all years. We did an analysis for the total group of patients as well as for special subgroups according to gender, age, ST-elevation-MI and shock–patients. Results: s. table 1 Table 1. Results: Analysis of data from 1999-2017. Cases . Clock shift in spring . Clock shift in autumn . 7 days before (n) . 7 days after (n) . relative risk* . 7 days before (n) . 7 days after (n) . relative risk* . Total MI 888 857 0,965 812 847 1,043 STEMI 444 423 0,953 398 441 1,108 NSTEMI 431 420 0,974 403 398 0,988 Men 616 591 0,959 551 601 1,091 Woman 268 258 0,963 256 242 0,945 Shock 56 54 0,964 37 72 1,946 men STEMI 322 295 0,916 276 310 1,123 woman STEMI 120 123 1,025 118 128 1,085 age ≤ 65 389 390 1,003 363 391 1,077 age > 65 489 465 0,951 445 453 1,018 Cases . Clock shift in spring . Clock shift in autumn . 7 days before (n) . 7 days after (n) . relative risk* . 7 days before (n) . 7 days after (n) . relative risk* . Total MI 888 857 0,965 812 847 1,043 STEMI 444 423 0,953 398 441 1,108 NSTEMI 431 420 0,974 403 398 0,988 Men 616 591 0,959 551 601 1,091 Woman 268 258 0,963 256 242 0,945 Shock 56 54 0,964 37 72 1,946 men STEMI 322 295 0,916 276 310 1,123 woman STEMI 120 123 1,025 118 128 1,085 age ≤ 65 389 390 1,003 363 391 1,077 age > 65 489 465 0,951 445 453 1,018 * calculated on the basis of the pooled absolute numbers of MI patients over all years one week before and one week after clock shifts. Open in new tab Table 1. Results: Analysis of data from 1999-2017. Cases . Clock shift in spring . Clock shift in autumn . 7 days before (n) . 7 days after (n) . relative risk* . 7 days before (n) . 7 days after (n) . relative risk* . Total MI 888 857 0,965 812 847 1,043 STEMI 444 423 0,953 398 441 1,108 NSTEMI 431 420 0,974 403 398 0,988 Men 616 591 0,959 551 601 1,091 Woman 268 258 0,963 256 242 0,945 Shock 56 54 0,964 37 72 1,946 men STEMI 322 295 0,916 276 310 1,123 woman STEMI 120 123 1,025 118 128 1,085 age ≤ 65 389 390 1,003 363 391 1,077 age > 65 489 465 0,951 445 453 1,018 Cases . Clock shift in spring . Clock shift in autumn . 7 days before (n) . 7 days after (n) . relative risk* . 7 days before (n) . 7 days after (n) . relative risk* . Total MI 888 857 0,965 812 847 1,043 STEMI 444 423 0,953 398 441 1,108 NSTEMI 431 420 0,974 403 398 0,988 Men 616 591 0,959 551 601 1,091 Woman 268 258 0,963 256 242 0,945 Shock 56 54 0,964 37 72 1,946 men STEMI 322 295 0,916 276 310 1,123 woman STEMI 120 123 1,025 118 128 1,085 age ≤ 65 389 390 1,003 363 391 1,077 age > 65 489 465 0,951 445 453 1,018 * calculated on the basis of the pooled absolute numbers of MI patients over all years one week before and one week after clock shifts. Open in new tab Conclusions: In the week after clock shift in autumn compared to the week before and compared to spring, men, STEMI, men with STEMI, and patients in shock were found more frequently. Possible chrono-biological and psycho-cardiological causes will be discussed. P148 https://esc365.escardio.org/Presentation/221530/abstract The impact of diabetes mellitus on the long-term outcome in patients with acute coronary syndrome and mid-range ejection fractionPolish Ministry of Health, Polish National Health Fund A Fojt,1 R Kowalik,1 C Smeding,1 M Gasior,2 G Opolski1 and M Gierlotka3 1Medical University of Warsaw, 1st Chair and Department of Cardiology, Warsaw, Poland 2Silesian Center for Heart Diseases (SCHD), Third Department of Cardiology, Zabrze, Poland 3University Hospital, University of Opole, Department of Cardiology, Opole, Poland Background: The correlation between diabetes and the risk of myocardial infarction (MI) is thoroughly documented in literature. Coronary heart disease is a major cause of morbidity and mortality among patients with diabetes mellitus. In addition, diabetes has been shown to be an independent risk factor for hospitalisation due to heart failure. It is well known that left ventricular systolic dysfunction is an independent risk factor for mortality after MI. Purpose: The aim of our study was to compare short-, and long-term outcomes of diabetic patients with MI, and with left ventricular ejection fraction (EF) between 40 and 49%, assessed during hospitalisation, with a non-diabetic control group. Methods: This analysis covered 16 467 patients from the Polish Registry of Acute Coronary Syndrome (PL-ACS) who were hospitalised due to STEMI or NSTEMI from January 2009 to December 2011. This registry was initiated by a Polish Centre for Heart Diseases and established in cooperation with the Ministry of Health and the National Health Fund as part of the National Program for the Prevention and Treatment of Cardiovascular Diseases. The study group consisted of patients with diabetes (type 1, type 2 and new-onset diabetes as diagnosed during hospitalisation) and EF between 40 and 49%. The control group consisted of non-diabetic patients with EF between 40 and 49%, sourced from the same national registry. Short-term (in-hospital and within 30-days post-discharge) as well as long-term (after 12- and 36 months) outcomes were assessed. Results: This analysis covered 16 467 patients who were hospitalised due to STEMI or NSTEMI. Patients with diabetes comprised 21% (3511 patients) whereas 79% (12956 patients) of the study cohort were non-diabetics. In the long-term follow-up (12-, and 36 months) after hospital discharge, re-infarction and stroke were more frequently observed in diabetic patients. Diabetic patients were also more commonly hospitalised due to heart failure than non-diabetic patients. This applied to both short- (30-day) and long-term follow-ups (12-, and 36 months). Diabetes was also associated with a higher frequency of end-stage renal disease and the resultant need for dialysis. After hospital discharge there was no difference in the 30-day mortality regardless of diabetes status. The 12-, and 36-month mortality was significantly higher in diabetic subgroup compared with the control subgroup (p<0.001). For non-diabetics, the annual mortality rate was 8,6%, compared to 13,6 % in diabetics. The 36 -month mortality was 16,2% and 25,2%, respectively. Conclusions: Subgroups with mid-range EF (40-49%) were selected according to definitions used in the guidelines of the 2016 European Society of Cardiology for the diagnosis and treatment of acute and chronic heart failure. In our short-, and long-term follow-up of MI patients, diabetes mellitus was associated with higher both mortality and adverse cardiovascular events. P149 https://esc365.escardio.org/Presentation/216442/abstract Impact of comorbidities on outcome of patients with ST elevation myocardial infarction A Campanile,1 M Ciccarelli,2 G Cannavaro2 and A Ravera1 1AOU S. Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy 2University of Salerno School of Medicine, Cardiology, Salerno, Italy Background: little information exists about the optimal management of ST elevation myocardial infarction (STEMI) in patients with several comorbidities. The Charlson Co-morbidity Index (CCI) is a recognized measure of co-morbid burden and a useful tool for estimating prognosis in cardiovascular patients. Purpose: to define the impact of the CCI on the short and long term outcome in STEMI. Methods: 222 patients with STEMI were included in the study. Information about baseline characteristics, treatments administered, and in-hospital complications were extrapolated from the discharge summary and the electronic chart records. We determined the CCI using an on-line medical calculator. Continuous variables were presented as median (interquartile range) while, categorical variables, as absolute number and percentage value. Chi-square test was performed for categorical variables and a Kruskal-Wallis for continuous variables. A logistic regression model and a Kaplan-Meyer analysis were carried out to identify, respectively, potential predictors of the short and long term outcome variable and to characterize the contribution of the CCI on the long-term survival curves. Short and long-term outcome variables were defined, respectively, as a combination of in-hospital mortality/complications, and long-term mortality/readmission, in survivors to discharge. All statistical analyses were performed using the SPSS 21.0 and a p < 0.05 was taken as significant. Results: based on the CCI median value we divided our population into two groups: the former with a CCI ≤ 3 and the latter with a CCI > 3. We compared these two groups in order to detect any significant difference. The female gender was prevalent in the group with a higher CCI. A higher CCI was also associated with higher Killip class and creatinine levels and with lower ejection fraction (EF) and haemoglobin levels at the admission. In-hospital mortality was 6.3%. The model for the in-hospital outcome showed, as main predictors, the following variables: Killip class > 1 (OR: 11.7; 95% CI: 5.23-26.4; p=0.00), CCI > 3 (OR: 2.31; 95% CI: 1.15-4.62; p=0.02) and EF (OR: 0.97; 95% CI: 0.93-1.01; p=0.07). During a mean follow-up period of 11,4 ± 4,5 months, 7 all-cause deaths occurred in survivors to discharge, with a 1-year mortality rate of 3.9%, and 26 patients were readmitted. Figure 1A shows the long-term outcome stratified by the CCI. The best prediction model for the long-term outcome (Figure 1B) included: creatinine (OR: 1.47; 95% CI: 0.99-2.22; p=0.06), Killip Class > 1 (OR: 3.17; 95% CI: 1.32-7.6; p=0.01), CCI > 3 (OR: 2.64; 95% CI: 1.13-6.2; p=0.02). Open in new tabDownload slide Conclusions: patients with higher CCI were more often women and had a higher risk profile on admission. The CCI was associated with a higher in hospital combined outcome of mortality/complications and, also, with a worse long-term outcome identified by the combination of long-term mortality/readmission. P151 https://esc365.escardio.org/Presentation/216429/abstract Early discharge within 48 to 72 hours following acute ST elevation myocardial infarction and primary PCI is not associated with high mortality rates or major adverse cardiovascular events for low Risk O Koren,1 M Mahamid,1 E Rozner1 and Y Turgeman1 1Haemek Medical Center, Heart Institute, Afula, Israel Background: Early hospital discharge following ST elevation myocardial infarction and primary PCI is reasonable after 72 hours in selected low risk patients. This recommendation was based mainly on data from fibrinolytic era. We assessed the outcome of early discharge, within 72 h. Method: We conducted a retrospective study based on data from 2012 to 2015. The patients were classified into three groups based on the duration of hospitalization; 48 h, 48–72 h, and >72 h. The primary endpoints were all-cause mortality and major cardiovascular events (MACE) within 30 days and 1 year. Secondary endpoint was acute kidney injury. Results: 178 patients were included; 60 patient (33.7%) were discharged within 48 hours, 75 patients (42.1%) discharge after 72 hours, and 43 patient (24.2%) discharged between 48 and 72 h. Patients discharged >72 h were significantly older (p <.001), had extensive myocardial damage (p < 0.001) and a significant reduction in left ventricular systolic function (p < 0.02). Most common catheterization approach in this group was the femoral artery (p < 0.02). No statistically significant difference observed between the three group regarding primary and secondary end point yet patient discharge within 48-72h had the lowest mortality rate and MACE compared to patient discharged within 48h and >72h. Conclusion: Our study shows that early discharge, within 48 to 72 hours from admission, after acute myocardial infarction and primary PCI is not associated with a significantly higher rate of mortality or MACE up to one year after discharge for selected low risk patients. Open in new tabDownload slide Table 1. Table 2 . <48 Hours (n=60) . 48-72 Hours (n=43) . >72 Hours (n=75) . P-Value . Acute kidney failure¥ 0 (0.0) 0 (0.0) 3 (4.0) .12 Mortality 30 days 1 (1.7) 0 (0.0) 3 (4.0) .35 1 Year 1 (1.7) 1 (2.3) 6 (8.0) .28 Major adverse cardiovascular events (MACE) 30 days rate (95% CI) 1(1.7) 1.67 (0.29-8.85) 0 (0) 0.00 (0.00-8.20) 1 (1.3) 1.34 (0.23-7.17) >.99 1 Year rate (95% CI) 6 (10.0) (4.66-20.15) 2 (4.6) 4.65 (1.28-15.45) 3 (4.0) 4.00 (1.37-11.11) .35 . <48 Hours (n=60) . 48-72 Hours (n=43) . >72 Hours (n=75) . P-Value . Acute kidney failure¥ 0 (0.0) 0 (0.0) 3 (4.0) .12 Mortality 30 days 1 (1.7) 0 (0.0) 3 (4.0) .35 1 Year 1 (1.7) 1 (2.3) 6 (8.0) .28 Major adverse cardiovascular events (MACE) 30 days rate (95% CI) 1(1.7) 1.67 (0.29-8.85) 0 (0) 0.00 (0.00-8.20) 1 (1.3) 1.34 (0.23-7.17) >.99 1 Year rate (95% CI) 6 (10.0) (4.66-20.15) 2 (4.6) 4.65 (1.28-15.45) 3 (4.0) 4.00 (1.37-11.11) .35 Primary and Secondary end points. Open in new tab Table 1. Table 2 . <48 Hours (n=60) . 48-72 Hours (n=43) . >72 Hours (n=75) . P-Value . Acute kidney failure¥ 0 (0.0) 0 (0.0) 3 (4.0) .12 Mortality 30 days 1 (1.7) 0 (0.0) 3 (4.0) .35 1 Year 1 (1.7) 1 (2.3) 6 (8.0) .28 Major adverse cardiovascular events (MACE) 30 days rate (95% CI) 1(1.7) 1.67 (0.29-8.85) 0 (0) 0.00 (0.00-8.20) 1 (1.3) 1.34 (0.23-7.17) >.99 1 Year rate (95% CI) 6 (10.0) (4.66-20.15) 2 (4.6) 4.65 (1.28-15.45) 3 (4.0) 4.00 (1.37-11.11) .35 . <48 Hours (n=60) . 48-72 Hours (n=43) . >72 Hours (n=75) . P-Value . Acute kidney failure¥ 0 (0.0) 0 (0.0) 3 (4.0) .12 Mortality 30 days 1 (1.7) 0 (0.0) 3 (4.0) .35 1 Year 1 (1.7) 1 (2.3) 6 (8.0) .28 Major adverse cardiovascular events (MACE) 30 days rate (95% CI) 1(1.7) 1.67 (0.29-8.85) 0 (0) 0.00 (0.00-8.20) 1 (1.3) 1.34 (0.23-7.17) >.99 1 Year rate (95% CI) 6 (10.0) (4.66-20.15) 2 (4.6) 4.65 (1.28-15.45) 3 (4.0) 4.00 (1.37-11.11) .35 Primary and Secondary end points. Open in new tab Acute Cardiac Care – Resuscitation P153 https://esc365.escardio.org/Presentation/216444/abstract Impact of vascular disease in the short-term prognosis of patients who underwent hypothermia after cardiac arrest.No conflicts of interest S Calero Nunez,1 R Ramos-Martinez,1 L Exposito-Calamardo,1 MJ Corbi-Pascual,1 MA Simon-Garcia,1 FM Salmeron-Martinez,1 MI Barrionuevo-Sanchez,1 S Diaz-Lancha,1 C Llanos-Guerrero,1 A De Leon-Ruiz,1 C Urraca-Espejel1 and VM Hidalgo-Olivares1 1Albacete University Hospital, Cardiology, Albacete, Spain Background: There is scarce evidence on the effect of vascular disease(VD: peripheral and coronary artery disease and/or stroke)in post-cardiac arrest syndrome(PCAS). Methods: Retrospective study of p who underwent therapeutic hypothermia(TH:32-36C°,24h) after CA from 2006-2019.Complications, mortality and neurological outcome were compared at discharge by groups according to the presence or absence of previous VD. Result: We included 115p(62,3±15y;33%women),67% suffered out of hospital CA, initial rhythm was schocable in 50%. 67% had not VD, they were younger with lower prevalence of cardiovascular risk factors, except smoking that was similar. The p with VD(33%) had more comorbidities:7.9%valvular diseases,8.3%ICD, 18.4%obstructive sleep apnea. There were no differences concerning time until cardiopulmonary resuscitation or spontaneous pulse recovery. Lactate was greater in p with VD. The performance of emergent coronary angiography(ECA) and the use of Swanz Ganz was more frequent in the VD group. There were not differences in the use of intraaortic balloon pump, renal replacement neither days of admission. There were not differences in general complications(42%), although there were more arrhythmic complications and in hospital mortality was greater in the VD group(63,2%vs41%,p=0.02).Neurological outcome were similar. Conclusion: VD is associated with in-hospital mortality and arrhythmic complications in p with PCAS, possibly due to their older age and comorbidity. However VD was not predictive of increased general complications. Table 1. . NO VD67%(77) . VD 33%(38) . p . TOTAL n =115 . Women 35,1% (27) 28,9% (11) 0,51 33% (38) Age 59,5 ± 17,2 68,11 ± 9,3 O,005 62,33 ± 15,5 Diabetes 20,8% (16) 47,4% (18) 0,003 29,6% (34) Smoker 29,9% (23) 26,3% (10) 0,12 28,7% (33) Lactate mg/dl 34,7 ±31,4 47,5 ±29,6 0,04 39,6 ±31,6 Time from CA to CPR; min 5,9 ±6,5 4,6 ±5,2 0,27 5,5 ±6 Time from CPR to pulse recovery; min 21,6 ±14,2 23,2 ±39,1 0,76 22,15 ±25,3 Swanz Ganz 1,3% (1) 10,5% (4) 0,022 4,3% (5) Emergent coronary angiography 31,1% (23) 51,4% (18) 0,041 62,4% (68) General complications 46,8% (36) 31,6% (12) 0,12 41,7% (48) Arrhythmic complications VT AVB 0 0 7,9% (3) 5,3% (2) 0,012 0,042 2,6% (3) 1,7% (2) Good neurological outcome CPC 1-2 53,9% (41) 38,9% (14) 0,137 49,1% (55) In hospital mortality 40,8% (31) 63,2% (24) 0,024 48,2% (55) . NO VD67%(77) . VD 33%(38) . p . TOTAL n =115 . Women 35,1% (27) 28,9% (11) 0,51 33% (38) Age 59,5 ± 17,2 68,11 ± 9,3 O,005 62,33 ± 15,5 Diabetes 20,8% (16) 47,4% (18) 0,003 29,6% (34) Smoker 29,9% (23) 26,3% (10) 0,12 28,7% (33) Lactate mg/dl 34,7 ±31,4 47,5 ±29,6 0,04 39,6 ±31,6 Time from CA to CPR; min 5,9 ±6,5 4,6 ±5,2 0,27 5,5 ±6 Time from CPR to pulse recovery; min 21,6 ±14,2 23,2 ±39,1 0,76 22,15 ±25,3 Swanz Ganz 1,3% (1) 10,5% (4) 0,022 4,3% (5) Emergent coronary angiography 31,1% (23) 51,4% (18) 0,041 62,4% (68) General complications 46,8% (36) 31,6% (12) 0,12 41,7% (48) Arrhythmic complications VT AVB 0 0 7,9% (3) 5,3% (2) 0,012 0,042 2,6% (3) 1,7% (2) Good neurological outcome CPC 1-2 53,9% (41) 38,9% (14) 0,137 49,1% (55) In hospital mortality 40,8% (31) 63,2% (24) 0,024 48,2% (55) Open in new tab Table 1. . NO VD67%(77) . VD 33%(38) . p . TOTAL n =115 . Women 35,1% (27) 28,9% (11) 0,51 33% (38) Age 59,5 ± 17,2 68,11 ± 9,3 O,005 62,33 ± 15,5 Diabetes 20,8% (16) 47,4% (18) 0,003 29,6% (34) Smoker 29,9% (23) 26,3% (10) 0,12 28,7% (33) Lactate mg/dl 34,7 ±31,4 47,5 ±29,6 0,04 39,6 ±31,6 Time from CA to CPR; min 5,9 ±6,5 4,6 ±5,2 0,27 5,5 ±6 Time from CPR to pulse recovery; min 21,6 ±14,2 23,2 ±39,1 0,76 22,15 ±25,3 Swanz Ganz 1,3% (1) 10,5% (4) 0,022 4,3% (5) Emergent coronary angiography 31,1% (23) 51,4% (18) 0,041 62,4% (68) General complications 46,8% (36) 31,6% (12) 0,12 41,7% (48) Arrhythmic complications VT AVB 0 0 7,9% (3) 5,3% (2) 0,012 0,042 2,6% (3) 1,7% (2) Good neurological outcome CPC 1-2 53,9% (41) 38,9% (14) 0,137 49,1% (55) In hospital mortality 40,8% (31) 63,2% (24) 0,024 48,2% (55) . NO VD67%(77) . VD 33%(38) . p . TOTAL n =115 . Women 35,1% (27) 28,9% (11) 0,51 33% (38) Age 59,5 ± 17,2 68,11 ± 9,3 O,005 62,33 ± 15,5 Diabetes 20,8% (16) 47,4% (18) 0,003 29,6% (34) Smoker 29,9% (23) 26,3% (10) 0,12 28,7% (33) Lactate mg/dl 34,7 ±31,4 47,5 ±29,6 0,04 39,6 ±31,6 Time from CA to CPR; min 5,9 ±6,5 4,6 ±5,2 0,27 5,5 ±6 Time from CPR to pulse recovery; min 21,6 ±14,2 23,2 ±39,1 0,76 22,15 ±25,3 Swanz Ganz 1,3% (1) 10,5% (4) 0,022 4,3% (5) Emergent coronary angiography 31,1% (23) 51,4% (18) 0,041 62,4% (68) General complications 46,8% (36) 31,6% (12) 0,12 41,7% (48) Arrhythmic complications VT AVB 0 0 7,9% (3) 5,3% (2) 0,012 0,042 2,6% (3) 1,7% (2) Good neurological outcome CPC 1-2 53,9% (41) 38,9% (14) 0,137 49,1% (55) In hospital mortality 40,8% (31) 63,2% (24) 0,024 48,2% (55) Open in new tab P154 https://esc365.escardio.org/Presentation/217597/abstract Monocyte subset distribution is associated with outcome in patients after cardiac arrest KA Krychtiuk,1 M Lenz,1 K Huber,2 C Hengstenberg,1 J Wojta,1 G Heinz1 and WS Speidl1 1Medical University of Vienna, Department of Internal Medicine II, Division of Cardiology, Vienna, Austria 2Wilhelminen Hospital, 3rd Department of Internal Medicine, Cardiology and Emergency Medicine, Vienna, Austria Background: After cardiac arrest and successful cardiopulmonary resuscitation with return of spontaneous circulation (ROSC), many patients show signs of an overactive immune activation. As key regulators of innate immunity, monocytes may be crucially involved in the development of this systemic inflammatory response. Monocytes can be distinguished into three subsets: classical monocytes (CM; CD14++CD16-); intermediate monocytes (IM; CD14++CD16+CCR2+) and non-classical monocytes (NCM; CD14+CD16++CCR2-). Purpose: The aim of this prospective, observational study was to analyze whether monocyte subset distribution is associated with 30-day survival in patients after cardiac arrest. Methods We included 50 patients admitted to our medical cardiovascular ICU after cardiac arrest. Flow cytometry data was available in 43 patients. Blood was taken on admission and monocyte subset distribution was analyzed by flow cytometry. Results Median age was 65 (IQR 50-74) years, 75.5% of patients were male and 30-day mortality was 47%. Of interest, monocyte subset distribution upon admission to the ICU did not differ according to 30-day mortality. However, patients that died within 30 days showed a strong increase in the pro-inflammatory subset of intermediate monocytes (9.4% (IQR 3.8-14.6) vs 4.1% (IQR: 1.7-8.3); p=0.049) and a decrease of classical monocytes (87.2% (IQR 76.6-89) vs 90.8% (IQR 85-92.4); p=0.035) 72 hours after admission. Discussion: A strong increase in the intermediate subset of monocytes 72 hours after admission to the ICU after cardiac arrest is strongly associated with 30-day mortality. This suggests that activation of the innate immune system as evidenced by monocyte subset distribution may play a significant role in patient outcome after cardiac arrest. Acute Cardiac Care – Prehospital and Emergency Department Care P155 https://esc365.escardio.org/Presentation/221090/abstract Analysis of the effectiveness of Chest Pain Alert Algorithm and HEART score for the detection of acute coronary syndrome in patients with chest pain presenting to the emergency department I Mrdovic,1 M Srdic,1 D Matic,1 M Viduljevic,1 L Savic1 and N Zlatic1 1Clinical Center of Serbia, Beograd, Serbia Background: Early identification of acute coronary syndrome (ACS) in chest pain (CP) patients presenting to the emergency department (ED) should result with timely treatment and improved prognosis. The HEART score has been used with success to detect ACS patients. The Chest Pain Alert Algorithm (CPAA) is an early diagnostic tool for ACS that does not require determination of cardiac troponin in the blood (cTn). Purpose: to compare the performance of the CPAA and HEART score in acute CP patients. Methods: We analyzed data from 672 all-comer patients enrolled prospectively in the Clinical Center of Serbia Chest Pain Register. High-sensitive cTn (hs-cTn) was measured in 356 patients in the ED; 254 with ongoing CP (CPo) and 102 with chest pain that has stopped before presentation (CPc). The primary end point was confirmation of ACS, defined as the presence of unstable angina, acute myocardial infarction (AMI) or sudden coronary death, in accordance with the actual ESC guidelines and the universal definition of AMI. Results: ACS has been confirmed in 306 (86%) of patients. The performances of CPAA and HEART score are shown in Table 1. In comparison to HEART score, CPAA showed non-inferior performance in CPc patients. In CPo patients, CPAA showed similar sensitivity, but significantly improved specificity, negative predictive value (NPV) and negative likelihood ratio (NLR). Table 1. . HEART . CPAA . HEART . CPAA . . CPo (n=254) . CPo . CPc (n=102) . CPc . AUC 0.853 0.929 0.853 0.894 SENZ (%) 97.2 97.7 92.1 91.8 SPEC (%) 35.1 83.8* 53.8 61.5 P.PV 93.7 97.2 93.2 96.4 N.PV 50.0 86.1* 55.5 50.0 P.LR 1.49 6.03 1.99 2.38 N.LR 7.97 27.44* 14.68 13.33 . HEART . CPAA . HEART . CPAA . . CPo (n=254) . CPo . CPc (n=102) . CPc . AUC 0.853 0.929 0.853 0.894 SENZ (%) 97.2 97.7 92.1 91.8 SPEC (%) 35.1 83.8* 53.8 61.5 P.PV 93.7 97.2 93.2 96.4 N.PV 50.0 86.1* 55.5 50.0 P.LR 1.49 6.03 1.99 2.38 N.LR 7.97 27.44* 14.68 13.33 * = significant difference, AUC = area under the ROC curve, PV=predictive value, LR = likelihood ratio, P.=positive, N.=negative. Multivariate analysis. Open in new tab Table 1. . HEART . CPAA . HEART . CPAA . . CPo (n=254) . CPo . CPc (n=102) . CPc . AUC 0.853 0.929 0.853 0.894 SENZ (%) 97.2 97.7 92.1 91.8 SPEC (%) 35.1 83.8* 53.8 61.5 P.PV 93.7 97.2 93.2 96.4 N.PV 50.0 86.1* 55.5 50.0 P.LR 1.49 6.03 1.99 2.38 N.LR 7.97 27.44* 14.68 13.33 . HEART . CPAA . HEART . CPAA . . CPo (n=254) . CPo . CPc (n=102) . CPc . AUC 0.853 0.929 0.853 0.894 SENZ (%) 97.2 97.7 92.1 91.8 SPEC (%) 35.1 83.8* 53.8 61.5 P.PV 93.7 97.2 93.2 96.4 N.PV 50.0 86.1* 55.5 50.0 P.LR 1.49 6.03 1.99 2.38 N.LR 7.97 27.44* 14.68 13.33 * = significant difference, AUC = area under the ROC curve, PV=predictive value, LR = likelihood ratio, P.=positive, N.=negative. Multivariate analysis. Open in new tab Conclusions: CPAA might be used for early identification of patients with CP and ACS with a non-inferior performance in comparison to the HEART score. The potential advantages might be improved specificity, as well as the lack of need for time-consuming biochemical markers. P156 https://esc365.escardio.org/Presentation/216419/abstract Comparison of long-term mortality of acute coronary syndrome patients base on the type of medical transport M Czapla,1 D Zysko2 and P Karniej1 1Wroclaw Medical University, Faculty of Health Sciences, Wroclaw, Poland 2Wroclaw Medical University, Department of Emergency Medicine, Faculty of Medicine, Wroclaw, Poland Introduction: In Poland patients with acute coronary syndrome (ACS) who present to hospitals without interventional facilities frequently require transfer to another hospital equipped with a cardiac catheterization laboratory by an emergency medical team (EMT) .We assessed the association of the type of medical transport with patient long-term mortality. Objectives: To assess whether the type of team transporting the ACS patients affects patient survival to hospital admission and long-term mortality. Materials: Study materials consisted of 500 patients who were transported by a specialist (with a medical doctor) and a basic (with paramedic) EMT from the Polish Ambulance Service in our city. The people were transported from admissions offices, emergency departments and 7 hospitals in the years 2010-2015 which had no coronary intervention centre to places that owned it. Methods: A retrospective analysis of medical records of patients transported by basic (BT) and specialist (ST) EMTs from hospitals without a cardiac cath lab to hospitals equipped with such a lab. The following parameters were analyzed: age, gender, the type of EMT transport, hemodynamic parameters, treatment administered during transport, the occurrence or lack of complications during transport as well as patient survival to hospital admission. Based on data obtained from the Poland Ministry of Internal Affairs and Administration, we determined the survival time and the long-term mortality. Statistical analysis was carried out to compare demographic and clinical parameters, the frequency of complications and the applied medical procedures. Cox regression models were used to identify independent risk factors for all-cause mortality. Results: The study involved 500 patients, with men constituting 58.4% and women – 41.6% of the study group. Mean age was 68.7 ± 13.9. Specialist EMTs transported 368 patients, while basic EMTs transported 132 patients (73.6 vs 26.4 p<0.001). Survival to admission was recorded in 499 patients (99.8%), i.e. in all patients in the ST group and 131 patients (99.2%) in the BT group. Long-term survival data was obtained for 453 patients including 333 TS and 120 TP. It was found that 119 patients from TS group died during the follow-up period, which was 36% of all patients in this group and 45 patients representing 37% in TP group. There was no statistically significant difference between the rates of death in the TP and TS groups over the entire observation period. Conclusions: Complications during medical transport of ACS patients from hospitals without a cardiac catheter lab to hospitals equipped with such a lab were rare and their incidence was not associated with the type of transporting EMT. The type of EMT was not associated with long-term patient mortality. P157 https://esc365.escardio.org/Presentation/217219/abstract Kids save lives in Greece-National training program of schoolchildren in cardiopulmonary resuscitation: evaluating the impact of a nationwide educational seminar in a cohort07/03/2020 17:30 E Sigala,1 F Yfanti,2 A Varvarouta,3 M Deligianni,4 C Kapnopoulos,5 V Flouda,6 O Chliara,7 K Fortounis,4 V Fyntanidou,8 E Papadopoulou,1 A Samaras,9 G Antonopoulou5 and A Stefanakis5 1Hippokration General Hospital, Athens, Greece 2General Hospital G. Papanikolaou, Thessaloniki, Greece 3St Andrews General Hospital of Patras, Patras, Greece 4Hospital Papageorgiou, Thessaloniki, Greece 5National Emergency Aid Centre, Athens, Greece 6Health Center, Thesprotikos Greece, Preveza, Greece 7Proprietary firm, Thessaloniki, Greece 8Ahepa General Hospital of Aristotle University, Thessaloniki, Greece 9Primary Education Management of Central Macedonia, Halkidiki, Greece Introduction: Greece is among European countries with the lowest bystander Cardiopulmonary Resuscitation (CPR) and Out—of—Hospital Cardiac Arrest (OHCA) survival rate as well. “KIDS SAVE LIVES” is a suggested training program by European Resuscitation Council (ERC) aims to educate all children in First Aid. We aimed to present the results of KIDS SAVE LIVES training program for the period 2016-2019. Methods: Hellenic Society of Emergency Prehospital Care and the Humanitarian Organisation “KIDS SAVE LIVES” set up a plan for establishing mandatory education of schoolchildren in CPR in Greece. Having the approval of Greek Ministry of Education, an initial 3month pilot period of KIDS SAVE LIVES course was implemented in the Region of Central Macedonia. After that, KIDS SAVE LIVES was implemented at a nationwide level since early 2018, in order every child over 10 years old to be trained. The courses consist of a 4hour session, was carried out on a voluntary basis by more than 600 certified ERC Instructors. Results: Since 2016, more than 42.416 schoolchildren ≥10yrs and teachers were trained in 470 schools (38.520 and 3.896 accordingly). More than 3000 certified by ERC, BLS-Providers and several BLS—Instructors Courses were organised for students and teachers; today, Greece is the country with the youngest certified BLS Instructors in Europe. Multiple positive results of this program have been achieved so far: 18 victims of OHCA resuscitated by trained bystanders after attending KIDS SAVE LIVES course during these years and Nefeli, is the first child that resuscitated an OHCA victim; 2 students, and 4 citizens following KIDS SAVE LIVES training, successfully resuscitated 6 small children and 3 adults who suffered from choking. Moreover, the establishment of a Public-Access Defibrillation to 124 AEDs in schools and in local communities, the creation of a free online application with the exact geographic location of 350 AEDs across the country, the “NO.NO.GO” community network of trained laypersons and AEDs for the early initiation of BLS in cases of OHCA were all considered positive outcomes of the KIDS SAVE LIVES implementation. Conclusion: Training schoolchildren in CPR can be part of a strategy for increasing bystander resuscitation rates. KIDS SAVE LIVES course is a successful method for mass training events and could be a decisive factor in achieving this strategy. Incorporating training into the mandatory education syllabus, will facilitate the formation of a pool of young promising BLS Providers and contributing so to the future improvement of survival after OHCA. Acute Cardiac Care – CCU, Intensive, and Critical Cardiovascular Care P159 https://esc365.escardio.org/Presentation/221095/abstract Creating a score to predict advanced AV block in patients with acute coronary syndrome JP De Sousa Bispo,1 TF Mota,1 R Fernandes,1 H Costa,1 N Marques,1 W Santos,1 J Mimoso,1 A Camacho1 and I Jesus1 1Faro Hospital, Cardiology, Faro, Portugal Objectives: To determine a score that can predict the development of Advanced AV Block (AVB) in patients admitted with Acute Coronary Syndrome (ACS). Methods: Retrospective, descriptive and correlational study of patients admitted in our Center with ACS between October 2010 and October 2018. We conducted an analysis of basal characteristics by determining correlation between categoric variables using the Qui scare test, and the continuous variables using the T-Student test, with a with a confidence interval of 95%. We identified independent predictors for AVB using a binary logistic regression analysis, with a p-value=0,05. We then applied a discriminatory function using the Wilks test to determine the discriminating score of the groups being analyzed. For statistical analysis we used SPSS 24.0. Results: Of 4348 patients admitted to our Center with ACS, 110 (2,5%) developed AVB. These patients had average age of 66±11 years, and 67,3% were male. At admission 24,5% presented as ACS without ST-segment Elevation and 75,5% as Myocardial Infarction with ST Segment Elevation (STEMI). Independent predictors of AVB were age>65 (p=0,014), STEMI at admission (P<0,001) and cardiogenic shock (CS) at presentation (p<0,001). We determined a score predictor of AVB in patients with ACS using the formula = -0,855 + (1,082 x STEMI) + (5,966 x CS) + (0,554 x age>65), and determined a cutoff of 0,52, with a sensitivity of 81%, specificity of 47% and discriminatory power of 80%. Conclusion: In patients admitted with ACS, 2,5% developed AVB. We determined a score predictor of AVB which included STEMI diagnosis at admission, age>65 and CS at admission, that shows a high discriminatory power. It’s a score that uses clinical variables, and allows its application in an early stage of patient admission, but its use still requires validation for clinical practice. P161 https://esc365.escardio.org/Presentation/216505/abstract Ultrasound guided vascular catheterization in non-pulsatile continuous circulation conditions in critical patients with VA ECMO or ventricular assist devices M Laimoud1 and M Alanazi2 1Cairo University Hospitals, Cairo, Egypt 2King Faisal Specialist Hospital & Research Center, King Faisal Heart Center, Riyadh, Saudi Arabia Introduction: central venous and arterial catheterisations are very common procedures performed by intensivists and anaesthetists. Traditionally, the technique of locating surface landmarks and palpation was used in catheterization. Vascular access can be challenging in patients with obesity, impalpable pulses, with haemodynamic instability, thrombocytopenia and coagulopathy. Objectives: to study the clinical effectiveness of vascular ultrasound in arterial and venous catheterization in critical patients with nonpulsatile circulation admitted at cardiac critical care units and to compare with landmark techniques. Methods: This retrospective study included patients from January 2015 to November 2018 who were admitted to adult cardiac critical care unit with left ventricular assist device (LVAD ) or veno-arterial extracorporeal membrane oxygenation (VA ECMO) and required arterial or venous vascular access. Demographic, clinical and laboratory data of patients were collected . The number of attempts for vascular lines insertion, first attempt and procedural success and complications were collected . Results: 292 vascular catheters were inserted in 152 critical patients.The first attempt success was achieved in (77.9% vs 34.6%, p=0.001 )and the procedural success was (100% vs 67.5%,p=0.001) in the ultrasound and landmark groups respectively . The number of attempts was (1.7 ± 0.6 vs 1.2 ± 0.4,p=0.001 ) and the complications occurred in ( 2.5% vs 21.2%,p=0.001 ) in the ultrasound and landmark groups respectively . Jugular catheterization was done in (42.9% vs 19.3%,p=0.001 ) while subclavian cannulation was done in ( 5% vs 42.3%, p=0.001 ) in the ultrasound and landmark groups respectively. Iatrogenic pneumothorax was happened in ( 0 vs 3.1%, p=0.001) and accidental puncture of adjacent artery was happened in ( 0 vs 14.7%,p=0.001) and haematoma formation was happened in (3% vs 9%, p=0.03 ) in the ultrasound and landmark groups respectively. Conclusion: arterial and venous catheterization guided by ultrasound in critical patients with nonpulsatile circulation and unstable haemodynamics was associated with higher procedural and first attempt success and less complications compared to landmark technique. P162 https://esc365.escardio.org/Presentation/216402/abstract Acute neurological complications in adult patients with cardiac dysfunction on veno-arterial extracorporeal membrane oxygenation support M Laimoud1 and W Ahmed2 1King Faisal Specialist Hospital & Research Center, King Faisal Heart Center, Riyadh, Saudi Arabia 2Cairo University Hospitals, Cairo, Egypt Introduction: Extracorporeal life support has markedly progressed over the recent years to support patients severe cardiac and pulmonary dysfunction refractory to conventional management . Many patients developed acute neurological complications while being supported with ECMO. Objectives: to study the frequencies and outcomes of CNS complications in adults patients with cardiogenic shock on VA ECMO and to study the risk factors of these CNS complications. Methods: we conducted a retrospective study including adult patients admitted to cardiac care unit with cardiopulmonary instability and supported with VA ECMO from January 2015 till December 2018 in a tertiary care hospital . Results: 67 patients with cardiogenic shock supported with VA-ECMO were included. 56.7% of them developed acute CNS events. According to brain CT imaging, ischaemic stroke was diagnosed in 14.9% and ICH was diagnosed in 11.9% of patients while 16.4% of patients with CNS events had negative brain CT imaging. The SOFA score was significantly higher in the group with CNS events at ICU admission and after 48 hours . As compared to patients with ischaemic strokes, patients with ICH were younger with less BMI, had higher SOFA scores at admission and at 48 hours of ICU admission, longer cardiopulmonary bypass and aortic clamping times and more support with central than peripheral VA ECMO. AF was more frequent in the group with CNS events espescially in the ischemic stroke subgroup. Presence of intracardiac thrombi was more frequent in the ischaemic stroke subgroup .there was no statistical significant difference between groups regarding ECMO circuits thrombi and use of activated factor VII for postoperative haemostasis . the use of IABP and presence of DM were more frequent in the ischaemic stroke subgroup . Patients with neurological events had hypoalbuminaemia and higher blood glucose and serum creatinine levels compared to those without CNS events. The peak lactate level and after 24 hours of ECMO support were significantly higher in those with CNS events. Patients with ICH had significant thrombocytopenia and higher INR with more prolonged PTT and PTT ratio than those with ischaemic stroke . Patients with neurological events had significant hospital mortality, more mechanical ventilation days, tracheostomy . AKI and haemodialysis compared with those without CNS events but there was no significant difference between both groups regarding ECMO duration, ICU and post ICU stay and 1 year mortality. Conclusion: acute neurological events are frequent in patients supported with VA ECMO and associated with significant hospital mortality, more mechanical ventilation days, tracheostomy, AKI and haemodialysis. ICH is more frequent in younger patients with low BMI, central VA ECMO after cardiothoracic surgeries, thrombocytopenia and coagulopathy . P163 https://esc365.escardio.org/Presentation/217608/abstract Uric acid correlates with circulating mitochondrial DNA and predicts mortality in critically ill patients M Lenz,1 KA Krychtiuk,1 S Ruhittel,1 PJ Hohensinner,1 C Kaun,1 J Wojta,1 G Heinz1 and WS Speidl1 1Medical University of Vienna, Vienna, Austria Introduction: It has recently been shown that mitochondrial DNA (mtDNA) is associated with outcome in critically ill patients, however measurement of mtDNA is time consuming and cumbersome. Uric acid is a product of the metabolic breakdown of purine nucleotides and can be measured routinely. Objectives: To analyze whether uric acid is associated with levels of mtDNA and predicts 30-day survival in ICU-patients. Methods: In this prospective, observational cohort study, 222 consecutive patients admitted to a cardiac ICU at a tertiary care center were enrolled. Blood was taken at admission to the ICU and levels of circulating mtDNA were quantified by real-time PCR. Furthermore uric acid was measured routinely at admission. Results: Mean Apache II score was 19.6±8.3 and 30-day mortality was 26.1%. Uric acid correlated with circulating mtDNA plasma levels (R=0.21; p<0.002). Non-survivors showed significant higher uric acid levels as compared to survivors (7.8±3.9 vs 6.2±2.5mg/dL). Patients with uric acid levels in the highest quartile (≥8.5mg/dL) showed a 2.8 (1.7 - 4.8)-fold risk of death as compared to patients in the lower quartiles (p<0.001). This increased risk of death was independent of age, gender, serum creatinine and APACHE II score. Conclusions: Uric acid levels correlate with circulating mtDNA and predict mortality in critically ill patients. P164 https://esc365.escardio.org/Presentation/216499/abstract The use of inotropes but not hyperchloremia, is an independent risk factor for acute renal injury in the postoperative period of cardiac surgeryThis study was funded by a grant from Fundación Cardioinfantil. It is a high-complexity cardiac private hospital of Bogotá DC, Colombia E-H Edgar Hernandez-Leiva1 and F-H Felipe Hernandez-Huertas2 1Foundation Cardioinfantil, Institute of Cardiology, Bogota, Colombia 2Escuela de Ciencias de la Salud de la Universidad del Rosario, Bogota DC, Colombia The use of inotropes, but not hyperchloraemia, is an independent risk factor for acute kidney injury after cardiac surgery. Introduction: Acute kidney failure (AKI) is a poor prognostic marker after cardiac surgery (CS). Recent studies suggest that hyperchloraemia is significantly associated with AKI. However, there is little information regarding the prevalence of abnormal chloride concentrations after CS and its relationship to AKI. On the other hand, the use of inotropes in postoperative CS has been related to several types of adverse outcomes. Purpose: The primary objective was to determine the relationship between hyperchloraemia and AKI in postoperative CS patients and evaluate whether variables associated with tissue hypoperfusion or the use of inotropes are related to the development of this complication. Methods: An analytical cohort study was performed at a tertiary-level hospital with cardiovascular focus. 464 adult who had undergone any type of CS were included. Results: AKI was found in 12.7% of patients (n=59). Additionally, 76% of patients (n=352) had hyperchloraemia at least once during the first 48 h after CS. The highest serum chloride level recorded postoperatively was significantly higher in the group with AKI (Table 1). However, when adjusted for the covariables described, this association was not significant. In the assessment of secondary outcomes, the multivariate analysis identified a significant association between AKI and arterial lactate on admission to the intensive care unit, but especially between AKI and the use of inotropes (Figure 1). Table 1. Variables for Patients in the AKI Group and Non-AKI Group. Variables . AKI (n=59) . Non-AKI (n=405) . P . Age, mean (SD) 60.52 (13.7) 59.32 (16.5) 0.54 Euroscore, median (IQR) 3.05 (1.8-6.7) 1.85 (1.0-3.6) 0.001 Postoperative inotropes, n(%) 35 (59.3) 77 (19.0) <0.01 Lactate on ICU admission, median (IQR) 2.4 (2-3.7) 2.2 (1.7-2.8) <0.01 Absence of lactate clearance during the first 6 h after surgery, n(%) 30 (51.7) 157 (39.3) 0.073 SVO2 on ICU admission, median (IQR) 68 (60.5-73) 72 (65-77) 0.054 Absence of an increase in SVO2 during the first 6 hours after surgery, n(%) 33 (60) 217 (58.0) 0.78 Chloride on admission, median (IQR) 111 (108.5-114.5) 112 (109-114) 0.67 Maximum chloride value during the first 48 h after surgery, median (IQR) 113 (110-117) 112 (109.5-115) 0.012 Average chloride value during the first 48 h after surgery, median (IQR) 111 (109-116) 111 (109- 13) 0.12 Variables . AKI (n=59) . Non-AKI (n=405) . P . Age, mean (SD) 60.52 (13.7) 59.32 (16.5) 0.54 Euroscore, median (IQR) 3.05 (1.8-6.7) 1.85 (1.0-3.6) 0.001 Postoperative inotropes, n(%) 35 (59.3) 77 (19.0) <0.01 Lactate on ICU admission, median (IQR) 2.4 (2-3.7) 2.2 (1.7-2.8) <0.01 Absence of lactate clearance during the first 6 h after surgery, n(%) 30 (51.7) 157 (39.3) 0.073 SVO2 on ICU admission, median (IQR) 68 (60.5-73) 72 (65-77) 0.054 Absence of an increase in SVO2 during the first 6 hours after surgery, n(%) 33 (60) 217 (58.0) 0.78 Chloride on admission, median (IQR) 111 (108.5-114.5) 112 (109-114) 0.67 Maximum chloride value during the first 48 h after surgery, median (IQR) 113 (110-117) 112 (109.5-115) 0.012 Average chloride value during the first 48 h after surgery, median (IQR) 111 (109-116) 111 (109- 13) 0.12 Open in new tab Table 1. Variables for Patients in the AKI Group and Non-AKI Group. Variables . AKI (n=59) . Non-AKI (n=405) . P . Age, mean (SD) 60.52 (13.7) 59.32 (16.5) 0.54 Euroscore, median (IQR) 3.05 (1.8-6.7) 1.85 (1.0-3.6) 0.001 Postoperative inotropes, n(%) 35 (59.3) 77 (19.0) <0.01 Lactate on ICU admission, median (IQR) 2.4 (2-3.7) 2.2 (1.7-2.8) <0.01 Absence of lactate clearance during the first 6 h after surgery, n(%) 30 (51.7) 157 (39.3) 0.073 SVO2 on ICU admission, median (IQR) 68 (60.5-73) 72 (65-77) 0.054 Absence of an increase in SVO2 during the first 6 hours after surgery, n(%) 33 (60) 217 (58.0) 0.78 Chloride on admission, median (IQR) 111 (108.5-114.5) 112 (109-114) 0.67 Maximum chloride value during the first 48 h after surgery, median (IQR) 113 (110-117) 112 (109.5-115) 0.012 Average chloride value during the first 48 h after surgery, median (IQR) 111 (109-116) 111 (109- 13) 0.12 Variables . AKI (n=59) . Non-AKI (n=405) . P . Age, mean (SD) 60.52 (13.7) 59.32 (16.5) 0.54 Euroscore, median (IQR) 3.05 (1.8-6.7) 1.85 (1.0-3.6) 0.001 Postoperative inotropes, n(%) 35 (59.3) 77 (19.0) <0.01 Lactate on ICU admission, median (IQR) 2.4 (2-3.7) 2.2 (1.7-2.8) <0.01 Absence of lactate clearance during the first 6 h after surgery, n(%) 30 (51.7) 157 (39.3) 0.073 SVO2 on ICU admission, median (IQR) 68 (60.5-73) 72 (65-77) 0.054 Absence of an increase in SVO2 during the first 6 hours after surgery, n(%) 33 (60) 217 (58.0) 0.78 Chloride on admission, median (IQR) 111 (108.5-114.5) 112 (109-114) 0.67 Maximum chloride value during the first 48 h after surgery, median (IQR) 113 (110-117) 112 (109.5-115) 0.012 Average chloride value during the first 48 h after surgery, median (IQR) 111 (109-116) 111 (109- 13) 0.12 Open in new tab Open in new tabDownload slide Multivariate analysis. Conclusion: Postoperative hyperchloraemia is common but not independently associated with AKI. This complication is mainly related to tissue hypoperfusion or the need for postoperative inotropes. P165 https://esc365.escardio.org/Presentation/221102/abstract Safety of percutaneous dilatational tracheotomy in patients on dual antiplatelet therapy and anticoagulation E Luesebrink,1 M Orban,1 K Stark1 and S Massberg1 1Ludwig-Maximilians University, Munich, Germany Percutaneous dilatational tracheotomy has become a routine procedure in intensive care Units. However, given the high and steadily growing number of patients receiving anticoagulation, dual antiplatelet therapy or even a combination of both, there are concerns about the safety of the procedure, in particular for critically ill patients with a high risk of bleeding. Retrospective single-center study: A total of 34 patients who underwent PDT according to Ciaglia’s technique with accompanying bronchoscopy in our cardiac ICU from January 2018 to May 2019 were included. Measurements and Main Results: Intravenous unfractionated heparin (prophylactic dosage) (n=4), intravenous unfractionated heparin (therapeutic dosage) (n=4), aspirin and intravenous unfractionated heparin (therapeutic dosage) (n=7), DAPT with intravenous unfractionated heparin (prophylactic dosage) (n=5) and DAPT with intravenous unfractionated heparin (therapeutic dosage) (n=14). TThere were no severe bleeding complications or potentially life-threatening procedure-related complications. Additionally, the rate of complications in patients with elevated body mass index was not increased. Conclusions: Bronchoscopy-guided PDT according to Ciaglia with careful consideration of all potential indications and contraindications may be a safe and low-complication procedure for airway Management: Table 1. Complication . I (n=4) . II (n=4) . III (n=7) . IV (n=5) . V (n=14) . Overall (%) . P-value . Intraprocedural bleeding 0 0 0 0 0 0 ns. Postprocedural bleeding 1 0 1 1 0 3 (8,8%) ns. Accidental cannula dislocation 0 0 0 0 0 0 ns. Accidental tubus dislocation 0 0 0 0 2 2 (5,9%) ns. Tracheocutaneous fistula 0 0 0 0 0 0 ns. Fracture of tracheal cartilage 0 0 3 0 1 4 (11,8%) ns. Pneumothorax 0 0 0 0 0 0 ns. Infection 0 0 0 0 0 0 ns. Wound healing disorder 0 0 0 0 0 0 ns. Granulation at the tracheostoma 0 0 0 0 0 0 ns. O2desaturation 0 0 0 0 0 0 ns. Complication . I (n=4) . II (n=4) . III (n=7) . IV (n=5) . V (n=14) . Overall (%) . P-value . Intraprocedural bleeding 0 0 0 0 0 0 ns. Postprocedural bleeding 1 0 1 1 0 3 (8,8%) ns. Accidental cannula dislocation 0 0 0 0 0 0 ns. Accidental tubus dislocation 0 0 0 0 2 2 (5,9%) ns. Tracheocutaneous fistula 0 0 0 0 0 0 ns. Fracture of tracheal cartilage 0 0 3 0 1 4 (11,8%) ns. Pneumothorax 0 0 0 0 0 0 ns. Infection 0 0 0 0 0 0 ns. Wound healing disorder 0 0 0 0 0 0 ns. Granulation at the tracheostoma 0 0 0 0 0 0 ns. O2desaturation 0 0 0 0 0 0 ns. Complications during and after PDT differentiated by treatment group. p-values < 0.05 were considered as significant; ns: non-significant. Open in new tab Table 1. Complication . I (n=4) . II (n=4) . III (n=7) . IV (n=5) . V (n=14) . Overall (%) . P-value . Intraprocedural bleeding 0 0 0 0 0 0 ns. Postprocedural bleeding 1 0 1 1 0 3 (8,8%) ns. Accidental cannula dislocation 0 0 0 0 0 0 ns. Accidental tubus dislocation 0 0 0 0 2 2 (5,9%) ns. Tracheocutaneous fistula 0 0 0 0 0 0 ns. Fracture of tracheal cartilage 0 0 3 0 1 4 (11,8%) ns. Pneumothorax 0 0 0 0 0 0 ns. Infection 0 0 0 0 0 0 ns. Wound healing disorder 0 0 0 0 0 0 ns. Granulation at the tracheostoma 0 0 0 0 0 0 ns. O2desaturation 0 0 0 0 0 0 ns. Complication . I (n=4) . II (n=4) . III (n=7) . IV (n=5) . V (n=14) . Overall (%) . P-value . Intraprocedural bleeding 0 0 0 0 0 0 ns. Postprocedural bleeding 1 0 1 1 0 3 (8,8%) ns. Accidental cannula dislocation 0 0 0 0 0 0 ns. Accidental tubus dislocation 0 0 0 0 2 2 (5,9%) ns. Tracheocutaneous fistula 0 0 0 0 0 0 ns. Fracture of tracheal cartilage 0 0 3 0 1 4 (11,8%) ns. Pneumothorax 0 0 0 0 0 0 ns. Infection 0 0 0 0 0 0 ns. Wound healing disorder 0 0 0 0 0 0 ns. Granulation at the tracheostoma 0 0 0 0 0 0 ns. O2desaturation 0 0 0 0 0 0 ns. Complications during and after PDT differentiated by treatment group. p-values < 0.05 were considered as significant; ns: non-significant. Open in new tab P166 https://esc365.escardio.org/Presentation/216447/abstract Lactate clearance as a predictor of neurological outcome and mortality in post cardiac arrest survivor treated with targeted temperature management during early phase of post cardiac arrest syndrome; Riset Unggulan Harapan Kita R Budiyanto1 and NT Sulastri1 1Harapan Kita Hospital, Jakarta, Indonesia Background: Targeted temperature management (TTM) has become standard of care to minimize brain injury and restoring brain function after Cardiac Arrest. The prognostication phase during post cardiac arrest management require multimodal assessment. Lactate serum known as a reliable prognostic marker is associated with outcome in trauma, septic and cardiac arrest. However, this association has not been validated in prospective cohort study on cardiac arrest survivor who treated with TTM. Purpose: The aim was to determine the lactate clearance as an outcome predictor for mortality and neurological in cardiac arrest survivor who treated with targeted temperature management (TTM) during early phase of Post Cardiac Arrest Syndrome (PCAS) Methods: This was a prospective observational cohort study subject cardiac arrest survivor underwent TTM during the period of July 2018 to August 2019. Subjects were examined lactate serum at 0 hour pre-induction, 12, 24, and 72 hour. Lactate clearance was measured using the following formula : [(lactate initial- Lactate serial)/lactate initial]x 100%. Sequential Organ Failure Assessment (SOFA) was used for mortality prediction, and calculated at 0 Hour pre-induction and 72 hour later. Cerebral performance category (CPC) was used to examine neurological outcome at 72 hours post induction or until 30 days afterward. The Primary outcome was neurological status at discharge and secondary outcome was in hospital mortality. Results: The study included 22 Post cardiac arrest survivor; 12 (54.5%) were died, and 1 (4.5%) were discharge with a poor neurological outcome. Higher serum level at 12 H [(Relative risk (RR) 0.625 95% CI 0.298-1.312)] And 24 Hours (RR) 0.875 95% [CI] (0.425 to 1.727) And 72 Hours RR 0.857 95% [CI] 0.425 to 1.727 were not associated with a poor neurological outcome and in hospital mortality. Lactate clearance was not associated with neurological outcome or in-hospital mortality at any time point after adjusting for confounders. Conclusion: Increased lactate serum was not associated with neurological outcome and in hospital mortality in cardiac arrest survivor treated with TTM. Furthermore, lactate clearance is not a robust marker to predict outcome in cardiac arrest survivor treated with TTM. However, the challenges of this pilot study were limited sample, high mortality, complex cases that might affects this result. Therefore, a multicenter study is require in order to gain larger data. P167 https://esc365.escardio.org/Presentation/216404/abstract Analysis of complications in patients supported with veno-arterial extracorporeal membrane oxygenator and its influence on survival. M Alonso Fernandez De Gatta,1 S Merchan Gomez,1 A Diego Nieto,1 M Gonzalez Cebrian,1 I Toranzo Nieto,1 E Alzola,1 F Martin Herrero,1 A Barrio Rodriguez,1 M Lopez Serna,1 L Rodriguez Estevez1 and PL Sanchez Fernandez1 1Complejo Asistencial Universitario de Salamanca, Salamanca, Spain Introduction: Complications in patients who receive veno-arterial extracorporeal membrane oxygenation (VA-ECMO) are frequent. Purpose: Characterize the complications suffered during and after support with VA-ECMO and analyze its relationship with patient survival. Methods: Retrospective study including all VA-ECMO implants in a referral hospital describing admission complications. Univariate and multivariate analysis of complications related to discharge survival. Results: 101 VA-ECMO were implanted from 2013 to Sep-2019 (table). Survival at discharge was 42.6%. Deaths were due to multiorgan dysfunction syndrome (27.7%), anoxic encephalopathy (8.9%) and bleeding (6%). Complications during admission (during ECMO support -mean 5.1±4 days- and after its withdrawal) were frequent, highlighting the vascular ones, hemorrhages and infections (figure). Figure. Open in new tabDownload slide Complications. Among the different complications, the need for renal replacement therapy (RRT) were associated with reduced survival (p=0.038). Infections during the admission (p=0.023), critical patient polyneuropathy (p<0.001) and the tracheostomy due to prolonged invasive ventilation (p=0,04) were more frequent in survivors at discharge, without finding differences in other described complications. At the multivariate analysis, the need for RRT was the only independent predictor of mortality (HR 4.4, IC95% 1.14-17.32, p=0,032). Conclusion: Complications during the admission of patients requiring VA-ECMO are frequent, highlighting the vascular ones, hemorrhages and infections. The need for RRT was the only independent predictor of mortality at discharge. Table 1. Baseline and admission situation. Baseline characteristics (n=101) . Periimplantation characteristics . Age (years) (mean+SD) Male (n, %) 61.3±9.9 74 (73.3%) Peripheral cannulation (n,%) Percutaneous implant (n,%) Intraaortic balloon pump (n,%) 83 (82.2%) 70 (69.3%) 48 (47.5%) Situation at the admission Bridge to (n,%) recovery transplant assistance decision 83 (82.2%) 7 (6.9%) 7 (6.9%) 2 (1.9%) Noradrenalin (n,%) Dobutamine (n,%) Adrenaline (n,%) 87 (86.1%) 86 (85.1%) 37 (36.6%) Indication (n,%) Blood test (mean+SD) Cardiogenic shock Cardiac arrest Electrical storm High-risk percutaneous intervention Postcardiotomy shock Others 47 (46.5%) 12 (11.9%) 8 (7.9%) 7 (6.9%) 25 (24.8%) 2 (1.9%) pH lactate (mmol/L) Creatinine (mg/dl) Bilirrubin (mg/dl) LDH (U/L) 7.25±0,2 7.13±4,6 1.63±1,4 1.1±1 1011±1200 LVEF (%) (mean+SD) RV dysfunction (n,%) 29.2±17.3 50 (49.5%) Preimplant cardiac arrest (n,%) Cardiac arrest duration (min) (n,%) ECMO-CPR (n,%) 56 (55.4%) 29.4±23 22 (21.8%) Baseline characteristics (n=101) . Periimplantation characteristics . Age (years) (mean+SD) Male (n, %) 61.3±9.9 74 (73.3%) Peripheral cannulation (n,%) Percutaneous implant (n,%) Intraaortic balloon pump (n,%) 83 (82.2%) 70 (69.3%) 48 (47.5%) Situation at the admission Bridge to (n,%) recovery transplant assistance decision 83 (82.2%) 7 (6.9%) 7 (6.9%) 2 (1.9%) Noradrenalin (n,%) Dobutamine (n,%) Adrenaline (n,%) 87 (86.1%) 86 (85.1%) 37 (36.6%) Indication (n,%) Blood test (mean+SD) Cardiogenic shock Cardiac arrest Electrical storm High-risk percutaneous intervention Postcardiotomy shock Others 47 (46.5%) 12 (11.9%) 8 (7.9%) 7 (6.9%) 25 (24.8%) 2 (1.9%) pH lactate (mmol/L) Creatinine (mg/dl) Bilirrubin (mg/dl) LDH (U/L) 7.25±0,2 7.13±4,6 1.63±1,4 1.1±1 1011±1200 LVEF (%) (mean+SD) RV dysfunction (n,%) 29.2±17.3 50 (49.5%) Preimplant cardiac arrest (n,%) Cardiac arrest duration (min) (n,%) ECMO-CPR (n,%) 56 (55.4%) 29.4±23 22 (21.8%) Abdreviations: CPR=cardiopulmonary resuscitation, LVEF=Left ventricular ejection fraction, RV=Right ventricular. Open in new tab Table 1. Baseline and admission situation. Baseline characteristics (n=101) . Periimplantation characteristics . Age (years) (mean+SD) Male (n, %) 61.3±9.9 74 (73.3%) Peripheral cannulation (n,%) Percutaneous implant (n,%) Intraaortic balloon pump (n,%) 83 (82.2%) 70 (69.3%) 48 (47.5%) Situation at the admission Bridge to (n,%) recovery transplant assistance decision 83 (82.2%) 7 (6.9%) 7 (6.9%) 2 (1.9%) Noradrenalin (n,%) Dobutamine (n,%) Adrenaline (n,%) 87 (86.1%) 86 (85.1%) 37 (36.6%) Indication (n,%) Blood test (mean+SD) Cardiogenic shock Cardiac arrest Electrical storm High-risk percutaneous intervention Postcardiotomy shock Others 47 (46.5%) 12 (11.9%) 8 (7.9%) 7 (6.9%) 25 (24.8%) 2 (1.9%) pH lactate (mmol/L) Creatinine (mg/dl) Bilirrubin (mg/dl) LDH (U/L) 7.25±0,2 7.13±4,6 1.63±1,4 1.1±1 1011±1200 LVEF (%) (mean+SD) RV dysfunction (n,%) 29.2±17.3 50 (49.5%) Preimplant cardiac arrest (n,%) Cardiac arrest duration (min) (n,%) ECMO-CPR (n,%) 56 (55.4%) 29.4±23 22 (21.8%) Baseline characteristics (n=101) . Periimplantation characteristics . Age (years) (mean+SD) Male (n, %) 61.3±9.9 74 (73.3%) Peripheral cannulation (n,%) Percutaneous implant (n,%) Intraaortic balloon pump (n,%) 83 (82.2%) 70 (69.3%) 48 (47.5%) Situation at the admission Bridge to (n,%) recovery transplant assistance decision 83 (82.2%) 7 (6.9%) 7 (6.9%) 2 (1.9%) Noradrenalin (n,%) Dobutamine (n,%) Adrenaline (n,%) 87 (86.1%) 86 (85.1%) 37 (36.6%) Indication (n,%) Blood test (mean+SD) Cardiogenic shock Cardiac arrest Electrical storm High-risk percutaneous intervention Postcardiotomy shock Others 47 (46.5%) 12 (11.9%) 8 (7.9%) 7 (6.9%) 25 (24.8%) 2 (1.9%) pH lactate (mmol/L) Creatinine (mg/dl) Bilirrubin (mg/dl) LDH (U/L) 7.25±0,2 7.13±4,6 1.63±1,4 1.1±1 1011±1200 LVEF (%) (mean+SD) RV dysfunction (n,%) 29.2±17.3 50 (49.5%) Preimplant cardiac arrest (n,%) Cardiac arrest duration (min) (n,%) ECMO-CPR (n,%) 56 (55.4%) 29.4±23 22 (21.8%) Abdreviations: CPR=cardiopulmonary resuscitation, LVEF=Left ventricular ejection fraction, RV=Right ventricular. Open in new tab P168 https://esc365.escardio.org/Presentation/217215/abstract Causes of death after ECMO weaning and predictors of survival to hospital discharge T Mariani,1 F Caniato,1 P Bernardo,1 A Sori,1 F Cappelli,1 C Agostini,1 A Lombardi1 and C Di Mario1 1Careggi University Hospital (AOUC), Florence, Italy Background: Veno-arterial extra corporeal membrane oxygenation (VA-ECMO) is a circulatory mechanical support that provides hemodynamic and respiratory assistance and thus can be used as a rescue therapy both in patients in cardiac arrest and in patients with cardiogenic shock; its utilization and availability is increasing but the mortality rate remains high. Purpose: The purpose of this retrospective study is to evaluate the leading causes of death after weaning from VA-ECMO and identify possible predictors of mortality. Methods: We collected data from the VA-ECMO registry of our center. We considered patients weaned from VA-ECMO and we divided them according to survival during the hospitalization. We analysed and compared basal characteristics (hypertension, diabetes, dyslipidaemia, body mass index, chronic coronary diseases, chronic kidney disease, chronic obstructive pulmonary disease, smoking), laboratory values (haemoglobin, white blood cells, platelets, creatinine, liver enzymes, NTproBNP, peak troponin I, lactate level) and complications (infective, vascular, cerebrovascular and haemorrhagic) between these two groups in search of mortality predictors after weaning. Results: We identified 57 consecutive patients receiving VA-ECMO from January 2014 to September 2019, both for cardiac arrest and for cardiogenic shock; 27 of them were weaned from VA-ECMO; in 7 patients the indication was cardiac arrest and in 20 patients was cardiogenic shock. Mean age was 51±15 years and 33% were women. 20 patients survived to hospital discharge; the cause of death was multiple organ failure in 3 patients, stroke in 2 patients, respiratory failure in 1 patient and bowel infarction in 1 patient. Deceased patients suffered more frequently of arterial hypertension (85% Vs. 25% p=0.005 OR 18–95% CI 1.72–88.08) and had higher BMI (30.89±4.92 Vs. 25.11±3.69 p 0.020 OR 1.4 -95% CI 1.04-1.89). Only lactate levels at 48 h significantly differed between the two groups (1.6±0.67 Vs. 2.48±0.64 p 0.037). The analysis of haemorrhagic, infective, vascular and cerebrovascular complications showed no differences between the two groups. Moreover, we found that the initial indication for VA-ECMO support (cardiac arrest or cardiogenic shock), was not correlated to mortality once patients were weaned. Conclusions: Mortality in patients receiving VA-ECMO remains high, even after successful weaning. We found some variables that showed significant statistical difference between patients who survived and those who died after weaning, nonetheless their utility in a clinical context has to be validated in further studies. The most interesting result of this study is that the indication for VA-EMCO support does not correlate to mortality once patients are weaned. P169 https://esc365.escardio.org/Presentation/216454/abstract Major neurological events associated with the use of extracorporeal membrane oxygenation devices in the coronary unit D Serrano Lozano,1 T Borderias Villaroel,1 S Gonzalez Lizarbe,1 S Catoya Villa,1 B De Tapia Majado,1 J Sanchez Cena,1 M Lozano Gonzalez,1 I Cabrera Rubio,1 V Burgos Palacios,1 C Castrillo Bustamante,1 M Cobo Belaustegui,1 M Ruiz Lera,1 A Canteli Alvarez,1 JE Lujan Valencia1 and JA Sarralde Aguayo1 1UNIVERSITY HOSPITAL MARQUES DE VALDECILLA, Santander, Spain Introduction: There is an increase in the use of mechanical circulatory support devices (MCS), such as extracorporeal membrane oxygenation (ECMO). These devices provide survival rates > 50% in patients with mortality close to 100%, but their use associates complications, the neurological events are among the most serious ones. Methods: Since April 2009, 252 MCS devices were implanted in our center in 206 patients; with 145 veno-arterial ECMO in 141 patients. We reviewed characteristics and frequency of major neurological events. Results: 107 were men (75.89%). Average age 57.48 years. INTERMACS 1 scale in 139 patients, 2 in 6 patients. Support indication can be seen in the graph. 25 patients had suffered a recovered cardiac arrest (CA) and 23 implants were performed during CA as a cardiopulmonary resuscitation maneuver. ECMO duration average time 5.07 days. Reason for withdrawal: recovery 72 patients (49.65%), death 46 (31.72%), other support device 26 (17.93%), heart transplant 1 (0.69%). During support, 15 patients suffered major neurological complications. 11 were anoxic encephalopathies, 10 of them in relation to previous CA and 4 were established strokes (2.83%) (3 ischemic and 1 hemorrhagic), the latter dying because of this cause. These patients are listed in Table 1. Anticoagulation was started after implantation in 112 cases. The initial strategy was bivalirudin in 21 devices (18.7%) and sodium heparin in 91 (81.3%), with 100-150 IU / Kg during the implant; according to the patient pathology and basal coagulation state. The initiation of anticoagulation was delayed for a minimum of 6-8 hours with an average of 21 hours. The activated partial thromboplastin time (aPTT) was monitored, for a 1.5-2.5 target ratio, initially every 4 hours and then every 12-24 hours when levels were stable. In heparinized patients, anti Xa determinations were used in cases where proper levels of aPTT were not reached. In 18 cases (16.07%), due to the difficulty of maintaining suitable and stable ratios of anticoagulation with heparin, it was changed to bivalirudin Conclussions: Using an appropriate anticoagulation strategy, with sodium heparin perfusion and controlled by aPTT ratios, alternatively controlled with antiXa or bivalirudin in selected cases, reduces the incidence of serious neurological complications in patients with VA ECMO compared to other series. Table 1. Patient . ECMO support duration (Hours) . Indication . Objetive . Cardiac arrest . Withdrawal . Neurological complication . Sequels . Anticoagulación empleada . Time to start anticoagulation Bigger and smaller aPTT ratio . Woman 51 years 427 h Post Heart transplant (Primary graft failure, Right ventricle) Recovery No Recovery Ischemic embolic stroke in right frontoparietal territory Left hemiparesis Sodium Heparin 5 h 1,90/4,57 Man 51 years 17,5 h Myocarditis Recovery Previously recovered Other circulatory support device Embolic ischemic stroke in the left middle cerebral artery territory, posterior, and posterior inferior cerebellar artery Mixed aphasia and residual hemiparesis in right limbs Sodium Heparin 6 h 1,06/2,25 Man 63 years 12 h Post Heart transplant (Primary graft failure, Right ventricle) Recovery No Recovery Embolic ischemic stroke in left middle cerebral artery territory (posterior hemorrhagic transformation) Motor aphasia, right homonymous hemianopia and right hemiplegia Sodium Heparin 12 h 1,02/3,21 Patient . ECMO support duration (Hours) . Indication . Objetive . Cardiac arrest . Withdrawal . Neurological complication . Sequels . Anticoagulación empleada . Time to start anticoagulation Bigger and smaller aPTT ratio . Woman 51 years 427 h Post Heart transplant (Primary graft failure, Right ventricle) Recovery No Recovery Ischemic embolic stroke in right frontoparietal territory Left hemiparesis Sodium Heparin 5 h 1,90/4,57 Man 51 years 17,5 h Myocarditis Recovery Previously recovered Other circulatory support device Embolic ischemic stroke in the left middle cerebral artery territory, posterior, and posterior inferior cerebellar artery Mixed aphasia and residual hemiparesis in right limbs Sodium Heparin 6 h 1,06/2,25 Man 63 years 12 h Post Heart transplant (Primary graft failure, Right ventricle) Recovery No Recovery Embolic ischemic stroke in left middle cerebral artery territory (posterior hemorrhagic transformation) Motor aphasia, right homonymous hemianopia and right hemiplegia Sodium Heparin 12 h 1,02/3,21 Open in new tab Table 1. Patient . ECMO support duration (Hours) . Indication . Objetive . Cardiac arrest . Withdrawal . Neurological complication . Sequels . Anticoagulación empleada . Time to start anticoagulation Bigger and smaller aPTT ratio . Woman 51 years 427 h Post Heart transplant (Primary graft failure, Right ventricle) Recovery No Recovery Ischemic embolic stroke in right frontoparietal territory Left hemiparesis Sodium Heparin 5 h 1,90/4,57 Man 51 years 17,5 h Myocarditis Recovery Previously recovered Other circulatory support device Embolic ischemic stroke in the left middle cerebral artery territory, posterior, and posterior inferior cerebellar artery Mixed aphasia and residual hemiparesis in right limbs Sodium Heparin 6 h 1,06/2,25 Man 63 years 12 h Post Heart transplant (Primary graft failure, Right ventricle) Recovery No Recovery Embolic ischemic stroke in left middle cerebral artery territory (posterior hemorrhagic transformation) Motor aphasia, right homonymous hemianopia and right hemiplegia Sodium Heparin 12 h 1,02/3,21 Patient . ECMO support duration (Hours) . Indication . Objetive . Cardiac arrest . Withdrawal . Neurological complication . Sequels . Anticoagulación empleada . Time to start anticoagulation Bigger and smaller aPTT ratio . Woman 51 years 427 h Post Heart transplant (Primary graft failure, Right ventricle) Recovery No Recovery Ischemic embolic stroke in right frontoparietal territory Left hemiparesis Sodium Heparin 5 h 1,90/4,57 Man 51 years 17,5 h Myocarditis Recovery Previously recovered Other circulatory support device Embolic ischemic stroke in the left middle cerebral artery territory, posterior, and posterior inferior cerebellar artery Mixed aphasia and residual hemiparesis in right limbs Sodium Heparin 6 h 1,06/2,25 Man 63 years 12 h Post Heart transplant (Primary graft failure, Right ventricle) Recovery No Recovery Embolic ischemic stroke in left middle cerebral artery territory (posterior hemorrhagic transformation) Motor aphasia, right homonymous hemianopia and right hemiplegia Sodium Heparin 12 h 1,02/3,21 Open in new tab Open in new tabDownload slide ECMO implant indication during 2009-2019. P170 https://esc365.escardio.org/Presentation/221295/abstract Variables predicting reintubation after coronary artery by-pass graft surgery D Aragiannis,1 KN Koumalos Nikolaos,1 E Sigala,1 D Lymperiadis1 and K Triantafyllou1 1Hippokration General Hospital, Cardiac Surgery, Athens, Greece Objective: After cardiac surgery procedures, weaning from mechanical ventilation and endotracheal extubation usually proceeds uncomplicatedly. Failure of the patient to tolerate extubation may reflect premature extubation or may be a marker of a sicker patient. In this study we evaluate the determinants, characteristics, and outcomes of the patients who were reintubated in the early postoperative period following cardiac surgery. Methods: The study population consisted of 320 patients (aged 66.1±0.95 years old), undergoing cardiac surgery with cardiopulmonary bypass. We enrolled the patients who needed reintubation during their stay in the ICU and tried to correlate patient characteristics, operation characteristics, and biochemical markers with the possibility of reintubation. Results: Twenty-nine patients (9%) needed reintubation during their stay in the ICU. The possibility of reintubation was positively correlated with age (rho=0.229, p=0.007), obstructive pulmonary disease (rho=0.409, p=0.001), cardiopulmonary bypass time (rho=0.183, p=0.032), renal failure (rho=0.322, p=0.0001), white blood cell count (rho=0.291, p=0.001), fever (rho=0.381, p=0.0001) and atrial fibrillation (0.323, p=0.0001). Patients who were reintubated had much higher mortality compared with the control group (rho=0.556, p=0.0001). Conclusions: Older patients with pulmonary disease are more vulnerable to reintubation especially after operations that need prolonged by pass time. Post operative complications especially infections and renal failure also contribute to this situation. P172 https://esc365.escardio.org/Presentation/216500/abstract The usefulness of perioperative lactate blood levels in patients undergoing heart valve surgeryStatutary work at Institute of Cardiology P Duchnowski,1 M Kusmierczyk,2 M Kozma1 and T Hryniewiecki1 1Institute of Cardiology in Anin, Department of Acquired Cardiac Defects, Warsaw, Poland 2Institute of Cardiology in Anin, Department of Cardiosurgery and Transplantology, Warsaw, Poland Background: The aim of the study was to assess the usefulness of lactate blood levels in the perioperative period in patients undergoing heart valve surgery. Methods: A prospective study was conducted on a group of consecutive patients with significant valvular heart disease that underwent elective valve surgery. The primary endpoint was total mortality in a 30-day follow-up. Univariate analysis, followed by multivariate regression analysis, was performed. Spearman’s rank correlation coefficient was used to search for associations between the postoperative serum lactates level and selected variables. Predictive value of lactates was assessed by a comparison of the areas under the receiver operator characteristics of the respective curve. Results: The study included 801 patients. The mean age in the study group was 64.5 (± 12.5). Thirty three (4.3%) patients had significantly impaired left ventricular systolic function (ejection fraction ≤ 35%). The primary end point occurred in 36 patients. Total mortality was 4.4% versus 3.8% expected mortality calculated using EuroSCORE II. The statistically significant predictors of primary end point at univariate analysis are presented in Table 1. At multivariate analysis lactate blood level measured one day after surgery (lac II) and ph measured one day after surgery remained independent predictors of the primary end-point. The area under receiver operator characteristic curve for primary end-point for lac II is 0.805 (95% CI 0.721–0.870) (sensitivity: 75%; specificity: 82%)(Figure 1). Table 1. Variable . Odds ratio . 95% Cl . p-value . Age, years 1.085 1.047-1.125 <0.0001 Lac I, mmol/L 2.001 1.427-2.803 <0.001 Lac II, mmol/L 1.813 1.377-3.389 <0.0001 ph II, 1.130 1.053-1.186 <0.0001 Hemoglobin, g/dL 0.569 0.469-0.690 <0.0001 LV ejection fraction, % 0.972 0.951-0.993 0.01 Variable . Odds ratio . 95% Cl . p-value . Age, years 1.085 1.047-1.125 <0.0001 Lac I, mmol/L 2.001 1.427-2.803 <0.001 Lac II, mmol/L 1.813 1.377-3.389 <0.0001 ph II, 1.130 1.053-1.186 <0.0001 Hemoglobin, g/dL 0.569 0.469-0.690 <0.0001 LV ejection fraction, % 0.972 0.951-0.993 0.01 Abbreviations: Hemoglobin = haemoglobin measured one day before operation, Hemoglobin II = haemoglobin measured one day after operation (18 hours after operation), Lac I = lactates measured 6 hours after operation. Lac II = lactates measured one day after operation (18 hours after operation), ph II = ph measured one day after operation (18 hours after operation). Open in new tab Table 1. Variable . Odds ratio . 95% Cl . p-value . Age, years 1.085 1.047-1.125 <0.0001 Lac I, mmol/L 2.001 1.427-2.803 <0.001 Lac II, mmol/L 1.813 1.377-3.389 <0.0001 ph II, 1.130 1.053-1.186 <0.0001 Hemoglobin, g/dL 0.569 0.469-0.690 <0.0001 LV ejection fraction, % 0.972 0.951-0.993 0.01 Variable . Odds ratio . 95% Cl . p-value . Age, years 1.085 1.047-1.125 <0.0001 Lac I, mmol/L 2.001 1.427-2.803 <0.001 Lac II, mmol/L 1.813 1.377-3.389 <0.0001 ph II, 1.130 1.053-1.186 <0.0001 Hemoglobin, g/dL 0.569 0.469-0.690 <0.0001 LV ejection fraction, % 0.972 0.951-0.993 0.01 Abbreviations: Hemoglobin = haemoglobin measured one day before operation, Hemoglobin II = haemoglobin measured one day after operation (18 hours after operation), Lac I = lactates measured 6 hours after operation. Lac II = lactates measured one day after operation (18 hours after operation), ph II = ph measured one day after operation (18 hours after operation). Open in new tab Figure 1. Open in new tabDownload slide Conclusions: Elevated postoperative lactate blood level was associated with a higher risk of postoperative death. P173 https://esc365.escardio.org/Presentation/216712/abstract Fluid therapy in non-septic acute decompensated heart failure patients and in- hospital mortality M Chlabicz,1 R Kazimierczyk,2 P Lopatowska,2 M Gil-Klimek,2 B Sobkowicz,2 M Gierlotka,3 K Kaminski,4 S Dobrzycki1 and A Tycinska2 1Medical University of Bialystok, Department of invasive cardiology, Bialystok, Poland 2Medical University of Bialystok, Department of cardiology, Bialystok, Poland 3Opole Medical University, Department of cardiology, Opole, Poland 4Medical University of Bialystok, Department of Population Medicine and Prevention of Civilization Diseases, Bialystok, Poland Background: Fluid therapy in congestive acute decompensated heart failure (ADHF) patients might be inappropriate and worsening prognosis. In-hospital mortality rate in the most severe ‘cold-wet’ (hemodynamic profile C) ADHF group is the worst and exceeds 40%. The relationship between the fluid balance and adverse outcomes in critically ill, usually septic intensive care patients is well established. However, there are no clear guidelines regarding the definition of the fluid overload, monitoring the volume status and, finally, the proper treatment in ‘cold-wet’ ADHF patients. The aim of our study was to analyze the effect of fluid administration on mortality in non-septic, ADHF patients with reduced ejection fraction. Material and methods: We analyzed 41 ADHF consecutive ‘cold-wet’ patients (mean age 69.3 ± 14.9 years, 27 men, LVEF 22.8 ± 11.1%, lactates 2.2 ± 1.6 mmol/L) without sepsis. At admission central venous pressure (CVP) was measured (17.6 ± 7.2 cm H2O), and ultrasound examination of inferior vena cava (IVC) was performed (IVC min. 18.6 ± 7.3mm and IVC max. 24.6 ± 4.3 mm). The mean dose of dobutamine within the first 24 h was 2.93 (±2.2) ug/kg/min., and norepinephrine was 0.05 (±0.1) ug/kg/min. Intravenous fluid infusion, hourly urine output as well as the net fluid balance within the first 24 h were assessed. Moreover, we compared the groups according to survival as well as 1st and 4th quartile of CVP. Results: Altogether 17 (41%) patients died: 16 (39%) during a mean of 11.2 ± 7.8 days of hospitalization and 1 during a 30-day follow up. Patients who received more fluids had lower MAP, higher SOFA score and needed higher doses of norepinephrine. Patients in the lowest CVP quartile (< 13 cm H2O) had significantly worse in-hospital survival as compared to patients in the highest quartile (> 24 cm H2O), p=0.012. Higher intravenous fluid volumes within the first 24 h were infused in patients in the lowest CVP quartile as compared to the highest CVP quartile (1791.7 ± 1357.8 mL vs. 754.5 ± 631.4 mL, p=0.046). Moreover, more fluids were infused in a group of patients who died during a hospital stay and at 30-day follow up (1362.8 ± 752.7 mL vs. 722.7 ± 1046.5 mL, p=0.004; 1348.8 ± 731.0 mL vs. 703.6 ± 1068.4 mL, p=0.002, respectively). Conclusions: CVP-guided intravenous fluid therapy is a common practice which in high risk ADHF ‘cold-wet’ patients might be harmful and should rather be avoided. Lower CVP seems to be related with worse prognosis. Open in new tabDownload slide Kaplan-Meyer curves presenting deteriora. P174 https://esc365.escardio.org/Presentation/221650/abstract Positive pressure ventilation parameters in the CICU: relationship between tidal volume, positive end-expiratory pressure and outcomes CL Alviar Restrepo,1 AY Lui,2 M Quien,1 A Vargas,1 JS Rico-Mesa,3 V Jaramillo,4 N Aiad,1 M Larico5 and N Smilowitz1 1New York University Langone Medical Center, New York, United States of America 2New York University School of Medicine, New York, United States of America 3University of Texas Health Science Center, San Antonio, United States of America 4Mayo Clinic, Phoenix, United States of America 5Clinica Alemana & Universidad del Desarrollo, Cardiologia y Cuidado Intensivo, Santiago, Chile Background: The use of mechanical ventilation (MV) in the cardiac intensive care unit (CICU) has become increasingly common. Low tidal volume (TV) ventilation has benefits in patients with ARDS, while positive end-expiratory pressure (PEEP) may impact hemodynamics. However the relationship between mechanical ventilation parameters and outcomes has not been systematically studied. We sought to analyze the interactions between tidal volume (TV) and PEEP with mortality. Methods: We included patients admitted to the CICU receiving invasive MV during the first 48hrs of admission. Patients were stratified into two groups of TV (low: <8ml/Kg of ideal body weight), normal-high (8 ml/Kg of ideal body weight), low and high PEEP (above and below the median for the cohort). The primary outcome was all cause 30-day mortality Results: A total of 291 CICU patients (age 68, IQR 57-78) were included. The median TV was 7.89 (IQR 7.18-8.96) and median PEEP was 5.5 (IQR 5.00-7.71) and median plateau pressure was 19.7 (IQR 17-23) cmH2O. Mortality did not differ between low TV (30.2%) and normal-high (25.0%, p =0.8), or between PEEP (29.6% vs 254%, p=0.5, above and below the median respectively). After multivariable adjustment differences in mortality remained non-significant for TV groups (OR 0.84 95% CI 0.65-1.08) as well as for PEEP groups (OR 0.93 95% CI 0.87-1.12). Conclusions: In a large cohort of patients undergoing MV in the CICU, the use of low TV ventilation is not associated with differences in mortality or MV duration. Similarly, with a median of 5cmH2O, there is no association between PEEP and mortality. Future prospective studies are required to evaluate the MV parameters in patients admitted to the CICU. P175 https://esc365.escardio.org/Presentation/217599/abstract Profile of patients admitted in the Intensive Cardiac Care Unit of a large general hospital A Kitsiou,1 P Grammata,1 M Chronaki,1 R Bader,1 A Kakkavas1 and T Papafanis1 1Sismanogleio General Hospital, Athens, Greece Introduction: The traditional Coronary Care Unit has been transformed into the contemporary Intensive Cardiac Care Unit (ICCU) over the last decades. It has been observed that the prevalence of acute coronary syndromes has decreased whereas other diagnoses increased. In this study we reviewed the admission diagnoses in the ICCU of our hospital over a five-year period (2014-2019). Methods and Results: We included 4378 patients (pts) with a mean age of 69.98 ± 14.15 years (68% men). Women were significantly older than men (74.73 ± 13.14 versus 67.74 ± 14.06 years, p<0.001). In addition to the main admission diagnosis other comorbidities were present, like chronic or acute kidney disease and anemia. The most common diagnosis was acute coronary syndrome (ST elevation myocardial infarction -STEMI, non ST elevation myocardial infarction -NSTEMI, unstable angina) in 55.1% of pts, followed by acute or decompensated heart failure in 16.2% of pts and bradycardia (including sick sinus syndrome, atrioventricular block, pacemaker malfunction) in 11.8% of pts. Other diagnoses were: atrial fibrillation/supraventricular tachycardia (AF/SVT) in 5.6 % of pts, cardiac arrest in 3.4% of pts, ventricular tachycardia/ventricular fibrillation (VT/VF, including ICD firing or malfunction) in 2.4% of pts, pericardial disease (including tamponade and large pericardial effusion) in 1.5% of pts, myocarditis/cardiomyopathy in 1.3% of pts, lung disease (including infection and/or exacerbation of chronic obstructive pulmonary disease) in 1.2% of pts and miscellaneous (including valvular heart disease, hemodynamically unstable pulmonary embolism, aortic aneurysm, drug poisoning, septic shock, electrocution) in 1.4% of pts. These data are depicted in figure 1. Among all pts, 364 (8.31%) pts were intubated and mechanically ventilated. Figure 1. Open in new tabDownload slide Conclusion: Our data show that, in addition to acute coronary syndromes, our ICCU, like most contemporary ICCUs in Western Europe and North America, admits patients with a variety of mostly cardiac but also a number of noncardiac pts requiring advanced monitoring and care. P176 https://esc365.escardio.org/Presentation/221651/abstract Relationship between positive end-expiratory pressure and tidal volume with survival in patients with preload and afterload dependent cardiovascular disease. CL Alviar Restrepo,1 AY Lui,2 M Quien,1 A Vargas,1 V Jaramillo-Restrepo,3 JS Rico-Mesa,4 K Alabdallah,5 N Aiad,1 M Larico6 and N Smilowitz1 1New York University Langone Medical Center, New York, United States of America 2New York University School of Medicine, New York, United States of America 3Mayo Clinic, Phoenix, United States of America 4University of Texas Health Science Center, San Antonio, United States of America 5Lincoln Hospital, New York, United States of America 6Clinica Alemana & Universidad del Desarrollo, Cardiologia y Cuidado Intensivo, Santiago, Chile Background: The use of positive end-expiratory pressure (PEEP) and different prescribed Tidal Volumes (TV) in patients with cardiovascular disease may affect clinical outcomes. However these effects may be dependent on the intrinsic cardiac function as well as the hemodynamic state of each patient. We aimed to analyze the interactions between PEEP and TV with survival in patients with cardiovascular disease according to their preload and afterload dependent status. Methods: We included patients admitted to the CICU receiving invasive MV during the first 48hrs of admission. Patients were stratified according as preload dependent (hypovolemia, right ventricular dysfunction, tamponade, hypertrophic obstructive cardiomyopathy or constriction), afterload dependent (left ventricular shock, elevated afterload) or neither preload/afterload dependence. Multivariate regression analysis was performed with PEEP, TV and covariates of survival, including age, sex, OASIS severity score, cardiac arrest, PaO2, PCO2 and plateau pressures. Results: A total of 291 CICU patients (age 68, IQR 57-78) undergoing mechanical ventilation (MV) were included. There were no differences in survival according to PEEP level in patients with preload dependent status (OR 1.74 95% CI 0.85-3.55, p=0.1) or afterload dependent status (OR 1.02 95% CI 0.84-1.24, p=0.9). Similarly, TV was not associated with mortality in patients with preload dependent status (OR 0.61 95% CI 0.20-1.89, p=0.4) or afterload dependent status (OR 0.84 95% CI 0.56-1.24, p=0.3). In patients with neither preload or afterload dependent status PEEP or TV was not associated with increased mortality. Conclusions: In patients with cardiovascular disease undergoing MV, there is no significant association between the level of PEEP or TV use and survival, even when stratifying patients according to their preload or afterload dependent status. Further research in this area is warranted to better understand the impact of positive pressure ventilation in patients with cardiovascular disease. P177 https://esc365.escardio.org/Presentation/216457/abstract Mechanical ventilation in cardiogenic shock: association between positive pressure ventilation and outcomes according to invasive hemodynamics. AY Lui,1 CL Alviar Restrepo,2 M Quien,2 V Jaramillo-Restrepo,3 JS Rico-Mesa,4 A Vargas,2 N Aiad,2 K Alabdallah,5 M Larico6 and N Smilowitz2 1New York University School of Medicine, New York, United States of America 2New York University Langone Medical Center, New York, United States of America 3Mayo Clinic, Phoenix, United States of America 4University of Texas Health Science Center, San Antonio, United States of America 5Lincoln Hospital, New York, United States of America 6Clinica Alemana & Universidad del Desarrollo, Cardiologia y Cuidado Intensivo, Santiago, Chile Background: The use of positive end-expiratory pressure (PEEP) may influence cardiac output according to the patient’s hemodynamics. However these effects have been only described in preclinical studies and very small patient series. Our aim was to evaluate the association between PEEP and clinical outcomes in patients undergoing mechanical ventilation (MV) who are also receiving invasive hemodynamic monitoring with a pulmonary artery catheter (PAC). Methods: We included patients admitted to the CICU with the diagnosis of cardiogenic shock (CS) receiving invasive MV during the first 48hrs of admission and who had a PAC in place. Patients were stratified according to their filling pressures as pulmonary artery diastolic pressure (PADP) above and below 20mmHg. Ventilatory parameters were measured and monitored every hour for the study period (48 hours). Outcomes of interest included lactate clearance, inotropic vasopressor score and survival and were compared according to the level of PEEP (above and below the median). Multivariate regression analysis was performed adjusting for age, sex, OASIS, PaO2, pH, peak lactate and presence of cardiac arrest Results: A total of 80 patients (age 65, IQR 54-79) with CS undergoing MV and PAC monitoring were included. The median PEEP in the low PADP was 7.7 (IQR 5.5-9.9, p =0.1)cmH2O and the median PEEP in the high PADP was 5.5 (IQR 5.0-6.6)cm H2O. In the low PADP group, unadjusted mortality was non statistically significantly higher in the group receiving PEEP below the median (33% vs 0%, p=0.1). In the high PADP group mortality was non-significantly higher in patients receiving PEEP above the median (57%) compared to the ones receiving PEEP below the median (33%, p =0.5). Multivariate regression demonstrated no difference in mortality according to PADP and PEEP level (OR 0.95 95% CI 0.60-1.50, p=0.83). In multivariate analysis there were no differences in lactate clearance or in the change o inotropic-vasopressor score (table). Table 1. Variable . Multivariate regression . p value . Lactate clearance OR 0.02 95% CI -0.66-0.72 0.8 Improvement in vasopressor/inotropic score OR 2.81 95% CI -53.48-59.12 0.9 Variable . Multivariate regression . p value . Lactate clearance OR 0.02 95% CI -0.66-0.72 0.8 Improvement in vasopressor/inotropic score OR 2.81 95% CI -53.48-59.12 0.9 Multivariate Regression Analysis. Open in new tab Table 1. Variable . Multivariate regression . p value . Lactate clearance OR 0.02 95% CI -0.66-0.72 0.8 Improvement in vasopressor/inotropic score OR 2.81 95% CI -53.48-59.12 0.9 Variable . Multivariate regression . p value . Lactate clearance OR 0.02 95% CI -0.66-0.72 0.8 Improvement in vasopressor/inotropic score OR 2.81 95% CI -53.48-59.12 0.9 Multivariate Regression Analysis. Open in new tab Conclusions: In patients with cardiogenic shock undergoing MV and invasive hemodynamic monitoring, PEEP levels were not associated with differences in mortality, lactate clearance and inotropic/vasopressor score delta according to the left ventricular filling pressures as measured by pulmonary artery diastolic pressures. Further research in this area is need to better characterize the impact of PEEP in hemodynamics and clinical outcomes in patients with cardiogenic shock. P180 https://esc365.escardio.org/Presentation/216478/abstract Prognostic value of microhemodynamic parameters of the early post-operatory in cardiac surgery of infective endocarditis CDG Cesar Del Castillo Gordillo,1 FYV Francisca Yanez Vidal,1 MLG Marcelo Luque Gonzalez,1 AIM Anibal Ibanez Mora1 and MOG Miguel Oyonarte Gomez1 1Hospital San Borja Arriaran, Santiago, Chile Introduction: Cardiac surgery of infective endocarditis [IE] is associated with proinflammatory status and distributive hemodynamic pattern. We know how microhemodynamic parameters are altered in other distributive states, but there is little evidence regarding the postoperative period of IE. Objective: To define the value of the tests of microhemodynamic parameters after cardiac surgery of IE. Methodology: Retrospective study of older than 18 years of age and cardiac surgical due to IE between 2013 and 2017. Exclusion of IE associated with intracardiac devices and/or right valves. Epidemiological variables, microbiology and valve involvement are recorded. The microhemodynamic parameters evaluated are: arterial lactate (normal value [NV] <18.9 mg / dl), veno-arterial difference of pCO2 [CO2 gap] (NV <6 mmHg), venous oxygen saturation [vSatO2] (NV> 65%) and excess bases [EB] (NV> -2). Analysis at admission of the critical cardiac care unit (time 0), it is dichotomized between normal and altered value. Those altered values are followed at 6 hours (time 6), a 10% decrease in lactate with respect to the initial is dichotomized and normalization in the rest. Match the risk of mortality from any cause for each parameter, measured with Odd Ratio (OR), 95% Confidence Interval (CI) and p-value. <v>Result:</v> 30 subjects, average age 58.2 (standard deviation [SD] 11.7) and male gender 70% (n = 21). Microbiology: Streptococcus sp 27% (n = 8); Staphylococcus sp 23% (n = 7); and negative blood culture 33.3% (n = 10). Valvular commitment: Native 80% (n = 24); Aortic 70% (n = 21), Mitral 50% (n = 15); And 20% mitroaortic (n = 6). EUROSCORE II average 12.2% (DE 14.8). SOFA average 6.3 (SD 4.2). Global mortality per year 30% (n = 7). Parameters time 0: average arterial lactate 29.3 (OR 7.2, CI 0.7-72, p 0.09); CO2 gap 6.3 (OR 0.8, IC 0.1-4.7, p 0.8); vSatO2 77 (OR 3.3, IC 0.2-61, p 0.4) and EB -2.1 (OR 1.9, IC 0.3-12, p 0.5). Parameters time 6: 10% decrease in lactate occurs 69% (9/13 subjects) with OR 2 (CI 0.1-22, p 0.6); Normalization of the CO2 gap 38% (5/13 subjects) with OR 1.3 (CI 0.1-20, p 0.8); and of EB 27% (5/18 subjects) with OR 7.1 (CI 0.3-156, p 0.2). Non-significant results for age, sex and microbiology. Conclusion: Tendency to higher mortality related to the level of lactate alteration, SatO2 and EB, with lower impact ratio for CO2 gap. Data provide evidence for prognostic assessment and treatment guidance in infective endocarditis after cardiac surgery. Sample size would explain the absence of statistical significance. P181 https://esc365.escardio.org/Presentation/217604/abstract Severe and deadly: a decade of infective endocarditis A Azul Freitas,1 S Martinho,1 J Almeida,1 C Ferreira,1 J Milner,1 J Ferreira,1 E Jorge1 and L Goncalves1 1University Hospitals of Coimbra, Cardiology, Coimbra, Portugal Background: Although the epidemiology of Infective endocarditis (IE) has changed over the decades, mortality remains very high. Purpose: We analysed the epidemiological and prognostic trends of IE patients admitted to a large university hospital during a 12-year period. Methods: We conducted a single-centre, retrospective observational study of 169 patients from 3 distinct cohorts admitted to a tertiary cardiology centre during the following periods: cohort 1 (2005-2010; 75 patients), cohort 2 (2013; 25 patients) and cohort 3 (2015-2016; 69 patients). A 6-month follow-up was conducted. Results: The incidence increased from 15 cases/year in the 2005-2010 period to 35 cases/year in the 2015-2016 period. Mean age was 60.9 ±14.4, 60±16.1 and 64.7±13.8 years in cohort 1, 2 and 3 respectively. Male preponderance was found in all cohorts (76%, 72% and 65.2%). Mean length of hospital stay was 36±21, 42±15 and 47±31 days. Aortic valve involvement was the most frequent (53%, 39% and 50.7%) followed by mitral (35%, 22% and 22%), mitral and aortic (4%, 22% and 10%) and tricuspid (9%, 11% and 3%). Prosthetic valves were affected in 31%, 40% and 30% whereas device-related in 20%, 4% and 15% in cohort 1, 2 and 3 respectively. Regarding microbiology, S. aureus was systematically the most frequent infectious agent (15% vs. 24% vs. 24.6%). Culture-negative IE was stable (34% vs. 20% vs. 26%). Neurologic complications were frequent (7% vs. 16% vs. 13%). The proportion of patients undergoing surgery has increased with time, from 29% in cohort 1 to 52% in cohort 2 and 54% in cohort 3. Additionally, median admission time to surgery has decreased from cohort 1 (38 days) to cohort 2 (30 days) and to cohort 3 (17 days). Notwithstanding this evolution, in-hospital (36% vs. 28% vs. 28%) and 6-month (47% vs 30% vs 36%) mortality remained very high. The presence of shock was associated with a high likelihood of dying (22% vs 100%, P<0.001), whereas heart surgery was associated with a lower in-hospital mortality (5.3% vs 36%, P=0.011). Conclusions: IE continues to be associated with high mortality. In patients with a surgical indication, surgery is an important prognostic factor. In the last decade there was an increase of patients undergoing surgery which, along with early intervention, seems to contribute to the reduction of mortality. The 2009 change of recommendation for antibiotic prophylaxis did not change IE epidemiology, but its incidence has numerically increased. Open in new tabDownload slide P182 https://esc365.escardio.org/Presentation/221518/abstract Evaluation of diaphragmatic excursion as a predictor of pulmonary complications in patients subjected to cardiac surgery M Luque,1 C Ramirez,1 D Orozco,1 E Bascunan,1 P Parra,1 C Del Castillo1 and S Gatta1 1Hospital San Borja Arriaran, Santiago, Chile Introduction: In the past years, the presence of diaphragmatic dysfunction (DD) has been demonstrated in patients with mechanical ventilation (MV) and its relationship with the presence of post-operative pulmonary complications, such as atelectasis, pleural effusion and pneumonia. The aim of this study is to evaluate DD in patients subjected to cardiac surgery (CS) as a predictor of pulmonary complications. Material and methods: A prospective observational study was conducted in a Coronary Care Unit. Patients subjected to cardiac surgery were included between April and August, 2018. Non-cardiac surgeries, minimally invasive procedures and device implantation were excluded. Using M-mode ultrasound with a 10-12 MHz transducer. Thhe excursion and diaphragmatic thickness were assessed on the 9th -10th intercostal space in the anterior axillary line. The measurement was made at the maximum inspiration before extubation and then daily until the discharge of the unit. Each one of them was made by physicians and physiotherapists. The normal diaphragmatic excursion was considered as > 2.5 cm. Pulmonary complications were documented by radiography and / or chest CT. T-student was used for parametric variables and wilcoxon for non-parametric variables. Results: 24 patients were included (56% men, mean age 66.2 ± 8.2 years), surgery more frequent in both groups was CABG (33.3%) and aortic valve replacement 25%. Patients were assigned to group A (<2.5 cm, n = 10) or group B (> 2.5 cm, n = 14). Patients in group 1 showed a longer time of extracorporeal circulation (81.57 ± 18.06 vs 64.64 ± 17.32, p 0.03), with no age difference (65.7 ± 8.5 versus 66.5 ± 7.92 years, p 0.81). All patients were extubated between 6 and 8 hours after admission to the unit, none required reintubation. The group B is associated with a lower number of events of basal atelectasis and pleural effusion (table 1). Table 1. . Group A ( < 2.5 cm) . Group A ( > 2.5 cm) . p-value . Pleural effusion 7 2 p < 0.01 Basal atelectasis 6 2 p < 0.01 Pleural drainage 3 0 p = 0.059 . Group A ( < 2.5 cm) . Group A ( > 2.5 cm) . p-value . Pleural effusion 7 2 p < 0.01 Basal atelectasis 6 2 p < 0.01 Pleural drainage 3 0 p = 0.059 Open in new tab Table 1. . Group A ( < 2.5 cm) . Group A ( > 2.5 cm) . p-value . Pleural effusion 7 2 p < 0.01 Basal atelectasis 6 2 p < 0.01 Pleural drainage 3 0 p = 0.059 . Group A ( < 2.5 cm) . Group A ( > 2.5 cm) . p-value . Pleural effusion 7 2 p < 0.01 Basal atelectasis 6 2 p < 0.01 Pleural drainage 3 0 p = 0.059 Open in new tab Conclusions: The group that exhibited the lowest diaphragmatic excursion was associated with a greater number of pulmonary complications during the postoperative period. The evaluation of the diaphragmatic excursion is an easy method to apply. Within the limitations of the study are the small sample number; a large-scale study is needed to conclusively answer its true usefulness. P183 https://esc365.escardio.org/Presentation/221532/abstract Trends of clinical features in octogenarian patients in the coronary unit B Olivares Martinez,1 M Garcia Del Rio,1 T Seoane Garcia,1 I Fernandez Valenzuela,1 N Garcia Gonzalez,1 IR Martinez Primoy,1 B Lorenzo Lopez,1 FJ Cortes Cortes,1 JC Garcia Rubira1 and RJ Hidalgo Urbano1 1University Hospital of Virgen Macarena, Cardiology, Seville, Spain Introduction: Elderly population is a growing group due to increase in life expectancy, with more comorbidities than younger patients, which are independent predictors of mortality. Despite recent advances, there is still little evidence regarding the most appropriate management of elderly patients. Material and methods: Cross-sectional study of patients older than or equal to 80 years admitted at a Coronary Unit (CU) in 2008 and 2018, registering comorbidities, causes of admission, complications, techniques employed and death rate. Results: 148 patients were included (median age 83 ± 4 years, male 52%): 74 in 2008 and other 74 on 2018 group. The most frequent comorbidity was arterial hypertension (84%), more prevalent in 2018 (90% vs. 78%; p value = 0,04). The median length of stay at CU was 4 ± 5 days, similar between both groups. The most frequent reason for admission was ACS (52% of total patients; 63.5% in 2018 and 40.5% in 2008). Heart failure as a cause of admission increased from 5.4% to 20.3% since 2008 to 2018. The most frequent complication was heart failure (36%); followed by respiratory failure (31%). 14% of the global group required Non-Invasive Mechanical Ventilation (NIMV) and 18%, Orotracheal Intubation (OI). Use of NIMV increased from 9 to 19% since 2008 to 2018 and OI from 12% to 24% (p value = 0.019). 75% of included patients underwent some interventional technique: 41.2% therapeutic catheterization, 12.2% diagnostic catheterization, 16.9% temporary or definitive pacemaker implantation (p value: non-significant). Death rate in global simple was 20%, which is higher along 2018 (27% versus 12%, p value = 0.02). Conclusion: Over the years, we have experienced a population aging, which translate into patients with greater number of comorbidities. Higher prevalence and advances about heart failure management have led to a higher percentage of admissions due to this disease. Despite the use of invasive techniques, mortality remains high, so additional studies are needed in order to help us treat the elderly patient. Coronary Intervention P187 https://esc365.escardio.org/Presentation/221104/abstract Transradial access through the anatomical snuffbox: Preliminary results of a feasibility study. G Tsigkas,1 A Papageorgiou,1 A Moulias,1 I Ntouvas,2 K Stavrou,1 A Apostolos,1 G Vasilagkos,1 A Papanikolaou,1 S Despotopoulos,1 N Grapsas,3 G Hahalis1 and P Davlouros1 1University Hospital of Patras, Department of Cardiology, Patras, Greece 2University Hospital of Patras, Department of Vascular Surgery, Patras, Greece 3St Andrews General Hospital of Patras, Department of Cardiology, Patras, Greece Introduction: The most recent guidelines suggest that transradial access is the gold standard for patients undergoing coronary angiography or angioplasty, especially for those suffering from acute coronary syndrome. A novel approach is the distal transradial approach (dTRA), through the anatomical snuffbox (AS). Purpose: The aim of this study is initially to record the patients that underwent catheterization through the dTRA. Moreover, it focuses on the success rate of the procedure or the need for crossover, on the possible local complications, on the time for hemostasis and finally on the incidence of radial artery occlusion (RAO). Methods- Materials: Α total of 167 consecutive patients were candidate for catheterization through the dTRA from November 2018 to March 2019. A predesigned protocol that consisted of at least 3 punctures or a maximum effort of 5 minutes was applied. The access through the AS was successful at 152 (91.0%) patients: 123 (80.9%) were men, 29 (19.1%) were women. The patients’ mean age was 64±12 years. The indication for catheterization was acute coronary syndrome (ACS) in 74 patients (48.7%), stable coronary artery disease (CAD) in 46 patients (30.3%) and other reasons in the rest 32 patients (21.0%). Of the 167 patients, 50 underwent angioplasty. Results: In 62 (40.8%) of those patients, vascular access site complications were tested by ultrasound, about 40±15 days after the procedure. Among them, 2 patients (3.2%) were diagnosed with arteriovenous communication and 2 (3.2%) with local occlusion at the puncture site, but with a normal radial artery flow proximal to the radial styloid process. The mean time of the hemostatic device was 50±10 minutes and there was no need for crossover in any case, after the sheath placement. Conclusion: The dTRA should be considered as an alternative access site for performing diagnostic and interventional coronary procedures, given the fact that it appears to have only few, mainly local complications, without any major clinical importance. In the meanwhile, it decreases dramatically the incidence of RAO, requires shorter hemostasis and thus quicker patients’ mobilization. P188 https://esc365.escardio.org/Presentation/216741/abstract The quality of life in patients with coronary artery disease before and after revascularizatoin Y Borkhalenko,1 O Zharinov,2 O Yepanchintseva1 and B Todurov1 1Heart Institute of the Ministry of Healthcare of Ukraine, Kyiv, Ukraine 2Shupyk Natoinal Medical Academy of Postgraduate Education, Kiev, Ukraine The aim of the study was to compare the changes of the values of quality of life (QoL) in patients with stable coronary artery disease and preserved left ventricular (LV) ejection fraction (EF) within 6 months after revascularization interventions (coronary artery bypass grafting – CABG, or percutaneous coronary intervention - PCI) and to identify the factors that may affect QoL changes. Materials and methods: A single-center prospective study included data from a clinical, instrumental and laboratory examination of 115 patients with CAD and preserved LV systolic function (LVEF ≥ 45%) consecutively selected for CABG (n = 71) or coronary stenting (n = 44). QoL was assessed by MLHFQ, SAQ and SF-36 questionnaires before and 6 months after myocardial revascularization. Also, changes in the distance of 6-minute walking test, Doppler echocardiographic indices of the LV diastolic function and the level of the brain natriuretic peptide (BNP) were analyzed. Results: After 6 months of follow-up in the study groups, the levels of QoL according to MLHFQ, SF-36 and SAQ scores significantly improved, compared to the baseline data (p <0.001). In both groups there was a decrease of the functional class of angina by the Canadian classification (p <0.001). There were no significant differences in the manifestation of stable angina pectoris in the compared groups after 6 months (p = 0.237). Improvement of QoL was associated with decrease of the BNP level from baseline 108.8 (50.1-185.4) pg / ml to 32.3 (12.6-57.8) pg / ml in the stenting group (p = 0.002) and from 115.4 (62.0-150.6) pg / ml to 52.4 (20.4-95.9) pg / ml in the CABG group (p <0.001). The distance of the 6-minute walk test in the stenting group increased from 223 (148-328) m to 550 (400-600) m; in the CABG group this distance was, respectively, 260 (195-300) m and 550 (415-600) m. Conclusions: Thus, in patients with stable ischemic coronary disease and preserved LV systolic function after coronary artery stenting or CABG, a significant improvement of QoL values was observed, compared to the baseline data. Favorable changes in QoL may be due to a decrease of angina pectoris, improvement of the Doppler echocardiographic parameters of LV diastolic function and functional status of the patients. The above-mentioned changes were associated with decrease of the BNP level. P189 https://esc365.escardio.org/Presentation/221289/abstract Elevated copeptin might predict cardiac events in patients with verified periprocedural myocardial injury after elective percutaneous coronary intervention- results of a pilot study. S Boskovic,1 A Karalejic,1 V Maravic-Stojkovic,1 P Otasevic1 and M Bojic1 1Dedinje Cardiovascular Institute, Belgrade University School of Medicine, Belgrade, Serbia Background: Myocardial injury and infarction defined as a significant rise in cardiac troponin (cTn) after elective percutaneous coronary interventions (PCI) are relatively frequent. However, definitions of this complication, use of different cut-of points for cTn values and its clinical importance are still matter of debate. Purpose: To assess whether adding copeptin in determination of myocardial injury definition can be used for prediction of major adverse cardiovascular events (MACE) in patients with already significantly elevated cTn after elective PCI Methods: Overall, 52 patients with elective PCI and signs of myocardial injury/infarction were included in this prospective, single-centre study. Significant cTn rise was defined as a ≥5x of 99th% of upper reference limit (URL) within first 24 hours after PCI. Copeptin was measured in all patients with positive cTn 6 hours after intervention. Copeptin value of 14 pmol/lit was considered to be elevated an all patients were divided according to this value in 2 groups: group 1 (copeptin ≤ 14 pmol/lit) and group 2 (copeptin > 14 pmol/lit). All patients were followed for cardiac events for 2 years. Primary outcome was defined as a composite of death, non-fatal myocardial infarction and hospitalization for cardiac reasons. Results: Of 52 patients with significant rise of cTn, 19 had copeptin values ≤ 14 pmol/lit (group 1) and 33 (group 2) had values of > 14 pmol/lit. Patients did not differ in baseline characteristics apart of age (group 1- 58.2+10.9 vs. group 2- 65.5+12.2 years, p=0.03). Also, there was no difference in number of vessel treated (group 1-1.26+0.45 vs. group 2-1.42+0.63, p=0.304) and total number of implanted stents (group 1- 1.58+0.67 vs. group 2-1.76+1.25, p= 0.493). Noticeably, peak values of cTn were significantly higher in those with elevated copeptin, (8.38+15.62 vs 2.84+4.22, p=0,026, but with high diversity of absolute values. Although incidence of observed complications after PCI seemed higher in group 2 it did not reach statistical significance (group 1- 5/19, 26.3% vs group 2 18/33, 54.5%, p=0.24). Overall, 17 primary outcome events were identified during follow up period. Incidence of death (group 1- 0/19, 0% vs. group 2- 4/33, 12.1%, p=0.284).and non-fatal myocardial infarction (group 1- 0/19, 0% vs. group 2- 3/33, 9.1%, p=0.312).was low, but showed increased trend of events in patients with copeptin > 14 pmol/lit. There was significant difference in primary outcome according to pre specified copeptin groups (group 1- 2/19, 10.5% vs. group 2- 15/33, 45.4%, p=0.014). Also, proportion of patients free of death, non-fatal myocardial infarction and hospitalization for cardiac reasons during follow up was significantly lower in those with copeptin > 14 pmol/lit. (54.6% vs 89.5%, log rank 0.013). Conclusion: Copeptin might be a valuable marker of cardiovascular event prediction in patients experiencing myocardial injury after elective PCI. P190 https://esc365.escardio.org/Presentation/216438/abstract Hemodynamics during Impella-protected PCI in high risk patients with reduced ejection fraction and multi-vessel disease T De Ferrari,1 P Meani,1 G Viola,1 N Morici,1 A Sacco,1 F Soriano,2 S Nonnini,3 M Bottiroli,3 A Calini,3 J Oreglia2 and F Oliva1 1ASST Great Metropolitan Niguarda, Niguarda Cardiocenter, UCIC, Milan, Italy 2ASST Great Metropolitan Niguarda, Niguarda Cardiocenter, Cath Lab, Milan, Italy 3ASST Great Metropolitan Niguarda, Niguarda Cardiocenter, Cardio-thoracic ICU, Milan, Italy Background: Percutaneous ventricular assistance by Impella is an emerging strategy to manage patients with reduced left-ventricular ejection fraction (LVEF) and complex coronary anatomy undergoing percutaneous coronary intervention (PCI). However, scanty data are nowadays available on hemodynamic behave during Impella-protected PCI. Purpose: In the prospective single-center study we investigated the Impella related hemodynamic changes in a consecutive series of high-risk patients who underwent Impella-protected PCI monitored by Pulmonary Artery catheter (PAC). Furthermore, secondary endpoints included safety, efficacy related to the device and patients in-hospital outcomes. Methods: In this prospective single-center study we enrolled all patients undergoing elective high-risk PCI with Impella prophylactic support (CP or 2.5). Inclusion criteria were LVEF ≤ 35% and anatomic coronary artery disease complexity. Swan-Ganz catheter and Impella were placed respectively through the internal jugular vein and left femoral artery. Hemodynamic parameters (RAP, s/d/mPAP, PCWP, SaO2, SvO2, CO-FICK) were systematically acquired during the procedure (Pre-PCI: Baseline, Impella with maximum flow; Post-PCI: Impella with maximum flow and Impella with minimum flow). Finally, In- hospital clinical and laboratory data were collected. Results: We enrolled 6 consecutive patients from September 2018 to September 2019. All patients had severe left ventricular dysfunction (LVEF = 29±6%) and multi-vessel coronary disease. Before coronary revascularization (Pre-PCI), Impella significantly decreased the PCWP (12.7±7.5 mmHg vs 9.0±5.8 mmHg, p=0.005). On the contrary, cardiac output significantly increased (4.1±0.9 l/min vs 5.2±0.8 l/min, p=0.044). However, at Post-PCI with Impella minimum support, PCWP slightly increased (9.8±2.8 mmHg vs 11.6±3.8 mmHg, p=0.195) and CO decreased (4.3 ± 0.3 l/min vs 3.8 ± 0.4 l/min, p=0.007). The mean treated coronary lesions were 2,6. Five patients were weaned off. However: two in-hospital MACE were observed: one patient died during the HR PCI, one had a peri-procedural myocardial infarction. Five out of six patients were successfully discharged. Conclusions: In patients with reduced LVEF and multivessel disease, the Impella showed a significant hemodynamic improvement in terms of left ventricle unloading and cardiac output. This hemodynamic benefit might positively impact on short-term angiographic, procedural and clinical outcomes. Further, invasive studies are needed. Figure 1. Open in new tabDownload slide PCWP an CO-FICK changes. Coronary Intervention: Primary and Acute PCI P191 https://esc365.escardio.org/Presentation/216734/abstract Results of percutaneous coronary intervention in de-novo coronary lesions with second-generation drug-coated balloons at a long-term follow-up. J Abellan-Huerta,1 I Sanchez Perez,1 F Lozano,1 P Perez-Diaz,1 M Negreira-Caamano,1 R Frias-Garcia,1 A Moron-Alguacil,1 J Martinez-Rio,1 VM Garcia-Munoz1 and MT Lopez-Lluva1 1Hospital General de Ciudad Real, Interventional Cardiology, Ciudad Real, Spain Introduction: Drug coated balloons (DCB) currently constitute one of the therapeutic tools used in percutaneous coronary interventions (PCI) of “De Novo” coronary lesions, mainly in bifurcations and small vessels. Nowadays, their results at a long-term follow up are unclear. Purpose: We aim To evaluate the efficacy and safety of second-generation drug coated balloons in “De Novo” coronary lesions at a long term follow-up. Methods: We prospectively included 198 lesions in 175 patients (67.5 ±12 years, 74.9% male) with “De Novo” lesions treated with DCB between March 2009 and March 2018. Additional bare metal stent (BMS) or drug eluting stent (DES) was implanted after DCB if the result was not satisfactory because of dissection, recoil or significant residual stenosis. We evaluated the presence of major cardiac events (MACE) after a clinical follow up (median 33 months): death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR) and thrombosis. Results: 43.3% of the patients had stable coronary artery disease, and 56.7% acute coronary syndromes (43.3% non-STEMI and 13.4% STEMI). 44.4% were diabetic patients, 75.3% had hypertension and 52.2% had dyslipidemia. 31.8% of lesions were bifurcations, 25.2% diffuse and 46.7% type B2/C lesions. Mean vessel diameter and lesion length were 2.5 ± 0.7 mm and 19.1 ± 8 mm, respectively. Coated drug was paclitaxel in 91.2% of lesions, and sirolimus in the remaining 8.8%. 72.6% of lesions were treated with DCB, 13.3% with DCB and BMS and 14.1% with DCB and DES. There were no significant differences regarding baseline characteristics of these three groups neither in the MACE rate after follow-up (p=0.5). Death rate was 6.1% (1.7% cardiovascular death, 4.4% non-cardiovascular death), nonfatal MI was 4.4% and TLR rate was 2.8% during follow-up. No cases of thrombosis were observed. We did not observed a higher need for additional stent after DCB in complex lesions (p=0.7) such as diffuse lesions (p=0.8), bifurcation lesions (p=0.7) or in vessel which diameter was 2.5 mm or less (p=0.5). Angiographic follow-up was 15%. Conclusions: Percutaneous coronary intervention of “De Novo” coronary lesions with second-generation drug eluting balloon offers very favorable results at a long-term follow up. There was not a higher need for additional stent in cases of small vessel or diffuse and bifurcated lesions. P192 https://esc365.escardio.org/Presentation/216456/abstract Mechanical thrombectomy in combination with glycoprotein IIb/IIIa inhibitors with or without stent implantation in patients presenting with STEMI and high thrombus burden K Kintis,1 CHR Mantis,2 E Papadakis,1 D Antonatos,1 K Thomopoulos,3 M Koutouzis,4 CH Armonis,2 I Tsiafoutis,4 A Poulianitou,2 V Kyriakopoulos,2 K Dimitriadis5 and S Patsilinakos2 1Konstantopoulio General Hospital, Athens, Greece 2Konstantopoulio General Hospital, Cardiology, Athens, Greece 3General-Maternity District Hospital Elena Venizelou, Athens, Greece 4Hellenic Red Cross Hospital, Cardiology, Athens, Greece 5Hippokration General Hospital, Cardiology, Athens, Greece Background/Introduction: High thrombus burden is an independent risk factor for death and complications, including no reflow, during primary percutaneous coronary intervention (PCI) for STEMI. Purpose: The aim was to investigate whether a strategy of mechanical thrombectomy in combination with glycoprotein IIb/IIIa inhibitors without stent implantation is associated with a reduced incidence of slow- or no-reflow, and other thrombotic complications compared with stenting in patients with high thrombus burden. Methods: A total of 210 patients with STEMI and high thrombus burden treated with thrombus aspiration in combination with glycoprotein IIb/IIIa inhibitors with or without stent implantation. Patients were divided into 2 groups: non-stent PCI group (n = 105) and stent PCI group (n = 105). We assessed angiographic and electrocardiographic signs of myocardial reperfusion, as well as clinical outcomes. The end points were a myocardial blush grade of 0 or 1 (defined as absent or minimal myocardial reperfusion, respectively) and the postprocedural frequencies of a TIMI flow grade of 3, 48 hours after primary PCI, complete resolution of ST-segment elevation immediately after primary PCI, target vessel revascularization, reinfarction, death, and the combination of major adverse cardiac events by 30 days after randomization. Results: A myocardial blush grade of 0 or 1 occurred in 26.3% of the patients in the stent PCI group and in 17.1% of those in the non-stent PCI group (p < 0.05). Complete resolution of ST-segment elevation occurred in 86.6% and 78.2% of patients, respectively (p = 0.35). At 30 days, the rate of death in the stent PCI group and non-stent PCI group was 1.7%, and 1.0%, respectively (p = 0.33), and the rate of adverse events was 12.1% and 2.2%, respectively (p < 0.01). Conclusions: Mechanical thrombectomy in combination with glycoprotein IIb/IIIa inhibitors without stenting is applicable and effective method in a large majority of patients with myocardial infarction with ST-segment elevation and high thrombus burden. It results in better reperfusion outcomes than conventional PCI with stent, irrespective of clinical and angiographic characteristics at baseline. P193 https://esc365.escardio.org/Presentation/216440/abstract Immediate and long-term predictors of outcomes in left main percutaneous coronary intervention: a center experience CC Oliveira,1 C Braga,1 I Campos,1 P Medeiros,1 C Pires,1 R Flores,1 F Mane,1 J Costa1 and J Marques1 1Hospital de Braga, Braga, Portugal Introduction: Acute myocardial infarction due to left main (LM) coronary artery disease is associated with significantly elevated morbidity and mortality. Purpose: To identify the immediate and long term predictors of death after LM percutaneous coronary intervention (PCI). Methods: Single-center, retrospective study performed from January 2015 to December 2017 in patients with LM coronary artery disease in which PCI was performed and died during hospitalization or follow-up (n= 17). Patients’ background characteristics and angiographic findings were analyzed. Results: During the analyzed period, it was performed 67 LM PCIs. Patients with LM PCI were mainly male (68.7%) with median age of 70.1 years. STEMI and NSTEMI ongoing instability were the main indications for PCI. 22.4% of patients were in cardiogenic shock (n=15). During hospitalization, 10 patients died. 60% of those were male and the median age was of 71.1 years. 60% of the patients had intermediate or high SYNTAX score. The main predictors of death at hospital in this population were cardiogenic shock (p<0.001), reduced ejection fraction (p<0.05) and the indication for PCI (p<0.05). 90% of patients who died were in cardiogenic shock. Among patients in cardiogenic shock, diastolic blood pressure value and complete left bundle branch were predictors of bad prognosis (p<0.05). No other differences were found between patients in cardiogenic shock that lived or died, but it is important to highlight the low number of patients (9 deaths vs 6 surviving patients). Patients were followed for at least 1 year. At follow-up, 7 patients died. The main predictors of long term death were chronic kidney disease and age (p< 0.05). 85% of deaths at follow-up were non-cardiovascular. Target lesion failure occurred in a low percentage of patients (5.97%) – 1 patient had acute stent thrombosis and 3 had stent restenosis. Conclusions: Elective angioplasty of LM in selected patients was associated with a high immediate success rate. In the same patients, the incidence of major cardiac events during follow-up was relatively low and deaths were mainly non-cardiovascular reflecting the age of patients which was a predictor of death. As expected, cardiogenic shock was associated with a higher mortality. Neverthless, early revascularization remains the cornerstone of the management of patients with ischemic cardiogenic shock and PCI may allow prompt restoration of coronary flow that would not be possible otherwise. Coronary Intervention: Restenosis P194 https://esc365.escardio.org/Presentation/216735/abstract Results of percutaneous coronary intervention with second-generation drug coated balloons at a long-term follow-up. J Abellan-Huerta,1 I Sanchez Perez,1 MT Lopez-Lluva,1 P Perez-Diaz,1 M Negreira-Caamano,1 R Frias-Garcia,1 J Martinez-Rio,1 A Moron-Alguacil,1 J Piqueras-Flores1 and F Lozano1 1Hospital General de Ciudad Real, Interventional Cardiology, Ciudad Real, Spain Introduction: Drug coated balloons (DCB) currently constitute one of the therapeutic tools used in percutaneous coronary interventions (PCI) of both stent restenosis and “De Novo” coronary lesions, mainly in bifurcations and small vessels. Nowadays, their results at a long-term follow up are unclear. Purpose: The main objective of this study was to evaluate the efficacy and safety of second-generation drug coated balloons (DCB) at a long term follow-up. Methods: We prospectively included 426 lesions in 346 patients (66.9± 12 years, 75.5% male) treated with DCB between March 2009 and March 2018. We evaluated the presence of major cardiac events (MACE) after a clinical follow up (median 32 months): death, nonfatal myocardial infarction, target lesion revascularization (TLR) and thrombosis. Results: 46.1% of patients had stable coronary artery disease, and 53.9% acute coronary syndromes (45.9% non-STEMI and 8% STEMI). 49.9% were diabetic patients, 80.5% had hypertension, 60.8% had dyslipidemia and 20.8% of lesions were bifurcations. Target lesion diameter was 2.5 mm or less in 52.3% of cases. Of 426 lesions, 44.7% were “De Novo” lesions and 55.3% were restenosis [40.4% restenosis of bare metal stent (BMS) and 14.9% of drug-eluting stent (DES)]. 82.3% of lesions were treated with DCB, 6.2% with DCB and BMS and 11.5% with DCB and DES. Death rate was 8.1% (2.9% cardiovascular death, 5.2% non-cardiovascular death), nonfatal MI rate was 4% and TLR rate was 4.5% during follow-up. Diabetic patients showed a higher incidence of MACE (9.8% vs 2.9%; p=0.05) and a higher incidence of cardiovascular death (5.4% vs 0.5%; p=0.03) at follow-up. No cases of thrombosis were observed, immediately after the procedure nor during follow up. Angiographic follow-up was 16.6%. Conclusions: Percutaneous coronary intervention of “De Novo” coronary lesions and in-stent restenosis (both BMS and DES) with second-generation drug eluting balloons provide very favorable outcomes at a long-term follow-up. However, diabetic patients presented more incidence of MACE and cardiovascular death during follow-up. P195 https://esc365.escardio.org/Presentation/216725/abstract Percutaneous coronary intervention of in-stent restenosis lesions with second-generation drug coated balloons: Results at a long-term follow-up. I Sanchez Perez,1 J Abellan-Huerta,1 MT Lopez-Lluva,1 P Perez-Diaz,1 M Negreira-Caamano,1 R Frias-Garcia,1 J Martinez-Rio,1 A Moron-Alguacil,1 VM Munoz-Garcia1 and F Lozano1 1Hospital General de Ciudad Real, Interventional Cardiology, Ciudad Real, Spain Introduction: Drug coated balloons (DCB) currently constitute one of the therapeutic tools used in percutaneous coronary interventions(PCI) of in-stent restenosis lesions. Nowadays, their results at a long-term follow up are unclear. Purpose: To evaluate the efficacy and safety of second-generation drug coated balloons (DCB) over in-stent restenosis at a long term follow-up. Methods: We prospectively included 250 lesions in 203 patients (66 ± 12 years, 76.1% male) with restenotic lesions treated with DCB between March 2009 and September 2018. We evaluated the presence of major cardiac events (MACE) after a clinical follow up (median 33 months): death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR) and thrombosis. Results: 48.6% of patients had stable coronary artery disease, and 51.4% acute coronary syndromes (47.8% non-STEMI and 3.6% STEMI). 53.4% were diabetic patients, 85% had hypertension and 67% had dyslipidemia. 12.5% of lesions were bifurcations. 49.7% were focal restenosis (type IA or IC of Mehran classification) and 50.4% were diffuse restenosis (type II or IV). 73.5% were bare metal stent (BMS) restenosis and 26.5% were drug-eluting stent (DES) restenosis. Predilation at high atmospheres was performed in 87.5% of patients with a balloon/stent diameter ratio of 1-1.5. DCB inflation was performed at a mean pressure of 17.2 ± 2.3 atm during at least 45 seconds. Coated drug was paclitaxel in the 91.1% of lesions, and sirolimus in the remaining 9.9%. An additional stent was implanted after DCB in the 11.2% of the restenosis. When comparing BMS vs DES restenotic lesions, there were no significant differences regarding baseline characteristics neither in the MACE rate after follow-up(p=0.08). Death rate was 9% (3.6% cardiovascular death, 5.4% non-cardiovascular death), nonfatal MI rate was 3.6% and TLR rate was 6.7% during follow-up. No cases of thrombosis were observed, immediately after the procedure nor during follow up. We did not observe a higher incidence of MACE (p=0.07) or need for additional stent after PCI in BMS vs DES restenosis (p=0.5). Angiographic follow-up was 18.3%. Conclusions: Despite the presence of both clinical and angiographic unfavorable risk factors, PCI with second-generation drug eluting balloon in BMS and DES in-stent restenotic lesions provide a very good results at a long-term follow up. Echocardiography P198 https://esc365.escardio.org/Presentation/216746/abstract Valvular and aortic involvement of patients with bicuspid aortic valve : an echocardiographic study S Serbout,1 A El Adaoui,1 L Azzouzi1 and R Habbal1 1Ibn Rochd University Hospital, Casablanca, Morocco Background: Bicuspid aortic valve (BAV) is the most common congenital cardiac abnormality, affecting approximately 1-2% of the general population(1,2),which 75% of them are male. Methods: A retrospective study had been performed from novembre 2018 until june 2019 in the department of Cardiology to assess the evolution of valvular and aortic involvement in patients with BAV. A total of 106 patients with BAV were included during a follow-up of 10 years. Aortic dimensions and other echocardiographic parameters were obtained from the echocardiography database. Results: Patients with BAV were mainly male (75,5%), with a mean age of 50 ± 15 years. we notice a majoration of the number of patients with AS over time (p < 0,001),with an involvement of TTE parameters of AS,this progression was significantly higher(p = 0.0025)in subjects with AS at inclusion:16cm/s/year against 4.6cm/s/y and an mean gradient of 3.5mmHg/year against 0.6mmHg/y.Whereas the progression of dilatation of sinus of Valsalva(SV)and tubular ascending aorta(TAA),was also more important in patients with AS at inclusion compared with those who had not,aortic diameters between the 1st and the last control,SV:0,17- 0,3 mm/year,TAA :0,32 - 0,6 mm/year. A significant progression of aortic dimeter was obreserved in patients with a small aorta at inclusion compared of others. Conclusion: This study reinforces the fact that clinical and echographic surveillance of these patients,even if they are asymptomatic,thus fundamental and necessary to better prevent complications. Table 1. Clinical characteristics of patients. . Population (n°106) . . . Age (years) 50± 15 Gender 80 (75.5%) HBP 54 (50.9%) smoking 15 (14.2%) Diabets 36 (34%) Dyslipidemia 23 (21.7%) CAD 13 (12.3%) Stroke 12 (11.3%) NHYA I-II 104 (98.1%) NYHA III-IV 2 (1.9%) variables 1ST Echocardiography Last control p SV(mm) 38 ± 6 40 ± 6 < 0.001 TAA 38 ± 6 41 ± 6 < 0.001 . Population (n°106) . . . Age (years) 50± 15 Gender 80 (75.5%) HBP 54 (50.9%) smoking 15 (14.2%) Diabets 36 (34%) Dyslipidemia 23 (21.7%) CAD 13 (12.3%) Stroke 12 (11.3%) NHYA I-II 104 (98.1%) NYHA III-IV 2 (1.9%) variables 1ST Echocardiography Last control p SV(mm) 38 ± 6 40 ± 6 < 0.001 TAA 38 ± 6 41 ± 6 < 0.001 Open in new tab Table 1. Clinical characteristics of patients. . Population (n°106) . . . Age (years) 50± 15 Gender 80 (75.5%) HBP 54 (50.9%) smoking 15 (14.2%) Diabets 36 (34%) Dyslipidemia 23 (21.7%) CAD 13 (12.3%) Stroke 12 (11.3%) NHYA I-II 104 (98.1%) NYHA III-IV 2 (1.9%) variables 1ST Echocardiography Last control p SV(mm) 38 ± 6 40 ± 6 < 0.001 TAA 38 ± 6 41 ± 6 < 0.001 . Population (n°106) . . . Age (years) 50± 15 Gender 80 (75.5%) HBP 54 (50.9%) smoking 15 (14.2%) Diabets 36 (34%) Dyslipidemia 23 (21.7%) CAD 13 (12.3%) Stroke 12 (11.3%) NHYA I-II 104 (98.1%) NYHA III-IV 2 (1.9%) variables 1ST Echocardiography Last control p SV(mm) 38 ± 6 40 ± 6 < 0.001 TAA 38 ± 6 41 ± 6 < 0.001 Open in new tab P199 https://esc365.escardio.org/Presentation/216433/abstract Experience of using FOCUS in a multidisciplinary hospital. O Dzhioeva1 1Russian National Research Medical University, Moscow, Russian Federation Currently, we have several EACVI\ESC position paperes on the use of mobile ultrasound devices and the FOCUS echocardiography in clinical practice. The FOCUS Protocol does not replace the expert echocardiographic Protocol, but it is an important part of the modern doctor’s examination, the so-called “phonendoscope with eyes”, which allows to optimize the time of examination of the patient. The purpose of the study: to assess the possibility of saving time when making a decision during the doctor’s duty shift in a multidisciplinary hospital. Results: during the night shift in the hospital as a cardiologist, consultations were carried out with patients of non-cardiac profile or with an unclear diagnosis using hand ULTRASOUND system LUMIFY. We compared the time spent from the initial consultation to the decision on the tactics of patient management with the use of a HUD by the doctor and without it. We consulted patients admitted to the hospital with dyspnea of unknown origin, patients with shock, in the surgical clinic we consulted patients with nonspecific complaints and ECG changes in the early postoperative period. When using a mobile ULTRASOUND system, the decision-making time was reduced by an average of 80 minutes. In the case of non-use of HUD, the delay was caused by calling diagnostic services and waiting for the Protocol of conclusions. Conclusion: the use of mobile devices is an important additional arsenal of the doctor in the clinics providing emergency care. P201 https://esc365.escardio.org/Presentation/217216/abstract Characterization of the population with infectious endocarditis and its evolution over the years. A Briosa,1 A Esteves,1 A Marques,1 AR Pereira,1 S Alegria,1 D Sebaiti,1 AL Broa,1 I Cruz1 and H Pereira1 1Hospital Garcia de Orta, Lisbon, Portugal Introduction: Despite advances in medicine and constant updates in the literature, infectious endocarditis (IE) remains a major cause of morbimortality in patients with valvular pathology. Aim: Characterization of the population with IE over 12 years (2006-2017) and assessment of changes regarding epidemiology and unfavorable outcomes (morbidity and mortality) over the years. Methods: Retrospective single center study that included patients (pts) with presumed / confirmed IE in the last 12 years. To evaluate the changes suffered over the years, the population was divided into two groups: group 1, which included patients from 2006 to 2011, and group 2, which included patients from 2012 to 2017. Results: Included 174 pts, 75% (n = 131) males, with a mean age of 61 ± 16 years. 41.3% (n = 75) had previous valvular disease, mainly due to degenerative cause(24.4%), 54% had hypertension, 25.3% heart failure (HF), 13, 8% lung disease (LD), 20.2% liver disease (LiD) and 12.8% had HIV infection. At admission, 53.5% had auscultation murmur (n = 91) and 47.9% had anemia. Native valve IE occurred in 74.1% of cases, with the aortic valve being the most affected (54%). The most frequent isolated agent was Staphylococcus aureus (24.7%, n = 43), and in 20.1% of the cases there was no isolation in blood cultures. The main complication developed was heart failure (42.1%), and there were embolic complications in 33.9% of cases. Mortality rate was 29.9%, and septic shock was the leading cause of death (35.6%). Group 2 had a higher incidence of hypertension (63% vs 39.4%, p = 0.002) but less comorbidities such as: LD (9.3% vs 21.2%, p = 0.027), LiD (12.1% vs 33.3%, p = 0.001) or HIV infection (8.5% vs 19.7%, p = 0.032). At admission, most of group 2 pts had anemia (66% vs 19.7%, p <0.001), with no differences regarding the presence of fever or murmur on auscultation. Still, there seems to be a statistical tendency for these pts not to have a murmur as an initial sign. Although there were no differences between the two groups regarding the type or location of the affected valve, there were fewer cases associated with prosthetic valves implanted less than 1 year ago (6.8% vs 36.8% p = 0.006) in group 2. S. aureus remained the main isolated agent in both populations. Regarding morbidity, there was a decrease in complications due to heart failure (32.4% vs 57.6%, p = 0.001) and embolization (27.6% vs 43.9%, p = 0.028), namelycerebral (40.5% vs 76.9%, p = 0.022) in pts of group 2. However, there was no reduction in mortality or long-term survival in either group. Conclusion: For the studied population, there were no significant clinical or epidemiological changes over the years, with Staphylococcus remaining the most common agent. Although mortality remains unchanged, there has been a lower incidence of long-term complications, namely HF or embolization, which warns us for the importance of an early diagnosis and treatment in preventing complications. P202 https://esc365.escardio.org/Presentation/216506/abstract Value of speckle tracking Echocardiography in detection clinically silent left ventricular systolic dysfunction in diabetic patients A El Gohary1 1research institute, Giza, Egypt Introduction: Diabetic patients with normal left ventricular ejection fraction are frequently associated with diastolic dysfunction .Speckle tracking is more sensitive than LVEF in detection subclinical LV systolic dysfunction However, it is not clear whether there is any difference in early LV systolic dysfunction between DM patients if they have controlled or uncontrolled blood glucose, and what is the duration of DM that contributes to preclinical impairment of LV systolic function. Aim: Detection of different patterns of global longitudinal strain in diabetic patients using global longitudinal strain by speckle tracking and trying to specify the time needed for DM to affect LV systolic function. Methods: fifty two diabetic patients had been referred from internal medicine clinic after they had been tested for HBA1c test and stratified into two groups Group І: it include26 DM patients (< or > five years) with controlled blood sugar. Group II: it include26 DM patients (< or > five years) with uncontrolled blood sugar. The two groups had been subjected to the following diagnostic workup: Full medical history, full clinical examination, laboratory assessment, twelve lead resting ECG,Stress ECG, Echocardiography study, Traditional Tissue Doppler imaging,Assessment of global longitudinal strain. Patients with IHD, Systolic dysfunction, CHD,Valvular, Arrhythmia, HOCM,Pericardial, major systemic disease had been excluded. Result: there was significant statistical difference in GLS, Age, Diabetic Type,Diabetic Duration,2HPP Blood sugar level, E/é ratio in controlled DM compared to uncontrolled DM (p<0.05), significant statistical difference in GLS in (<5years to >5years) diabetic duration(p<0.05), there was no significant difference in Gender,FBS. EF, E/A in controlled DM compared to uncontrolled DM. Conclusion: Our study reinforces that LVEF measured by traditional echocardiographic method is not a sensitive indicator for the detection of subclinical systolic dysfunction. Diabetic duration was strongly correlated with reduction of global Longitudinal strain. 2DSTE has the potential for detecting subclinical LV systolic dysfunction, and it might provide useful information for the risk stratification of an asymptomatic diabetic population. Poor blood glucose control, as indicated by HbA1c>6.5%, leads to reductions in LV global longitudinal systolic strain, which is associated with preclinical LV dysfunction. We described the early markers of systolic dysfunction following established diastolic dysfunction in diabetic patients. Future question: Is depressed GLS reversible or not?? Need more studies. recommendation: Wide spread application of 2DSTE to calculate GLS in all diabetic patients to detect as early as possible the deleterious effects of DM on myocardium. Coronary CT Angiography P207 https://esc365.escardio.org/Presentation/221516/abstract CTCA vs Invasive Angiography in previous bypass patients presenting with NSTEACS. S Hill,1 S Thiru2 and A Farag1 1Warrington and Halton Hospitals NHS Foundation Trust, Warrington, United Kingdom of Great Britain & Northern Ireland 2Wythenshawe Hospital, Manchester, United Kingdom of Great Britain & Northern Ireland Background: Inpatient invasive angiography for previous bypass patients presenting with NSTE-ACS is usually a complex lengthy procedure requiring a large amount of contrast and radiation time. Quite often grafts’ details are missing which adds to the procedure complexity and uncertainty. CT Coronary Angiogram (CTCA) is accurate in detecting stenosis in bypass grafts with sensitivity, specificity, negative and positive predictive values of 97%, 97%, 93% and 99%, respectively. We aim to compare the different management strategies in 2 hospitals of previous bypass patients presenting with stable NSTE-ACS: Hospital A performing CTCA first and Hospital B performing invasive angiography before deciding the next step in the management. Methods: We retrospectively analysed the procedure and electronic records for previous bypass patients presenting with stable NSTE-ACS in 2 hospitals between April 2017 – January 2019. Hospital A routinely performed CTCA first while Hospital B routinely performed invasive angiography first. Results: 71 patients were identified for this observational study. The mean age was 72 years. There were 19 females, 52 males. 35 patients were diabetic. Hospital A: 35 patients underwent inpatient CTCA first. 11 patients had an invasive angiogram after the CTCA (31%) and only 5 of these patients (14%) underwent Percutaneous Coronary Intervention (PCI). Hospital B: 36 patients had an invasive coronary angiogram first. 14 of these patients (39%) underwent subsequent PCI and 2 patients (6%) had a CTCA. There was no difference between both hospitals in terms of length of stay, patients in Hospital A staying an average (median) of 7 days, and Hospital B staying an average (median) 8 days. In-hospital mortality (Hospital A:1, Hospital B:2), 30-day mortality (Hospital A:1, Hospital B:1) and 12 month mortality (Hospital A:1, Hospital B:0) rates were similar for both hospitals. Conclusion: This small observational study reflects two different real life practices in managing CABG patients presenting with stable NSTE-ACS. Adopting an invasive angiogram approach first leads to statistically significantly more PCI procedures (25% difference, P-Value: 0.01928) with no clear impact on mortality. A larger scale study will corroborate our findings. Table 1. . CTCA at Hospital A . Invasive Angiogram at Hospital B . Statistically Significant Difference . Contrast Average 102 mls (Range 80 - 200 mls) 234 mls (Range 70 - 600 mls) 132 mls (t-statistic 5.922, DF 54, P<0.0001) Radiation Average 885 mGY*cm (Range 124 - 2,747 mGY*cm) 42,492 mGY*cm (Range 16,299 - 125,940 mGY*cm) 41,607 mGY*cm (t-statistic 8.326, DF 54, P<0.0001) Time Average Approx. 15 mins 78 mins (Range 35 - 153 mins) n/a . CTCA at Hospital A . Invasive Angiogram at Hospital B . Statistically Significant Difference . Contrast Average 102 mls (Range 80 - 200 mls) 234 mls (Range 70 - 600 mls) 132 mls (t-statistic 5.922, DF 54, P<0.0001) Radiation Average 885 mGY*cm (Range 124 - 2,747 mGY*cm) 42,492 mGY*cm (Range 16,299 - 125,940 mGY*cm) 41,607 mGY*cm (t-statistic 8.326, DF 54, P<0.0001) Time Average Approx. 15 mins 78 mins (Range 35 - 153 mins) n/a The following table shows the difference in procedure parameters between CTCA at Hospital A and invasive angiogram at Hospital B. Open in new tab Table 1. . CTCA at Hospital A . Invasive Angiogram at Hospital B . Statistically Significant Difference . Contrast Average 102 mls (Range 80 - 200 mls) 234 mls (Range 70 - 600 mls) 132 mls (t-statistic 5.922, DF 54, P<0.0001) Radiation Average 885 mGY*cm (Range 124 - 2,747 mGY*cm) 42,492 mGY*cm (Range 16,299 - 125,940 mGY*cm) 41,607 mGY*cm (t-statistic 8.326, DF 54, P<0.0001) Time Average Approx. 15 mins 78 mins (Range 35 - 153 mins) n/a . CTCA at Hospital A . Invasive Angiogram at Hospital B . Statistically Significant Difference . Contrast Average 102 mls (Range 80 - 200 mls) 234 mls (Range 70 - 600 mls) 132 mls (t-statistic 5.922, DF 54, P<0.0001) Radiation Average 885 mGY*cm (Range 124 - 2,747 mGY*cm) 42,492 mGY*cm (Range 16,299 - 125,940 mGY*cm) 41,607 mGY*cm (t-statistic 8.326, DF 54, P<0.0001) Time Average Approx. 15 mins 78 mins (Range 35 - 153 mins) n/a The following table shows the difference in procedure parameters between CTCA at Hospital A and invasive angiogram at Hospital B. Open in new tab P208 https://esc365.escardio.org/Presentation/217591/abstract Does coronary calcium scoring adds value to cardiovascular risk prediction in asymptomatic population? M Temtem,1 M Serrao,1 A Pereira,1 J A Sousa,1 F Mendonca,1 J Monteiro,1 A C Sousa,1 E Henriques,1 S Freitas,1 S Borges,1 I Ornelas,1 A Drumond,1 R Palma Dos Reis2 and M I Medonca1 1Funchal Hospital, Research Unit, Funchal, Portugal 2New University of Lisbon, Faculty of Medical Sciences, Lisbon, Portugal Background: Despite being a controversial subject, multiple guidelines mention the use of Coronary Artery Calcification (CAC) scoring in the cardiovascular risk prediction, in asymptomatic population. The inclusion of CAC scoring in traditional risk models may help in decision-make providing better cardiovascular risk stratification. Purpose: The aim of our study is to estimate the impact of CAC scoring in cardiovascular events risk prediction in a model based on traditional risk factors (TRFs). Methods and Results: The study consisted of 994 asymptomatic individuals free of known coronary heart disease, enrolled from GENEMACOR study and referred for computed tomography for the CAC scoring assessment. A cohort of 789 was followed for a mean of 4.9±3.2 years for the primary endpoint of all-cause of cardiovascular events. The following traditional risk factors were considered: (1) current cigarette smoking, (2) dyslipidemia, (3) diabetes mellitus, (4) hypertension and (5) family history of coronary heart disease. Among this population, the extent of CAC differs significantly between men and women in the same age group. Therefore, the distribution of CAC score by age and gender was done by using the Hoff→s nomogram (a). According to this nomogram, 3 categories were created: low CAC (0≤CAC<100 and P<50); moderate CAC (100≤CAC<400 or P50-75) and high CAC (CAC≥400 or P>75). Two Cox regression models were created, the first only with TRFs and the second adding the CAC severity categories. Harrell’s C-statistic was 0.679 (0.612-0.746) within the model without CAC categories and 0.792 (0.725-0.829) in the CAC model, providing evidence of the significant improvement due to inclusion of CAC categories (p=0.006). Conclusion: Our results point to the importance of the inclusion of CAC in both primary and secondary prevention to an improved risk stratification. Larger prospective multicentre cohorts with longer follow-up should reproduce and validate these findings. (a)Ref: Hoff JA, Chomka EV, Krainik AJ, Daviglus M, Rich S, Kondos GT. Age and gender distributions of coronary artery calcium detected by electron beam tomography in 35,246 adults. Am J Cardiol. 2001;87(12):1335–1339. doi: 10.1016/S0002-9149(01)01548-X. Table 1. Evaluation of Model Performance. Models . C-index . 95% CI . P value . TRFs 0.679 (0.612 - 0.746) 0.006 TRFs+CAC Score 0.792 (0.725 - 0.829) Models . C-index . 95% CI . P value . TRFs 0.679 (0.612 - 0.746) 0.006 TRFs+CAC Score 0.792 (0.725 - 0.829) Open in new tab Table 1. Evaluation of Model Performance. Models . C-index . 95% CI . P value . TRFs 0.679 (0.612 - 0.746) 0.006 TRFs+CAC Score 0.792 (0.725 - 0.829) Models . C-index . 95% CI . P value . TRFs 0.679 (0.612 - 0.746) 0.006 TRFs+CAC Score 0.792 (0.725 - 0.829) Open in new tab Anticoagulants P212 https://esc365.escardio.org/Presentation/216428/abstract Dynamics of antithrombotic therapy administration rate and potential adherence to treatment in patients with atrial fibrillation during the acute phase of myocardial infarction K Pereverzeva,1 S Yakushin1 and A Vorobyev1 1Ryazan State Academician Medical University, Ryazan, Russian Federation Aim: To assess the dynamics of oral anticoagulants (OAC) administration rate and potential adherence to treatment in patients with atrial fibrillation (AF) in the acute phase of myocardial infarction (MI) in 2016-2017 and in 2018. Materials and methods: The study included patients with AF, who were admitted with MI to one of the clinics in 2016-2017 and in 2018. There were no exclusion criteria. The OAC administration rate was defined by the medical records, the potential adherence to treatment was assessed using a quantitative adherence questionnaire (CAQ)-25 percentage, while values of 0-50% were regarded as “low” level of potential adherence to treatment, 51-75% - “average” level, and 75% -100% - as a “high” level of potential adherence to treatment. In 2016-2017 the study included 104 patients with AF in the acute phase of myocardial infarction, in 2018 - 63 patients. Both groups of patients were comparable in the main clinical and demographic characteristics. Results: Among all patients included into the study in 2016-2017 OACs were prescribed in 16.3% of cases. In 6.7% of cases, OACs were prescribed as a part of triple antithrombotic therapy (ATT), in 8.7% as a part of double ATT (OAC + antiplatelet agent), and in 1.0% as a monotherapy. Among all OACs, warfarin was prescribed in 64.7% of cases, and rivaroxaban in 35.3%. 76.9% of patients received dual antiplatelet therapy. 2.9% of patients were not prescribed with ATT; in 3.8% of patients only one antiplatelet agent was prescribed. In 2018, the OAC administration rate significantly increased by 5.7 times (p<0.05) and amounted to 92.1% of cases. The OAC administration rate as a part of triple ATT significantly increased by 6.4 times (p<0.05) and amounted to 42.9% of cases, and the OAC administration rate as a part of dual ATT increased by 5.6 times (p <0.05 ) and amounted to 49.2%; there were no cases of OAC monotherapy in 2018. The percentage of patients receiving warfarin and rivaroxaban therapy did not significantly change (p> 0.05) and amounted to 44.8% and 55.2%, respectively. In 2018, the number of patients receiving dual antiplatelet therapy (p<0.05) has significantly reduced 12.2 times and amounted to 6.3% of patients. The number of patients receiving therapy with one antiplatelet agent did not significantly change (p>0.05) and amounted to 1.6% of patients. The potential adherence of patients with AF in the acute phase of myocardial infarction to drug therapy in both studied periods was low and amounted to 40.37% [30.86; 52.32] in 2016-2017, and 44.32% [30.32; 51.39] in 2018, p> 0.05. Conclusion: 1. The OAC administration in AF in the acute phase of myocardial infarction during 2016-2018 significantly increased 5.7 times (p <0.05). 2. The potential adherence of patients with AF in the acute phase of myocardial infarction to drug therapy has increased 1.1 times (p> 0.05) and is still low currently. P213 https://esc365.escardio.org/Presentation/217222/abstract Patient’s awareness of Idarucizumab and subsequent preference over anticoagulation. A Ioannidis1 1Thessaloniki General Hospital ‘G. Gennimatas’, Thessaloniki, Greece Background: Clinical guidelines recommend taking into account the patient’s preference when deciding on the options of direct oral anticoagulation (DOAC) therapy. Therefore, education is a prerequisite for informed, involved patients and patient-centred care. Purpose: The aim of this study was to assess the patient’s awareness about the existence of the dabigatran specific reversal agent (Idarucizumab) and whether the patient was involved in the decision of the specific DOAC regimen. Methods: Outpatient atrial fibrillation (AF) patients on DOAC were invited to participate by answering a short questionnaire and, if agreed, were scheduled for a further assessment of AF related knowledge (as part of validation study of the Greek version of the Jessa Atrial fibrillation Knowledge Questionnaire). Analyses were performed by IBM SPSS Statistics. Results: In total 174 patients (92 females, 52.9%) fully answered the questionnaire (mean age: 64±7.6 years old). The vast majority of patients (151, 86.8%) were not aware of the existence of any specific reversal agent. Moreover, only about one of five patients on dabigatran (23 out of 73, 21.9%) knew about the dabigatran specific reversal agent, mainly from sources other than their doctor (e.g. leaflet in office waiting room). All patients agreed that they would prefer to have been informed about the current specific reversal agents when deciding on DOAC therapy. Worrisome enough, none of the questioned patients could recall whether their doctors had specifically referred to the other available DOAC agents. Conclusions: The sample of Greek AF patients showed a noticeably low awareness of the existence of specific DOAC reversal agent. It seems that DOAC prescription was a rather limited shared decision. Further research is warranted to confirm the aforementioned results. Antiplatelet Drugs P214 https://esc365.escardio.org/Presentation/221100/abstract Real world data of ticagrelor in acute coronary syndrome: does it translate into better prognosis? JP De Sousa Bispo,1 TF Mota,1 R Fernandes,1 H Costa,1 N Marques,1 J Mimoso,1 A Camacho1 and I Jesus1 1Faro Hospital, Cardiology, Faro, Portugal Objective: To determine whether systematic use of ticagrelor in patients with Acute Coronary Syndrome (ACS) versus clopidogrel resulted in a 1-year mortality and hospital admission rates reduction. Methods: Retrospective study, where we created a contemporaneous electronic record with all ACS patients admitted to our cardiology department between October 2010 and September 2017. Until January 2016 all patients were systematically treated with aspirin + clopidogrel during hospital stay and upon discharge. Since then, patients were systematically treated with aspirin + ticagrelor, except if perceived to be at high hemorrhagic risk, needed additional anticoagulation therapy, or had other contra-indication to ticagrelor. We compared basal characteristics and in-hospital occurrences, and 1-year mortality and re-admission rates between both groups. For statistical analysis we used SPSS v24.0. Results: A total of 3817 patients were admitted with ACS during the period of the analysis. 964 (25,3%) patients were excluded because of missing data. Of the 2853 included, 2226 (78%) were male, and the average age was 64,8 ± 13,0 years. 446 (15,6%) were medicated with aspirin + ticagrelor, and 2407 (84,4%) were medicated with aspirin + clopidogrel. Baseline characteristics between both groups were similar, with exception with prevalence of smoking (41,0% in the ticagrelor group versus 33,4%, p=0,022), high blood cholesterol (53,2%% in the ticagrelor group versus 61,5%, p=0,010), angina (22,4% in the ticagrelor group versus 36,8%, p=0,022), history of previous ACS (18,6% in the ticagrelor group versus 22,5%, p=0,022) and angioplasty (15,1% in the ticagrelor group versus 19,7%, p=0,022) During hospital stay, patients in the ticagrelor group were more frequently submitted to coronary angiography (91,0% versus 83,0%, p<0,001), angioplasty (83,0% versus 73,4%, p<0,001). In-hospital complications was similar between both groups, as was the mortality rate (3,1% versus 2,5%, p<0,430). There was no difference in either 1-year mortality rate (4,7% versus 7,0%, p=0,111) or the hospitalization rate (17,1% versus 19,1%, p=0,374) between both groups Conclusion: Systematic use of aspirin + ticagrelor versus clopidogrel + aspirin did not translate into reduction of events at 1 year in patients with ACS treated in our center. More data of ticagrelor in the real world, and with longer follow-up is needed to access whether this therapy actually improves patient outcomes. P215 https://esc365.escardio.org/Presentation/221098/abstract Myocardial inflammation: Is the use of anti-inflammatory medication harmful? H Miranda,1 H Santos,1 M Santos,1 I Santos,1 C Sousa1 and J Tavares1 1Hospitalar Center Barreiro-Montijo, Lisbon, Portugal Introduction: Myocarditis(MCD) is a common inflammatory heart disease. Because the symptoms and clinical presentation are highly variable, the correct diagnosis remains challenging. Moreover, in the absence of relevant clinical trials and guidelines, the approach of MCD from diagnosis, treatment and follow-up is largely empirical. Objectives: Descriptive analysis of epidemiological and diagnostic data of patients and evaluation of the use of Non-steroidal anti-inflammatory drugs (NSAIDs), in particular acetylsalicylic acid (ASA) in the outcome. Methods: Retrospective analysis of patients (P) admitted in our department, with confirmed diagnosis of MCD, within a period of 6,5 years. We analyzed common epidemiological variables, evolution during hospitalization, established therapeutics and occurrence of cardiovascular events - CVE (new episode of myo/pericarditis, LVEF < 50% or arrhythmias) during a 3 years follow-up period (FUP), when applicable Results: 42 patients were included. The mean age of the population was 31.12 ± 10.32 years, with a predominance of males (76.2%). More than half of the P (69.05%) have experienced a recent gastrointestinal/ upper respiratory infection. The most common symptom was chest pain (95,4%), with 4,76% having a previous episode of myo/pericarditis. The most common ECG pathological finding was ST elevation (33,3%). 14,6% presented with impaired left ventricular ejection fraction (LVEF<50%), evaluated by echocardiography. Pericardial effusion and thickening were present in 19% and 23,8% of P, respectively. Cardiac catheterization and MRI were performed in 28, 57% and 83,3% of P, respectively. Late gadolinium enhancement was present in 73,8%, with inferolateral segment being the most involved area (31,8%). Concerning discharge medication, 71,43 % received an ASA, 21,4% a betablocker, 16,7% an Angiotensin Converting Enzyme Inhibitor and 4.8% a Mineralocorticoid Receptor Antagonist. At medical release, the P presented a mean hospitalization of 5,5 ± 2,75 days. Only 1 P died during hospital length. Regarding CVE 4 P had a CVE during hospital stay and 13 P during the FUP. We found a statistically significant association (p<0,003) between CVE and the use of ASA, with P not receiving ASA having an odd 10x greater to show a CVE compared to P who received ASA. Conclusion: Optimal medical therapy has yet to be defined, but ASA seems to decrease the occurrence of CVE. However, more extensive studies are needed to confirm the real impact of ASA in MCD. Computer Modeling and Simulation P218 https://esc365.escardio.org/Presentation/216420/abstract Compensatory mechanisms of gene regulation in response to chronic stress I Campos,1 M Laranjo,2 S Neves,2 F Marques,2 N Sousa,2 C Vieira,1 C Oliveira,1 C Marques Pires,1 P Medeiros,1 R Flores,1 F Mane,1 J Marques1 and VH Pereira1 1Hospital de Braga, Cardiology, Braga, Portugal 2University of Minho - Life and Health Sciences Research Institute (ICVS), Braga, Portugal Introduction: Cardiovascular diseases are the major cause of death worldwide. Classical risk factors such as diabetes mellitus, arterial hypertension and smoking are recognised for their role in these diseases. However, other risk factors are now being considered like psychological stress and depression. One of the mechanisms underlying this association may be the mal-adaptive response to stress that disrupts the hypothalamus-hypophysis-adrenal axis, the renin-angiotensin-aldosterone system and the sympathetic nervous system. Purpose: To evaluate the impact of chronic stress on the genetic expression of molecules involved in the adrenergic and catecholaminergic pathways in the myocardium. Methods: Eighteen adult male rats were randomly distributed in two groups: a control group and a group submitted to chronic mild stress protocol (CMS). This protocol consists of a sequential and random application of various stress factors (food deprivation, water deprivation, damp bedding, sloped box, light-dark rhythm alteration and confinement to a restricted space), during 4 consecutive weeks. After this period, all the animals were sacrificed and the left ventricle apex was collected and dissected. The expression of NPY, TH, GRK2, GRK5, β1AR, β2AR, β3AR and α1AR (adrenergic pathway) and acetylcholinesterase and VIP and M2ACh muscarinic receptors (catecholaminergic pathway) was quantified using real time-PCR. Results: GRK2 had a median genetic expression superior in animals subjected to chronic mild stress protocol [Mdn=0,040762 (0,036941-0,064620)] compared to the one found in the control group [Mdn=0,011624 (0,001181-0,031060)] (U=18,0; Z=−1,99; p=0,05; r=0,47). There were no significant differences found in the other proteins studied. Conclusion: The genetic expression of GRK2 in stressed animals is superior comparing to the control group, which represents an attempt to desensitize adrenergic receptors. This may imply a compensatory mechanism in response to an excessive catecholaminergic stimulus triggered by chronic stress. Acute Coronary Syndromes – Pathophysiology and Mechanisms 289 https://esc365.escardio.org/Presentation/217592/abstract Early ventricular fibrillation in Acute Coronary Syndrome. The role of previous antiplatelet therapy. B Lorenzo-Lopez,1 M Butron-Calderon,1 JA Arboleda-Sanchez,2 M Almendro-Delia,1 A Garcia-Alcantara,3 JJ Arias-Garrido,4 JC Rodriguez-Yanez,5 G Alonso-Munoz,6 R De La Chica-Ruiz-Ruano,7 A Reina-Toral,7 A Varela-Lopez,8 AM Poullet-Brea,2 B Zaya-Ganfo,9 R Hidalgo-Urbano1 and JC Garcia-Rubira1 1UNIVERSITY HOSPITAL VIRGEN MACARENA, Seville, Spain 2Regional University Hospital of Malaga, Malaga, Spain 3UNIVERSITY HOSPITAL VIRGEN DE LA VICTORIA, Malaga, Spain 4Hospital del SAS, Jerez de la Frontera, Spain 5Puerto Real Hospital, Puerto Real, Spain 6GENERAL HOSPITAL OF H.U. REINA SOFIA, Cordoba, Spain 7University Hospital Virgen de las Nieves, Granada, Spain 8Hospital de Antequera, Antequera, Spain 9Hospital Costa del Sol, Marbella, Spain Introduction: Some studies have shown a possible relationship between ventricular fibrillation (VF) in Acute Coronary Syndromes (ACS) and previous antiplatelet therapy. We analyze this relationship in a large cohort of patients. Methods: Multicenter prospective observational study of 49 hospitals in Andalucía, Spain (ARIAM-Andalucía Registry) from 2001 to 2012. We analyzed Non-ST Elevation Myocardial Infarction (NSTEMI) and ST-Elevation Myocardial Infarction (STEMI) patients whose antiplatelet treatment status on the week before admission was known. We defined early VF as the one that occurred previous to ICU/Coronary Care Unit admission. Results: Out of 14051 patients included (mean age 63.2 ± 12.7 years; 24.2% women), 9515 (67.7%) presented as STEMI, and 27.7% of the patients were on previous antiplatelet therapy. Early VF occurred in 816 (5.8%) patients; it occurred more frequently in STEMI than in NSTEMI (4.9% vs. 0.9%, p<0.001). Early VF was significantly more frequent in those patients without previous antiplatelet therapy (4.7% vs. 1.12%, OR 0.61, IC95% 0.51 – 0.73, p<0.001), either they presented as STEMI or NSTEMI. However, no significant relationship between early VF and antiplatelet therapy was detected in the multivariate analysis adjusted by cardiovascular risk factors and previous treatments, although a protective tendency of antiplatelet treatment was found (OR 0.84, IC95% 0.66 – 1.07, p=0.16). Independent predictors of early VF were age, gender, diabetes, dyslipidemia, STEMI or Killip ≥ 2 at presentation. Conclusion: Although early VF in patients admitted with ACS occurs less frequently among those who were taking previous antiplatelet treatment, no significant relationship was found after adjusting by multiple variables. Acute Coronary Syndromes – Prevention 292 https://esc365.escardio.org/Presentation/221522/abstract Impact of a deployment overseas in the metabolic profile and cardiovascular risk of the portuguese soldiers JA Da Conceicao Pedro Pais,1 R Guerreiro,1 M Carrington,1 AR Rocha,1 B Picarra,1 AR Santos1 and S Lima Gil2 1Hospital Espirito Santo de Evora, Departement of Cardiology, Evora, Portugal 2Military Clinical Center, Evora, Portugal Introduction: As the civilian population has been suffering from an increase in major cardiovascular risk factors in younger age groups, the Portuguese army has been experiencing a similar trend. Until now, there was no national information concerning the impact of a mission overseas in the cardiovascular profile of the Portuguese Soldiers. Purpose: To characterise the metabolic profile and cardiovascular risk of the Portuguese soldiers before and after a deployment to a mission overseas. Population and Methods: Prospective study conducted during 9 months that included 169 soldiers that were evaluated before and after the deployment. 3 soldiers were lost to follow-up due to earlier evacuation from the deployment. Patients’ age, gender, past medical history, weight, body mass index (BMI), blood pressure (BP), fasting glycaemia, abdominal perimeter and lipid profile in those > 35 years-old were recorded. 10 year cardiovascular risk was calculated before and after the deployment using Body mass index Framingham score. Statistical analysis using paired tests (student’s T test and Chi squared) were used to determine the impact of the mission in the different variables. A p- value< 0.05 was considered statistic significant. Results: Study population was constituted by 97% of males (n=161). The mean age was 27.77 ± 6.90 years. The difference between before and after the deployment in the mean values of the following variables was statistically significant: weight (77.50± 8.96 vs 79.70 ± 9.00 kg; p<0.001), BMI (24.90± 2.43 vs 25.60±2.30 kg/m2; p<0.001), systolic BP (133.20± 12.86 vs 123.66 ± 11.92 mmHg, p<0.001), diastolic BP (75.98± 9.04 vs 70.01 ± 9.36 mmHg, p<0.001), fasting glycaemia (89.90 ± 8.18 vs 85.04 ± 8.47 mg/dL, p<0.001). Abdominal perimeter and lipid profile have no significant differences. The number of patients considered to have hypertension (defined as SBP>140 mmHg or DBP > 90 mmHg) was significantly reduced after the deployment (25.3%vs6,6%, p<0,001). Smoking has present in 44.6% of the study population before and after the deployment. 10 year cardiovascular risk was marginally lower after the deployment (3.34 ± 3.93 vs 2.91 ± 3.46; p<0.041). None of the patients were submitted to medical treatment and diet and rest hours were similar for all military personnel. Conclusion: In this expectedly healthy population there was a high prevalence of reversible and treatable cardiovascular risk factors. 9 months of deployment overseas, with controlled diet and practice of physical exercise, resulted in the reduction of BP, hypertension, fasting glycaemia and 10-year cardiovascular risk. The increase in weight and BMI can be explained by the increase in muscle mass, as there was no increase in abdominal perimeter. This study demonstrates that, even in a controlled and stressful environment, non-pharmacological measures are important and are effective in controlling and reducing cardiovascular risk. Acute Nursing Care 295 https://esc365.escardio.org/Presentation/216399/abstract Acceptance of the illness and readiness for hospital discharge of patients after acute myocardial infarction MH Lisiak,1 O Kowalska,2 J Jaroch,2 R Wyderka2 and I Uchmanowicz1 1Wroclaw Medical University, Department of Clinical Nursing, Wroclaw, Poland 2Specialist Hospital. T. Marciniak, Department of Cardiology, Wroclaw, Poland Background: The occurrence of acute coronary syndrome (ACS) has varying degrees of impact on the patients’ everyday life. It causes adverse effects and negative emotions associated with the disease. Patients who have low level of readiness for the discharge from the hospital after ACS are associated with a higher risk of complications and re-hospitalisation. It is expected that effective identification and appropriate preparation of patients for the discharge can improve adherence and biopsychosocial function. Purpose: The aim of the study was to analyse the relationship between the acceptance of illness and readiness for hospital discharge after a myocardial infarction treated with percutaneous coronary angioplasty. Methods: The study was conducted in 100 patients (63 men) hospitalized in the Department of Cardiology. The patients were divided into two groups - patients under 65 y/o (group A) and patients over 65 y/o (group B). Patients were examined the day before their discharge from the hospital. Standardized questionnaires were used: Readiness for Hospital Discharge after Myocardial Infarction Scale (RHD-MIS), Acceptance of Illness Scale (AIS) and a socio-clinical questionnaire. Results were considered significant at p < 0.05. Results: The mean age of participants was 66.57 ± 8.77 years. Approximately 42.4 % of them presented with STEMI, 57.6 % with non-ST-segment elevation myocardial infarction. The analysis of AIS scale showed that the mean level of disease acceptance was lower in group B than in group A: M=23.08 points vs. 27.76 points, respectively. The level of readiness for discharge from the hospital assessed with RHD-MIS general score was medium in both groups A and B: M=49.60 vs. M=46.22, respectively. The further analysis has shown that AIS is positively and moderately correlated with the overall result (RHDS): rho=0.460; p<0.01; expectations: rho=0.345; p<0.01; the subjective assessment: rho=0.365; p<0.01 and weakly and positively with the objective assessment: rho=0.259; p<0.01. Based on the regression coefficients it was presented that AIS was moderately and positively correlated with the readiness for discharge (beta= 0.446; p<0.001) and increases its level. Among other factors which had a negative significant impact on the readiness for discharge from the hospital were older age (rho=−0.231; p<0.05) and existing comorbidities (objective assessment p<0.004). Conclusions: Our findings demonstrate that patients had a moderate level of readiness for hospital discharge. The elderly patients had worse results on each scale. Acceptance of the disease improves the level of patients’ readiness to hospital discharge after ACS. Readiness to discharge should be routinely assessed in patients with AMI. The results will be supportive to the identification of those who require additional and personalised education. Acute Cardiac Care – Cardiac Arrest 298 https://esc365.escardio.org/Presentation/221287/abstract Effect of contemporary targeted temperature management on ecg measured pr duration and relation to survival following out-of-hospital cardiac The Danish Heart Foundation, The Interreg IVA ØKS, J Thomsen,1 C Hassager,2 J Bro-Jeppesen,1 H Soeholm,1 J Grand,1 M Frydland,1 S Wiberg1 and J Kjaergaard1 1Rigshospitalet - Copenhagen University Hospital, Department of Cardiology B, The Heart Centre, Copenhagen, Denmark 2Rigshospitalet - Copenhagen University Hospital, Department of Thoracic Anaesthesiology, The Heart Centre, Copenhagen University Hospital Rigshospita, Copenhagen, Denmark Background: Bradycardia during targeted temperature management (TTM) has been shown to be strongly associated with a higher survival rate and favorable outcome following out-of-hospital cardiac arrest (OHCA), possibly due to preserved autonomic regulation of the heart. The PR-interval in the ECG is influence by vagal tonus and may exhibit prognostic information during TTM, but the effect of different levels of TTM and association with outcome has not been examined previously. Purpose: We sought to determine whether the PR-interval is influenced by two levels of TTM and hypothesized that a prolonged PR-interval would be associated with a higher 180-day survival rate similar to findings from observed bradycardia. Methods: The present study is an ECG-substudy of the TTM-trial (OHCA-patients randomized to TTM at 33°C vs. 36°C). Twenty-four sites participated in the substudy, with serial ECGs available from 680 (94%) patients. The PR-interval was manually obtained from each ECG. Patients were stratified by the median PR-interval in each TTM group in outcome analysis. Results: For patients in sinus rhythm at hospital arrival (n=441), the PR-interval was 178 ms. The PR-interval increased slightly in the 33°C group at target temperature but remained at the same level in the 36°C group. The PR-interval decreased in both TTM-groups after rewarming to normothermia, reaching similar levels (Figure). An overall significant interaction was found during the course of TTM (pinteraction=0.04) between the temperature groups. Open in new tabDownload slide A PR-interval above median at admission (short PR: 64% vs long PR: 51%, p=0.01) and at target temperature (short PR: 61% vs long PR: 51%, p=0.02) was associated with a lower 180-day survival rate. But after adjustment for factors known to influence mortality after OHCA, no significant association with mortality was found for the PR-interval. Higher age (OR/year: 1.05 (1.04-1.08), p<0.001) and male sex (OR 3.08 (1.74-5.44), p<0.001) were independently associated with an PR-interval above the median. Conclusion: The PR-interval increased significantly during TTM at 33°C compared to 36°C with a significant interaction throughout TTM. Increased PR-interval at admission after OHCA was associated with a lower survival rate with relation to higher age. 299 https://esc365.escardio.org/Presentation/216508/abstract Whole-body oxygen consumption during targeted temperature management at 33 degrees C versus 36 degrees C after out-of-hospital cardiac arrest. J Grand,1 C Hassager,1 J Bro-Jeppesen,1 F Gustafsson,1 N Nielsen2 and J Kjaergaard1 1Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark 2Helsingborg Hospital, Department of Anesthesiology and Intensive Care, Helsingborg, Sweden Background: Cardiovascular dysfunction is common after out-of-hospital cardiac arrest (OHCA) and infusion with fluids and vasopressors are central parts of treatment during targeted temperature management (TTM). However, whole-body oxygen delivery and consumption have not previously been investigated during TTM at different temperature levels and the effect of TTM at 33°C on whole-body oxygen consumption (VO2) is unknown. Purpose: The aim was to investigate VO2 at TTM of 33°C (TTM33) versus 36°C (TTM36). Methods: Single-center substudy of 171 patients included in the TTM-trial randomly assigned to TTM33 or TTM36 for 24 hours after out-of-hospital cardiac arrest. We calculated VO2 according to the principle of Fick (VO2 = cardiac output * arterio-venous oxygen content difference). Primary end point was VO2 after 24 hours of TTM. Cardiac output was estimated by pulmonary artery catheter (PAC). Arteriovenous oxygen content difference was calculated from arterial and venous oxygen saturation and hemoglobin. Measurements and Main Results: We excluded 19 (11%) patients with no hemodynamic PAC-measurements. Patients were 61 (±11) years old, 86% were men and 91% had a witnessed OHCA. At ICU-admission, VO2 was 222 ml O2 per minute (95% confidence interval 209-236). At 24 hours, the TTM33 group had a significantly lower VO2 compared with TTM36 (165 ml O2 per minute; 95% confidence interval, 130–198) versus (217 ml O2 per minute; 95% confidence interval, 163–268), p<0.001. During 24 hours of cooling, the overall difference was 50 ml O2 per minute (Pgroup <0.0001), and there was no significant difference between the groups at time 36 and 48 (Figure). VO2 during the first 48 hours of hospital-admission correlated significantly with temperature, and for each degree lower body temperature, the VO2 fell by 20 ml O2 per minute; (95% confidence interval, 17–23), p<0.001. Similar findings were seen when analyzing TTM33 (18 ml O2 per minute 95% confidence interval, 15–22) and TTM36 (18 ml O2 per minute 95% confidence interval, 11–25) separately (both groups: p<0.0001). Open in new tabDownload slide VO2 during TTM and correlation. Conclusions: Targeted temperature management at 33°C compared to 36°C after OHCA is associated with significantly lower VO2. For each degree lower body temperature, the VO2 fell by 20 ml O2 per minute in a linear relationship. These findings may be of physiological value when treating post-OHCA patients under hypothermia and during fever. 300 https://esc365.escardio.org/Presentation/216468/abstract Persistent coma at 72 hours in survivors of out-of-hospital cardiac arrest treated by targeted temperature management predicts unfavourable six-month neurologic outcomes M Kleissner,1 M Sramko,1 J Kettner1 and J Kautzner1 1Institute for Clinical and Experimental Medicine (IKEM), Department of Cardiology, Prague, Czechia Background: Early realistic prognostication in comatose survivors of an out-of-hospital cardiac arrest (OHCA) may help in family counselling and important therapeutic decision making. Purpose: We sought to describe neurologic outcomes of a selected population of OHCA survivors who remain comatose on the third day after OHCA. Methods: Out of 204 consecutive survivors of OHCA who underwent targeted temperature management and had available six-month follow-up, we selected 73 individuals (36%) who remained in coma at 72 hours after the cardiac arrest, off any sedative drugs. We evaluated six-month neurologic outcomes by the cerebral performance category score (CPC). Results: Of the 73 patients with persistent coma on the third day after OHCA, only 1 patient (1 %) had favourable six-month neurologic outcome (CPC 2). The remaining 72 patients (99 %) were either dead (n = 62 [85 %]) or had poor neurologic outcomes (CPC 3: n = 2 [3 %], CPC 4: n = 8 [11 %]). The sensitivity, specificity, positive and negative predictive value of persistent coma at 72 hours for unfavourable six-month neurologic outcomes was: 86 %, 99 %, 99% and 91 %, respectively. Conclusion: Persistent coma in non-sedated patients at 72 hours after OHCA strongly predicts poor mid-term neurologic outcomes, regardless of any other clinical variables. This information may help in therapeutic decision making and avoiding futile care. Open in new tabDownload slide Neurologic outcomes. 302 https://esc365.escardio.org/Presentation/216430/abstract Early prognosis after out of hospital cardiac arrest based upon biomarkers of brain injury measured at admission to hospital.The study was supported by Ministry of Science and Higher Education/Military Institute of Medicine, Warsaw, Poland (grant no 474/WIM). R Ryczek,1 PJ Kwasiborski,2 A Agnieszka Rzeszotarska,3 J Korsak,3 MBL Buksinska-Lisik2 and P Krzesinski1 1Military Institute of Medicine, Cardiology And Internal Medicine Department, Warsaw, Poland 2Medical University of Warsaw, 3rd Department of Internal Medicine and Cardiology, Second Faculty of Medicine, Warsaw, Poland 3Military Institute of Medicine, Department of Clinical Transfusiology, Warsaw, Poland Background: Mortality rates among patients after out-of-hospital-cardiac-arrest (OHCA) remain high. Ischemic brain damage is one of the leading cause of bad prognosis after OHCA. Proper early prognostication is essential element in clinical decision whether to escalate or withdraw life sustaining therapy, but there is lack of reliable prognostic tools in the first 24 hours after admission. After that time multimodal prognostication strategy algorithm have been proposed. One of the prognostication variables is increase in concentrations of biomarkers of neuron injury, such as neuron specific enolase (NSE) and glial S-100B protein detected during serial testing. Maximal concentrations are observed from 24 to 72 hours, being wildly acknowledged to have prognostic value. Purpose of the study was testing if one-fold NSE and S-100B measurement at admission have prognostic values for the clinical outcome of unconsciousness patients after OHCA at an very early period of care. Methods: 74 patients after OHCA (52 male, mean age 64.4±14.7years) admitted unconscious to intensive care unit from September 2016 to July 2019 were enrolled to the study. In addition to standard clinical and laboratory assessment NSE and S-100B were measured at admission. In statistical analysis the classic normality tests were introduced and according to the results further parametric or nonparametric analysis was performed. The logistic regression model and ROC analysis were done to evaluate the prognostic usefulness of the proposed biomarkers. Death and poor neurologic status at discharge (Cerebral Performance Category ≥4) were considered as bad clinical outcome. Results: Univariate logistic regression analysis revealed, that high concentrations of both biomarkers at the admission were related with increased risk of bad prognosis (n=49), NSE OR 1.006 (95% CI 1.002-1.110; p=0.004) and S-100B OR 1,098 (95% CI 1.025-1.175; p<0,0001). In ROC analyses the NSE AUC equaled 0.796 (95% CI 0,682-0,910), and the S-100B AUC equaled 0,789 (95% CI 0,677-0,901). The multi-marker approach with the cut-off values for NSE ≥ 28ng/ml accompanied by S-100B ≥ 850ng/ml allowed to identify the group of patients with the bad prognosis with 100% specificity (Figure 1). Open in new tabDownload slide The S-100 and NSE at admission. Conclusions: Both NSE and S-100B measured at admission allowed for reliable prediction of bad clinical outcome in unconsciousness patients admitted after OHCA. The most encouraging finding of this study is that the proposed multi-marker approach enables to discriminate patients as early as in the first 24 hours of hospitalization. 303 https://esc365.escardio.org/Presentation/216749/abstract Ventricular fibrillation amplitude spectral area and end-tidal carbon dioxide for shock success and ROSC prediction. Is there a correlation? E Baldi,1 E Aramendi,2 B Chicote,2 U Irusta,2 A Palo,3 S Compagnoni,1 R Fracchia,1 G Iotti,4 L Oltrona Visconti5 and S Savastano5 1Foundation IRCCS Policlinic San Matteo - University of Pavia, Pavia, Italy 2University of the Basque Country (UPV/EHU), Escuela de Ingeniería de Bilbao, Bilbao, Spain 3Foundation IRCCS Policlinic San Matteo, AAT118 Pavia, Pavia, Italy 4Foundation IRCCS Policlinic San Matteo, Intensive Care Unit, Pavia, Italy 5Foundation IRCCS Policlinic San Matteo, Division of Cardiology, Pavia, Italy Background: Ventricular fibrillation amplitude spectral area (AMSA) and end-tidal carbon dioxide (ETCO2) have been shown to be predictors of shock success and return of spontaneous circulation (ROSC). In an animal study, they have been shown to be correlated, but little is known about their combined use, which is the aim of our study. Purpose: We aimed to assess the combined role of AMSA and ETCO2 for the prediction of shock success and ROSC and to clarify if they are correlated in humans. Methods: Patients enrolled in a Cardiac Arrest registry in northern Italy from January 2015 to December 2018 with a shockable presenting rhythm and with ETCO2 available were retrospectively reviewed. The median ETCO2 value in the minute before the shock (MEtCO2) was computed automatically from the capnogram (when available) or from the report of the monitor/defibrillator. AMSA was computed using a 2-s preshock ECG interval, leaving 1-s guard before the shock. The ECG was bandpass filtered (0.5-30Hz) and the Fast Fourier Transform computed to obtain AMSA in the 2-48 Hz range. Predictive models based on MEtCO2, AMSA and their combination were evaluated in terms of Area Under the Curve (AUC) for 100 train/test repetitions. Results: The study group contained 103 patients (38 with sustained ROSC) with 351 shocks (169 successful, 62 followed by any ROSC, and 182 unsuccessful). MEtCO2 and AMSA were significant predictors of shock success with median (Q1-Q3) AUC 0.60 (0.57-0.63) and 0.68 (0.65-0.71) respectively, and of ROSC with AUC 0.57 (0.53-0.60) and 0.73 (0.71-0.77). Their combination increased the AUC to 0.70 (0.66-0.74) for shock success, and to AUC 0.77 (0.74-0.80) for ROSC. The Spearman correlation coefficient between AMSA and MEtCO2 was significant in patients who achieved ROSC (r=0.34, p=0.037), but not in the ones who didn’t (r=0.01, p=0.9). Conclusion: AMSA and ETCO2 are predictors of shock success and ROSC and, if combined, their predictive power increases. Notably, they were correlated only in patients who achieved ROSC suggesting pathophysiological speculations for further investigation. Coronary CT Angiography 305 https://esc365.escardio.org/Presentation/217585/abstract Can genetic variants associated to coronary artery disease risk be involved in the arterial plaque development? M Temtem,1 M Serrao,1 A Pereira,1 J A Sousa,1 F Mendonca,1 J Monteiro,1 A C Sousa,1 E Henriques,1 M Rodrigues,1 S Borges,1 G Guerra,1 I Ornelas,1 A Drumond,1 R Palma Dos Reis2 and M I Mendonca1 1Funchal Hospital, Research Unit, Funchal, Portugal 2New University of Lisbon, Faculty of Medical Sciences, Lisbon, Portugal Coronary Artery Calcium (CAC) scoring has been widely used in genetic studies of subclinical atherosclerosis. These studies have revealed several SNPs involved in plaque calcification, but with contradictory results. Aim: Identify genetic variants associated to CAC scoring and subclinical atherosclerosis, in an asymptomatic cohort with high CAC scoring. Methods: The study consisted of 994 individuals free of known coronary heart disease, enrolled from GENEMACOR study and referred for computed tomography for CAC scoring assessment. 33 SNPs previously associated to CAD were evaluated. Two categories were generated according to CAC scores: CAC<100 and percentile<50 (low CAC risk) and CAC ≥400 or percentile>75 (high CAC risk). The association of each genetic variant with CAC was evaluated, in each category, by Chi-squared test. A multivariate analysis (logistic regression) was then performed with all the variants associated with CAC scores in the univariate analysis, adjusted for all confounding factors (age, gender, type2 diabetes, hypertension, dyslipidemia, smoking and sedentary lifestyle). Results: Variants MIA3 rs17465637 and CDKN2B rs4977574 are associated with high CAC scores (p=0.022 and p=0.011, respectively). After multivariate analysis, these genetic variants remained in the model, showing a strong association with high CAC scores, even after adjusting for all confounding factors (OR 3.067, p=0.010 and OR 1.957, p=0.009; respectively). Conclusion: Genetic variants MIA3 rs17465637 and CDKN2B rs4977574 are independent determinants of high CAC scoring and reflect subclinical atherosclerosis burden. These markers can be used to non-invasively assess the presence and severity of atherosclerosis and may represent an additional tool in primary prevention of Coronary Disease. Table 1. Risk factors for increased CAC. Variables . OR (95% CI) . p-value . Diabetes 3.583 (2.222 - 5.777) <0.0001 Smoking status 1.908 (1.275 - 2.855) 0.002 Hypertension 1.793 (1.252 - 2.566) 0.001 MIA3 0.027 AC 2.478 (1.049 - 5.858) 0.039 CC 3.067 (1.312 - 7.169) 0.010 CDKN2B 0.009 AG 1.196 (0.730 - 1.960) 0.478 GG 1.957 (1.182 - 3.240) 0.009 Constant 0.045 <0.0001 Variables . OR (95% CI) . p-value . Diabetes 3.583 (2.222 - 5.777) <0.0001 Smoking status 1.908 (1.275 - 2.855) 0.002 Hypertension 1.793 (1.252 - 2.566) 0.001 MIA3 0.027 AC 2.478 (1.049 - 5.858) 0.039 CC 3.067 (1.312 - 7.169) 0.010 CDKN2B 0.009 AG 1.196 (0.730 - 1.960) 0.478 GG 1.957 (1.182 - 3.240) 0.009 Constant 0.045 <0.0001 Open in new tab Table 1. Risk factors for increased CAC. Variables . OR (95% CI) . p-value . Diabetes 3.583 (2.222 - 5.777) <0.0001 Smoking status 1.908 (1.275 - 2.855) 0.002 Hypertension 1.793 (1.252 - 2.566) 0.001 MIA3 0.027 AC 2.478 (1.049 - 5.858) 0.039 CC 3.067 (1.312 - 7.169) 0.010 CDKN2B 0.009 AG 1.196 (0.730 - 1.960) 0.478 GG 1.957 (1.182 - 3.240) 0.009 Constant 0.045 <0.0001 Variables . OR (95% CI) . p-value . Diabetes 3.583 (2.222 - 5.777) <0.0001 Smoking status 1.908 (1.275 - 2.855) 0.002 Hypertension 1.793 (1.252 - 2.566) 0.001 MIA3 0.027 AC 2.478 (1.049 - 5.858) 0.039 CC 3.067 (1.312 - 7.169) 0.010 CDKN2B 0.009 AG 1.196 (0.730 - 1.960) 0.478 GG 1.957 (1.182 - 3.240) 0.009 Constant 0.045 <0.0001 Open in new tab 306 https://esc365.escardio.org/Presentation/217595/abstract Long-term CAD events rate according to CAC scoring burden, in asymptomatic population M Serrao,1 M Temtem,1 A Pereira,1 JA Sousa,1 M Neto,1 J Monteiro,1 A C Sousa,1 S Freitas,1 M Rodrigues,1 S Borges,1 A I Freitas,1 I Ornelas,1 A Drumond,1 P Palma Dos Reis2 and M I Mendonca1 1Funchal Hospital, Research Unit, Funchal, Portugal 2New University of Lisbon, Faculty of Medical Sciences, Lisbon, Portugal Background: Coronary artery calcification (CAC) indicates the presence of atherosclerotic lesions and serves as a marker of prognosis in patients with coronary artery disease (CAD). However, its role in individuals apparently without coronary artery disease remains contradictory. Purpose: This study intends to evaluate the value of the CAC score for determining the prognosis of patients with no coronary disease (CAD). Methods and Results: The study consisted of 994 asymptomatic individuals free of known coronary heart disease, enrolled from GENEMACOR study controls and referred for computed tomography for the CAC scoring assessment. A cohort of 789 was followed for a mean of 4.9±3.2 years for the primary end point of all-cause of cardiovascular events. Among this population, the extent of CAC differs significantly between men and women in the same age group. Therefore, the distribution of CAC score by age and gender was done by using the Hoff’s nomogram (Hoff 2001). According to this nomogram, 3 categories were created: low CAC (0≤CAC<100 and P<50); moderate CAC (100≤CAC<400 or P50-75) and high CAC (CAC≥400 or P>75). Cox proportional model verified that those having high CAC were associated with 8.012-fold higher events risk probability when compared to those with lower CAC. Curves representing the cumulative probability of survival were generated using Kaplan-Meier estimates stratified by categories of increasing CAC. Higher CAC had a higher rate event probability compared with lower CAC category. Conclusion: This study reveals that individuals with elevated CAC have a considerably higher CAD event rates than those with lower CAC. This tool may help to estimate the probability for CAD events in asymptomatic population. Larger studies should reproduce and validate these findings. Open in new tabDownload slide Kaplan-Meier by CAC categories. Acute Cardiac Care – CCU, Intensive, and Critical Cardiovascular Care 327 https://esc365.escardio.org/Presentation/217221/abstract Modulating preload in acute pulmonary embolismNovo Nordisk Foundation and Holger and Ruth Hesse’s Memorial Foundation CS Mortensen,1 AK Hansen,1 MD Lyhne,1 JG Schultz,1 JE Nielsen-Kudsk1 and A Andersen1 1Aarhus University Hospital, Department of Cardiology - Research, Aarhus, Denmark Background: Acute pulmonary embolism (PE) is a common and potentially fatal disease. Death often occurs within few hours after presentation due to failure of the right ventricle (RV). The vicious cycle leading to RV failure starts with imbalance in the filling of the RV. Therefore, optimal volume status aiming to maintain the optimal RV preload is crucial to avoid deterioration and failure. However, the present data supporting hemodynamic regimes in acute PE are few and contradictive. Purpose: To characterize the hemodynamic effects of increased preload with fluid loading and decreased preload with diuretic treatment in an established porcine model of acute intermediate-risk PE. Methods: After administration of consecutive, autologous PE, 22 pigs were randomized into three subgroups: Fluid (n=8, isotonic saline, 1 L/hour), diuretic (n=8, furosemide 40 mg, refract boluses) and vehicle (n=6, no treatment). Animals were evaluated at baseline, after PE, and every 30 minutes for two hours using bi-ventricular pressure-volume loop recordings, pulmonary and systemic invasive pressure measurements, diuretic output, respiratory parameters, and blood analysis. Results: Administration of PE increased pulmonary artery pressure (p<0.0001), pulmonary vascular resistance (PVR) (p<0.01) and right ventricular arterial elastance (p<0.01) compared to baseline using a paired t-test. Fluid loading of 0.5-1.0 L increased preload (p<0.05) and improved cardiac output (p<0.01) and RV ejection fraction (EF) (p<0.01) while PVR decreased (p<0.05) compared to post-PE using two-way ANOVA. Diuretic treatment decreased preload (p<0.05), increased RV contractility (p<0.01) and both pulmonary- and systemic vascular resistance (SVR) (p<0.05 and p<0.01) resulting in an unaltered systemic blood pressure compared to post-PE using two-way ANOVA. (Figure 1) Figure 1. Open in new tabDownload slide Conclusion: Comprehensive physiological evaluation of the hemodynamic effects of altered preload in acute intermediate-risk PE indicated, that limited, but not excessive, fluid loading seemed beneficial for RV function as CO and RV EF increased. On the other hand, diuretics preserved systemic blood pressure at the expense of increased intrinsic RV contractility, PVR and SVR. ST-Elevation Myocardial Infarction (STEMI) 328 https://esc365.escardio.org/Presentation/221286/abstract Early left ventricular thrombus formation after ST-elevation myocardial infarction: a prospective observational CMR study M Holzknecht,1 SJ Reinstadler,1 M Reindl,1 C Tiller,1 A Mayr,2 G Klug1 and B Metzler1 1Medical University of Innsbruck, University Clinic of Internal Medicine III, Cardiology and Angiology, Innsbruck, Austria 2Medical University of Innsbruck, University Clinic of Radiology, Innsbruck, Austria Background: Left ventricular (LV) thrombus formation is a severe complication after acute ST-segment elevation myocardial infarction (STEMI). However, the incidence and determinants of LV thrombus formation are still a matter of controversy. Purpose: We aimed to assess the incidence of early LV thrombus formation as detected by cardiac magnetic resonance (CMR) imaging and its determinants in a large contemporary cohort of STEMI patients treated with primary percutaneous coronary intervention (PPCI). Methods: This observational study included 530 consecutive STEMI patients treated with PPCI. Contrast enhanced CMR was performed at a median of 3 days (interquartile range 2-4 days) after PPCI for the evaluation of LV thrombus formation, LV function and infarct severity including infarct size (IS) and microvascular obstruction (MVO). Results: LV thrombi were detected in 3.2% of the overall cohort (n=17). In all patients presenting with LV thrombus, left anterior descending artery (LAD) was identified as culprit lesion. Accordingly, the incidence of LV thrombi in anterior STEMI patients (n=247) was 6.9%. The occurrence of thrombi was significantly associated with reduced LV ejection fraction (LVEF) (p<0.001), larger LV end-diastolic volume (LVEDV) (p<0.001) and LV end-systolic volume (p<0.001), larger areas of MVO (p=0.003) and larger IS (p<0.001). Furthermore, increased levels of peak high sensitivity cardiac Troponin T (p<0.001) were significantly related to LV thrombi. After multivariable analysis, only LVEF (odds ratio (OR): 0.91, 95% confidence interval (CI) 0.87-0.96; p=0.001) and LVEDV (OR: 1.02, 95% CI 1.01-1.03; p=0.004) emerged as independent predictors of LV thrombus formation. Conclusion: The risk of early LV thrombus formation remains considerable in contemporary treated STEMI patients, especially in those with LAD as culprit lesion. Among CMR parameters, only baseline LVEF and LVEDV, but not IS or MVO, independently predicted LV thrombus formation after STEMI. ST-Elevation Myocardial Infarction (STEMI) 330 https://esc365.escardio.org/Presentation/216732/abstract Relationship between admission Q waves and microvascular injury in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention C Tiller,1 M Reindl,1 M Holzknecht,1 L Innerhofer,1 M Wagner,1 I Lechner,1 A Mayr,2 G Klug,1 A Bauer,1 B Metzler1 and S Reinstadler1 1Innsbruck Medical University, Internal Medicine III, Cardiology & Angiology, Innsbruck, Austria 2Innsbruck Medical University, University Clinic of Radiology, Innsbruck, Austria Background: Using comprehensive cardiac magnetic resonance (CMR) imaging in patients suffering from ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (pPCI), we sought to investigate the association of admission Q waves with microvascular injury (microvascular obstruction (MVO) and intramyocardial haemorrhage (IMH)). Methods: This prospective observational study included 195 STEMI patients treated with pPCI. Admission 12-lead electrocardiography was evaluated for the presence of pathological Q waves, defined as a Q wave duration of >30ms and a depth of >0.1mV. CMR was performed at 3 (interquartile range: 2-5) days after pPCI to determine infarct characteristics including MVO (late gadolinium enhancement) and IMH (T2* mapping). Results: Admission Q waves were observed in 53% of patients (n=104). These patients had a significantly lower BMI (p=0.005), more frequent left anterior descending artery as culprit lesion (p=0.005), were less frequent smokers (p=0.048) and had higher rates of pre-interventional TIMI flow 0 (p=0.018). Patients with Q waves showed a significantly larger infarct size (19%vs.12% of left ventricular mass,p<0.001), lower ejection fraction (49%vs.54%,p=0.001), worse global strain parameters (all p<0.005) and more severe microvascular injury (MVO: 68%vs.34%,p<0.001; IMH: 42%vs.18%,p<0.001). Q waves remained associated with both MVO (odds ratio: 3.82, 95% confidence interval: 1.99 to 7.30,p<0.001) and IMH (odds ratio: 2.29, 95% confidence interval: 1.17 to 4.49,p=0.013) after adjusting for potential confounders (total ischemia time, culprit lesion, pre-interventional TIMI flow 0, ST-segment elevation). Conclusions: Admission Q waves, derived from the readily available ECG, emerged as independent early markers of CMR-determined microvascular injury in STEMI patients undergoing pPCI. Pulmonary Embolism 331 https://esc365.escardio.org/Presentation/216441/abstract Immediate cardiopulmonary responses in consecutive, acute pulmonary embolism Aarhus University, the Laerdal Foundation for Acute Medicine, Soester and Verner Lipperts Foundation, Holger and Ruth Hesse’s Memorial Fondation MD Lyhne,1 JG Schultz,1 CS Mortensen,1 AK Hansen,1 A Andersen1 and JE Nielsen-Kudsk1 1Aarhus University Hospital, Skejby, Department of Cardiology & Institute of Clinical Medicine, Aarhus, Denmark Background: Acute pulmonary embolism (PE) is life-threatening and death often occurs within minutes to hours after presentation. The vicious circle that leads to right ventricular (RV) failure and death includes a number of cardiopulmonary factors but each may act differently to consecutive PE and increased clot burden. Research have focused on hemodynamics hours or days after onset of PE whereas the cardiovascular physiology in the immediate, critical timeframe is undescribed. Purpose: The present study aimed to describe the immediate cardiopulmonary responses in consecutive, acute PE. Methods: Twelve pigs were randomized to autologous, central PE or sham. Consecutive PE (size 20x1 cm) were administered every 15 minutes until mean pulmonary arterial pressure (mPAP) was doubled or 6 large PEs were given. Cardiopulmonary responses were evaluated at 1, 2, 5 and 13 minutes after each PE by bi-ventricular pressurevolume loop recordings, pulmonary and systemic invasive pressure measurements, arterial and central venous blood gasses, and respiratory parameters. The study was approved by the Danish Animal Research Inspectorate. Results: Consecutive PE caused significant increase in mPAP in PE animals compared to sham (two-way ANOVA, p<0.0001, see figure). The response in mPAP was significantly larger at the first PE compared to the second (difference 6.1±2.3 mmHg, p=0.04) followed by stepwise increments with each subsequent PE. PE also caused a significant increase in pulmonary vascular resistance and arterial elastance compared to sham (two-way ANOVA p<0.05 for both) but without significant difference in response between each consecutive PE. Consecutive PE caused RV end-systolic and end-diastolic dilatation and reduced RV ejection fraction compared to sham (two-way ANOVA p<0.05 for all, see figure). Left ventricular pressures and volumes decreased immediately after all PEs but repeatedly returned to baseline values within 15 minutes (see figure). Blood gas analyses showed that PaO2 decreased and pulmonary shunt and physiological dead space progressively increased (two-way ANOVA p<0.01 for all, see figure) with subsequent PE showing a relationship to clot burden. Conclusions: Comprehensive physiological evaluation of acute PE with high temporal resolution reveals, that cardiopulmonary variables change quickly in the minutes following acute PE. A significant mPAP increase and RV dilation is seen at the first PE whereas RV afterload and RV function are maintained until the third PE. Acute Coronary Syndromes - Clinical 332 https://esc365.escardio.org/Presentation/216401/abstract Acute coronary syndrome in young women: characteristics, etiology and in-hospital outcomes D Araiza Garaygordobil,1 H Gonzalez-Pacheco,1 CP Paredes-Paucar,1 JL Briseno-De La Cruz,1 S Mendoza-Garcia,1 A Altamirano-Castillo,1 D Sierra-Lara,1 D Manzur-Sandoval1 and A Arias-Mendoza1 1National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico Background: In-hospital mortality and recurrent cardiovascular events are shown to be higher in women with acute coronary syndromes (ACS) than in men. At present, however, there has been little research among young women at pre-menopausal age. Purpose: The objective of this work was to compare risk factors, clinical features, and outcomes among young women with premature ACS. Methods: This analysis is based on 11,483 patients with acute coronary syndrome who were admitted to a cardiovascular care center in Mexico. Three different groups were analyzed: women <50 years old, women ≥50 years old and men. Results: Overall, 20.9% (2,401/11,483) of patients were women, from which 8.3% (201/2,401) were <50 years old (mean, 48 years). Women aged <50 years with ACS differed from older women in their clinical characteristics, treatment, and clinical outcome. Women ≥50 years had a higher frequency of hypertension, diabetes and dyslipidemia; women <50 years old showed a significantly higher smoking frequency (p<0.0001); diabetes and hypertension were present in 31.3% and 40.8% of the cases, respectively. At admission, ST-segment–elevation myocardial infarction (STEMI) was present in 48.8%, 38.3%, and 52.7% for women <50 years old, women ≥50 years old and men, respectively (p<0.0001). For younger women, coronary angiography was performed more frequently, compared to older women and men (84.6% vs. 70.8% vs. 81.5% respectively, p <0.0001). Etiology of ACS was attributed to non-atherosclerotic causes in 16.1% of cases in women <50 years old (coronary embolism, spontaneous coronary dissection and arteritis). Coronary atherosclerotic burden was higher in women ≥50 years old (multi-vessel disease in 28.9%, 40.0%, and 46.0% in women <50 years, women ≥50 years and in men, respectively, p<0.0001).Percutaneous coronary intervention was performed in 50.7%, 46.6% and 59.7% (p<0.0001). The overall in-hospital mortality was significantly higher among women ≥50 years old (5.0%, 10.9%, and 6.4% for women <50 years, women ≥50 years and in men, respectively; P < 0.0001). Among patients with STEMI, we highlight the high mortality rate in women ≥50 years of age (7.1%, 17.2% and 8.6% for women <50 years old, women ≥50 years, and in men, respectively p<0.0001). Conclusions: The study showed that in young women with ACS, smoking is the main risk factor, non-atherosclerotic causes are more frequent, and in-hospital mortality is high, which may reflect a high-risk clinical profile. Women ≥50 years of age have higher mortality than men. Acute Cardiac Care – Cardiac Arrest 333 https://esc365.escardio.org/Presentation/216437/abstract Hemodynamics and vasopressor support during prolonged targeted temperature management after out-of-hospital cardiac arrest J Grand,1 C Hassager,1 M Skrifvars,2 A Grejs,3 BS Rasmussen,4 T Laitio,5 C Storm,6 F Taccone,7 E Soreide8 and H Kirkegaard3 1Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark 2Helsinki University Hospital, Department of Emergency Care and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland 3Skejby University Hospital, Research Center for Emergency Medicine, Aarhus, Denmark 4Aalborg University Hospital, ANAESTHESIOLOGY AND INTENSIVE CARE, Aalborg, Denmark 5Turku University Hospital, Anaesthesiology and intensive Care, Turku, Finland 6Charit?? - Universit??tsmedizin Berlin, Department of intensive care medicine, Berlin, Germany 7Erasme Hospital (ULB), Department of Intensive Care, Brussels, Belgium 8Stavanger University Hospital, Department of Clinical Medicine, Stavanger, Norway Background: After resuscitation from out-of-hospital cardiac arrest (OHCA), patients may suffer from the post-cardiac arrest syndrome (PCAS) characterized among other entities by hemodynamic instability. Targeted temperature management (TTM) has been implemented as neuroprotection after OHCA, however TTM infers various effects on patient hemodynamics. In the “Targeted Temperature Management for 48 vs 24 Hours” (TTH48)-trial, the effect of prolonged TTM (48 hours) on neurological outcome was investigated. However, no previous studies have investigated the effect of prolonged TTM on hemodynamic function after OHCA. Purpose: The aim was to describe the hemodynamic profile of patients undergoing prolonged TTM in relation to survival status as a post hoc analysis of a trial cohort of PCAS-patients. Methods: Multi-center substudy of 71 patients surviving at least two days included in the prolonged hypothermia arm in the prospective, randomized TTH48-trial. Vasopressor load was calculated for each patient: Vasopressor load (μg/kg/min) = norepinephrine (μg/kg/min) + dopamine (μg/kg/min/100) + epinephrine (μg/kg/min). Survival status was recorded 180 days after OHCA. Survivors and non-survivors were compared during prolonged TTM by repeated measurements mixed models. Measurements and results: Mean age was 61±12 years, 63 (89%) were males and mean time to return of spontaneous circulation was 24±14 minutes. After 180 days, 53 (75%) were still alive. In survivors, vasopressor load increased during the first part of TTM reaching maximum at 0.09 μg/kg/min 95%CI [0.05-0.15] at 33 hours after ICU-admission. In non-survivors the vasopressor load increased further reaching maximum after 42 hours (0.12 μg/kg/min 95%CI [0.05-0.3]). Vasopressor load were not different between survivors and non-survivors during the first 24 hours of TTM (pgroup=0.83). However, vasopressor load during prolonged TTM (24-48 hours) tended to be higher in non-survivors (pgroup=0.07) (Figure). Mean arterial pressure was kept stationary around 73 mm Hg during prolonged TTM with no difference between survivors and non-survivors (p=0.89). Heart rate was significantly higher in non-survivors during prolonged TTM (mean difference: 7 beats per minute 95%CI [0-14], p=0.04) (Figure). Open in new tabDownload slide Vasopressor, HR and MAP during TTM48. Conclusions: Heart rate was significantly higher and vasopressor load tended to be higher in non-survivors during prolonged TTM. Furthermore, in non-survivors, vasopressor load increased throughout all 48 hours. Mean arterial pressure was not different between survivors and non-survivors during prolonged TTM. ST-Elevation Myocardial Infarction (STEMI) 373 https://esc365.escardio.org/Presentation/216460/abstract Neurohormonal activation is higher at hospital admission in women compared to men with ST-elevation myocardial infarctionRighospitalets Forskningsfond, Forskningspuljen ml RH og OUH, The Danish Heart Foundation (Hjerteforeningen) M Frydland,1 JE Moeller,2 S Wiberg,1 O Moeller-Helgestad,2 MG Lindholm,1 LO Jensen,2 JH Thomsen,1 J Kjaergaard,1 L Holmvang1 and C Hassager1 1Rigshospitalet - Copenhagen University Hospital, Cardiology, Copenhagen, Denmark 2Odense University Hospital, Department of Cardiology, Odense, Denmark Background: Mortality in patients with ST-elevation myocardial infarction (STEMI) has been reduced substantially throughout the past decades. However, mortality rates among women are higher than in men and remain an unsolved clinical challenge. Level of neurohormonal activation and inflammation have previously been shown to be associated with mortality in STEMI patients. Whether concentration of biomarkers reflecting these processes are different in men and women with STEMI is unknown. Aim: To assess the admission concentration of biomarkers reflecting neurohormonal activation (copeptin, pro-atrial natriutic peptide (proANP), and mid-regional-pro-adrenomedullin (MRproADM)) and inflammation (ST2, and c-reactive peptide (CRP)) in men and women with STEMI. Methods: From 1892 consecutive STEMI patients admitted at two Danish tertiary heart centres, 93% had blood sampled for biomarker analysis drawn at admission immediately before angiography during a one year period (2015-2016). Results: From the cohort, 500 (26%) were women. Women were older, had more hypertension (50% vs 43%, p=0.008) but less known ischemic heart disease (12% vs 17%, p=0.01) than men. Furthermore, women had longer time from symptom debut to angiography (median (25th; 75thpercentile) 210 (135-408) vs 181 (340-125) minutes, p=0.0003), but similar final left ventricular ejection fraction (LVEF, mean (SD) 45 (12) vs 45 (12), p=0.17) compared to men. One-year all-cause mortality was significantly higher in women (13% vs. 8.2%, p=0.002). Biomarkers of neurohormonal activation (proANP and MRproADM) were higher in women whereas biomarkers of inflammation showed divergent results with lower ST2 and CRP higher in women (Figure). We found no difference in copeptin. When adjusting for age, LVEF, diabetes, and time from symptom debut to angiography/blood sampling only the difference in neurohormonal activation (proANP (p<0.0001) and MRproADM (p<0.0001)) remained significant. Conclusion: Mortality in female STEMI-patients is higher than in men. Admission concentration of biomarkers of neurohormonal activation are higher in female patients, while inflammatory markers showed divergent result. Figure. Open in new tabDownload slide Acute Cardiac Care – Cardiogenic Shock 374 https://esc365.escardio.org/Presentation/216702/abstract Awake venoarterial extracorporeal membrane oxygenation in cardiogenic shock: a propensity score matched analysisS. Montero was funded by a 2016 Clinical Training Grant awarded by the European Society of Cardiology S Montero,1 F Huang,2 M Rivas-Lasarte,3 J Chommeloux,2 N Brechot,2 G Hekimian,2 G Franchineau,2 CE Luyt,2 C Garcia-Garcia,1 A Bayes-Genis,1 G Lebreton,4 J Cinca,3 A Combes,2 J Alvarez-Garcia3 and M Schmidt2 1Hospital Germans Trias i Pujol, Barcelona, Spain 2Hopital La Pitie Salpetriere, Medical Intensive Care Unit, Paris, France 3Hospital de la Santa Creu i Sant Pau, Barcelona, Spain 4Hopital La Pitie Salpetriere, Thoracic and Cardiovascular department, Paris, France Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is the first-line therapy for refractory cardiogenic shock (CS), but its applicability is undermined by the high morbidity associated with its complications, especially those related to mechanical ventilation (MV). Purpose To assess the impact on survival of keeping patients awake during the VA-ECMO run in the context of refractory CS. Methods: A 7-year database of patients with peripheral VA-ECMO was used to perform a propensity score (PS) matched analysis in order to balance their clinical profile. Patients were classified as “awake and partially awake” or “non-awake” if MV was present ≤50% or >50% of the ECMO run. Primary outcomes were 60-day and 1-year mortality, and secondary outcomes included rates of ventilator-associated pneumonia (VAP) and ECMO-related complications. Results: Out of 231 patients included, 91 patients (39%) were “awake and partially awake” and 140 patients (61%) “non-awake”. After PS matching adjustment, the “awake and partially awake” group had significantly better 60-day (19% vs 46%, p<0.006) and 1-year survival (32% vs 57%, p<0.018), as well as reduced rates of VAP (34% vs 64%, p=0.004) and less antibiotic and sedative drugs consumption. Conclusions: An “awake” VA-ECMO strategy in CS is safe and is associated with improved short- and long-term survival compared to mechanically ventilated patients. Open in new tabDownload slide Survival at 60-days and 1-year. Acute Heart Failure: Non-pharmacological Treatment 376 https://esc365.escardio.org/Presentation/216748/abstract Ventricular assist device as bridge to heart transplant. When should we include the patient in heart transplant waiting list? B Tapia Majado,1 S Catoya Villa,1 J Sanchez Cena,1 S Gonzalez Lizarbe,1 T Borderias Villaroel,1 D Serrano Lozano,1 M Lozano Gonzalez,1 I Cabrera Rubio,1 JE Lujan Valencia,1 V Burgos Palacios,1 C Castrillo Bustamante,1 M Ruiz Lera,1 A Canteli Alvarez,1 M Cobo Belaustegui1 and A Sarralde Aguayo1 1University Hospital Marques de Valdecilla, Santander, Spain Introduction: The use of circulatory support devices (CSD) as a bridge to heart transplantation (BTT) has become a common strategy in patients in INTERMACS 1-3 situation. Despite being an invasive therapy, support with these devices does not confer a worse prognosis if the heart transplant (HT) is performedafter reaching clinical stability. Purpose: Our goal is to evaluate the characteristics of the patients with short-term ventricular assist device (ST-VAD) implanted as BTT. Methods: Since 2009, a total of 252 CSD have been implanted in our hospital to 206 patients, 98 of whom were ST-VADs. Of these, 85 were implanted as BTT. Results: 83.5% were male, with a mean age of 53.9 (± 10.03) years. All ST-VADs were Levitronix Centrimag®: 58.8% were left-sided VAD (LVAD), 1.2% right-sided (RVAD) and 40% biventricular (initial 36.5%, sequential 3.5%). The underlying disease is shown in Graph 1. At the moment of implantation, 85.9% of the patients were in INTERMACS profile 2 or 3, and 94.1% required inotropic support. 78.8% of the patients were listed, with an average support time of 20.3 (± 14.6) days until inclusion. At the time of inclusion, 95.5% did not require invasive mechanical ventilation. Non patient had liver failure, 1.5% had renal failure and lactate was normal (6.9 ± 2.2 mg / dL) in all cases. Also, the need for inotropic support was lower. 94% were undergoing physical therapy and 86.6% were recieving oral feeding. The average number of days in Grade 0 emergency was 10.9 (± 8.7) and the total support was 27.5 (± 17.9) days. 95.5% of the patients included in HT waiting list were transplanted. The survival rate of this group at one year was 95.3%. Conclusions: The use of ST-VAD in patients in INTERMACS 2-3 situation allows recovering organic damage and improve patient functional status before HT. This translates into a high one-year survival. Table 1. Complication during VAD support. RENAL FAILURE (n, %) 29 (34,12%) BLEEDING (n, %) 64 (75,29%) CARDIAC TAMPONADE: 49,41% REOPERATION (n, %) 50 (58,82%) CARDIAC TAMPONADE: 47,06% Nº RE-OP/PAT.:2,21± 1,67 INFECTION (n, %) 58 (68,24%) Respiratory infection: 36,47% Bacteriemia: 16,47% Sepsis: 9,41% Urinary tract: 4,70% Surgical wound: 1,18% VASCULAR COMPLICATION (n, %) 2 (2,35%) CENTRAL NERVOUS SYSTEM COMPLICATION (n, %) 20/85 (23,53%) Anoxic: 2,45% Ischemic stroke without sequelae: 12,94% Ischemic strokewith sequelae 7,06% Hemorrhagic stroke: 1,18% DEVICE COMPLICATION (n, %) 16 (18,82%) Infection: 4,70% Hemolysis: 4,70% Structural failure: 2,35% Cannula thrombosis: 7,06% REASON FOR VAD WITHDRAWAL (n, %) HEART TRANSPLANT:64(75,3%) DEATH: 21 (24,70%) DEATH CAUSE BEFORE BEING INCLUDED (n, %) 18 (21,18%) Multiorganic failure: 2 (11,11%) Infection: 6 (33,33%) Ischemic stroke: 2 (11,11%) Hemorrhage: 3 (16,67%) VAD implant complication:1 (5,55%) Vascular air embolism: 2 (11,11%) Futility: 1 (5,55%) Other: 1 (5,55%) VAD SUPPORT INVASIVE MECHANICAL VENTILATION ICU LENGTH OF STAY HOSPITAL LENGTH OF STAY (Days) (M±SD) 27,49± 17,97 10,16± 8,67 44,48 ± 25,99 66,37 ± 40,04 RENAL FAILURE (n, %) 29 (34,12%) BLEEDING (n, %) 64 (75,29%) CARDIAC TAMPONADE: 49,41% REOPERATION (n, %) 50 (58,82%) CARDIAC TAMPONADE: 47,06% Nº RE-OP/PAT.:2,21± 1,67 INFECTION (n, %) 58 (68,24%) Respiratory infection: 36,47% Bacteriemia: 16,47% Sepsis: 9,41% Urinary tract: 4,70% Surgical wound: 1,18% VASCULAR COMPLICATION (n, %) 2 (2,35%) CENTRAL NERVOUS SYSTEM COMPLICATION (n, %) 20/85 (23,53%) Anoxic: 2,45% Ischemic stroke without sequelae: 12,94% Ischemic strokewith sequelae 7,06% Hemorrhagic stroke: 1,18% DEVICE COMPLICATION (n, %) 16 (18,82%) Infection: 4,70% Hemolysis: 4,70% Structural failure: 2,35% Cannula thrombosis: 7,06% REASON FOR VAD WITHDRAWAL (n, %) HEART TRANSPLANT:64(75,3%) DEATH: 21 (24,70%) DEATH CAUSE BEFORE BEING INCLUDED (n, %) 18 (21,18%) Multiorganic failure: 2 (11,11%) Infection: 6 (33,33%) Ischemic stroke: 2 (11,11%) Hemorrhage: 3 (16,67%) VAD implant complication:1 (5,55%) Vascular air embolism: 2 (11,11%) Futility: 1 (5,55%) Other: 1 (5,55%) VAD SUPPORT INVASIVE MECHANICAL VENTILATION ICU LENGTH OF STAY HOSPITAL LENGTH OF STAY (Days) (M±SD) 27,49± 17,97 10,16± 8,67 44,48 ± 25,99 66,37 ± 40,04 Open in new tab Table 1. Complication during VAD support. RENAL FAILURE (n, %) 29 (34,12%) BLEEDING (n, %) 64 (75,29%) CARDIAC TAMPONADE: 49,41% REOPERATION (n, %) 50 (58,82%) CARDIAC TAMPONADE: 47,06% Nº RE-OP/PAT.:2,21± 1,67 INFECTION (n, %) 58 (68,24%) Respiratory infection: 36,47% Bacteriemia: 16,47% Sepsis: 9,41% Urinary tract: 4,70% Surgical wound: 1,18% VASCULAR COMPLICATION (n, %) 2 (2,35%) CENTRAL NERVOUS SYSTEM COMPLICATION (n, %) 20/85 (23,53%) Anoxic: 2,45% Ischemic stroke without sequelae: 12,94% Ischemic strokewith sequelae 7,06% Hemorrhagic stroke: 1,18% DEVICE COMPLICATION (n, %) 16 (18,82%) Infection: 4,70% Hemolysis: 4,70% Structural failure: 2,35% Cannula thrombosis: 7,06% REASON FOR VAD WITHDRAWAL (n, %) HEART TRANSPLANT:64(75,3%) DEATH: 21 (24,70%) DEATH CAUSE BEFORE BEING INCLUDED (n, %) 18 (21,18%) Multiorganic failure: 2 (11,11%) Infection: 6 (33,33%) Ischemic stroke: 2 (11,11%) Hemorrhage: 3 (16,67%) VAD implant complication:1 (5,55%) Vascular air embolism: 2 (11,11%) Futility: 1 (5,55%) Other: 1 (5,55%) VAD SUPPORT INVASIVE MECHANICAL VENTILATION ICU LENGTH OF STAY HOSPITAL LENGTH OF STAY (Days) (M±SD) 27,49± 17,97 10,16± 8,67 44,48 ± 25,99 66,37 ± 40,04 RENAL FAILURE (n, %) 29 (34,12%) BLEEDING (n, %) 64 (75,29%) CARDIAC TAMPONADE: 49,41% REOPERATION (n, %) 50 (58,82%) CARDIAC TAMPONADE: 47,06% Nº RE-OP/PAT.:2,21± 1,67 INFECTION (n, %) 58 (68,24%) Respiratory infection: 36,47% Bacteriemia: 16,47% Sepsis: 9,41% Urinary tract: 4,70% Surgical wound: 1,18% VASCULAR COMPLICATION (n, %) 2 (2,35%) CENTRAL NERVOUS SYSTEM COMPLICATION (n, %) 20/85 (23,53%) Anoxic: 2,45% Ischemic stroke without sequelae: 12,94% Ischemic strokewith sequelae 7,06% Hemorrhagic stroke: 1,18% DEVICE COMPLICATION (n, %) 16 (18,82%) Infection: 4,70% Hemolysis: 4,70% Structural failure: 2,35% Cannula thrombosis: 7,06% REASON FOR VAD WITHDRAWAL (n, %) HEART TRANSPLANT:64(75,3%) DEATH: 21 (24,70%) DEATH CAUSE BEFORE BEING INCLUDED (n, %) 18 (21,18%) Multiorganic failure: 2 (11,11%) Infection: 6 (33,33%) Ischemic stroke: 2 (11,11%) Hemorrhage: 3 (16,67%) VAD implant complication:1 (5,55%) Vascular air embolism: 2 (11,11%) Futility: 1 (5,55%) Other: 1 (5,55%) VAD SUPPORT INVASIVE MECHANICAL VENTILATION ICU LENGTH OF STAY HOSPITAL LENGTH OF STAY (Days) (M±SD) 27,49± 17,97 10,16± 8,67 44,48 ± 25,99 66,37 ± 40,04 Open in new tab Graph 1. Open in new tabDownload slide Underlying disease. 378 https://esc365.escardio.org/Presentation/216415/abstract Clinical picture, management and risk stratification in patients with cardiogenic shock: does gender matter? D Luiso,1 E Collado Lledo,1 I Llao,1 M Rivas-Lasarte,2 V Gonzalez-Fernandez,3 FJ Noriega,4 FJ Hernandez-Perez,5 O Alegre,1 A Sionis,2 RM Lidon,3 A Viana-Tejedor,4 J Segovia-Cubero5 and A Ariza-Sole1 1University Hospital Bellvitge, Department of Cardiology, Barcelona, Spain 2Sant Pau Hospital, Department of Cardiology, Barcelona, Spain 3University Hospital Vall d’Hebron, Department of Cardiology, Barcelona, Spain 4Hospital Clinico San Carlos, Department of Cardiology, Madrid, Spain 5University Hospital Puerta de Hierro Majadahonda, Department of Cardiology, Madrid, Spain Background: Early recognition and risk stratification are crucial in patients with cardiogenic shock (CS) for selection of the optimal treatment strategy. A significantly lower adherence to recommendations has been consistently described in women with cardiovascular diseases. Little information exists about potential disparities in clinical picture, management and risk stratification according to gender in patients with CS. Methods: Data from the multicenter Red-Shock registry were used. All consecutive patients with CS were included. Both the CardShock and the IABP-SHOCK II risk scores were calculated in the study cohort. The primary end-point was in-hospital mortality. The discriminative ability of both scores was assessed by a binary regression logistic model, calculating Receiver Operating Characteristic (ROC) curves and the corresponding Area Under the Curve (AUC). Results: A total of 793 patients with CS were included, of whom 222 (28%) were female. Women were significantly older and had a significantly lower proportion of chronic obstructive pulmonary disease and prior myocardial infarction. CS was less often related to ACS in women. The proportion of use of vasoactive drugs, renal replacement therapy, invasive ventilation, therapeutic hypothermia and mechanical circulatory support was similar between both groups. In-hospital mortality for the overall cohort was 346/793 (43.6%). Mortality was not significantly different according to gender (p=0.194). CardShock risk score showed a good ability for predicting in-hospital mortality both in man (AUC 0.69) and women (AUC 0.735) (Figure 1). Likewise, the IABP-II successfully predicted in-hospital mortality in both groups (man: AUC 0.693; women: AUC 0.722) (Figure 2). Conclusions: About one of each three of patients with CS from this series were women. No significant differences were observed regarding management and in-hospital mortality according to gender. Both the CardShock and IABP-II risk scores depicted a good ability for predicting mortality also in women with CS. Open in new tabDownload slide ROC curves. Acute Cardiac Care – Cardiogenic Shock 380 https://esc365.escardio.org/Presentation/217584/abstract Biomarkers reflecting neurohormonal activation and inflammation are correlated with the ORBI Risk Score and predictive of in-hospital cardiogenic shock development in STEMI-patients KP Frederiksen,1 H Soeholm,1 C Hassager,2 JE Moeller,3 J Hartvig-Thomsen,2 O Moeller-Helgestad,3 S Wiberg,2 LO Jensen,3 L Holmvang2 and M Frydland2 1University Hospital, Department of Cardiology, Roskilde, Denmark 2Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark 3Odense University Hospital, Department of Cardiology, Odense, Denmark Background: The overall mortality in ST-elevation myocardial infarction (STEMI) patients has been reduced dramatically throughout the past decades. However, among the 5-10% of STEMI-patients who develop cardiogenic shock (CS) the 30-day mortality is 50%. Approximately half of STEMI-patients developing CS are hemodynamically stable at hospital admission but deteriorate during the hospitalization. Recently the ORBI Risk Score has been established as a strong predictor for development of in-hospital CS in the seemingly stable STEMI-patients. Besides hemodynamically instability, CS is characterized by inflammation and neurohumoral activation. Biomarkers at admission reflecting these processes have been found predictive of development of in-hospital CS, but whether they correlate with the ORBI Risk Score are unknown. Purpose: In this study, we aimed to investigate the association between admission concentration of biomarkers reflecting inflammation and neurohumoral activation and the ORBI Risk Score in STEMI-patients. Methods: A total of 1892 consecutive STEMI-patients were admitted throughout 1 year in 2015/2016 at two Danish tertiary heart centers. The ORBI Risk Score was assessed (comprised by: age >70 years, prior stroke/transient ischemic attack, cardiac arrest upon admission, anterior STEMI, first medical contact-to-primary PCI delay >90 min, Killip class, heart rate >90/min, a combination of systolic blood pressure <125mmHg and pulse pressure <45 mmHg, glycaemia >10 mmol/L, culprit lesion of the left main coronary artery, and post-pPCI TIMI flow grade <3). Blood samples were acquired at hospital admission prior to angiography (ST2, copeptin, pro-atrial natriuretic peptide (proANP), and mid-regional pro-adrenomedullin (MRproADM)). Patients were stratified according to the ORBI Risk Score in 4 groups (0-7, 8-10, 11-12, and ≥13 points). Complete data were available in 82% of cases. Results: In total, 194 patients (10%) developed CS, whereof 82 (42%) developed in-hospital CS. When stratified according to level of ORBI risk score, patients with 8-10, 11-12, and ≥13 points had a 6.6%, 17%, and 19% risk of in-hospital CS development, respectively, whereas patients with score 0-7 had a low risk. All four biomarkers correlated with the score (Pearson correlation coefficient 0.22-0.31, p<0001 for all). The ORBI Risk Score had an overall predictive value of in-hospital CS development of area under the operating characteristics curve (AUCROC) of 0.84 (0.78-0.89), p<0.0001. MRproADM (0.88, p=0.03) and proANP (0.87, p=0.0009) increased the AUCROC of the ORBI Risk Score significantly, whereas ST2 and copeptin did not. Conclusion: The ORBI Risk Score is predictive of in-hospital CS development in a Danish consecutive STEMI-cohort. Admission concentration of biomarkers reflecting neurohumoral activation and inflammation are correlated with the risk score. MRproADM and proANP may add relevant predictive value to the score. Figure. Open in new tabDownload slide 381 https://esc365.escardio.org/Presentation/216504/abstract Ultrasound guided arterial catheterization in critical patients with non-pulsatile continuous circulation conditions on ventricular assist devices or VA ECMO M Laimoud1 and M Alanazi2 1Cairo University Hospitals, Cairo, Egypt 2King Faisal Specialist Hospital & Research Center, King Faisal Heart Center, Riyadh, Saudi Arabia Introduction: arterial catheterizations, especially of radial and femoral arteries, are very common procedures performed by physicians dealing with critical patients for invasive haemodynamic monitoring and frequent arterial blood sampling Traditionally, the technique of locating surface landmarks and palpation was used in catheterization . Getting arterial access can be challenging in critical patients with haemodynamic instability, impalpable pulses and coagulopathy. Objective: to study the effectiveness of vascular ultrasound in arterial catheterization in critical patients with nonpulsatile circulation admitted at cardiac critical care units in comparison with the landmark technique. Methods: This retrospective study was conducted in a tertiary care hospital and included patients from January 2015 to November 2018 who were admitted to adult cardiac critical care unit with veno-arterial extracorporeal membrane oxygenation (VA ECMO) or left ventricular assist device (LVAD ) and required arterial vascular access for invasive haemodynamic monitoring . Clinical and laboratory data of patients were collected . The number of attempts for arterial lines insertion, complications, first attempt and procedural success were collected . Results: 124 vascular catheters were inserted in 109 critical patients. 87 (79.8%) patients were haemodynamically unstable and supported with vasopressors infusions . heparin infusion was maintained in 91(83.4% ) patients while 18 (16.51%) patients were anticoagulated with oral warfarin therapy during arterial catheterization. The first attempt success was achieved in (78.9% vs 5.6%, p=0.001 ) and the procedural success was (100% vs 62.1%,p=0.001) in the ultrasound and landmark groups respectively . The number of attempts was (1.2±0.4 vs 2.1±0.5,p=0.001 ) and the haematoma occurred in ( 2.8 vs 11.1 %,p=0.001 ) in the ultrasound and landmark groups respectively . Conclusion: ultrasound guided arterial catheterization in critical patients with unstable haemodynamics and nonpulsatile continuous circulation was associated with higher first attempt and procedural success and less complications compared to the landmark technique. Acute Heart Failure - Clinical 382 https://esc365.escardio.org/Presentation/221526/abstract Left ventricular assist devices improve pulmonary hemodynamics in bridge to transplant patients with end stage heart failure A Gkouziouta,1 E Fountas,1 I Armenis,1 ME Zymatoura,1 D Miliopoulos,1 A Tsiambalis,1 M Bonios,1 S Adamopoulos1 and N Kogerakis1 1Onassis Cardiac Surgery Center, Athens, Greece Introduction: Pulmonary hypertension is a frequent sequelae of end-stage heart failure and remains a contraindication for cardiac transplantation. Pulsatile LVADs have been shown to effectively reduce pulmonary hypertension in these patients. However, it remains to be seen if newer continuous flow LVADs have a similar effect on pulmonary hypertension. The objective of this study was to determine if the Heartware (HW), a continuous flow LVAD is effective in improving pulmonary hemodynamics in bridge-to-transplant patients. Methods: 56 patients with end-stage heart failure underwent placement of Heartware as a bridge-to-transplant (BTT) at our institution.Pulmonary hemodynamics were evaluated with right heart catheterization at baseline, after placement of an intra-aortic balloon pump (IABP), and post-LVAD (prior to heart transplant). Results: Demographic data of these patients were as follows: mean age 51.6 ± 13.3 years, 70% male, LVEF 14.7 ± 5.11%, 56.6% ischemic etiology and 83.3% received IABP prior to LVAD. Following LVAD support (mean duration of 146. 41 ± 73.83 days), systolic and diastolic pulmonary artery pressures (SPAP and DPAP) decreased significantly (SPAP 56.8 ± 13.55 mmHg, DPAP 28.27 ± 6.23 mmHg to SPAP 35.38 ± 10.23 mmHg, DPAP 15.71 ± 5.36 mmHg; p < 0.001). Similarly, pulmonary vascular resistance (PVR) decreased significantly from 3.69 ± 2.02 to 2.00 ± 0.85 Woods units (p = 0.004). Transpulmonary gradient (TPG) also declined significantly post-LVAD from 13.3 ± 5.6 to 9.35 ± 2.98 mmHg (p = 0.02). Conclusion: Continuous flow LVADs effectively improve pulmonary hemodynamics associated with end-stage heart failure. Therefore, adequate left ventricular decompression achieved with continuous flow LVAD support can reverse significant pulmonary hypertension in end-stage heart failure patients making them eligible for cardiac transplantation. Acute Cardiac Care – Cardiogenic Shock 383 https://esc365.escardio.org/Presentation/216410/abstract Cardiogenic shock due to predominantly right ventricular failure following myocardial infarctionThe Danish heart foundation, an unrestricted research grant from Abiomed and The Jørgen Møller foundation. J Josiassen,1 OK Lerche-Helgestad,2 JE Moeller,2 H Schmidt,3 LO Jensen,2 L Holmvang,1 HB Ravn4 and C Hassager1 1Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark 2Odense University Hospital, Department of Cardiology, Odense, Denmark 3Odense University Hospital, Department of Cardiothoracic Anaesthesia, Odense, Denmark 4Rigshospitalet - Copenhagen University Hospital, Department of Cardiothoracic Anaesthesia, Copenhagen, Denmark Introduction: Most studies assessing cardiogenic shock due to acute myocardial infarction (AMICS) focus on cardiogenic shock due to failure of the left ventricle (LV). Patients with AMICS due to predominantly right ventricle (RV) failure are sparsely described. Purpose: The purpose of the study was to assess patients with AMICS due to predominantly RV failure in terms of demographics, treatment and outcome in comparison with patients where AMICS was caused by predominantly LV failure. Methods: All patients admitted with AMICS between 2010-2017 at two tertiary heart centres with a patient recruitment area corresponding two-thirds of the Danish population were individually identified by chart review. No exact consensus on RV infarction exists, but in this AMICS due to predominantly RV failure was identified via patient records and echocardiographic examinations and defined as: AMICS with LVEF≥45% and a culprit lesion in either the right coronary artery or in the left circumflex artery if left dominant. Results: A total of 1482 AMICS patients underwent acute revascularisation. Upon exclusion of patients with an LM culprit 1288 patients remained for further analysis. Hereof 158 (12%) patients developed cardiogenic shock due to predominantly RV failure, while 1130 (88 %) had predominantly LV involvement. Besides having a significantly higher LVEF caused by the categorisation (median 45% vs 30%), patients with predominantly RV failure were more frequently females (34% vs 23%, p=0.003), they had a lower heart rate (mean 78 vs 86, p=0.01) and more often needed temporary pacing (28% vs 17%, p=0.0004). Out-of-hospital cardiac arrest as presenting symptom was comparable among the two groups (45-47%, p=0.65). AMICS patients with predominantly RV failure had a 30-day mortality rate of 36% which was significantly lower compared to the patients with predominantly LV involvement (47%), Figure. After multivariate adjustment for factors associated with mortality in AMICS, including age, gender and lactate level upon AMICS development the signal persisted (predominantly LV failure vs predominantly RV failure: Hazard ratio 1.40; 95% confidence interval 1.04-1.89; p=0.03). Figure. Open in new tabDownload slide Conclusion: AMICS due to predominantly RV failure is associated with a better prognosis compared to cases with predominantly LV involvement. Acute Cardiac Care – Cardiogenic Shock 384 https://esc365.escardio.org/Presentation/216411/abstract Cardiogenic shock patients presenting with and without out of hospital cardiac arrest are different clinical entities The Danish heart foundation, an unrestricted research grant from Abiomed and The Jørgen Møller foundation. J Josiassen,1 OK Lerche-Helgestad,2 JE Moeller,2 J Kjaergaard,1 HF Hoejgaard,3 H Schmidt,3 LO Jensen,2 L Holmvang,1 HB Ravn4 and C Hassager1 1Rigshospitalet - Copenhagen University Hospital, Department of Cardiology, Copenhagen, Denmark 2Odense University Hospital, Department of Cardiology, Odense, Denmark 3Odense University Hospital, Department of Cardiothoracic Anaesthesia, Odense, Denmark 4Rigshospitalet - Copenhagen University Hospital, Department of Cardiothoracic Anaesthesia, Copenhagen, Denmark Introduction: Cardiogenic shock due to acute myocardial infarction (AMICS) carries 30-day mortality rates as high as 50%. The vast majority of study cohorts assessing AMICS include patients presenting both with and without out-of-hospital cardiac arrest (OHCA). However, there is accumulating evidence that OHCA and non-OHCA patients represent separate clinical entities, thus combining these AMICS subgroups in the same trial may be problematic. Purpose: To compare haemodynamics and management of OHCA and non-OHCA AMICS patients during their ICU admission and assess 30-day mortality in order to evaluate whether these two subgroups should be handled separately in future trials. Methods: In the period of 2010-2017 all AMICS patients admitted at two tertiary heart centres in Denmark were individually identified through patient records. During the first 72 hours of ICU admission number and dosage of vasoactive drugs, mean arterial blood pressure (MAP), arterial lactate and cardiac output (CO) were recorded at certain timepoints. Cardiac output (CO) was measured by thermodilution in a subgroup of 438 patients monitored with a pulmonary artery catheter. All ICU variables were tested by repeated measurement mixed models for unstructured covariance structure. Results: A total of 1716 AMICS patients were identified of which 723 (42%) presented with OHCA. Of the complete cohort 1532 patients survived to ICU admission. At the time of ICU arrival, there were no differences between OHCA and non-OHCA patients in terms of criteria commonly used in the definition of cardiogenic shock, including MAP (72vs70 mmHg, p=0.12), lactate (4.4vs4.0 mmol/L, p=0.09) and CO (4.2vs4.3 L/min, p=0.30). However, during the following 72 hours marked differences were seen. OHCA patients had a higher MAP (p<0.0001, see figure) despite a lower need for vasoactive drugs (p=0.049, see figure) and had a higher CO compared to non-OHCA patients (p<0.0001, see figure). They also had a better lactate clearance during the first 24 hours (p<0.0001, see figure). Figure. Open in new tabDownload slide OHCA patients had a 30-day mortality of 49%, which was significantly lower than non-OHCA patients (57%). However, when adjusting for age this difference disappeared. Cause of death differed among the two groups. Anoxic brain injury was the leading cause of death (56%) among OHCA patients followed by cardiac failure (27%), while mortality among non-OHCA patients was primarily driven by cardiac failure (60%) and anoxic brain injury only the cause of death in 4% of the cases (p<0.0001). Conclusion: AMICS patients presenting with and without OHCA have comparable metabolic and haemodynamic profiles at ICU admission. However, during the following 72 hours extensive metabolic and haemodynamic differences develop between OHCA and non-OHCA AMICS patients. Ultimately cause of death also highly differ among subgroups, thus combining and treating OHCA and non-OHCA AMICS patients as one entity should be done with great caution. Coronary Intervention: Mechanical Circulatory Support 385 https://esc365.escardio.org/Presentation/216720/abstract Mechanical circulatory support with VA-ECMO in post-cardiotomy shock, what is the current situation? B Tapia Majado,1 S Catoya Villa,1 J Sanchez Cena,1 T Borderias Villaroel,1 S Gonzalez Lizarbe,1 I Cabrera Rubio,1 M Lozano Gonzalez,1 M Molina San Quirico,1 JE Lujan Valencia,1 V Burgos Palacios,1 M Ruiz Lera,1 C Castrillo Bustamante,1 A Canteli Alvarez,1 M Cobo Belaustegui1 and A Sarralde Aguayo1 1University Hospital Marques de Valdecilla, Santander, Spain Introduction: The use of short-term circulatory support devices (ST-CSD) in cardiogenic shock has been increasing in the last years. Currently, postcardiotomy shock is one of the situations where ST-CSD are essential. Purpose: Our aim is to describe our results using ST-CSD in postcardiotomy shock, in order to analyze in which situations a better evolution of these patients could be expected. Methods: Since 2009 a total of 223 ST-CSD have been implanted in our hospital, 128 of whom were VA-ECMO. Of these, 46 were implanted in the situation of refractory postcardiotomy shock. Results: Of the 46 VA-ECMO needed in postcardiotomy shock, 24 were implanted in the cardiac surgery operating room (CS-OR) due to the impossibility of weaning from extracorporeal circulation (ECC); and 22 VA-ECMO in the cardiac intensive care unit (CICU) due to delayed postcardiotomy shock. The objective was the recovery in the majority of patients (93,5%), and bridge to decision in 6,5%. Support duration was 5,08 ± 3,7 days, and 54,3% of the devices were removed due to recovery of ventricular function (EF > 35-40%). The type of support was: Maquet PLS® (66,7%), Cardiohelp® (31,1%) and Levitronix® Centrimag (2,2%). The survival rate at one year was 45,6%, which was much better in the cases of delayed shock (54,5%), than in the cases of immediate implant in the CS-OR (37,5%). Probably this happens because in the group of deferred shock, the support was removed due to recovery of ventricular function (EF> 40%). However, on the other hand, in the group of immediate shock, the device was removed after a favorable weaning, although in fewer patients EF was higher than 40%. Conclusions: Although postcardiotomy shock continues to be a situation with a very high mortality with standard treatment, the use of ST-CSD as VA-ECMO and the adequate selection of candidates and the time of implant, is capital to improve overall survival. Figure. Open in new tabDownload slide Survival. Table 1. Characteristics and complications. . IMMEDIATE SHOCK 24 patients (52,17%) . DELAYED SHOCK 22 patients (47,82%) . AGE (Years of age) (M ± SD) GENDER (%) 67,49±10,64 Male: 54,16% Female: 45,83% 66,04±8,61 Male: 86,36% Female: 13,63% ARTERIAL HYPERTENSION(%) DIABETES MELLITUS (%) CHRONIC OBSTRUCTIVE PULMONARY DISEASE (%) RENAL FAILURE (%) 18 (75%) 7 (29,16%) 3 (12,5%) 5 (20,83%) 12 (59,09%) 3 (13,63%) 1 (4,54%) 5 (22,72%) TYPE OF SURGERY (%) CARDIOPULMONARY BYPASS TIME (Minutes) (M ± SD) CORONARY: 4 (16,66%) VALVULAR: 6 (25%) AORTA: 2 (8,33%) CONGENITAL: 1 (4,16%) COMBINED: 8 (33,33%) OTHER: 3 (12,5%) 232,25± 100,47 CORONARY: 3 (13,63%) VALVULAR: 9 (40,90%) AORTA: 1 (4,54%) CONGENITAL: 0 COMBINED: 8 (36,36%) OTHER: 1 (4,54%) 212,90±79,84 RENAL FAILURE POST-ECMO (n, %) BLEEDING (n, %) REOPERATION (n, %) 11 (45,83%) 9 (37,5%) CARDIAC TAMPONADE: 6/9 8 (33,33%) CARDIAC TAMPONADE: 6/8 Nº RE-OP/PAT.: 1,22 ± 0,44 15 (68,18%) 12 (54,54%) CARDIAC TAMPONADE: 8/12 11 (50%) CARDIAC TAMPONADE: 8/11 Nº RE-OP/PAT.: 1,94 ± 0,82 INFECTION (n, %) 6 (25%) RESPIRATORY INFECTION: 3/6 SEPSIS: 2/6 BACTERIEMIA: 1/6 SURGICAL WOUND: 0 12 (54,54%) RESPIRATORY INFECTION: 5/12 SEPSIS: 3/12 BACTERIEMIA: 2/12 SURGICAL WOUND: 2/12 INADEQUATE LV UNLOADING (n, %) 8 (33,33%) CONSERVATIVE TREATMENT: 6/8 VENT IMPLANT: 2/8 VAD CHANGE: 0 12 (54,54%) CONSERVATIVE TREATMENT: 10/12 VENT IMPLANT: 1/12 VAD CHANGE: 1/12 REASON FOR ECMO WITHDRAWAL (n, %) RECOVERY: 13/24 (54,16%) VAD CHANGE: 0 DEATH: 11 (45,83%) RECOVERY: 12/22 (54,54%) VAD CHANGE: 1/22 (4,54%) DEATH: 9/22 (40,90%) INVASIVE MECHANICAL VENTILATION TIME (Days) (M ± SD) LENGTH OF STAY (Days) (M ± SD) SUPPORT TIME (Days) (M ± SD) 9,91 ±9,71 ICU: 14,45 ± 14,55 HOSPITAL: 30,92 ± 28,69 4 ± 3,53 12,96 ± 13,34 ICU: 22,44 ± 20,85 HOSPITAL: 39,88 ±34,83 6,25 ± 3,69 . IMMEDIATE SHOCK 24 patients (52,17%) . DELAYED SHOCK 22 patients (47,82%) . AGE (Years of age) (M ± SD) GENDER (%) 67,49±10,64 Male: 54,16% Female: 45,83% 66,04±8,61 Male: 86,36% Female: 13,63% ARTERIAL HYPERTENSION(%) DIABETES MELLITUS (%) CHRONIC OBSTRUCTIVE PULMONARY DISEASE (%) RENAL FAILURE (%) 18 (75%) 7 (29,16%) 3 (12,5%) 5 (20,83%) 12 (59,09%) 3 (13,63%) 1 (4,54%) 5 (22,72%) TYPE OF SURGERY (%) CARDIOPULMONARY BYPASS TIME (Minutes) (M ± SD) CORONARY: 4 (16,66%) VALVULAR: 6 (25%) AORTA: 2 (8,33%) CONGENITAL: 1 (4,16%) COMBINED: 8 (33,33%) OTHER: 3 (12,5%) 232,25± 100,47 CORONARY: 3 (13,63%) VALVULAR: 9 (40,90%) AORTA: 1 (4,54%) CONGENITAL: 0 COMBINED: 8 (36,36%) OTHER: 1 (4,54%) 212,90±79,84 RENAL FAILURE POST-ECMO (n, %) BLEEDING (n, %) REOPERATION (n, %) 11 (45,83%) 9 (37,5%) CARDIAC TAMPONADE: 6/9 8 (33,33%) CARDIAC TAMPONADE: 6/8 Nº RE-OP/PAT.: 1,22 ± 0,44 15 (68,18%) 12 (54,54%) CARDIAC TAMPONADE: 8/12 11 (50%) CARDIAC TAMPONADE: 8/11 Nº RE-OP/PAT.: 1,94 ± 0,82 INFECTION (n, %) 6 (25%) RESPIRATORY INFECTION: 3/6 SEPSIS: 2/6 BACTERIEMIA: 1/6 SURGICAL WOUND: 0 12 (54,54%) RESPIRATORY INFECTION: 5/12 SEPSIS: 3/12 BACTERIEMIA: 2/12 SURGICAL WOUND: 2/12 INADEQUATE LV UNLOADING (n, %) 8 (33,33%) CONSERVATIVE TREATMENT: 6/8 VENT IMPLANT: 2/8 VAD CHANGE: 0 12 (54,54%) CONSERVATIVE TREATMENT: 10/12 VENT IMPLANT: 1/12 VAD CHANGE: 1/12 REASON FOR ECMO WITHDRAWAL (n, %) RECOVERY: 13/24 (54,16%) VAD CHANGE: 0 DEATH: 11 (45,83%) RECOVERY: 12/22 (54,54%) VAD CHANGE: 1/22 (4,54%) DEATH: 9/22 (40,90%) INVASIVE MECHANICAL VENTILATION TIME (Days) (M ± SD) LENGTH OF STAY (Days) (M ± SD) SUPPORT TIME (Days) (M ± SD) 9,91 ±9,71 ICU: 14,45 ± 14,55 HOSPITAL: 30,92 ± 28,69 4 ± 3,53 12,96 ± 13,34 ICU: 22,44 ± 20,85 HOSPITAL: 39,88 ±34,83 6,25 ± 3,69 Open in new tab Table 1. Characteristics and complications. . IMMEDIATE SHOCK 24 patients (52,17%) . DELAYED SHOCK 22 patients (47,82%) . AGE (Years of age) (M ± SD) GENDER (%) 67,49±10,64 Male: 54,16% Female: 45,83% 66,04±8,61 Male: 86,36% Female: 13,63% ARTERIAL HYPERTENSION(%) DIABETES MELLITUS (%) CHRONIC OBSTRUCTIVE PULMONARY DISEASE (%) RENAL FAILURE (%) 18 (75%) 7 (29,16%) 3 (12,5%) 5 (20,83%) 12 (59,09%) 3 (13,63%) 1 (4,54%) 5 (22,72%) TYPE OF SURGERY (%) CARDIOPULMONARY BYPASS TIME (Minutes) (M ± SD) CORONARY: 4 (16,66%) VALVULAR: 6 (25%) AORTA: 2 (8,33%) CONGENITAL: 1 (4,16%) COMBINED: 8 (33,33%) OTHER: 3 (12,5%) 232,25± 100,47 CORONARY: 3 (13,63%) VALVULAR: 9 (40,90%) AORTA: 1 (4,54%) CONGENITAL: 0 COMBINED: 8 (36,36%) OTHER: 1 (4,54%) 212,90±79,84 RENAL FAILURE POST-ECMO (n, %) BLEEDING (n, %) REOPERATION (n, %) 11 (45,83%) 9 (37,5%) CARDIAC TAMPONADE: 6/9 8 (33,33%) CARDIAC TAMPONADE: 6/8 Nº RE-OP/PAT.: 1,22 ± 0,44 15 (68,18%) 12 (54,54%) CARDIAC TAMPONADE: 8/12 11 (50%) CARDIAC TAMPONADE: 8/11 Nº RE-OP/PAT.: 1,94 ± 0,82 INFECTION (n, %) 6 (25%) RESPIRATORY INFECTION: 3/6 SEPSIS: 2/6 BACTERIEMIA: 1/6 SURGICAL WOUND: 0 12 (54,54%) RESPIRATORY INFECTION: 5/12 SEPSIS: 3/12 BACTERIEMIA: 2/12 SURGICAL WOUND: 2/12 INADEQUATE LV UNLOADING (n, %) 8 (33,33%) CONSERVATIVE TREATMENT: 6/8 VENT IMPLANT: 2/8 VAD CHANGE: 0 12 (54,54%) CONSERVATIVE TREATMENT: 10/12 VENT IMPLANT: 1/12 VAD CHANGE: 1/12 REASON FOR ECMO WITHDRAWAL (n, %) RECOVERY: 13/24 (54,16%) VAD CHANGE: 0 DEATH: 11 (45,83%) RECOVERY: 12/22 (54,54%) VAD CHANGE: 1/22 (4,54%) DEATH: 9/22 (40,90%) INVASIVE MECHANICAL VENTILATION TIME (Days) (M ± SD) LENGTH OF STAY (Days) (M ± SD) SUPPORT TIME (Days) (M ± SD) 9,91 ±9,71 ICU: 14,45 ± 14,55 HOSPITAL: 30,92 ± 28,69 4 ± 3,53 12,96 ± 13,34 ICU: 22,44 ± 20,85 HOSPITAL: 39,88 ±34,83 6,25 ± 3,69 . IMMEDIATE SHOCK 24 patients (52,17%) . DELAYED SHOCK 22 patients (47,82%) . AGE (Years of age) (M ± SD) GENDER (%) 67,49±10,64 Male: 54,16% Female: 45,83% 66,04±8,61 Male: 86,36% Female: 13,63% ARTERIAL HYPERTENSION(%) DIABETES MELLITUS (%) CHRONIC OBSTRUCTIVE PULMONARY DISEASE (%) RENAL FAILURE (%) 18 (75%) 7 (29,16%) 3 (12,5%) 5 (20,83%) 12 (59,09%) 3 (13,63%) 1 (4,54%) 5 (22,72%) TYPE OF SURGERY (%) CARDIOPULMONARY BYPASS TIME (Minutes) (M ± SD) CORONARY: 4 (16,66%) VALVULAR: 6 (25%) AORTA: 2 (8,33%) CONGENITAL: 1 (4,16%) COMBINED: 8 (33,33%) OTHER: 3 (12,5%) 232,25± 100,47 CORONARY: 3 (13,63%) VALVULAR: 9 (40,90%) AORTA: 1 (4,54%) CONGENITAL: 0 COMBINED: 8 (36,36%) OTHER: 1 (4,54%) 212,90±79,84 RENAL FAILURE POST-ECMO (n, %) BLEEDING (n, %) REOPERATION (n, %) 11 (45,83%) 9 (37,5%) CARDIAC TAMPONADE: 6/9 8 (33,33%) CARDIAC TAMPONADE: 6/8 Nº RE-OP/PAT.: 1,22 ± 0,44 15 (68,18%) 12 (54,54%) CARDIAC TAMPONADE: 8/12 11 (50%) CARDIAC TAMPONADE: 8/11 Nº RE-OP/PAT.: 1,94 ± 0,82 INFECTION (n, %) 6 (25%) RESPIRATORY INFECTION: 3/6 SEPSIS: 2/6 BACTERIEMIA: 1/6 SURGICAL WOUND: 0 12 (54,54%) RESPIRATORY INFECTION: 5/12 SEPSIS: 3/12 BACTERIEMIA: 2/12 SURGICAL WOUND: 2/12 INADEQUATE LV UNLOADING (n, %) 8 (33,33%) CONSERVATIVE TREATMENT: 6/8 VENT IMPLANT: 2/8 VAD CHANGE: 0 12 (54,54%) CONSERVATIVE TREATMENT: 10/12 VENT IMPLANT: 1/12 VAD CHANGE: 1/12 REASON FOR ECMO WITHDRAWAL (n, %) RECOVERY: 13/24 (54,16%) VAD CHANGE: 0 DEATH: 11 (45,83%) RECOVERY: 12/22 (54,54%) VAD CHANGE: 1/22 (4,54%) DEATH: 9/22 (40,90%) INVASIVE MECHANICAL VENTILATION TIME (Days) (M ± SD) LENGTH OF STAY (Days) (M ± SD) SUPPORT TIME (Days) (M ± SD) 9,91 ±9,71 ICU: 14,45 ± 14,55 HOSPITAL: 30,92 ± 28,69 4 ± 3,53 12,96 ± 13,34 ICU: 22,44 ± 20,85 HOSPITAL: 39,88 ±34,83 6,25 ± 3,69 Open in new tab Acute Heart Failure: Pharmacotherapy 386 https://esc365.escardio.org/Presentation/216403/abstract Adrenaline use and associated short-term prognosis in a multicenter cohort of cardiogenic shock patients J Fernandez Martinez,1 M Rivas-Lasarte,1 J Sans-Rosello,1 E Collado,2 A Viana-Tejedor,3 J Segovia,4 A Ariza2 and A Sionis1 1Hospital de la Santa Creu i Sant Pau, Barcelona, Spain 2University Hospital Bellvitge, Cardiology, Barcelona, Spain 3Hospital Clinico San Carlos, Cardiology, Madrid, Spain 4University Hospital Puerta de Hierro Majadahonda, Cardiology, Madrid, Spain Background: Use of adrenaline in cardiogenic shock (CS) has been associated with higher incidence of refractory shock and mortality. Nevertheless, it is still used extensively due to its combined inotropic and vasopressor properties. Purpose: To assess the use of adrenaline in the Red-Shock registry, a multicenter cohort of CS patients and its relationship with in-hospital mortality. Methods: We describe the differences between patients treated with adrenaline and those who were not. All the 14 variables with a p<0.1 were entered in a propensity score (PS). The association of adrenaline with in-hospital mortality was adjusted by the PS. Results: The Red-Shock cohort included 793 patients. 16% were treated with adrenaline. These were younger and had less comorbidities but presented at admission with more severe parameters of shock, as higher lactate or altered mental status. Regarding management they were more often intubated, received renal replacement therapy or assist devices. In-hospital mortality was 39% in patients non-treated with adrenaline and 64% in patients treated with adrenaline. After adjusting by the PS, the use of adrenaline remained significantly associated with in-hospital mortality [OR: 1.67 (95% CI: 1.07- 2.59), p=0.023]. Table 1. . NO ADRENALINE (n=661) . ADRENALINE (n=132) . p-value . Age 65,55 ± 14,43 62,77 ± 15,23 0,045 Diabetes mellitus 274 (41%) 40 (30%) 0,017 Previous peripheral artery disease 82 (12%) 8 (6%) 0,036 Lactate (mmol/l) 4,79 ± 4,21 7,74 ± 5,36 0,000 Altered mental status 370 (56%) 116 (88%) 0,000 Mechanical ventilation 0,000  No 220 (33%) 7 (5%)  Invasive 365 (55%) 124 (94%) Renal replacement therapy 108 (16%) 42 (32%) 0,000 No mechanical support 343 (51,9%) 42 (31,8%) 0,000 In-hospital death 261 (39%) 85 (64%) 0,000 . NO ADRENALINE (n=661) . ADRENALINE (n=132) . p-value . Age 65,55 ± 14,43 62,77 ± 15,23 0,045 Diabetes mellitus 274 (41%) 40 (30%) 0,017 Previous peripheral artery disease 82 (12%) 8 (6%) 0,036 Lactate (mmol/l) 4,79 ± 4,21 7,74 ± 5,36 0,000 Altered mental status 370 (56%) 116 (88%) 0,000 Mechanical ventilation 0,000  No 220 (33%) 7 (5%)  Invasive 365 (55%) 124 (94%) Renal replacement therapy 108 (16%) 42 (32%) 0,000 No mechanical support 343 (51,9%) 42 (31,8%) 0,000 In-hospital death 261 (39%) 85 (64%) 0,000 Correlation between PPV and VarianceHP. Open in new tab Table 1. . NO ADRENALINE (n=661) . ADRENALINE (n=132) . p-value . Age 65,55 ± 14,43 62,77 ± 15,23 0,045 Diabetes mellitus 274 (41%) 40 (30%) 0,017 Previous peripheral artery disease 82 (12%) 8 (6%) 0,036 Lactate (mmol/l) 4,79 ± 4,21 7,74 ± 5,36 0,000 Altered mental status 370 (56%) 116 (88%) 0,000 Mechanical ventilation 0,000  No 220 (33%) 7 (5%)  Invasive 365 (55%) 124 (94%) Renal replacement therapy 108 (16%) 42 (32%) 0,000 No mechanical support 343 (51,9%) 42 (31,8%) 0,000 In-hospital death 261 (39%) 85 (64%) 0,000 . NO ADRENALINE (n=661) . ADRENALINE (n=132) . p-value . Age 65,55 ± 14,43 62,77 ± 15,23 0,045 Diabetes mellitus 274 (41%) 40 (30%) 0,017 Previous peripheral artery disease 82 (12%) 8 (6%) 0,036 Lactate (mmol/l) 4,79 ± 4,21 7,74 ± 5,36 0,000 Altered mental status 370 (56%) 116 (88%) 0,000 Mechanical ventilation 0,000  No 220 (33%) 7 (5%)  Invasive 365 (55%) 124 (94%) Renal replacement therapy 108 (16%) 42 (32%) 0,000 No mechanical support 343 (51,9%) 42 (31,8%) 0,000 In-hospital death 261 (39%) 85 (64%) 0,000 Correlation between PPV and VarianceHP. Open in new tab Conclusion(s): In our cohort, adrenaline use was 16%. Interestingly, patients treated with adrenaline were younger and had less comorbidities. Its association with in-hospital mortality persisted despite adjusting by a PS. Mechanical circulatory support should preferentially be considered in these patients. Acute Cardiac Care – Cardiogenic Shock 387 https://esc365.escardio.org/Presentation/216487/abstract Sex-specific management in patients with acute myocardial infarction and cardiogenic shockSupported by a grant agreement (602202) from the European Union Seventh Framework Program and by the German Heart Research Foundation Impact of Levosimendan use on the success of weaning and survival of patients M Rubini Gimenez,1 U Zeymer,2 S Desch,1 S De Waha-Thiele,3 J Poess,3 G Fuernau,3 J Stepinska,4 K Huber5 and H Thiele1 1Heart Center of Leipzig, Leipzig, Germany 2Klinikum Ludwigshafen, Ludwigshafen, Germany 3University Heart Center, Luebeck, Germany 4Institute of Cardiology, Warsaw, Poland 5Medical University of Vienna, Vienna, Austria Background: Women are more likely to suffer and die from cardiogenic shock (CS) as the most severe complication of acute myocardial infarction (AMI). Data concerning optimal management for women with CS are scarce. Aim of this study was therefore to better define characteristics of women suffering CS and to investigate the influence of sex on different treatment strategies including coronary revascularization. Methods: In the CULPRIT-SHOCK trial, patients with CS complicating AMI and multivessel coronary artery disease were randomly assigned to one of the following coronary revascularization strategies: either percutaneous coronary intervention (PCI) of the culprit-lesion-only or immediate multivessel PCI. Primary endpoint was a composite of death from any cause or severe renal failure leading to renal replacement therapy within 30 days after randomization. We investigated sex-specific differences in general and according to the revascularization strategies. Results: Among all 686 randomized patients included in the analysis 24% were female. Women were older, had more often diabetes mellitus and known renal insufficiency, whereas they had less often a history of previous AMI and smoking. After 30 days, the primary clinical endpoint was not significantly different between groups (56% women versus 49% men, OR 1.29; 95% CI 0.91 -1.84; p=0.15). There was no interaction between sex and coronary revascularization strategy regarding mortality and renal failure (pinteraction=0.11), the primary endpoint occurred in 56% of women treated by the culprit-lesion-only strategy vs. 42% men, whereas 55% of women and of men in the multivessel PCI group experienced the primary endpoint. Conclusions: Although women presented with a different risk profile, mortality and renal replacement after 30 days were similar to men. Sex did not influence mortality and renal failure according to the different coronary revascularization strategies. These data suggest that women and men presenting with CS complicating AMI and multivessel coronary artery disease should be treated equally. 388 https://esc365.escardio.org/Presentation/221521/abstract Home monitoring is associated with fewergastrointestinal bleeding events following assist device implantation A Gkouziouta,1 N Aravanis,1 D Miliopoulos,1 E Fountas,1 M Bonios,1 S Adamopoulos1 and N Kogerakis1 1Onassis Cardiac Surgery Center, Athens, Greece Introduction: Patients (pts) treated with a continuous flow left ventricular assist device (LVAD) are at increased risk for both bleeding and thromboembolic events. Maintenance of oral anticoagulation (AC) in the therapeutic range is difficult to achieve. Hypothesis: Increased frequency of international normalized ratio (INR) home monitoring (HM) decreases the incidence of gastrointestinal bleeding and thromboembolic events (stroke, pump thrombosis) compared to standard of care (SOC). Methods: We analyzed the efficacy of outpatient AC monitoring in consecutive pts who underwent VAD implantation at our institution between 2008-2018. Time in therapeutic range (TTR) was defined as percent of time with INR 2.5-2.8. HM pts had biweekly INR measurements using the Coagucheck XS ROCHE, while SOC pts had INR measured every 1-3 weeks. Gastrointestinal bleeding (GIB) and thromboembolic events were assessed by retrospective blinded chart review. Logistic regression was used to model the impact of TTR on the risk of GIB and THROMB. Results: There were 85 pts: 44 in HM and 40 in SC arm with similar characteristics . SOC patients were more likely to have ischemic cardiomyopathy (63% vs 30%, p=0.006) and an LVAD (60% vs 25%, p=0.002). The use of HM was associated with a 19.7% reduction in the risk of GIB (8.8% vs 28.5%, p=0.043) and a trend towards lower risk of THROMB (6.8% vs 14.9%, p=0.19). HM pts had significantly longer TTR (52±20% vs 39±22%, p=0.007). Each percentage increase in TTR was associated with a 5.2% decrease in the risk of GIB [Odds Ratio (OR) 0.95, 95% Confidence Interval (CI) 0.91-0.99, p=0.009] even after adjustment for aspirin use and monitoring duration (OR 0.95, 95% CI 0.91-0.99, p=0.020). There was a similar decrease in the risk of overall bleeding (OR 0.94, 95% CI 0.90-0.98, p=0.008). Conclusions: Increased frequency of home INR monitoring achieved a higher TTR and was associated with a 20% reduction in risk of gastrointestinal bleeding. Arrhythmias, General – Treatment 389 https://esc365.escardio.org/Presentation/221520/abstract Frequency and patterns of implantable cardiac defibrillator therapies in patients with ventricular assist devices A Gkouziouta,1 A Kostopoulou,1 M Spartalis,1 E Fountas,1 N Aravanis,1 ME Zimatoura,1 D Miliopoulos,1 E Livanis,1 S Adamopoulos1 and N Kogerakis1 1Onassis Cardiac Surgery Center, Athens, Greece Durable ventricular assist devices (VADs) use is a life -saving therapy in patients with end-stage heart failure. These patients are at high risk for ventricular arrhythmias. The pattern of ICD therapies in these patients is not well characterized. Methods: Our single-center retrospective cohort included 86 patients with ICDs and VADs followed at our Centre. Data collected included frequency of ICD therapies, type of therapy (appropriate vs. inappropriate; shocks vs. anti-tachycardia pacing (ATP)), and time-course of therapies. Results: 36 patients (42%) received ICD therapy during a mean follow-up period of 13.6 months. There were 105 episodes (2.9 episodes/patient) during which ICD therapies were delivered, with a total of 379 individual arrhythmias treated (3.6 arrhythmias per episode of therapy). 61.4% of therapies were appropriate, 8.4% were inappropriate, and 31.6% were unknown. Of the 79 episodes treated with appropriate therapy, 36 episodes (46%) required ICD shocks, whereas 43 episodes (54%) were treated with ATP alone. Overall, 33% of the total cohort and 81% of patients who received therapy received at least one ICD shock. Twenty-two patients (61%) received therapy between 1-3 times, while the remainder (14 patients, 39%) received therapy 3-10 times. Eighteen (17%) episodes occurred within the first month after LVAD implantation, with 10 (10%) occurring between 1-3 months, 53 (50%) occurring between 3-12 months, and 24 (23%) occurring more than one year after VAD implantation. Conclusion: Analysis of our VAD cohort revealed three important findings: 1. ICD therapy is very common (42%) in the first year especially after LVAD implantation; 2. Ventricular arrhythmias are highly clustered in this cohort; 3. ATP is frequently effective. These findings have important implications on device follow-up and programming for this expanding patient population. Acute Cardiac Care – CCU, Intensive, and Critical Cardiovascular Care 390 https://esc365.escardio.org/Presentation/216740/abstract The link between peripheral microcirculation and autonomic nervous system in patients admitted to the intensive care unitThis study is part of the Ricerca Finalizzata Giovani Ricercatori 2013 Project, funded by the Italian Ministry of Health. D Fina,1 V Bari,1 A Fantinato,1 E Vaini,1 V Pistuddi,1 A Porta2 and M Ranucci1 1IRCCS Policlinico San Donato, Department of Cardiothoracic, Vascular Anesthesia and Intensive Care, San Donato Milanese, Italy 2University of Milan, Department of Biomedical Sciences for Health, Milan, Italy Background: A reduction of baroreflex sensitivity (BRS) has been described in several cardiovascular and systemic diseases. Assessment of peripheral microcirculation allows prognostic considerations and promotes an advanced management for critically ill patients. Given the emerging consideration to both autonomic control markers and microcirculation, it is still unknown if BRS decreases according to the severity of microvascular impairment. PURPOSE: To evaluate the correlation between peripheral microcirculation and BRS and the possibility to predict postoperative atrial fibrillation (AF) and acute kidney dysfunction (AKD) by their combined analysis. Methods: Patients undergoing CABG were selected. ECG and invasive assessment of arterial pressure were performed in pre-operative setting. BRS was tested by heart period (HP) interval and systolic arterial pressure (SAP) spontaneous variability, according to frequency domain techniques. Sublingual sidestream-darkfield images in 4 different sites were acquired. Table 1. BRS and microcirculatory data. Variable [unity of measure] . No AKD . AKD . P value . Variance HP [ms2] 386,53±401,84 338,54±556, 29 0,36 Variance SAP [mmHg2] 6,7±3,18 12, 85±10,77 0,12 alfaLF [ms/mmHg] 25,91±15, 3 13,47±10,53 0,02* TVD [n/mm2] 7,46±1,13 8,32±2,12 0,3 PPV [%] 94±5,5 90,9±9,9 0,86 HI [%] 0,3±0,11 0,27±0,10 0,48 No AF AF Variance HP [ms2] 444,9±558, 38 122,66±77,7 0,31 Variance SAP [mmHg2] 11,41±10,37 8,65±5,46 0,9 alfaLF [ms/mmHg] 19,06±14,79 15,14±11,38 0,54 Variable [unity of measure] . No AKD . AKD . P value . Variance HP [ms2] 386,53±401,84 338,54±556, 29 0,36 Variance SAP [mmHg2] 6,7±3,18 12, 85±10,77 0,12 alfaLF [ms/mmHg] 25,91±15, 3 13,47±10,53 0,02* TVD [n/mm2] 7,46±1,13 8,32±2,12 0,3 PPV [%] 94±5,5 90,9±9,9 0,86 HI [%] 0,3±0,11 0,27±0,10 0,48 No AF AF Variance HP [ms2] 444,9±558, 38 122,66±77,7 0,31 Variance SAP [mmHg2] 11,41±10,37 8,65±5,46 0,9 alfaLF [ms/mmHg] 19,06±14,79 15,14±11,38 0,54 alfaLF (square root of the ratio between low frequency power of HP and SAP in absolute units); TVD=total vessel density; HI=heterogeneity index Open in new tab Table 1. BRS and microcirculatory data. Variable [unity of measure] . No AKD . AKD . P value . Variance HP [ms2] 386,53±401,84 338,54±556, 29 0,36 Variance SAP [mmHg2] 6,7±3,18 12, 85±10,77 0,12 alfaLF [ms/mmHg] 25,91±15, 3 13,47±10,53 0,02* TVD [n/mm2] 7,46±1,13 8,32±2,12 0,3 PPV [%] 94±5,5 90,9±9,9 0,86 HI [%] 0,3±0,11 0,27±0,10 0,48 No AF AF Variance HP [ms2] 444,9±558, 38 122,66±77,7 0,31 Variance SAP [mmHg2] 11,41±10,37 8,65±5,46 0,9 alfaLF [ms/mmHg] 19,06±14,79 15,14±11,38 0,54 Variable [unity of measure] . No AKD . AKD . P value . Variance HP [ms2] 386,53±401,84 338,54±556, 29 0,36 Variance SAP [mmHg2] 6,7±3,18 12, 85±10,77 0,12 alfaLF [ms/mmHg] 25,91±15, 3 13,47±10,53 0,02* TVD [n/mm2] 7,46±1,13 8,32±2,12 0,3 PPV [%] 94±5,5 90,9±9,9 0,86 HI [%] 0,3±0,11 0,27±0,10 0,48 No AF AF Variance HP [ms2] 444,9±558, 38 122,66±77,7 0,31 Variance SAP [mmHg2] 11,41±10,37 8,65±5,46 0,9 alfaLF [ms/mmHg] 19,06±14,79 15,14±11,38 0,54 alfaLF (square root of the ratio between low frequency power of HP and SAP in absolute units); TVD=total vessel density; HI=heterogeneity index Open in new tab Open in new tabDownload slide Correlation between PPV and VarianceHP. Results: Twenty-two patients were enrolled. Mean ICU stay was 2 days (range 1 – 7 days). Only 1 patient died due to low cardiac output syndrome. Main data about ANS monitoring and microcirculatory status are summarized in the Table. An altered autonomic function was observed in patients developing AKD. A logarithmic correlation between HP variance and percentage of perfused vessels (PPV) was shown (see Picture). Conclusions: An altered BRS can predict AKD. A considerable correlation between impaired microcirculation and altered BRS was observed, showing that severe grades of autonomic dysfunction are associated with a maladaptive response of microcirculation, claiming dedicated investigations. Cardiovascular Pharmacotherapy 391 https://esc365.escardio.org/Presentation/216697/abstract Antithrombotic management in transaortic valve implantation: who need what? A historic cohort study R Grippo,1 G Esposito,1 I Bassi,1 L Testa,2 F De Marco,2 N Morici,1 F Soriano,1 S Nava,1 N Veas,1 JA Oreglia,1 F Oliva1 and F Bedogni2 1ASST Great Metropolitan Niguarda, Milan, Italy 2IRCCS Policlinico San Donato, San Donato Milanese, Italy Background: Aortic valve stenosis (AVS) is the most common valvular heart disease in the western world. In recent years trans-catheter aortic valve implantation (TAVI) became a first-choice treatment for patients with AVS and high operative risk. Oral anticoagulation (OAC) is the universally recognised therapy for patients treated with surgical valve replacement (mechanical or biological prosthesis), while there are few evidence about the best antithrombotic strategy (AS) in patients who undergo TAVI, and specifically for those with atrial fibrillation (AF). Purpose: Historic cohort study aimed at evaluating the association between the discharge AS and outcome (a composite of stroke and overall mortality) at 6-month follow-up. Methods and Results: 1054 consecutive patients who underwent TAVI between January 2015 and March 2019 at our Hospitals were included in the study. 41 patients on triple therapy, 1 patient treated with dipyridamole and 103 patients without accurate data on the antithrombotic regimen or who modified the AS in the first 6-month follow-up, were excluded. Therefore, the final study population enrolled 909 patients divided by AS at discharge. Categorical variables were presented as number and percentages compared by the χ2 test, whereas continuous variables were presented as means and standard deviations and compared by ANOVA (with Tukey HSD correction). A multivariable analysis (logistic model) was performed to evaluate the association among antithrombotic regimens at discharge adjusting for AF (any: new onset and already known), known coronary artery disease, serum creatinine and haemoglobin on admission. Dummy variables were introduced to define SAPT as the reference group for the AS: the other categories included DAPT, only OAC, OAC + APT treatment. Table 1 describes the most relevant clinical characteristics according to the AS at discharge: there was no relevant unbalance among the reported variables, except the indication for each antithrombotic regimen (coronary artery disease vs AF). At logistic analysis, AF (any: known and new onset) was an independent predictor of overall death and stroke (AF: OR 2.28, p-value 0.010) along with creatinine and haemoglobin on admission, whereas there was no association with the AS adopted (OAC vs DAPT vs OAC+SAPT). The model including the AS achieved a moderate discrimination (AUC of 0.67; 95% CI 0.6-0.74), that did not substantially change if this predictor was excluded. Table 1. Open in new tabDownload slide Clinical characteristics. Conclusions: Our data suggest that, apart patients with recent stent implantation, a DAPT regimen after TAVI should not be considered the reference standard. In most patients, SAPT could be considered the best choice to address the trade-off between the thrombotic and bleeding risk. AF remains an independent and strong prognostic marker of worse outcome and specific interventional strategies should not be withdrawn in order to decrease the thromboembolic risk. Acute Nursing Care 392 https://esc365.escardio.org/Presentation/217212/abstract Accuracy of precordial ECG lead placement by nurses in the emergency department. A Ioannidis,1 A Pechlevanis2 and M Paraskelidou2 1Thessaloniki General Hospital ‘G. Gennimatas’, Thessaloniki, Greece 2Thessaloniki General Hospital “Agios Pavlos”, Thessaloniki, Greece Background: Electrocardiogram (ECG) is routinely acquired in patients visiting Emergency Departments (ED). The malposition of ECG leads can lead to false negatives or false positives hampering the diagnostic evaluation. EDs in Greece are, unsuitably, understaffed with nurses with different levels of competence, knowledge and training. Purpose: The aim of this study was to assess the accuracy of precordial ECG lead placement in relation to their work experience in terms of years on duty and frequency of ECG recording. Methods: The study was conducted in three tertiary hospitals in Northern Greece. In total, 87 nurses participated by answering a short questionnaire and by placing coloured sticker dots (diameter 18mm) on a purposely carved, landmark printed A3 page which was placed on a specially sculpted mannequin. Analyses were performed by IBM SPSS Statistics. Results: There were only 183 (35.1%) accurate dots placements (defined as positioned within a 50% enlarged circle), with lower percentage noted for lead V3 (Table 1). A distressing 10.7% of dots were glued at far-off positions. Of note, vertical misplacement was mostly observed in leads V1 and V2 (placed too superiorly) while horizontal misplacement involved mostly leads V5 and V6 (placed too medially). Nurses with <5 years work experience (n=32, 36.8%) performed worse than more experienced ones by placing accurately only 52 dots (27.1%) especially if their workload counted roughly to <20 ECG recordings per week. Largely, performing >40 ECG per week was correlated to an overall ≥3 accurate dots placing regardless of the duration of work experience. Table 1. Accuracy of lead placement (n, %). LEAD . Accurate (d: ≤27mm) . Inaccurate (d: 28-36mm) . Inaccurate (d: ≥37mm) . V1 34 (39.1) 42 (48.3) 11 (12.6) V2 35 (40.2) 43 (49.4) 9 (10.3) V3 19 (21.8) 57 (65.5) 11 (12.6) V4 28 (32.2) 49 (56.3) 10 (11.5) V5 31 (35.6) 49 (56.3) 7 (8.0) V6 36 (41.4) 43 (49.4) 8 (9.2) LEAD . Accurate (d: ≤27mm) . Inaccurate (d: 28-36mm) . Inaccurate (d: ≥37mm) . V1 34 (39.1) 42 (48.3) 11 (12.6) V2 35 (40.2) 43 (49.4) 9 (10.3) V3 19 (21.8) 57 (65.5) 11 (12.6) V4 28 (32.2) 49 (56.3) 10 (11.5) V5 31 (35.6) 49 (56.3) 7 (8.0) V6 36 (41.4) 43 (49.4) 8 (9.2) d: diameter. Open in new tab Table 1. Accuracy of lead placement (n, %). LEAD . Accurate (d: ≤27mm) . Inaccurate (d: 28-36mm) . Inaccurate (d: ≥37mm) . V1 34 (39.1) 42 (48.3) 11 (12.6) V2 35 (40.2) 43 (49.4) 9 (10.3) V3 19 (21.8) 57 (65.5) 11 (12.6) V4 28 (32.2) 49 (56.3) 10 (11.5) V5 31 (35.6) 49 (56.3) 7 (8.0) V6 36 (41.4) 43 (49.4) 8 (9.2) LEAD . Accurate (d: ≤27mm) . Inaccurate (d: 28-36mm) . Inaccurate (d: ≥37mm) . V1 34 (39.1) 42 (48.3) 11 (12.6) V2 35 (40.2) 43 (49.4) 9 (10.3) V3 19 (21.8) 57 (65.5) 11 (12.6) V4 28 (32.2) 49 (56.3) 10 (11.5) V5 31 (35.6) 49 (56.3) 7 (8.0) V6 36 (41.4) 43 (49.4) 8 (9.2) d: diameter. Open in new tab Conclusions: Precordial ECG lead misplacement is worryingly common in ED. Nurse’s experience, both in terms of practise duration and of workload, seems to affect the accuracy of lead placement. Further research is warranted to assess possible training modules addressing the aforementioned limited accuracy. Coronary Intervention: Mechanical Circulatory Support 407 https://esc365.escardio.org/Presentation/216475/abstract Procedure Volume and Outcomes in Patients with VA-ECMO Support PM Becher,1 AG Gossling,1 BS Schrage,1 SL Ludwig,1 NF Fluschnik,1 MS Seiffert,1 ALM Bernhardt,2 HR Reichenspurner,2 SB Blankenberg1 and DW Westermann1 1University Heart and Vascular Center Hamburg, Hamburg, Germany 2University Heart Center Hamburg, Department of Cardiovascular Surgery, Hamburg, Germany Background: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients with critical cardiopulmonary failure. The association between hospital volume of VA-ECMO procedures and outcomes has not been described. Material and Methods: By using administrative data from the German Federal Health Monitoring System, we analyzed all VA-ECMO procedures performed in Germany from 2013 to 2016 regarding the association of procedural volumes with outcomes and complications. Results During the study period, 10207 VA-ECMO procedures were performed at 223 hospitals; mean age was 61 years, 43.4 % had prior CPR and 71.2 % were male patients. Acute coronary syndrome was the primary diagnosis for VA-ECMO implantation (n = 6202, 60.8 %). The majority of implantations (n = 5421) was performed at hospitals in the lowest volume category (≤50 implantations per year). There was a significant association between annualized volume of VA-ECMO procedures and 30-day in-hospital mortality for centers with lower vs. higher volume per year. Multivariable Cox regression showed an increased 30-day in-hospital mortality at hospitals with the lowest volume category (Hazard Ratio 1.125 (95 % confidence interval 1.049 - 1.203), p = 0.001). However, more complications were observed at hospitals with higher VA-ECMO volume. Conclusion: In this analysis of all German VA-ECMO procedures, the majority of implantations was performed at hospitals with the lowest annual volume. 30-day in-hospital mortality risk was higher in hospitals with the lowest annual VA-ECMO volume, whereas complication risk was higher in hospitals with the highest annual VA-ECMO volume. Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome 409 https://esc365.escardio.org/Presentation/216733/abstract Relative impact of left ventricle ejection fraction and functional NYHA class at discharge after acute myocardial infarction on 3-year outcomes (analysis from the PL-ACS registry)Ministry of Health of Poland M Gierlotka,1 A Tycinska,2 P Trzeciak,3 A Duszanska,4 A Kleinrok5 and M Gasior3 1University of Opole, Department of Cardiology, University Hospital, Opole, Poland 2Medical University of Bialystok, Bialystok, Poland 3SMDZ in Zabrze, Medical University of Silesia in Katowice, 3rd Department of Cardiology, Zabrze, Poland 4University Hospital in Opole, Department of Cardiology, Opole, Poland 5Regional Hospital Pope John Paul II, Department of Cardiology, Zamosc, Poland Heart failure (HF) is one of the main causes of poor outcomes after discharging home patients hospitalized due to acute myocardial infarction (AMI). The aim of this analysis was to assess the relative impact of left ventricle ejection fraction (LVEF) and functional status (NYHA class) at discharge on 3-year outcomes after acute phase of AMI. Methods: We used the Polish Registry of Acute Coronary Syndromes (PL-ACS) database (for baseline characteristics of AMI patients from years 2009-2011) linked to the database of the only health insurer in Poland (National Health Fund) for 3-year follow-up data, concerning rehospitalizations and total mortality. Several multivariate models were built to adjust the 3-year outcomes for baseline clinical characteristics and treatments. Results: Altogether 52086 patients with AMI (50.4%% NSTEMI and 49.6% STEMI), with known both LVEF and NYHA class at the time of discharging home were analysed. The distributions of LVEF at discharge were as follows: ≥50% - 54%, 40-49% - 29%, 30-39% - 12%, ≤29% - 5%, and NYHA classes: I – 62%, II - 32%, III or IV - 5%. The rate invasive treatment of AMI during index hospitalization was 94% and it varies between 80% and 97%, being lower in patients with lower LVEF and higher NYHA class. After 3 years follow up period 7844 (15.0%) of patients died, 31046 (59.6%) were rehospitalized for cardiovascular reasons (CV), 6719 (12.9%) due to heart failure, 1309 (2.5%) had ICD or CRT-D implanted, percutaneous revascularization was needed for 12435 (23.9%) patients and surgical for 3580 (6.9%). In multivariate models both lower LVEF and higher NYHA class were significantly and additively associated with higher mortality, the risk of rehospitalization due to heart failure, as well as ICD or CRT-D implantation. Additionally, lower LVEF, but not NYHA class, was significantly associated with higher risk of rehospitalization due to CV reasons. Higher NYHA class was significantly associated with lower rates of revascularizations procedures, while lower LVEF only modestly. Adjusted relative risk of 3-year outcomes in the subgroups of patients according to LVEF and NYHA class at discharge are shown at the figure. Open in new tabDownload slide Adjusted relative risk of 3-year outcome. Conclusion: Functional status assessed by NYHA class at discharge home from AMI has an important additive value to left ventricle ejection fraction in prediction of long-term outcomes. Acute Heart Failure - Clinical P411 https://esc365.escardio.org/Presentation/221105/abstract Vascular access as a predictor of mortality in cardiogenic shock: 1-year follow-up H Miranda,1 H Santos,1 C Sousa,1 I Almeida1 and J Tavares1 1Hospitalar Center Barreiro-Montijo, Lisbon, Portugal Introduction: Cardiogenic shock (CS) is the leading cause of death in patients with acute coronary syndrome (ACS). Revascularization is the only well-studied evidence-based therapy with proven survival benefit. Despite this, optimal access site is not clearly defined in this kind of patients. Objectives: To evaluate the impact of vascular access (femoral versus radial) on the outcome of patients admitted with CS, during 1-year follow-up. Material and Methods: Retrospective study, based on the Portuguese National Registry of Acute Coronary Syndrome (ACS), from 10/10/2010 to 31/12/2018. All patients admitted for CS in the context of ACS were selected. Exclusion criteria: Killip class I-III, lack of information on coronary angiography and vascular access. Results: The initial pool was comprised of 377 patients with ACS. After applying the exclusion criteria, only 301 ended up being included. Male predominance (67.4%). Mean age 68±13 years. Hypertension (68,1%), diabetes (32,6%) and dyslipidaemia (49,6%) were the most frequent comorbidities. 84,4% of the included patients had a diagnosis of ACS with elevation of the ST segment. Mean time symptoms-reperfusion and 1st medical contact-reperfusion contact of 323 and 149 minutes, respectively. PCI was performed, using the femoral access, in 61,8% of the cases. Mean Systolic pressure and diastolic pressure of 94±31 and 59±21 mmHg, respectively. Mean BNP of 725±1111 pg/ml. Mean LVEF of 41±13%. We found out a greater use of intra-aortic balloon and temporary pacemaker in patients with femoral access (p-value of 0.022 and <0,001, respectively), as well as a higher prevalence of atrioventricular block, cardiac arrest and hospital death (p-value 0.002, 0,015 and <0.001, respectively) when compared to radial access. After 1-year follow-up our study revealed no statistic differences between the 2 groups ( Log Rank p-value = 0,540) Conclusion: Early and definitive restoration of coronary blood flow is the standard therapy in patients admitted for CS in the context of myocardial ischemia. According to our findings, the vascular access had some impact on mortality at hospital admission but no differences after 1-year follow-up. P412 https://esc365.escardio.org/Presentation/216496/abstract The predictive value of ACEF score for in-hospital mortality in patients with cardiogenic shockNone T Cinar,1 MI Hayiroglu,1 M Seker,1 S Dogan,1 V Cicek,1 A Oz,1 M Uzun1 and AL Orhan1 1Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey Introduction: The aim of the present study was to assess the predictive value of the age, creatinine, ejection fraction (ACEF) score for in-hospital mortality in patients with cardiogenic shock (CS) secondary to ST-elevation myocardial infarction (STEMI). Material and methods: This single-center, retrospective study was based on a comprehensive analysis of the hospital records of 318 consecutive CS patients. The ACEF score was calculated for each patient using the equation of age/ejection fraction +1 if creatinine level is >2 mg/dL. The study population was stratified into tertiles: T1, T2, and T3, based on the ACEF score. The primary endpoint of the study was the incidence of in-hospital mortality. Results: The incidence of in-hospital mortality was significantly greater in patients with a high ACEF score (T3 group) compared with the intermediate (T2 group) or the low score group (T1 group) [86.8% (n=92 patients) vs 57.5% (n=61 patients) vs 34.9% (n=37 patients), respectively; p<0.05 for each]. In multivariable models, after adjusting for all covariables, the risk of in-hospital mortality was 3.21 [95% confidence interval (CI): 2.29–4.58] for patients allocated to the T3 group. The optimal cut-off for the ACEF score for in-hospital mortality was 2.24, with a sensitivity of 74% and a specificity of 77%. Conclusion: To the best of our knowledge, this is the first study that has demonstrated a prognostic value of the ACEF score in patients with STEMI-related CS. Table 1. In-hospital event rates and logistic regression models for mortality by ACEF score tertiles. ACEF score . . T1 . T2 . T3 . In-hospital mortality Number of deaths 37 61 92 Mortality, % 34.9 57.5 86.8 Mortality, OR (%95 CI) Model 1:unadjusted 1[Reference] 2.52 (1.66-4.98) 3.88 (2.32-6.22) Model 2: adjusted for all covariatesa 1[Reference] 2.12 (1.42-4.22) 3.21 (2.29-4.58) ACEF score . . T1 . T2 . T3 . In-hospital mortality Number of deaths 37 61 92 Mortality, % 34.9 57.5 86.8 Mortality, OR (%95 CI) Model 1:unadjusted 1[Reference] 2.52 (1.66-4.98) 3.88 (2.32-6.22) Model 2: adjusted for all covariatesa 1[Reference] 2.12 (1.42-4.22) 3.21 (2.29-4.58) Open in new tab Table 1. In-hospital event rates and logistic regression models for mortality by ACEF score tertiles. ACEF score . . T1 . T2 . T3 . In-hospital mortality Number of deaths 37 61 92 Mortality, % 34.9 57.5 86.8 Mortality, OR (%95 CI) Model 1:unadjusted 1[Reference] 2.52 (1.66-4.98) 3.88 (2.32-6.22) Model 2: adjusted for all covariatesa 1[Reference] 2.12 (1.42-4.22) 3.21 (2.29-4.58) ACEF score . . T1 . T2 . T3 . In-hospital mortality Number of deaths 37 61 92 Mortality, % 34.9 57.5 86.8 Mortality, OR (%95 CI) Model 1:unadjusted 1[Reference] 2.52 (1.66-4.98) 3.88 (2.32-6.22) Model 2: adjusted for all covariatesa 1[Reference] 2.12 (1.42-4.22) 3.21 (2.29-4.58) Open in new tab Figure 1. Open in new tabDownload slide P413 https://esc365.escardio.org/Presentation/221106/abstract What if worsening renal function in acutely decompensated heart failure patients is not so bad? P Rafouli-Stergiou,1 J Parissis,1 V Bistola,1 G Bakosis,1 S Liori,1 G Doumanis,1 M Thodi,1 G Filippatos1 and E Iliodromitis1 1Attikon University Hospital - 2nd Department of Cardiology - Heart Failure Unit, Athens, Greece Worsening renal function (WRF) during hospitalization for acutely decompensated heart failure (ADHF) is a frequent complication that has multiple explanations. Adverse outcome of these patients has not been adequately verified, maybe because it depends on the primary mechanism of this phenomenon. Sometimes, transient WRF may be owing to intensive decongestion therapies, hemoconcentration, and initiation or up-grading of HF treatments. This retrospective analysis aims to identify the impact of WRF on prognosis, as well as, possible hemodynamic and neurohormonal interactions. We included 100 consecutive hospitalized patients for ADHF (NYHA III-IV and LVEF≤35%) with concomitant renal dysfunction (eGFR<60ml/m2) on admission. WRF during hospitalization was determined as increase in serum creatinine by 0.3 mg/dl or 25%. We evaluated differences in prognosis of patients with or without WRF, up to 1 year after discharge, using major adverse cardiovascular events (MACE) rates, which included both all-cause death and AHF hospitalizations. Patients were on average 70±9 years old, 83% male, and 11% of the study population developed WRF. MACE rates did not demonstrate statistically significant differences among patients with and without WRF either short-term in 2-months (54% vs. 39%, p=0.319) or long-term in 6 and 12 months (80% vs. 64%, p=0.296 and 84% vs. 70%, p=0.416, respectively). Interestingly, these two groups differed hemodynamically and neurohormonally. Patients with WRF had elevated BNP levels on admission (1844±947 vs. 1162±807 pg/ml, p=0.048), as well as higher mean blood pressure (MBP) and right ventricular systolic pressure (RVSP) on admission (47±13 vs. 58±24 mmHg, p=0.026 and 51±13 vs. 62±10 mmHg, p=0.047). Specifically, by using MBP as a marker of perfusion and RVSP as a marker of congestion, these findings may reflect the type of AHF patient that is warm and wet. Patients of the aforementioned clinical classification are more prone to intensive decongestion strategies and HF therapies with a possible negative impact on renal function. However, this impact may be temporary with no association with adverse prognosis, as it was demonstrated in our study. WRF in ADHF patients is a common phenomenon, to which multiple mechanisms may contribute, altering the prognosis of this heterogeneous population. Physicians may be misled by an increase in creatinine as sign of acute kidney injury and delay optimal medical therapy or hospital discharge. Careful clinical assessment, successful resolution of congestion and optimal HF treatment strategies, regardless of transient WRF, are essential for more favorable outcomes of this difficult to manage population. P414 https://esc365.escardio.org/Presentation/216498/abstract The S2PLIT score predicts mortality and rehospitalization in acutely decompensated heart failure C Vila Cha Vaz Saleiro,1 D Campos,1 R Teixeira,1 J Lopes,1 JP Sousa,1 L Puga,1 J Ribeiro,1 A Gomes,1 M Costa,1 C Lourenco1 and L Goncalves1 1University Hospitals of Coimbra, Coimbra, Portugal Background: The S2PLIT score was shown to have a high accuracy (area under the curve, [AUC] 0.900) to predict 1-year all-cause mortality in acutely decompensated heart failure (ADHF). Nevertheless, ADHF patients are also at increased risk of new hospitalization, which has major implications in patient’s well-being and heath resources. Aim: To assess the value of the S2PLIT score to identify and stratify ADHF patients regarding not only mortality but also heart failure (HF) and rehospitalization. Methods: 208 patients admitted to a single coronary care unit with ADHF, who survived hospital stay were included. The S2PLIT score (includes: left ventricular ejection fraction [LVEF], creatinine, sodium, uric acid, systolic blood pressure [SBP] and prior HF hospitalization) was applied in our sample. Patients were categorized according to pre-defined mortality risk categories: low-risk (≤2 points), intermediate-risk (3-4 points) and high-risk (≥5 points). The primary endpoint was a combined outcome of all-cause mortality and HF rehospitalization. Event free survival analysis was done according to the Kaplan-Meyer method and receiver operating characteristic analysis was used to determine the accuracy of the score to distinguish patients who met the endpoint. Analysis were conducted at both, 1 and 4 years follow-up. Open in new tabDownload slide Results: 82% of the patients were male, with mean age 69±14 years old. Ischemic cardiomyopathy (29%) was the most common HF aetiology. In 52.9% of the cases, it was the first hospitalization for HF. Mean SBP was 122±30 mmHg and mean LVEF was 33±12%. Average levels of creatinine, sodium and uric acid were 151±123 mmol/L, 139±4 mmol/L and 504±173 mmol/L, respectively. 28.4% of the patients fitted in the low-risk group, 45.7% in the intermediate-risk and 26% in the high-risk. 90 and 117 patients met the primary endpoint at 1 and 4 years, respectively. Kaplan-Meyer curves showed different event free survival among risk groups at 12 (77% vs 57% vs 30%, Log Rank P<0.001 – Figure 1) and 48 months (63% vs 40% vs 21%, Log Rank P<0.001 – Figure 2). The area AUC for the score at 1-year was 0.691 (95% CI 0.62-0.75, P<0.001) and 0.682 (95% CI 0.61-0.75, P<0.001) at 4 years follow-up. Conclusion: Beyond what was already shown before by other authors, in our study the S2PLIT score also showed a good accuracy for the composed endpoint of all-cause mortality and HF rehospitalization, at 1 and 4 years follow-up. P415 https://esc365.escardio.org/Presentation/221512/abstract Acute heart failure O Tica1 and OTILIA Tica1 1University of Medicine of Oradea-Faculty of Medicine and Pharmacy of Oradea, Oradea, Romania Background: Dilated cardiomyopathy (DCM) is a primary myocardial disease defined by the presence of heart dilation associated with left ventricular systolic dysfunction. Myocardial fibrosis is an important factor in the development and progression DCM. Extracellular matrix (ECM) is playing a central role in this condition. Aim: Our study aim is to describe the morphological changes in the interstitium of myocardial specimens in patients with DCM. Methods: We performed a retrospective study were we included all autopsied patients in our department with diagnosis of DCM (238 patients) during a period of 2 years. Exclusion criteria were trauma related deaths. Harvested myocardial fragment were kept in buffered 10% formalin solution for 72 hours. These fragments were histopathological processed for staining with Hematoxylin and Eosin (HE) and for special staining (Massons trichrome, Van Gieson) in evaluating the degree of fibrosis. Results and discussions: DCM was diagnosed during autopsies in patients admitted especially in cardiology clinic as primary diagnosis of death. Gross examination revealed increased heart weight with thickening of muscle wall (or thinning), fibrosis of the endocardium and dilation of cavities (especially left ventricular cavity). In HE slides we can appreciate myocite impairment, and fibrosis. The pattern of fibrosis is diffuse or focal, with a predominant perivascular topography shown better in Massons trichrome slides. Collagen fibers are present in interstitial space with the dissection of myocites. Fibrosis may be due on one hand to myocardial hypoxia and on the othe hand to the presence of large number of fibroblasts. It is clear that interstitial fibrosis contributes to ventricular dysfunction and affects prognosis in patients with DCM. Conclusions: DCM is a major cause of mortality in patients admitted in hospital. The morphological changes are sometimes extensive and sometimes barely noticeable, that puts endomyocardial biopsy almost out of the diagnostic algorithm. P418 https://esc365.escardio.org/Presentation/221514/abstract Central line associated blood stream infections in inotrope dependent patients waiting for heart transplantation A Gkouziouta,1 N Kogerakis,1 D Miliopoulos,1 E Fountas,1 M Bonios,1 CH Panagiotou,1 S Chatzianastasiou,1 V Voudris1 and S Adamopoulos1 1Onassis Cardiac Surgery Center, Athens, Greece Background: Patients with advanced heart failure waiting for heart transplantation characterized as Status 1A require high-dose inotropes. Central line-associated bloodstream infection (CLABSI) is a severe complication in such patients. Methods: We retrospectively studied 95 patients listed as Status 1A between 2003 and 2018 at our institution. Characteristics of the CLABSIs were further assessed. Logistic regression analysis was used to identify predictors of CLASBIs. Results: The majority of our patients were men (82%) . At the time of listing, mean age was 47±10 years and there were 52 (51%) past smokers with 27 (27%) diabetics. Ischemic disease was the etiology of cardiomyopathy in 39 (39%) patients and implantable defibrillators were present in 50 patients.The mean creatinine at time of listing was 1.37±0.3 mg/dL, while the mean BMI was 28±4 kg/m2. There were 14 (16%)patients who experienced a total of 19 CLABSIs. Among those with CLABSIs, a median of 6 PAC procedures (mean 7.3±5.3) were performed, with 44% placed in the internal jugular vein, 44% in subclavian vein and the remainder in the femoral vein. Patients who developed CLABSIs had catheters in place for a mean duration of 158±90. Co-agulase negative staphylococcus (CNS) was the pathogen in the majority of the cases.CLABSIs and Staphylococcus aureus was the cause for another 6 CLABSIs . The mean time to first CLABSI was 86±77 after being listed as Status 1A. The mean duration to CLABSI from catheter placement was mean: 15±11. Age, history of smoking, obesity, diabetes and renal dysfunction were not associated with CLABSIs. Conclusions: Among heart failure patients listed as Status 1A for heart transplantation, nearly a quarter of all patients developed CLABSIs, leading to a downgrade of the status on the transplant waiting list. CNS was the most common pathogen. P419 https://esc365.escardio.org/Presentation/216731/abstract Predictors of early death in high risk acute heart failure patients treated with levosimendan A Duszanska,1 T Czarnik,2 J Bugajski,1 J Plonka,1 A Tycinska,3 M Gawor2 and M Gierlotka4 1University Hospital in Opole, Department of Cardiology, Opole, Poland 2University Hospital in Opole, Department of Anesthesiology and Intensive Care, Opole, Poland 3Medical University of Bialystok, Bialystok, Poland 4University of Opole, Department of Cardiology, University Hospital, Opole, Poland Data on potential advantages of levosimendan in the management of acute heart failure are ambiguous. However, due to its mechanisms of action comprising positive inotropy, vasodilation and cardioprotection, it is used in clinical practice in different clinical scenarios. The aim of the present analysis was to assess the predictors of early death in high risk acute heart failure patients treated with levosimendan. Methods: We analyzed 61 consecutive patients (pts) admitted with high risk AHF to one center and treated in both intensive cardiac care unit (34 pts) and general intensive care unit (27 pts). Levosimendan was administered as a 24-hour infusion of 12.5 mg total dose except for 9 patients (2 pts - terminated earlier due to intolerance, 1 pt - death during infusion, 5 pts – 48h infusion, 1 pt - 72h infusion). Results: (table). The etiology of AHF was primary of cardiac origin in 58 of patients (current acute myocardial infarction - 28 pts (NSTEMI - 7 pts, STEMI - 21 pts), other ischemic - 18 pts, acute myocarditis - 5 pts, cardiomyopathies - 4 pts, other cardiac – 3 pts). The remaining 3 reasons of AHF were acute respiratory failure, infective endocarditis and hypothermia. During hospitalization 21 (34%) died. Patients with AHF who died were of higher risk profile (more often with cardiogenic shock, higher heart rate, lactate levels, with median Intermacs 1 compared to 3 in patients with non-AMI related AHF). They were also more often treated in general ICU. Median time from admission to levosimendan therapy tend to be shorter in patients who died (2 days, IQR 1 - 4 days vs. 5 days, IQR 2 - 9 days; p = 0.064). Five patients who finally survived were treated with levosimendan twice during hospitalization. Levosimendan were given on top of other catecholamines in all patients who died except 1 pt. Oppositely, in 9 patients (22%) who survived it was used without any catecholamines treatment. Adrenaline, noradrenaline and dobutamine were more frequently used in patients who died and consequently, an average number of catecholamines used per patient was higher (2.5 vs 1.4 in pts who survived). Open in new tabDownload slide Conclusion: Patients with high risk acute heart failure treated with levosimendan and hemodynamical instability such as cardiogenic shock, lower Intermacs, increased heart rate and lactate levels, concomitant use of vasopressors are at higher risk of mortality. P420 https://esc365.escardio.org/Presentation/216406/abstract Anisocytosis predicts postoperative renal replacement therapy in patients undergoing heart valve surgeryNo P Duchnowski,1 M Kusmierczyk,2 M Kozma1 and T Hryniewiecki1 1Institute of Cardiology in Anin, Department of Acquired Cardiac Defects, Warsaw, Poland 2Institute of Cardiology in Anin, Department of Cardiosurgery and Transplantology, Warsaw, Poland Background: Acute kidney injury (AKI) is one of the serious postoperative complications in patients undergoing heart valve surgery. The aim of the present study was to identify selected biomarkers to predict AKI requiring renal replacement. Methods: A prospective study was conducted on a group of 751 patients undergoing heart valve surgery. The data on risk factors, preoperative complete blood count, course of operations and the postoperative period were assessed. The primary endpoint at the 30-day follow-up was postoperative AKI requiring renal replacement therapy. The secondary end-point was death from all causes in patients with postoperative AKI requiring renal replacement. Results: The primary endpoint occurred in 46 patients. The statistically significant predictors of postoperative renal replacement therapy at univariate and multivariate analysis are presented in Table 1. At multivariate analysis: age, red cell distribution width (RDW) and C-reactive protein remained independent predictors of the primary endpoint. Hemoglobin and RDW were associated with an increased risk of death. Table 1. Analysis of predictive factors for the occurrence of postoperative renal replacement therapy. Variable . Univariate analysis . Multivariate analysis . Odds ratio . 95% Cl . p-value . Odds ratio . 95% Cl . p-value . Age, years 1.066 1.031-1.103 0.002 1.082 1.019-1.162 0.02 CBT, min 1.202 1.101 - 1.303 0.04 CRP, mg/dL 2.442 1.546-3.556 0.002 2.386 1.416-3.268 0.04 Creatinine, mmol/L 1.160 1.094-1.242 0.001 GFR, (ml/min/1,73 m2), n (%) 0.944 0.927-0.962 0.004 Hemoglobin, g/dL 0.595 0.491-0.721 0.001 LVEF, % 0.966 0.944-0.988 0.003 RDW, (%) 1.697 1.290-2.233 0.0002 1.578 1.208-2.544 0.003 RDW1, (%) 1.798 1.135-2.448 0.009 Variable . Univariate analysis . Multivariate analysis . Odds ratio . 95% Cl . p-value . Odds ratio . 95% Cl . p-value . Age, years 1.066 1.031-1.103 0.002 1.082 1.019-1.162 0.02 CBT, min 1.202 1.101 - 1.303 0.04 CRP, mg/dL 2.442 1.546-3.556 0.002 2.386 1.416-3.268 0.04 Creatinine, mmol/L 1.160 1.094-1.242 0.001 GFR, (ml/min/1,73 m2), n (%) 0.944 0.927-0.962 0.004 Hemoglobin, g/dL 0.595 0.491-0.721 0.001 LVEF, % 0.966 0.944-0.988 0.003 RDW, (%) 1.697 1.290-2.233 0.0002 1.578 1.208-2.544 0.003 RDW1, (%) 1.798 1.135-2.448 0.009 Abbreviations: CBT = cardiopulmonary bypass time, CRP = c-reactive protein, GFR = glomerular filtration rate, LV = left ventricle, RDW = red cell distribution width (preoperative), RDW1= red cell distribution width measured 48 hours after surgery. Open in new tab Table 1. Analysis of predictive factors for the occurrence of postoperative renal replacement therapy. Variable . Univariate analysis . Multivariate analysis . Odds ratio . 95% Cl . p-value . Odds ratio . 95% Cl . p-value . Age, years 1.066 1.031-1.103 0.002 1.082 1.019-1.162 0.02 CBT, min 1.202 1.101 - 1.303 0.04 CRP, mg/dL 2.442 1.546-3.556 0.002 2.386 1.416-3.268 0.04 Creatinine, mmol/L 1.160 1.094-1.242 0.001 GFR, (ml/min/1,73 m2), n (%) 0.944 0.927-0.962 0.004 Hemoglobin, g/dL 0.595 0.491-0.721 0.001 LVEF, % 0.966 0.944-0.988 0.003 RDW, (%) 1.697 1.290-2.233 0.0002 1.578 1.208-2.544 0.003 RDW1, (%) 1.798 1.135-2.448 0.009 Variable . Univariate analysis . Multivariate analysis . Odds ratio . 95% Cl . p-value . Odds ratio . 95% Cl . p-value . Age, years 1.066 1.031-1.103 0.002 1.082 1.019-1.162 0.02 CBT, min 1.202 1.101 - 1.303 0.04 CRP, mg/dL 2.442 1.546-3.556 0.002 2.386 1.416-3.268 0.04 Creatinine, mmol/L 1.160 1.094-1.242 0.001 GFR, (ml/min/1,73 m2), n (%) 0.944 0.927-0.962 0.004 Hemoglobin, g/dL 0.595 0.491-0.721 0.001 LVEF, % 0.966 0.944-0.988 0.003 RDW, (%) 1.697 1.290-2.233 0.0002 1.578 1.208-2.544 0.003 RDW1, (%) 1.798 1.135-2.448 0.009 Abbreviations: CBT = cardiopulmonary bypass time, CRP = c-reactive protein, GFR = glomerular filtration rate, LV = left ventricle, RDW = red cell distribution width (preoperative), RDW1= red cell distribution width measured 48 hours after surgery. Open in new tab Conclusions: Elevated RDW is associated with a higher risk of postoperative AKI and death in patients with AKI. P422 https://esc365.escardio.org/Presentation/221524/abstract Left circumflex coronary artery as the culprit vessel in non-ST segment elevation myocardial infarction (NSTEMI): electrocardiographic parameters, infarct size, reperfusion delay and prognosis.No sources of funding were provided for this work. P Perez Diaz,1 A Jurado Roman,2 I Sanchez Perez,1 MT Lopez Lluva,1 J Abellan Huerta,1 R Maseda Uriza,1 J Piqueras Flores,1 R Frias Garcia,1 J Martinez Del Rio1 and F Lozano Ruiz Poveda1 1Hospital General de Ciudad Real, Cardiology, Ciudad Real, Spain 2University Hospital La Paz, Cardiology, Madrid, Spain Background: Left circumflex (LCx) occlusion is underdiagnosed in most of studies about myocardial infarction, due to its poor electrocardiographic expressiveness and late diagnosis, which leads to longer higher reperfusion time. Purpose: To compare peak of cardiac biomarkers, electrocardiographic abnormalities, reperfusion delay, hospital stay and survival in non-ST segment elevation myocardial infarction (NSTEMI), due to left anterior descending (LAD), left circumflex (LCx) or right coronary artery (RCA) stenosis. Methods: Observational prospective study including 455 patients with NSTEMI in a single university hospital between 2016 and 2018. We analyzed clinical presentation, peak of markers, electrocardiogram and reperfusion delay. Average hospital stay and long-term mortality were assessed in case of occlusion of left anterior descending (LAD), left circumflex (LCx) or right coronary artery (RCA) occlusion (TIMI = 0). Results: LCx was occluded in 7% (culprit lesion in 16%). Peak of troponin was 13 ± 40.65 ± 157 y 19 ± 49 ng/ml in LAD, LCx and RCA respectively (p<0.01). The most frequent ECG finding in LCX stenosis was “repolarization abnormalities or ST depression in lateral leads” (sensitivity 22%; specificity 99%; positive predictive value 88%, negative predictive value 87%). Median time from symptoms onset to emergency department was 161 ± 353, 180 ± 236 and 231 ± 412 minutes respectively (p=0.223). No differences in median time from emergency unit to invasive cardiology department were detected (p=0.058). 265 patients underwent percutaneous coronary intervention (PCI): 19 thrombectomy (4%) and 245 direct stenting or predilatation and stenting technique (92%). Median syntax score was 13 ± 18, and success rate 96%. No differences in average hospital stay, left systolic function, complications after procedure and all-cause mortality before discharge and 1 year after discharge were detected. Conclusions: Isolated ST depression in lateral leads seems to be a low sensitive but highly specific electrocardiographic parameter in NSTEMI due to LCx stenosis. We detected a higher infarct size in these patients due to its poor electrocardiographic expressiveness, but no differences in reperfusion delay were showed. Open in new tabDownload slide Reperfusion delay. P423 https://esc365.escardio.org/Presentation/221525/abstract Left circumflex coronary artery as the culprit vessel in ST segment elevation myocardial infarction (STEMI): electrocardiographic parameters, infarct size, reperfusion delay and prognosis.No sources of funding were provided for this work. P Perez Diaz,1 A Jurado Roman,2 I Sanchez Perez,1 MT Lopez Lluva,1 J Abellan Huerta,1 R Maseda Uriza,1 J Piqueras Flores,1 R Frias Garcia,1 A Moron Alguacil1 and F Lozano Ruiz Poveda1 1Hospital General de Ciudad Real, Cardiology, Ciudad Real, Spain 2University Hospital La Paz, Cardiology, Madrid, Spain Background: Left circumflex (LCx) occlusion is underdiagnosed in most of studies about myocardial infarction, due to its poor electrocardiographic expressiveness and late diagnosis, which leads to longer higher reperfusion time. Purpose: To compare peak of cardiac biomarkers, electrocardiographic abnormalities, reperfusion delay, hospital stay and survival in STEMI, due to left anterior descending (LAD), left circumflex (LCx) or right coronary artery (RCA) stenosis. Open in new tabDownload slide Reperfusion delay. Methods: Observational prospective study including 323 patients with STEMI in a single university hospital between 2016 and 2018. We analyzed clinical presentation, peak of markers, electrocardiogram and reperfusion delay. Average hospital stay and long-term mortality were assessed in case of occlusion of left anterior descending (LAD), left circumflex (LCx) or right coronary artery (RCA) occlusion (TIMI = 0). Results: LCx was occluded in 13% (culprit lesion in 14%). Peak of troponin was 75 ± 51, 47 ± 57 and 37 ± 64 ng/ml in LAD, LCx and RCA respectively (p<0.01). The most frequent ECG finding in LCX stenosis was “ST depression in V1-V4 leads and ST elevation in inferior leads” (sensitivity 11%; specificity 96%; positive predictive value 29%, negative predictive value 86%). Median time from symptoms onset to emergency department was 139 ± 3131, 157 ± 220 and 166 ± 116 minutes respectively (p=0.101). No differences in median time from emergency unit to invasive cardiology department were detected (p=0.767). 305 patients underwent percutaneous coronary intervention (PCI): 142 thrombectomy (47%) and 270 direct stenting or predilatation and stenting technique (89%). Median syntax score was 12 ± 16, and success rate 99%. Patients with LDA occlusion presented lower systolic function after AMI (43%, 52% and 54%; p<0.001), and higher rate of all-cause mortality before discharge (p= 0.009), 6 months (0.014) and 1 year after myocardial infarction (p=0.036). Conclusions: ST depression in V1-V4 leads and ST elevation in inferior leads seems to be a low sensitive but highly specific electrocardiographic parameter in STEMI due to LCx stenosis. We did not detect a higher infarct size nor longer reperfusion time in these patients, but patients with STEMI due to LAD occlusion presented higher short and medium-term mortality. Non-ST-Elevation Myocardial Infarction (NSTEMI) P424 https://esc365.escardio.org/Presentation/216698/abstract Association between clinical risk score (HEART, GRACE and TIMI) and angiographic complexity in acute coronary syndrome without ST-segment elevationNot applicable D Mota,1 AV Cedro,1 LN Ohe,1 LS Castro,2 A Timerman1 and JRC Junior1 1Institute Dante Pazzanese of Cardiology, Sao Paulo, Brazil 2Federal University of Sao Paulo (UNIFESP), Sao Paulo, Brazil Introduction: GRACE, TIMI and HEART scores have been previously validated to predict events among patients with non-ST elevation acute coronary syndrome (Non-ST ACS), but the ability of these scores to discriminate the angiographic complexity of coronary artery disease has not been clearly established. The presented study was developed to evaluate the correlation between these clinical scores and the anatomical complexity assessed by SYNTAX score. Methods: this is a observational study encompassing patients with Non-ST ACS referred to invasive stratification in a cardiac hospital, between July 2018 and February 2019. Association between the scores was established by bivariate correlations. Statistical significance was used at 5% (p <0.05). Results: 138 patients were enrolled. Mean GRACE, TIMI and HEART scores were 98.1±29, 2.9±2 e 5±1.6, respectively and the average SYNTAX was 11±7.2. There was a positive correlation between the clinical scores and the SYNTAX [HEART (r=0.32; p<0.01), GRACE (r=0.26; p<0.01) and TIMI (r=0.24; p<0.01)]. The HEART score was the one with the highest AUC to predict a SYNTAX ≥32 [HEART = 0,81 (IC95% 0.7-0.91), p<0.001]. Open in new tabDownload slide ROC curves. Table 1. Comparison between clinical risk scores. . Total . Syntax ≥23a . Syntax >32b . GRACE Mean ± SD 98.1 ± 29.7 117.1 ± 40.6** 135.2 ± 47.6** >139, n(%) 9 (6.5) 7 (31.8)** 6 (54.5)** AUC 0.66 (0.53-0.79) 0.76 (0.53-0.79) TIMI Mean ± SD 2.9 ± 2.0 3.6 ± 1.7** 4.6 ± 1.8** ≥5. n(%) 16 (11.6) 7 (30.4)** 6 (54.5)** AUC 0.66 (0.53-0.79) 0.81 (0.64-0.97) HEART Mean + SD 5.0 ± 1.6 6.2 ± 1.7** 6.9 ± 1.8** ≥7 n (%) 26 (18.8) 8 (34.8)* 6 (54.5)** AUC 0.72 (0.62-0.83) 0.81 (0.70-0.92) SYNTAX, Mean ± SD 11.0 ± 7,2 31.3 ± 4.6** 34.9 ± 2.9** . Total . Syntax ≥23a . Syntax >32b . GRACE Mean ± SD 98.1 ± 29.7 117.1 ± 40.6** 135.2 ± 47.6** >139, n(%) 9 (6.5) 7 (31.8)** 6 (54.5)** AUC 0.66 (0.53-0.79) 0.76 (0.53-0.79) TIMI Mean ± SD 2.9 ± 2.0 3.6 ± 1.7** 4.6 ± 1.8** ≥5. n(%) 16 (11.6) 7 (30.4)** 6 (54.5)** AUC 0.66 (0.53-0.79) 0.81 (0.64-0.97) HEART Mean + SD 5.0 ± 1.6 6.2 ± 1.7** 6.9 ± 1.8** ≥7 n (%) 26 (18.8) 8 (34.8)* 6 (54.5)** AUC 0.72 (0.62-0.83) 0.81 (0.70-0.92) SYNTAX, Mean ± SD 11.0 ± 7,2 31.3 ± 4.6** 34.9 ± 2.9** Comparison of SYNTAX groups score in column a) <23 versus ≥23 and column b) ≤32 versus> 32.* p < 0.05; ** p < 0.01. AUC: area under the receiver operating characteristic (ROC) curve; CAD: Coronary Artery Disease; LMCA: Left Main Coronary Artery Open in new tab Table 1. Comparison between clinical risk scores. . Total . Syntax ≥23a . Syntax >32b . GRACE Mean ± SD 98.1 ± 29.7 117.1 ± 40.6** 135.2 ± 47.6** >139, n(%) 9 (6.5) 7 (31.8)** 6 (54.5)** AUC 0.66 (0.53-0.79) 0.76 (0.53-0.79) TIMI Mean ± SD 2.9 ± 2.0 3.6 ± 1.7** 4.6 ± 1.8** ≥5. n(%) 16 (11.6) 7 (30.4)** 6 (54.5)** AUC 0.66 (0.53-0.79) 0.81 (0.64-0.97) HEART Mean + SD 5.0 ± 1.6 6.2 ± 1.7** 6.9 ± 1.8** ≥7 n (%) 26 (18.8) 8 (34.8)* 6 (54.5)** AUC 0.72 (0.62-0.83) 0.81 (0.70-0.92) SYNTAX, Mean ± SD 11.0 ± 7,2 31.3 ± 4.6** 34.9 ± 2.9** . Total . Syntax ≥23a . Syntax >32b . GRACE Mean ± SD 98.1 ± 29.7 117.1 ± 40.6** 135.2 ± 47.6** >139, n(%) 9 (6.5) 7 (31.8)** 6 (54.5)** AUC 0.66 (0.53-0.79) 0.76 (0.53-0.79) TIMI Mean ± SD 2.9 ± 2.0 3.6 ± 1.7** 4.6 ± 1.8** ≥5. n(%) 16 (11.6) 7 (30.4)** 6 (54.5)** AUC 0.66 (0.53-0.79) 0.81 (0.64-0.97) HEART Mean + SD 5.0 ± 1.6 6.2 ± 1.7** 6.9 ± 1.8** ≥7 n (%) 26 (18.8) 8 (34.8)* 6 (54.5)** AUC 0.72 (0.62-0.83) 0.81 (0.70-0.92) SYNTAX, Mean ± SD 11.0 ± 7,2 31.3 ± 4.6** 34.9 ± 2.9** Comparison of SYNTAX groups score in column a) <23 versus ≥23 and column b) ≤32 versus> 32.* p < 0.05; ** p < 0.01. AUC: area under the receiver operating characteristic (ROC) curve; CAD: Coronary Artery Disease; LMCA: Left Main Coronary Artery Open in new tab Conclusion: All the three clinical scores presented a positive, although moderated, association with the SYNTAX score. HEART score was the best to predict the presence of complex CAD assessed by the SYNTAX score. Non-ST-Elevation Myocardial Infarction (NSTEMI) P425 https://esc365.escardio.org/Presentation/216723/abstract Non st elevation myocardial infarction in acute left circumflex occlusion - prognostic impact of a concealed severity J Lopes,1 C Saleiro,1 D Campos,1 J Sousa,1 L Puga,1 J Ribeiro,1 C Lourenco1 and L Goncalves1 1University Hospitals of Coimbra, Cardiology, Coimbra, Portugal Background: The ability to diagnose acute left circumflex artery (LCx) occlusion by 12-lead ECG is often much more difficult than occlusions involving the other main coronary arteries, with over half of acute occlusions of the LCx presenting without characteristic ST segment elevation. In the literature, ST-elevation myocardial infarction (STEMI) is higher risk than NSTEMI in the acute setting, but the acute risk and outcomes of NSTEMI secondary to occluded LCx as culprit are less clear. Aim: Assess and compare the baseline characteristics and prognosis of the patients (P) with NSTEMI with acute LCx occlusion (group 1) with both STEMI with acute LCx occlusion (group 2) and NSTEMI with LCx as culprit but without acute occlusion (group 3). Methods: Retrospective study, based on the National Registry of Acute Coronary Syndromes, with P included between 01/10/2010 to 7/09/2016. We included only the P with myocardial infarction and LCx as the culprit vessel, and divided them in 3 groups (G). The 3 G were compared for its demographic, clinical and laboratory characteristics. We also compared hospital mortality and readmissions with acute heart failure (AFH) on follow up. We used Kaplan-Meier survival method to compare survival curves of the 2 G with LCx acute occlusion. Results: We included 1840 P, 410 for group 1 (G1), 515 for group 2 (G2) and 915 for group 3 (G3). The analyzed sample had a mean age of 64 ± 13, with 78,9% of the masculine sex. When it comes to the classical risk factors for coronary disease (tobacco, hypertension, diabetes and dyslipidemia), valvular disease, chronic renal insufficiency or reduced systolic function of the left ventricle (<50%), the prevalence in G1 was always in a mid-position between the prevalence of G2 and G3. G1 P had a higher systolic arterial pressure on admission, when compared with G2 and G3 (p< 0,001), were more symptomatic on admission (p< 0,001), needed more nitrates during hospitalization (p < 0,001), had less coronary angioplasty procedures (p < 0,001) and needed more coronary bypass surgery. In-hospital mortality rate was of 3,3% in G2, 2,0% in G1 and 0,8% in G3, which was a statistically significant difference (p= 0,002). The Kaplan-Meier estimates indicated that one-year overall survival rate in G1 was 94,3% and in G2 was 95,8%, with a Log Rank p value = 0,481, showing no statistical difference. There was no difference in the rate of readmissions with heart failure between G1 vs G2 (Log Rank, p value = 0,367) or between G2 vs G3 (Log Rank p value = 0,284). Open in new tabDownload slide Survival_LCx. Conclusion: We can conclude that NSTEMI with acute LCx occlusion (group 1) is of intermediate risk when it comes to in-hospital mortality, have intermediate baseline characteristics and a similar survival rate when compared with STEMI with acute LCx occlusion. There was no difference in AHF readmission rates between the 3 groups in this study. ST-Elevation Myocardial Infarction (STEMI) P428 https://esc365.escardio.org/Presentation/216743/abstract The role of cardiac magnetic resonance imaging in differentiating acute myocarditis from acute ST-elevation myocardial infarction R Diaz1 and D Silva2 1Universidad de Valparaíso, Departamento de Medicina Interna, VIÑA DEL MAR, Chile 2Clínica Reñaca, Unidad de Cuidados Intensivos, VIÑA DEL MAR, Chile Background/Introduction: Acute myocarditis (AM) is often difficult to differentiate from acute ST-elevation myocardial infarction (STEMI), even when invasive coronary angiography (ICA) demonstrates normal coronary arteries (CAs). An accurate diagnosis is indispensable to ensure precise and optimal treatment. Purpose: The present study aims to evaluate the utility of cardiac magnetic resonance imaging (CMRI) in differentiating AM from STEMI. Methods: We investigated 18 consecutive patients presenting with prolonged chest pain, electrocardiographic ST-segment elevation, elevated troponin levels, and normal CAs according to ICA. Patients underwent a CMR study 72 hours after the angiography if renal functions were normal. The CMRI involved cine-CMR sequences to evaluate the presence of segmental wall motion abnormalities, T2-weighted STIR imaging to detect oedema, and delayed contrast-enhancement (DCE) imaging 10 minutes after gadolinium administration to detect fibrosis. Patients with previous myocardial infarctions, other known heart diseases, or contra-indications for CMRI studies were excluded. Results: All patients were initially diagnosed with STEMI, and three of them received thrombolytic therapy. In all patients, AM was diagnosed by the presence of left ventricular (LV) oedema and epicardial or intra-myocardial DCE without endocardial involvement. The mean age of the patients was 35.3 ± 12.4 years (89.9% males). Mean peak troponin levels were 19.8 ± 16.2 ng/mL (normal: <0.03 ng/mL), mean peak creatine kinase-MB levels were 35.0 ± 34.5 ng/mL (normal: <5.0 ng/mL), C-reactive protein levels were 41.6 ± 39.2 mg/L (normal: <5.0 mg/L), and brain natriuretic peptide levels were 117.3 ± 102.2 pg/mL (normal: <56.6 pg/mL). The white blood count was 10.386 ± 2.806 mm3 (normal: 4.400–11.500 mm3), erythrocyte sedimentation rate was 16.4 ± 10.4 mm/Hr (normal: <15 mm/Hr), LV end-diastolic volume index 71.0 ± 9.7 mL/m2 (normal: 53–97 mL/m2), LV end-systolic volume index 28.7 ± 4.1 mL/m2 (normal: 10–34 mL/m2 ), ejection fraction 59.7 ± 4.5% (normal: 59–83%), and LV mass 65.0 ± 11.5 g/m2 (normal: 42–78 g/m2). LV epicardial and/or intra-myocardial DCE involvement was located in the lateral wall in 87.5% of patients, the inferior wall in 43.8%, the septal wall in 43.8%, the anterior wall in 25%, and the apex in 18.8%. No segmental LV contraction abnormalities were identified. Conclusion: CMRI allows us to differentiate between AM and acute myocardial infarction in patients hospitalized with suspected STEMI and normal CAs, helping to institute optimal therapeutic strategies. P429 https://esc365.escardio.org/Presentation/216715/abstract impact of off-hour presentation on in-hospital mortality of patients with acute ST-Segment Elevation Myocardial Infarction treated with primary angioplasty in a region without STEMI networkTabriz university of medical science ELNAZ Javanshir,1 A Separham1 and ELHAM Darzi Ramandi1 1Tabriz University of Medical Sciences, cardiology, Tabriz, Iran (Islamic Republic of) Introduction: This study aimed to assess the effect of the admission time (on-hours versus off-hours) on in-hospital prognosis in patients with ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PPCI) in a region without STEMI network. Methods: We analysed in-hospital mortality among 300 consecutive ST-segment elevation myocardial infarction (STEMI) patients treated with PPCI between March 2012 and February 2017. Patients were divided according to admission time into on-hours admission (08:00 AM until 08:00 PM on weekdays) versus off-hours admission (08:00 PM until 08:00 AM on weekdays and 24 h on weekends and holidays). Demographic and clinical data as well as in-hospital mortality were compared between two groups. Results: One hundred and seventy eight (59.3%) patients were admitted during on-hours, and 122 (40.7%) patients were presented in off-hours. The mean door-to-balloon time was 42.3 min in the off-hours group and 34.2 min in the on-hours group with no statistically significant difference (p=0.39). The mortality rate was 3.9% at on-hours presentation versus 4.09% in off-hours admission (p=0.58) Conclusion: Despite no efficient STEMI network in present study, off-hour presentation had no significant impact on in-hospital prognosis in patients with STEMI treated with primary PCI. Larger studies are warranted in order to determine prognostic role of off-hour presentation in patients with STEMI undergoing primary angioplasty . ST-Elevation Myocardial Infarction (STEMI) P433 https://esc365.escardio.org/Presentation/217588/abstract Characteristics, management and in-hospital outcomes of patients with spontaneous coronary artery dissection (SCAD). J Carmona Carmona,1 P Perez Espejo,2 C Urraca Espejel,3 IR Martinez Primoy,1 DF Arroyo Monino,1 P Villar Calle,1 N Garcia Gonzalez,1 P Ruiz Garcia,1 B Olivares Martinez,1 A Gomez Gonzalez,1 DA Chipayo Gonzales,2 S Rodriguez De Leiras Otero,1 T Seoane Garcia,1 R Hidalgo Urbano1 and JC Garcia Rubira1 1UNIVERSITY HOSPITAL VIRGEN MACARENA, Seville, Spain 2HOSPITAL SAN PEDRO DE ALCANTARA, Caceres, Spain 3Albacete University Hospital, Albacete, Spain Introduction: Spontaneous coronary artery dissection (SCAD) is an under diagnosed cause of acute coronary syndrome, particularly in healthy young women. Objectives: Our study evaluated the baseline characteristics, clinical presentation, and in-hospital management of patients diagnosed of SCAD due to and acute coronary síndrome. Methods: Multicentre observational retrospective study of patients hospitalized from March 2005 to April 2019 who presented with an acute coronary syndrome and were diagnosed as SCAD after an invasive coronary angiography was performed. Results: 91 patients with SCAD were analyzed. The mean age was 55.44± 12.06 years. 71.4% women, 28.6% men. 44% had hypertension, 13.2% diabetes mellitus, 27.5% hyperlipidaemia, and 12.1% endocrinology disorders (7.7% hypothyroidism). Only one case occurred during pregnancy. Most of the patients (75.8%) presented with typical chest pain. Physical stress was found to be the most frequent trigger (16.5%), followed by emotional trigger (12.1%). 45.1% of SCAD patients presented with ST elevation myocardial infarction. Two cases presented with cardiac arrest. A total of 46.2% underwent percutaneous revascularization, and 2 patients had surgical approach. At discharge 79.2% were under dual antiplatelet therapy (33% with prasugrel or ticagrelor) and b-blockers were prescribed in 91.2% of the patients. No deads were registered during hospitalization. Conclusions: Due to lack of awareness SCAD is an underdiagnosed cause of ACS that should be considered, especially in mid-age women. Although medical treatment is generally recommended due to revascularization risks, almost half of our patients underwent percutaneous intervention with non in-hospital mortality. P435 https://esc365.escardio.org/Presentation/216495/abstract The impact of first contact-to-balloon time on intrahospital mortality in ST-elevation myocardial infarction presenting with out-of-hospital cardiac arrest and cardiogenic shock M Jarakovic,1 S Bjelica,1 M Kovacevic,1 M Petrovic,1 S Dimic,1 S Keca,1 B Crnomarkovic,1 M Trajkovic1 and G Panic1 1Institute of Cardiovascular Diseases of Vojvodina, Cardiology Department, Sremska Kamenica, Serbia Introduction: Despite advances in the treatment of ST-segment elevation myocardial infarction (STEMI), two groups of patients remain a challenge: those presenting with out-of-hospital cardiac arrest (OHCA) and with cardiogenic shock (CS) and especially those patients in whom OHCA and CS are simultaneously present. OHCA and CS in patients with STEMI may impact the transport time between first medical contact and arrival at a center for primary percutaneous coronary intervention (PPCI). Only a few studies are addressing the impact of first contact-to-balloon time on mortality in STEMI patients with CS and OHCA. Purpose: The aim of this research was to evaluate the influence of first contact-to-balloon time on intrahospital mortality in STEMI patients with OHCA and CS present prior to percutaneous coronary intervention (PCI). Methods: The research was conducted as a retrospective cohort analysis of data taken from the hospital registry of OHCA and included 116 STEMI patients who presented with OHCA and were admitted at the PCI center for early PCI (≤24h from admission), from January 2007 until August 2019. We assessed the influence of first contact-to balloon time (≤90 min vs. >90 min) on intrahospital mortality in STEMI patients with OHCA and CS present prior to PCI. Results: Among STEMI patients who presented with OHCA, CS was present in 53 patients (45.7%) prior PCI. The mean age of our study group was 63 ± 12 years. From all the resuscitated STEMI patients with CS, 47 (88.7%) had contact-to-balloon time longer than 90 minutes. The overall mortality of resuscitated STEMI patients with CS was 25 (47.2%). Prolongation of contact-to-balloon time (≥90 min) in resuscitated STEMI patients with CS caused significantly higher mortality in comparison with patients with CS in whom first contact-to-balloon time lasted less than 90min (51.1% vs. 16.7% respectively; p<0.0005). In the investigated group of patients, the following predictors significantly affected prolongation of contact-to-balloon time and the occurrence of fatal outcome in the univariate logistic regression analysis: GCS ≤ 8 (OR 0.128 [0.041-0.397], p<0.0005), assisted ventilation (OR 9.014 [2.907-27.943], p<0.0005) and implantation of intraaortic balloon pump (IABP) prior PPCI (OR 3.000 [1.019-8.829], p<0.0005). When the multivariable logistic regression model was performed, only assisted ventilation proved to be an independent predictor of intrahospital mortality (OR 7.055 [2.191-22.720], p=0.001). Conclusion: In our group of STEMI patients presenting with OHCA and CS prior to PCI, GCS≤8, assisted ventilation and implantation of IABP prior PPCI prolonged contact-to-balloon time and affected the occurrence of fatal outcome and assisted ventilation prior PCI proved to be an independent predictor of in-hospital mortality. In our group of STEMI patients with OHCA and CS time from first medical contact to PPCI is a strong predictor of adverse outcome. P436 https://esc365.escardio.org/Presentation/221092/abstract Comparison of relative fat mass index with other obesity parameters in predicting clinical severity and prognosis of acute myocardial infarctionNA Z Babic,1 M Mornar Jelavic2 and H Pintaric3 1University Hospital Sestre Milosrdnice, Coronary Care Unit, Zagreb, Croatia 2Institute for Cardiovascular Diseases & Rehabilitation, Zagreb, Croatia 3University Hospital Sestre Milosrdnice, Emergency Department, Zagreb, Croatia Background: Relative Fat Mass Index (RFMI) is a novel anthropometric parameter, which is more accurate than body mass index (BMI) to estimate whole-body fat percentage. Purpose: To compare RFMI with other obesity parameters in predicting clinical severity and prognosis of acute ST-elevation myocardial infarction (STEMI). Methods: This prospective study included 250 acute STEMI patients treated with primary percutaneous coronary intervention. We collected data about baseline (medical history, demography, body mass index (BMI), waist circumference (WC), waist-to-hip (WHR), waist-to-height ratio (WHtR)), severity (clinical presentation, laboratory, echocardiography, coronary angiography, in-hospital complications), and prognostic parameters (major adverse cardiovascular events (MACE)) during 12-month following up. Results: We have found subjects with increased RFMI (55.2%) had higher rate of in-hospital complications (47.8% vs 33.9%) and wider stents (3.5 vs 3.0 mm); negative correlation of BMI with the number of significantly stenosed proximal coronary segments (rho= -0.15) and positive correlation with diameter of stents (rho=0.24); positive correlation of WC with hospital stay (days) (rho=0.14); positive correlations of WHtR with hospital stay (days) (rho=0.14) and all in-hospital complications (rho=0.12); positive correlation of RFMI with all in-hospital complications (rho=0.16) and negative correlations with parameters of myocardial necrosis (maximal cTnT (ng/mL) (rho= -0.18), and maximal CK (U/L) values (rho= -0.17)); the number of significantly stenosed coronary arteries has positive effect on MACE (Cox Hazard ratio 1.78 [1.26 to 2.52]), (P<0.05). Conclusion: RFMI and WHtR are superior in predicting clinical severity of acute STEMI, while the severity of coronary artery disease has influence on prognosis. P438 https://esc365.escardio.org/Presentation/217413/abstract Impact of preprocedural TIMI flow on clinical outcome in acute ST elevation myocardial infarction patients with single vessel disease after primary percutaneous coronary intervention H Hayrapetyan,1 SA Torozyan,1 HH Petrosyan1 and AA Tsaturyan1 1Erebouni MC, Yerevan, Armenia Purpose: the aim of this study is comparing hospital indicators and in-hospital complications between preprocedural low and high grade TIMI flow patients with ST elevation myocardial infarction (STEMI) and single vessel disease after primary percutaneous coronary intervention (PCI). Methods: the study included 114 STEMI patients undergoing primary PCI. All of these patients had single vessel coronary artery disease. 57 of these patients had preprocedural 0 grade of TIMI flow (Group 1) and 57 had ≥ 1 grade of TIMI flow (Group 2). Other parameters in the groups were comparable. Study groups were followed after primary PCI for comparing acute heart failure (Killip class > 2), pulseless ventricular tachycardia (VT) or ventricular fibrillation (VF) and cardiovascular (CV) death rates. Also was compared average length of hospital stay between two groups. The patients underwent primary PCI according to ESC Guidelines for the Management of acute myocardial infarction in patients presenting with ST-segment elevation. Results: we found no significant between-group differences for acute heart failure 5.26% (3 of 57 patients) in Group 1 vs 3,51% (2 of 57 patients) in Group 2, p=0.648; pulseless VT or VF 7% (4 of 57 patients) in Group 1 vs 3.5% (2 of 57 patients) in Group 2, p=0.4; cardiovascular death rates 6.51% (3 of 57 patients) in Group 1 vs 0 (0 of 57 patients) in Group 2, p=0.0752. Also we found no significant between – group difference for average length of hospital stay 6.1 in Group 1 vs 5.4 0.46 in Group 2 (Cl = 95%, p = 0.0829). Conclusion: preprocedural low grade TIMI flow may not influence on in-hospital acute heart failure, pulseless VT or VF and cardiovascular mortality rates in STEMI patients with single vessel disease. Also preprocedural low grade TIMI flow may not influence on average length of hospital stay. Conflict of interest: non declared P439 https://esc365.escardio.org/Presentation/217414/abstract Impact of total ischemic time on in-hospital complications in patients undergoing primary percutaneous coronary intervention with acute ST-segment elevation myocardial infarction H Hayrapetyan,1 SA Torozyan,1 HH Petrosyan1 and AA Tsaturyan1 1Erebouni MC, Yerevan, Armenia Background: early reperfusion of the infarct-related coronary artery is an important issue in improvement of outcomes after ST-segment elevation myocardial infarction (STEMI). Several studies have shown the importance of total ischemic time (TIT). Increasing of TIT lead to pour long-term outcome. The dependence of in- hospital complications on TIT studied less than long-term outcomes. Purpose: the aim of this study was to compare in-hospital complications between STEMI patients with different TIT. Methods: the study included 224 STEMI patients undergoing primary percutaneous coronary intervention (pPCI). TIT was defined as the time from the symptoms onset to reperfusion (wire crossing). 127 of these patients had ≤ 6 hour (Group 1) and 97 had > 6 hour and < 12 hour TIT (Group 2). Other parameters in the groups were comparable. Study groups were followed for comparing acute heart failure (AHF)(Killip class > 2), in-hospital pneumonia, sustained ventricular tachycardia (VT), ventricular fibrillation (VF), atrial fibrillation (AF), AV – block (> I degree), stent thrombosis rate. All patients were treated according to ESC Guidelines for the Management of acute myocardial infarction in patients presenting with ST-segment elevation. Results: mean TIT in Group 1 was 4 We found significant between-group difference for VF rate 6.3% ( 8 of 127 patients) in Group1 vs 1.03% (1 of 97) in Group 2 (p=0,0466).There were no significant between-group differences for other complications: in Group 1 and Group 2 AF 5.5% ( 7 of 127 patients) vs 7.2% (7 of 97 patients) (p=0.6), AHF (Killip class>2) 3.15% (4 of 127 patients) vs 3.09% (3 of 97 patients) (p=0.98), in-hospital pneumonia 3.94% (5 of 127 patients) vs 8.25% (8 of 97 patients) (p=0.171), sustained VT 3.15% ( 4 of 127 patients) vs 1.03 % (1 of 97 patients) (p=0.289), AV block (> I degree) 5.51% (7 of 127 patients) vs 2.06% (2 of 97 patients) (p = 0.194), stent thrombosis rates 1.55% (2 of 127 patients) vs 0 (0 of 97 patients) (p=0.215) respectively. Conclusion: STEMI patients with ≤ 6 hour TIT have higher in – hospital VF rate than STEMI patients with > 6 hour TIT. The rate of In – hospital complications, such as acute heart failure, pneumonia, AF, sustained VT, AV – block (>I degree), stent thrombosis, doesn’t differ depending on TIT in STEMI patients. Conflict of interest: non declared P440 https://esc365.escardio.org/Presentation/217224/abstract Role of echocardiography hemodynamic measurement as a predictor of in-hospital mortality in ST-elevation myocardial infarction patients AW Nugraha,1 E Ruspiono,1 T Astiawati,1 A Wibisono,1 FS Laitupa,1 SG Hayon,1 NA Suyani,1 RD Sungkono,1 MA Kusuma,1 DA Rahmi1 and YD Larasati1 1Dr. Iskak General Hospital, Tulungagung, East Java, Indonesia Background: In acute setting, Echocardiography measurement is important to evaluate functional cardiac hemodynamic status in STEMI patients. It can also be used to detect STEMI-related cardiac event earlier especially in-hospital mortality. Due to its applicability and reliability, echocardiography should be utilized to provide better patient outcome. Aim: to investigate the independent predictor of in-hospital mortality in STEMI patients based on echocardiographic hemodynamic function. Method: This retrospective study consisted of STEMI patients based on our Hospital acute coronary syndrome registry from January 2019 to June 2019. We included patient who had reperfusion therapy and admitted to intensive coronary care unit. Hemodynamic function consisted of ejection fraction (EF), cardiac output (CO), tricuspid annular plane systolic excursion (TAPSE), estimation of right atrial pressure (eRAP), systemic vascular resistance (SVR) were assessed by echocardiography examination during intensive care. We divided patient into two group based on mortality status. Baseline characteristics for each group were analyzed using bivariate analysis. Hemodynamic parameters and in-hospital mortality were assessed using multivariate analysis, logistic regression, (p<0.05) to investigate the independent predictor. Result: Out of 88 patients, 59 patients (67%) had primary PCI and 29 patients (33%) had fibrinolysis. In-hospital death occurred in 12 patients. Based on hemodynamic function, cardiac output was the only independent predictor for in-hospital mortality (p=0.037, RR 3.873, 95% CI 1.087-13.8). Mean cardiac output average for each group was 2.82 ± 0.941 and 3.65 ± 1.113, respectively. Conclusion: Cardiac output as independent predictor can be used to evaluate in-hospital mortality. So, it is recommended to use echocardiographic hemodynamic measurement for initial evaluation and monitoring patient’s outcome during hospitalization. P441 https://esc365.escardio.org/Presentation/216503/abstract Tricuspid annular plane systolic excursion (TAPSE) related to in-hospital mortality in ST-Elevation Myocardial Infarction (STEMI) patients RD Sungkono,1 T Astiawati,1 E Ruspiono,1 A Wibisono,1 FS Laitupa,1 AW Nugraha,1 SG Hayon,1 MA Kusuma,1 NA Suyani,1 DA Rahmi1 and YD Larasati1 1Dr. Iskak General Hospital, Tulungagung, East Java, Indonesia Background:ST-elevation myocardial infarction (STEMI) is one of leading cause of cardiovascular death. Right ventricular (RV) function is a strong outcome predictor in many cardiovascular diseases. The assessment of right ventricle systolic function can be done using Tricuspid Annular Plain Systolic Excursion (TAPSE) parameters. Right ventricle systolic function assessment using TAPSE is considered quite accurate, easy, affordable, and safe. Thus, it is commonly used in daily practice. Early detection of low TAPSE with echocardiography in STEMI patients may predict outcome. Aim: Our objective was to investigate TAPSE related to in-hospital mortality in STEMI patients. Method: In this retrospective cohort study, we included STEMI patients who were admitted to intensive cardiac care unit (ICCU). Within 24 hours after ICCU admission clinical and hemodynamic variables were registered including echocardiographic measurements of right ventricular function, that were assessed using tricuspid annular plane systolic excursion (TAPSE). Patients were then divided into two groups (TAPSE < 1.6 cm and ≥ 1.6 cm).Baseline characteristic for each group were analysed using bivariate analysis, independent t test used to analyse the associations between TAPSE from echocardiography measurements in STEMI patients and in-hospital mortality. Result: Out of 117 STEMI patients, there were 93 (79.5%) males and 24 (20.5%) females. Patients with TAPSE < 1.6 cm had significantly lower diastolic pressure (p = 0.032), lower cardiac output (CO) (p = 0.012), greater blood glucose levels on admission (p = 0.025) compared to patients with TAPSE ≥ 1.6 cm, and 62% had Killip class 2-4 (p <0.001, RR 2.345). Based on infarct location, patients with TAPSE < 1.6 cm located had stemi inferior (n = 34, p = 0.008) and right ventricular involvement (n = 16, p = 0.048). Related to in-hospital mortality, patients with TAPSE < 1.6 cm had higher mortality outcome (p = 0.01, RR 3.685, CI 1.246-10.896). Open in new tabDownload slide In-Hospital Mortality and TAPSE. Conclusion: RV dysfunction measured by TAPSE was related to in-hospital mortality in STEMI patients. Any decrease in TAPSE below 1.6cm is both statistically and clinically important, raising consideration for monitoring and eventual interventions. Acute Coronary Syndromes: Shock P444 https://esc365.escardio.org/Presentation/216455/abstract Mechanical complications after myocardial infarction: uncommon but still lethal. A Fernandez Valledor,1 P Cepas Guillen,1 P Vidal Cales,1 S Vazquez Calvo,1 B Carbonell Prat,1 M Izquierdo Ribas,1 E Flores Umanzor,1 O De Diego Soler,1 T Lopez Sobrino1 and R Andrea Riba2 1Hospital Clinic de Barcelona, Cardiology Department, Barcelona, Spain 2Hospital Clinic de Barcelona, Hospital Clinic and University of Barcelona, IDIBAPS, Barcelona, Spain Introduction: Historically, mechanical complications (MC) after myocardial infarction are associated with poor outcomes. The incidence of MC has decreased in the last decades due to the establishment of primary percutaneous intervention programs for STEMI. However, there is limited data from the era of more advanced interventional techniques and adjunctive therapies including entricular assist devices. Objective: To characterize the MC in the STEMI population in terms of frequency, natural history, use of mechanical assistance, type of intervention and in-hospital mortality. Methods: Retrospective, observational and single-center analysis of a cohort of patients with STEMI admitted or referred to our center because of a MC between May / 2017 and April / 2019. Results: from a total of 842 patients with STEMI, 6 (1.9%) were identified with MC, including 6 ventricular septal defects (VSD), 5 acute mitral regurgitation (MR) because of papillary muscle rupture (PMR) and 5 cardiac ruptures (CR). Mean age was 72 years, being the 81%, males. 56% were hypertensive and 12% had a previous history of ischemic heart disease. Regarding the location of infarction, 30% were anterior (anterior descending artery) and 70% inferior (right coronary 66%; circumflex 33%). Two thirds were presented as subacute infarctions, defined by more than 24 hours of pain until catheterization. Angioplasty was performed in 69% of patients, although the final flow achieved was TIMI 0-2 almost in a half (47%). Multivessel disease was present in 67%. The most frequent presentation was pulmonary edema (50%), followed by cardiogenic shock (31%). The mean time to diagnosis was 46 h. The use of mechanical assistance devices (IABP and/or ECMO) was 63%. IABP was implanted in all patients with PMR and in the half of cases of VSD. Two ECMOs were implanted in patients with VSD. An emergent intervention (<24h) was carried out in 47%, performing a percutaneous management in 2 patients (one mitral reparation with Mitraclip and one septal closure with Amplatzter). In-hospital mortality was 50%. Conclusions: Although the incidence of MC has decreased after the implementation of primary angioplasty, the mortality still remains high even with the development of more advanced interventional techniques in the management of cardiogenic shock and the possibility of a percutaneous approach. An early diagnosis of STEMI may reduce fatal events. Table 1. Prognosis of our cohort with MC. . ALL (N = 16) . Cardiac rupture (n = 5) . VSD (n = 6) . Papillary rupture (n = 5) . In-hospital mortality 8 (50) 3 (60) 2 (33) 3 (60) Mortality according to intervention: Medical treatment Surgical Percutaneous 5 (71) 2 (25) 1 (50) 2 (66) 1 (50) NA 1 (50) 0 (0) 1 (100) 2 (100) 1 (50) 0 (0) . ALL (N = 16) . Cardiac rupture (n = 5) . VSD (n = 6) . Papillary rupture (n = 5) . In-hospital mortality 8 (50) 3 (60) 2 (33) 3 (60) Mortality according to intervention: Medical treatment Surgical Percutaneous 5 (71) 2 (25) 1 (50) 2 (66) 1 (50) NA 1 (50) 0 (0) 1 (100) 2 (100) 1 (50) 0 (0) NA: do not apply; MC: mechanical complication; VSD: ventricular septal defect. Open in new tab Table 1. Prognosis of our cohort with MC. . ALL (N = 16) . Cardiac rupture (n = 5) . VSD (n = 6) . Papillary rupture (n = 5) . In-hospital mortality 8 (50) 3 (60) 2 (33) 3 (60) Mortality according to intervention: Medical treatment Surgical Percutaneous 5 (71) 2 (25) 1 (50) 2 (66) 1 (50) NA 1 (50) 0 (0) 1 (100) 2 (100) 1 (50) 0 (0) . ALL (N = 16) . Cardiac rupture (n = 5) . VSD (n = 6) . Papillary rupture (n = 5) . In-hospital mortality 8 (50) 3 (60) 2 (33) 3 (60) Mortality according to intervention: Medical treatment Surgical Percutaneous 5 (71) 2 (25) 1 (50) 2 (66) 1 (50) NA 1 (50) 0 (0) 1 (100) 2 (100) 1 (50) 0 (0) NA: do not apply; MC: mechanical complication; VSD: ventricular septal defect. Open in new tab P445 https://esc365.escardio.org/Presentation/216724/abstract Outcome after primary percutaneous coronary intervention for ST-segment elevation myocardial infarction complicated by cardiogenic shock. S Yatsu,1 M Ogita,1 H Wada,1 Y Nozaki,1 D Takahashi,1 R Nishio,1 K Yasuda,1 M Takeuchi,1 T Sonoda,1 T Shiozawa,1 S Tsuboi,1 T Dohi2 and S Suwa1 1Juntendo University Shizuoka Hospital, Izunokuni, Japan 2Juntendo University School of Medicine, Department of Cardiology, Tokyo, Japan Background: Primary percutaneous coronary intervention (PCI) for ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS) might reduce a risk of subsequent cardiovascular events, however, remains challenging. Open in new tabDownload slide Purpose: The purpose of this study was to evaluate the clinical characteristics and long-term outcome of patients undergoing primary PCI in the setting of STEMI with CS. Methods: We conducted an observational cohort study of STEMI patients underwent primary PCI between April 2004 and December 2017 at Juntendo University Shizuoka Hospital. The primary outcome was cardiovascular death during the mean follow-up period of 3yrs and we performed the landmark analysis for the incidence of the primary endpoint from 0-day to 1-year and from 1-year to 10-year. Results: Among 1758 ACS patients of the current cohort, 212 patients (12.1%) were CS on admission and had significantly higher 30-day cardiovascular mortality (26.4%) compared with those without CS. Landmark Kaplan-Meier analysis showed that mortality from 0-day to 1-year was significantly higher in patients with CS (log-rank p < 0.0001) and multivariate Cox regression analysis showed cardiogenic shock was significantly associated with higher cardiovascular mortality (adjusted HR 11.8, 95%CI 7.78-18.1, p < 0.0001), while mortality from 1-year to 10-year was comparable(log-rank p = 0.68). Conclusion: STEMI patients with CS on admission had higher 1-year cardiovascular mortality, however, long-term mortality beyond 1 year was comparable. Surviving the early phase of AMI is essential for STEMI patients with CS to improve long-term outcome. P447 https://esc365.escardio.org/Presentation/216747/abstract Vascular Complications during Mechanical Circulatory Support in patients with Ventricular Septal Rupture complicating Acute Myocardial Infarction. JD Sanchez Vega,1 JM Vieitez Florez,1 GL Alonso Salinas,1 JL Zamorano1 and M Sanmartin Fernandez1 1University Hospital Ramon y Cajal de Madrid, Madrid, Spain Background: The use of circulatory support following a post-infarction ventricular septal rupture (VSR) is becoming routine strategy. However, percutaneous access is frequently associated with vascular complications. The goal of this study was to analyse the frequency and implications of vascular complications derived from this type of treatment. Material and Methods: We collected data from a multicentre retrospective registry of post-infarction VSR in 9 acute cardiac care units managed by cardiologists. This analysis include 99 of 105 patients with data regarding vascular complications. Results: A total of 24 patients (24.2%) experienced vascular complications (thrombotic=13;haemorrhagic=11). Vascular complications were more frequently associated with mechanical circulatory support, but did not have a impact on survival (in-hospital mortality 66.7%vs61.3%, p=0.638), although was associated with prolonged ICU and hospital stay, need for surgical repair, transfusions and dialysis(Table1). Table 1. Baseline characteristics, results. Variables . Vascular complications (n=24) . No vascular complications (n=75) . P . Age (years) 67.3±9.0 73.2±10.7 0.018 Female sex 6 (25.0%) 31 (41.3%) 0.15 Diabetes mellitus 5 (20.8%) 27 (36.0%) 0.167 GFR(ml/min/1.73m2) 56.5±27.8 51.8±21.5 0.386 Previous peripheral artery disease 0 (0%) 6 (8.0%) 0.153 Circulatory Support 23 (95.8%) 48 (64.9%) 0.0003 IABP 22 (91.7%) 46 (62.2%) 0.006 ECMO* 14 (58.3%) 8 (10.7%) <0.001 Surgical repair 21 (87.5%) 45 (60%) 0.013 Death 16 (66.7%) 46 (61.3%) 0.638 Hospitalization days (between survivors)* 69.5 (44-92.5) 34 (23-50) 0.01 Intensive care unit days (between survivors)* 37 (32-65) 22 (15-40) 0.025 Need for transfusion 21 (91.3%) 32 (49.2%) <0.001 Need for dialysis 11 (45.8%) 12 (18.2%) 0.013 Variables . Vascular complications (n=24) . No vascular complications (n=75) . P . Age (years) 67.3±9.0 73.2±10.7 0.018 Female sex 6 (25.0%) 31 (41.3%) 0.15 Diabetes mellitus 5 (20.8%) 27 (36.0%) 0.167 GFR(ml/min/1.73m2) 56.5±27.8 51.8±21.5 0.386 Previous peripheral artery disease 0 (0%) 6 (8.0%) 0.153 Circulatory Support 23 (95.8%) 48 (64.9%) 0.0003 IABP 22 (91.7%) 46 (62.2%) 0.006 ECMO* 14 (58.3%) 8 (10.7%) <0.001 Surgical repair 21 (87.5%) 45 (60%) 0.013 Death 16 (66.7%) 46 (61.3%) 0.638 Hospitalization days (between survivors)* 69.5 (44-92.5) 34 (23-50) 0.01 Intensive care unit days (between survivors)* 37 (32-65) 22 (15-40) 0.025 Need for transfusion 21 (91.3%) 32 (49.2%) <0.001 Need for dialysis 11 (45.8%) 12 (18.2%) 0.013 * Non normal distribution. Open in new tab Table 1. Baseline characteristics, results. Variables . Vascular complications (n=24) . No vascular complications (n=75) . P . Age (years) 67.3±9.0 73.2±10.7 0.018 Female sex 6 (25.0%) 31 (41.3%) 0.15 Diabetes mellitus 5 (20.8%) 27 (36.0%) 0.167 GFR(ml/min/1.73m2) 56.5±27.8 51.8±21.5 0.386 Previous peripheral artery disease 0 (0%) 6 (8.0%) 0.153 Circulatory Support 23 (95.8%) 48 (64.9%) 0.0003 IABP 22 (91.7%) 46 (62.2%) 0.006 ECMO* 14 (58.3%) 8 (10.7%) <0.001 Surgical repair 21 (87.5%) 45 (60%) 0.013 Death 16 (66.7%) 46 (61.3%) 0.638 Hospitalization days (between survivors)* 69.5 (44-92.5) 34 (23-50) 0.01 Intensive care unit days (between survivors)* 37 (32-65) 22 (15-40) 0.025 Need for transfusion 21 (91.3%) 32 (49.2%) <0.001 Need for dialysis 11 (45.8%) 12 (18.2%) 0.013 Variables . Vascular complications (n=24) . No vascular complications (n=75) . P . Age (years) 67.3±9.0 73.2±10.7 0.018 Female sex 6 (25.0%) 31 (41.3%) 0.15 Diabetes mellitus 5 (20.8%) 27 (36.0%) 0.167 GFR(ml/min/1.73m2) 56.5±27.8 51.8±21.5 0.386 Previous peripheral artery disease 0 (0%) 6 (8.0%) 0.153 Circulatory Support 23 (95.8%) 48 (64.9%) 0.0003 IABP 22 (91.7%) 46 (62.2%) 0.006 ECMO* 14 (58.3%) 8 (10.7%) <0.001 Surgical repair 21 (87.5%) 45 (60%) 0.013 Death 16 (66.7%) 46 (61.3%) 0.638 Hospitalization days (between survivors)* 69.5 (44-92.5) 34 (23-50) 0.01 Intensive care unit days (between survivors)* 37 (32-65) 22 (15-40) 0.025 Need for transfusion 21 (91.3%) 32 (49.2%) <0.001 Need for dialysis 11 (45.8%) 12 (18.2%) 0.013 * Non normal distribution. Open in new tab Conclusions: Vascular complications further worsen the prognosis of post-infarction VSR, specially related to the use of mechanical support devices. Thus, a careful individual risk/benefit estimation and careful control of antithrombotic therapy is crucial for the management of these patients. P448 https://esc365.escardio.org/Presentation/216716/abstract Influence of Circulatory Support in Ventricular Septal Rupture After Acute Myocardial Infarction. Results from a Multicentre Registry of 105 patients. JD Sanchez Vega,1 JM Vieitez Florez,1 GL Alonso Salinas,1 JL Zamorano1 and M Sanmartin Fernandez1 1University Hospital Ramon y Cajal de Madrid, Madrid, Spain Background: Ventricular septal rupture (VSR) after an acute myocardial infarct (AMI) is an uncommon complication of extreme severity. The use of ventricular assist devices (VAD) as a bridge to surgical repair is an attractive strategy, that theoretically allows more time for the friable septum borders to better hold future surgical sutures. However, overall results are not clear with relatively few reports from small case series. Material and methods: A multicentre retrospective registry was done with 9 hospitals with 24/7 interventional and surgical facilities and availability of different mechanical assist devices, mainly IABP and ECMO. All consecutive post-AMI patients with VSR were included between the years 2008 and 2018, without exclusion criteria. Results Of the 103 patients included, 74 (72%) required a VAD. IABP was used in 71(68,9%), ECMO in 22(21.0%) and combined IABP/ECMO in 19(17.9%). The use of VAD was more frequent among younger men with larger defects, who were destined for surgery. Baseline clinical, anatomic and procedural characteristics are summarised in the table. There was a trend to improved survival with VAD (table 1). Table 1. Results from study. Variables . VAD (n=74) . No VAD (n=29) . P . Age (years) 68.3±9.4 78.3±10.0 <0.01 Female sex 22(29.7%) 16(55.2%) 0.02 Diabetes 21 (28.4%) 13 (44.8%) 0.11 Peripheral artery disease 3 (4%) 3 (10.4%) 0.22 Previous AMI 6 (8.1%) 2 (6.9%) 0.83 Previous stroke 2 (2.7%) 2 (3.9%) 0.32 GFR (ml/min) 52.7 ± 21.9 52.5 ± 24.9 0.96 VSR Size (cm) 1.78 ± 0.90 1.09 ± 0.65 0.02 Surgical repair 59 (79.7%) 31 (9%) <0.01 Percutaneous repair 6 (8.1%) 1 (3.4%) 0.4 Heart transplant 4 (5.4%) 1 (3.5%) 0.68 Hospitalization days* 54.8 ± 49.3 41.7 ± 54.7 0.5 Intensive care unit days* 34.5 ± 28.6 23.8 ± 6.7 0.23 Death 44 (59.5%) 22 (75.9%) 0.12 Variables . VAD (n=74) . No VAD (n=29) . P . Age (years) 68.3±9.4 78.3±10.0 <0.01 Female sex 22(29.7%) 16(55.2%) 0.02 Diabetes 21 (28.4%) 13 (44.8%) 0.11 Peripheral artery disease 3 (4%) 3 (10.4%) 0.22 Previous AMI 6 (8.1%) 2 (6.9%) 0.83 Previous stroke 2 (2.7%) 2 (3.9%) 0.32 GFR (ml/min) 52.7 ± 21.9 52.5 ± 24.9 0.96 VSR Size (cm) 1.78 ± 0.90 1.09 ± 0.65 0.02 Surgical repair 59 (79.7%) 31 (9%) <0.01 Percutaneous repair 6 (8.1%) 1 (3.4%) 0.4 Heart transplant 4 (5.4%) 1 (3.5%) 0.68 Hospitalization days* 54.8 ± 49.3 41.7 ± 54.7 0.5 Intensive care unit days* 34.5 ± 28.6 23.8 ± 6.7 0.23 Death 44 (59.5%) 22 (75.9%) 0.12 * Data correspond to survivors only. Open in new tab Table 1. Results from study. Variables . VAD (n=74) . No VAD (n=29) . P . Age (years) 68.3±9.4 78.3±10.0 <0.01 Female sex 22(29.7%) 16(55.2%) 0.02 Diabetes 21 (28.4%) 13 (44.8%) 0.11 Peripheral artery disease 3 (4%) 3 (10.4%) 0.22 Previous AMI 6 (8.1%) 2 (6.9%) 0.83 Previous stroke 2 (2.7%) 2 (3.9%) 0.32 GFR (ml/min) 52.7 ± 21.9 52.5 ± 24.9 0.96 VSR Size (cm) 1.78 ± 0.90 1.09 ± 0.65 0.02 Surgical repair 59 (79.7%) 31 (9%) <0.01 Percutaneous repair 6 (8.1%) 1 (3.4%) 0.4 Heart transplant 4 (5.4%) 1 (3.5%) 0.68 Hospitalization days* 54.8 ± 49.3 41.7 ± 54.7 0.5 Intensive care unit days* 34.5 ± 28.6 23.8 ± 6.7 0.23 Death 44 (59.5%) 22 (75.9%) 0.12 Variables . VAD (n=74) . No VAD (n=29) . P . Age (years) 68.3±9.4 78.3±10.0 <0.01 Female sex 22(29.7%) 16(55.2%) 0.02 Diabetes 21 (28.4%) 13 (44.8%) 0.11 Peripheral artery disease 3 (4%) 3 (10.4%) 0.22 Previous AMI 6 (8.1%) 2 (6.9%) 0.83 Previous stroke 2 (2.7%) 2 (3.9%) 0.32 GFR (ml/min) 52.7 ± 21.9 52.5 ± 24.9 0.96 VSR Size (cm) 1.78 ± 0.90 1.09 ± 0.65 0.02 Surgical repair 59 (79.7%) 31 (9%) <0.01 Percutaneous repair 6 (8.1%) 1 (3.4%) 0.4 Heart transplant 4 (5.4%) 1 (3.5%) 0.68 Hospitalization days* 54.8 ± 49.3 41.7 ± 54.7 0.5 Intensive care unit days* 34.5 ± 28.6 23.8 ± 6.7 0.23 Death 44 (59.5%) 22 (75.9%) 0.12 * Data correspond to survivors only. Open in new tab Conclusions: In this moderate-sized multicentre registry, there was a non-significant trend to greater survival with the use of mechanical circulatory support before planned surgical repair. P449 https://esc365.escardio.org/Presentation/216477/abstract Prognostic impact of BNP in patients presenting with STEMI and cardiogenic shock. I Almeida,1 H Miranda,1 H Santos,1 M Santos,1 J Chin,1 C Sousa,1 S Almeida1 and J Tavares1 1Hospital N.S. Rosario, Barreiro, Portugal Introduction: Brain natriuretic peptides (BNP) increase in clinical situations associated with myocardial and hemodynamic stress, namely in cardiogenic shock. Objective: Evaluation of prognostic value of BNP in the development of in-hospital cardiogenic shock in patients admitted with ST elevation myocardial infarction (STEMI). Material and methods: Retrospective analysis of patients’ data admitted with STEMI at multicentric registry between October 2010 and January 2019. Patients were divided into two groups: group 1 – patients presenting with cardiogenic shock (6.9%) and group 2 – without cardiogenic shock (93.1%). Demographic and clinical characteristics were compared. A logistic regression was performed to evaluate prognostic value of BNP in the development of in-hospital cardiogenic shock and cardiovascular events. Results: Admitted 1650 patients with STEMI. Group 1 patients were older (70±13 vs 64±13 years, p<0.001). Most patients were male in both groups (58.8 vs 76.6%, p < 0.001). A higher percentage of group 1 patients had a previous diagnosis of heart failure (7.9 vs 1.8%, p < 0.001) and chronic kidney disease (2.6 vs 11.0%, p <0.001). Mean values of BNP at admission were: 798±984 in group 1 vs 303±600 pg/ml in group 2 (p<0.001). The maximum value of creatinine was also higher in group 1: 1.9±1.2 vs 1.1±0.7 mg/dl, p <0.001. A minor percentage of group 1 patients presented in sinus rhythm (80.7 vs 92.6%, p < 0.001). All patients were submitted to coronary angiography: group 1 patients presented more frequently involvement of the left main (9.6 vs 2.1%, p < 0.001) and multivessel disease (41.1 vs 57.9%, p < 0.001). In group 1 patients mean left ventricle ejection fraction (LVEF) during hospitalization was lower: 41±13 vs 54±13 %, p<0.001. Group 1 patients needed organ support techniques in a higher rate: intra-aortic pump (7.0 vs 0.1%, p < 0.001), temporary pacemaker (21.9 vs 2.5%, p < 0.001), non-invasive ventilation (14.9 vs 1.1%, p < 0.001) and invasive ventilation (23.7 vs 2.5%, p < 0.001). Logistic regression identified as prognostic factors of in-hospital cardiogenic shock: BNP levels > 400 pg/ml (p 0.002), female gender (p 0.014), cardiac arrest (p < 0.001), systolic blood pressure < 90mmHg (p < 0.001), multivessel disease (p 0.016), left main as the culprit artery (p 0.002) and LVEF < 30% (0.002). Conclusion: In addition to clinical and coronary markers of severity, higher levels of BNP predicted the development of in-hospital cardiogenic shock and cardiovascular events in patients admitted with STEMI. Acute Coronary Syndromes: Post-Infarction Period P451 https://esc365.escardio.org/Presentation/216722/abstract Myeloperoxidase predicts recurrent coronary events in patients after acute myocardial infarction M Radosavljevic-Radovanovic,1 M Pejic,2 N Radovanovic,2 A Cvetkovic,3 P Mitrovic,1 A Novakovic,4 N Lojovic3 and E Kecman3 1Clinical center of Serbia and School of medicine University of Belgrade, Belgrade, Serbia 2Emergency center, Clinical center of Serbia, Coronary care unit, Belgrade, Serbia 3University of Belgrade, Belgrade, Serbia 4Clinical center of Serbia, Belgrade, Serbia Background: Patients with previous myocardial infarction (MI) are classified as chronic coronary artery disease patients. Still, their biological profile, as well as prognosis, may differ significantly. In spite of the well-known role of inflammation in atherothrombosis, data about inflammatory biomarkers’ value in the secondary prevention are still contradictory. Fig. Open in new tabDownload slide Purpose: To determine the long-term prognostic value of myeloperoxidase (MPO) in outpatients with previous MI, as well as it’s association with traditional risk factors, characteristics of infarction and early post-infarction course. Methods: We included 100 consecutive ambulatory patients, who have had acute MI one year ago. After the clinical, ECG and echocardiographic examination, blood samples were drawn for routine laboratory analysis and previously mentioned inflammatory biomarker. Patients with other diseases that may influence the values of inflammatory markers were excluded from the study. The follow-up lasted 2 years and we recorded all new coronary events (NCE). Results: Patients with previous MI have higher values of MPO compared to those described for healthy population. These higher values of MPO were associated with age (p=0.001) and GRACE risk score at discharge (p=0.003). Multivariate regression analysis identified MPO as independently associated with RCE (HR 2.05; 95%CI 1.02-4.11; p=0.041). ROC curve analysis identified the best prognostic cut-off value of MPO, beeing 139 pmol/L. Conclusions: In our study, MPO was independently associated with recurrent ischemic events in outpatients after AMI, at the cut-off value of 139 pmol/L. Acute Coronary Syndromes: Myocardial Infarction with Non-obstructive Coronary Arteries P452 https://esc365.escardio.org/Presentation/216446/abstract Indicators of adrenoreactivity of erythrocyte membranes in patients with myocardial infarction and nonobstructive atherosclerosis of the coronary arteries in comparison with the control group DA Vorobeva,1 TYU Rebrova,1 SA Afanasyev1 and V V Ryabov1 1Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, Russian Federation Background: Patients with myocardial infarction and non-obstructive atherosclerosis of the coronary arteries (MINOCA) represent a heterogeneous group of with not well known mechanisms of AMI. We hypothesized that MINOCA patients have distinctive features of sympatho-adrenal system (SAS) activation in comparison with patients with stenosis atherosclerosis which can play a significant role in the development of ischemic events. According to the literature, the method for assessing of adrenoreactivity of an organism is a method for assessing the β-adrenoreactivity of red blood cell membranes (β-AWP) to study the indicators of β-adrenoreception of cell membranes in patients with AMI and non-obstructive atherosclerosis compared with patients with AMI and single-vessel coronary artery disease. Material and methods: The study is non-randomized open controlled. The study is registered on ClinicalTrials.gov: NCT03572023.Inclusion criteria are listed on the site. An analysis of the organism’s beta-adrenergic reactivity by changing erythrocyte osmoresistance was carried out using a set of reagents BETA-ARM AGAT. The parameter β-AWP was studied upon admission, one the2th, on the 4th and 7th day from AMI, the normal level of β-AWP <20 rel.units. Results: The study included 40 patients with AMI (20 patients in the main and control groups), and 77.5% with STEMI. Among them the average age of patients in the main and control groups was 63.9 ± 11.9 and 60.3 ± 8.6, respectively. The risk on the GRACE scale in MINOCA patients was 8.1% (2.0; 9.0), in the control group - 4.4% (2.0; 5.0) (p> 0.05), median time of admission to the hospital - 353 min (120; 465). Upon admission an increase on cardiospecific enzymes was detected in all patients.The median β-AWP in the total sample was 43.0 (29.0; 61.6) rel. units, after 1 day - 48.6 (38.5; 57.3) rel. units, on the 4th day - 49.4 (39.0; 63.4) rel. units, 7 days - 53.6 (35.2; 67.7) rel. units (p >0.05). The average value of β-AWP in the 1st group at admission 51.9 (26.5; 61.0) rel. units, after a day - 50.4 (35.7; 56.7 ) rel.units, 4 days - 47.9 (37.0; 57.0) rel.units, 7 days - 45.2 (32.3; 69.0) rel.units, (p> 0.05 ), In the 2nd group, the average value of β-AWP at admission is 42.0 (35.0; 61.6) rel.units, in a day - 47.4 (38.5; 58.3) rel.units, 4 days - 57.0 (43.1; 69.0) rel.units, 7th day - 59.3 (41.0; 67.8), (p> 0.05). The groups did not differ statistically. Conclusions: Thus the level of β-AWP in patients with AMI with non-obstructive atherosclerosis was 2 times higher than normal values at all control points, and comparable to the level of β-AWP in with single-vessel coronary artery disease which indicated a high level of SAS activation and decreasing of in β-adrenergic receptors amount. P453 https://esc365.escardio.org/Presentation/217220/abstract MINOCA before 2017 ESC clinical practice guidelines: an opportunity for improvement T Lopez-Sobrino,1 M Izquierdo,1 P Cepas Guillen,1 M Roque,1 C Falces1 and M Sabate Tenas1 1Hospital Clinic de Barcelona, Barcelona, Spain Background: Etiology of around 25% of acute myocardial infarctions (AMI) without obstructive atherosclerotic coronary disease (MINOCA) is unknown. In this population, treatment with ASA, ACE inhibitors and statins has been associated with better prognosis. Purpose: to evaluate clinical characteristics, management and prognosis of MINOCA patients before ESC clinical guidelines were published in 2017. Methods: Observational, single-tertiary-center, retrospective study. All patients diagnosed of MINOCA for 1-year period were included. Demographic, clinical and procedural data were collected. In-hospital mortality, treatment adherence, morbidity and mortality during 21.3 months follow-up were evaluated. Results: Between 2016-2017, 1,014 patients were admitted for ACS, 120 fulfilled criteria for MINOCA. After research for alternative causes, 39 patients (57% male, mean age 66.3 years) remained without alternative diagnosis, this latter group was analyzed. 33% of patients had more than one cardiovascular risk factor, 85% presented typical chest pain. Average troponin peak was 1.795ng/mL (NV: 0.017ng/ml). Medium GRACE and CRUSADE risk scores were 120 and 29 respectively. A transthoracic echocardiogram was performed in 80% of the patients, the rest of the diagnostic tests were performed infrequently. Open in new tabDownload slide Incidence of combined end point. Table 1. Alternative diagnosis research. Diagnostic test . Number of patients studied . Ventriculogaphy 5 (13%) IVUS/OCT 0 (0%) Coronary spasm induction test 0 (0%) D dimer 4 (10%) Pulmonary angioCT scan 3 (8%) Repeated coronary angiography 1 (3%) Echocardiography 31 (80%) Cardiac MRI scan 3 (8%) Diagnostic test . Number of patients studied . Ventriculogaphy 5 (13%) IVUS/OCT 0 (0%) Coronary spasm induction test 0 (0%) D dimer 4 (10%) Pulmonary angioCT scan 3 (8%) Repeated coronary angiography 1 (3%) Echocardiography 31 (80%) Cardiac MRI scan 3 (8%) Tests performed for alternative diagnosis reserch Open in new tab Table 1. Alternative diagnosis research. Diagnostic test . Number of patients studied . Ventriculogaphy 5 (13%) IVUS/OCT 0 (0%) Coronary spasm induction test 0 (0%) D dimer 4 (10%) Pulmonary angioCT scan 3 (8%) Repeated coronary angiography 1 (3%) Echocardiography 31 (80%) Cardiac MRI scan 3 (8%) Diagnostic test . Number of patients studied . Ventriculogaphy 5 (13%) IVUS/OCT 0 (0%) Coronary spasm induction test 0 (0%) D dimer 4 (10%) Pulmonary angioCT scan 3 (8%) Repeated coronary angiography 1 (3%) Echocardiography 31 (80%) Cardiac MRI scan 3 (8%) Tests performed for alternative diagnosis reserch Open in new tab ASA was prescribed in 75%, 69% received statins, 56% ACE inhibitors and 39% beta blockers. Adherence to prescribed treatment was 76%. During follow-up, 43% of the patients presented an adverse event: namely cardiovascular mortality (5%), major bleeding (5%), stroke (3%) and readmission (38%). There were no cases of new AMI. Medical treatment was not associated with adverse clinical events. Conclusions: Patients admitted for MINOCA without alternative diagnosis prior to 2017 ESC guidelines underwent few complementary examinations. They presented high morbi-mortality. A change in diagnostic and therapeutic process is necessary for these patients. Acute Coronary Syndromes: Tako-Tsubo Cardiomyopathy P457 https://esc365.escardio.org/Presentation/216706/abstract Chronobiological profile of takotsubo syndrome P Von Hafe Leite,1 B Faria,1 G Faia,1 F Cardoso,1 D Bento,2 S Ribeiro,1 N Marques,2 O Azevedo1 and A Lourenco1 1Hospital Senhora da Oliveira - Guimaraes, Guimaraes, Portugal 2Faro Hospital, Cardiology, Faro, Portugal Background: Takotsubo syndrome (TTS) is a stress-induced reversible left ventricular (LV) systolic dysfunction. The occurrence of some cardiovascular events, such as acute myocardial infarction, is not evenly distributed within the time period of the day or the year. However, there have been few studies evaluating the chronobiology of TTS. Purpose: To investigate the chronobiological profile of TTS and its variations according to age, gender and precipitating factor. Methods: Multicenter retrospective study including 101 patients diagnosed with TTS from January 2004 to December 2017. These patients were grouped according to the time of day, day of the week, month and season, in which TTS developed. Sub-analyses were performed for gender, age and precipitating factor. Results: TTS patients were predominantly females (92%, n = 93) and had a mean age at diagnosis of 76 ± 12 years. Precipitating factor (emotional or physical stress) was present in 56 patients (55.4%). The development of TTS differed as a function of season (chi-square = 28.23, p < 0001), with the peak in summer (n = 46, 45,5%) and the nadir in winter (n = 9, 8.9%). Events were most frequent in August and June (n = 16, 15.8% chi-square = 35.99, p < 0.001). TTS was most frequent in the morning (n = 22, 34.4%) and least so at night (n = 6, 9.4%, chi-square = 10.13, p = 0.018). TTS was more common on Wednesday (n = 21, 20.8%) and least so on Friday (n= 6, 5.9%, chi-square = 13.15, P = 0.041). In men, there were no differences in temporal distribution. Women had more events in summer (n = 43, 46.2%), in June (n = 16, 17.2%), on Wednesday (n = 20, 21.5%) (chi square 25.59, p < 0,001; chi square 37.19, p < 0.001; chi square 15.61, p = 0.016, respectively), but no statistically significant difference in circadian rhythm. In older patients (≥ 75 years), had more events in summer (n = 26, 46.4%, chi square 15.43, p = 0.001) and morning (n = 14, 25%, chi square 10.37, p = 0.016). In younger patients, only season had a statistically significant difference, with more frequency of TTS in summer (n = 22, chi square 15.41, p = 0.001). Patients without an identifiable stress precipitating factor, presented the same TTS chronobiological profile as the total sample. Patients with stress precipitating factor also had the same TTS profile, except for a higher frequency of TTS on Thursday and at evening (n = 16, 28.6%, chi square 15.50, p = 0.017 and n = 15, 28.8%, chi square 8.31, p = 0.040). Conclusion: TTS chronobiological profile is characterized by preferred peaks in the morning, on Wednesday and summer. Age, gender and stress factor do not influence these temporal patterns except in patients with precipitating factor that demonstrate a higher frequency of events on Thursday and at evening. Further studies are needed to investigate the potential link between the chronobiological profile of TTS and its underlying pathophysiologic mechanisms. Acute Coronary Syndromes: Tako-Tsubo Cardiomyopathy P458 https://esc365.escardio.org/Presentation/221615/abstract New hypotheses in stress cardiomyopathy JCEM Echarte Morales,1 PMS Menendez,1 JBR Borrego-Rodriguez,1 ETS Tundidor-Sanz,1 LGB Garcia Bueno,1 LAR Alvarez Roy,1 SCG Del Castillo,1 CMC Minguito,1 CGF Galan,1 AMC Martin,1 JMS Maillo,1 MRS Rodriguez1 and FFV Fernandez-Vazquez1 1Hospital of Leon, Leon, Spain Background: Stress cardiomyopathy defines a pathology consisting of a dysfunction transient and acute left ventricular, commonly of the apical segments, presenting as an acute coronary syndrome with normal coronaries. His pathophysiology continues to be unknown. Purpose: The aim of this study is to analyze the characteristics of the patients, clinical presentation and prognosis, raising a possible immuno-allergic contribution as the basis of said entity. Methods: We included all patients presenting with stress cardiomyopathy in a tertiary center during a period of 4 years. There were no exclusion criteria. We collected demographic, clinical, procedural data and ventricular recovery at follow-up. Results: 42 patients, 30 women (72.4%) and 12 men (27.6%) were analyzed. Middle age It was 72.3 years. Baseline characteristics: hypertensive (55.2%), dyslipidemic (41%) and diabetics (17.2%). The 24.1% (n = 10) of patients had a history of extrinsic bronchial asthma and the 35.7% (n = 15) allergic. More than half of the patients (n = 24, 51.7%) had at least one of them. Symptom of onset: chest pain (93.1%) and dyspnea (6.9%). Arrhythmic events: no arrhythmia (82.8%), atrial fibrillation (13.8%) and a single ventricular tachycardia patient. Killip classification at admission: 75.9% presented as Killip I, 20.7% Killip II and a single patient with shock cardiogenic 97% were apical dyskinesias and 3% of the patients inverse Tako-Tsubo (at analyze the subgroup with allergy or bronchial asthma, all of them presented apical dyskinesia, and in no reverse case). The mean left ventricular ejection fraction was 39% and at follow-up all patients recovered function. Conclusions: Stress cardiomyopathy is an entity with a good prognosis, with high proportion of patients with extrinsic asthma or a history of allergy, which could indicate a possible immunoallergic physiopathology. P460 https://esc365.escardio.org/Presentation/216710/abstract Evaluation of patients with initial suspicion of tako-tsubo cardiomyopathy: a seven-year prospective study J Martinez Del Rio,1 J Piqueras Flores,1 D Salas Bravo,1 A Moreno Reig,1 M Rayo Gutierrez,1 M Negreira Caamano,1 P Perez Diaz,1 MA Montero Gaspar,1 JM Arizon Munoz,1 R Maseda Uriza,1 R Frias Garcia,1 A Moron Alguacil,1 M Munoz Garcia,1 D Aguila Gordo1 and C Mateo Gomez1 1Hospital General de Ciudad Real, Cardiology, Ciudad Real, Spain Introduction: Tako-tsubo cardiomyopathy (TC) is a clinical entity characterized by transient regional systolic ventricular dysfunction without significant obstructive coronary artery disease. Because of the clinical presentation, and its association with elevation of cardiac biomarkers and electrocardiogram abnormalities, differential diagnosis with acute myocardial infarction must be done, even more if we attend to their different treatments and prognosis. Purpose: The main objective was to analyze the characteristics of the patients with initial suspicion of TC and to analyze the differences between definitive diagnosis of TC according to Clinic Mayo criteria with the rest of patients who finally had another diagnosis. Methods: We prospectively included 81 consecutive patients (69.6 ± 11.4 years, 87.7% female) with initial suspicion of Takotsubo cardiomyopathy in a third-level reference hospital between May 2012 and July 2019. We evaluated the clinical characteristics, the presentation in the electro and echocardiogram, the coronary angiography and the hospital management. We performed clinical follow-up with a median of 27 months. Results: The 72.8% of patients had high blood pressure, 42.0% dyslipidemia and 16,0% diabetes mellitus. It is remarkable that 51.9% had a preceding stressful event (emotional or physical triggers), and 44.4% had personal history of mixed anxiety-depression disorder (MADD). The ECG sign most frequently was T-wave inversion (86.3%) and the mean of Troponin-I peak was 6.2±9.8 ng/ml. The mean of initial left ventricular ejection fraction was 40.4 ± 12.3%. According to cardiac magnetic resonance findings and Mayo Clinic criteria, the 76.5% of patients were diagnosed of TC. Between patients with TC definitive and the rest, TC patients were older (71.5±9.8 vs 63.6 ±14.0 years, p = 0.02) and had personal history of MADD more frequently (54.8 vs 10.5%, p=0.001) Furthemore, TC patients showed less Troponin-I peak (3.8±4.5 vs 13.7±16.7 ng/mL, p=0.005), less cardiac output (4.1±1.1 vs 5.5±1.6 L/min, p=0.03)measured with cardiac magnetic resonance (CMR) and higher InterTAK diagnostic score values (54.3±19.7 vs 40.8±18.0 points, p=0.02). At discharge, in the TC group the mortality was 1.6%, compared with 5.3% in non-TC group, although not statistically significant difference between groups was found (p=0.19). At follow up, in the TC group there were five recurrence cases, while in non-TC group there were not recurrence (p=0.33). Conclusions: In this study, patients with definitive TC diagnosis showed similar clinical characteristics similar to those described in other studies. In comparison with non-TC group, patients with TC definitive were older, showed lower peak of troponin and less cardiac output measured with CMR. However, no statistically significant differences in rates of mortality were observed between groups. P462 https://esc365.escardio.org/Presentation/216493/abstract Takotsubo syndrome:How to predict left ventricular dysfunction? TE Graca Rodrigues,1 N Cunha,1 SC Pereira,1 P Antonio,1 P Morais,1 R Santos,1 A Nunes-Ferreira,1 J Rigueira,1 I Aguiar-Ricardo,1 J Agostinho,1 P Carrilho-Ferreira1 and FJ Pinto1 1Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal Introduction: Takotsubo syndrome (TS) is a cardiomyopathy that clinically mimics an acute coronary syndrome and is often associated with physical or emotional stress. Although it is an usually benign condition, it may be associated with significant ventricular dysfunction, so it is important to identify patients at higher risk. Objective: To assess epidemiological and clinical characteristics of a population with TS and evaluation of variables associated with left ventricular dysfunction. Methods: Retrospective, unicentric cohort study that included consecutive patients with TS diagnosis between January 2015 to December 2018. Demographic, clinical, electrocardiographic, echocardiographic, and laboratory data were collected. For statistical analysis, the chi-square test and the student T-test were used. Results: A total of 54 patients (87% female, 67.4 ± 12 years) were included in the study with a mean InterTAK score of 58.5 ± 17 (68.6% with a score > 50; 18, 5% between 30-50 and 1.9% <30 points). The most frequent comorbidities were HTN 74.1%, diabetes 25.9%, dyslipidemia 46.3% and depressive syndrome 26.4%. The majority of women (87.8%) were in the postmenopausal period. Emotional stress was identified as a trigger factor in 57.4% of cases and physical stress in 38.9%. The mean hospitalization time was 9.5 ± 5.8 days. Of the electrocardiographic characteristics at admission, ST elevation was found in 50% of patients, ST deflection in 18.5% and inversion of T wave in 37%, mean QTc of 421 ± 38 msec. Echocardiographic evaluation showed a mean left ventricular ejection fraction (LVEF) at admission of 47.8 ± 10%, with 17 patients having LVEF < 40% (31.5%). The TS when preceded by physical stress was associated with a lower LVEF on admission (43.4 ± 9.8 vs 50.7 ± 9.4, p = 0.008). There was a tendency for the postmenopausal period being protective of the development of ventricular dysfunction (X2 = 4.2, p = 0.041, OR = 0.16 CI 0.03-1.07), with no relation to anymore comorbidity. No ECG pattern was associated with ventricular dysfunction. Conclusions: In this population, the presence of physical stress was more frequently associated with a compromised ventricular function, and the postmenopausal period appeared to be protective. The identification of ventricular dysfunction preditors may allow the identification of patients at higher risk and who benefit more rigorous monitoring. Acute Cardiac Care – Cardiogenic Shock P464 https://esc365.escardio.org/Presentation/216443/abstract Impact of Levosimendan use on the success of weaning and survival of patients with veno-arterial extracorporeal membrane oxygenator. M Alonso Fernandez De Gatta,1 S Merchan Gomez,1 M Gonzalez Cebrian,1 A Diego Nieto,1 E Alzola,1 A Barrio Rodriguez,1 I Toranzo Nieto,1 M Martin Herrero,1 M Lopez Serna,1 L Rodriguez Estevez1 and PL Sanchez Fernandez1 1Complejo Asistencial Universitario de Salamanca, Salamanca, Spain Introduction: Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) provides effective cardiopulmonary support. However, weaning failure and mortality is significant. Small retrospective studies suggest the possible utility of levosimendan in this environment, especially in post-cardiodiotomy shock. Purpose Our objective was to assess the usefulness of levosimendan in the weaning of ECMO-VA and its impact on survival. Methods: Retrospective analysis of all ECMO-VA implants in referral hospital. Patients (p) who received levosimendan (clinical criteria, dose 0.1 mcg/kg/min) were compared versus those who did not, regarding weaning failure (death in ECMO, during first 48h after withdrawal or due to cardiogenic shock during the admission) and survival. Results: From 2013 to 2019, 91 ECMO-VA were implanted (table), 87.9% bridge to recovery, 6.6% to transplant and 3.3% to ventricular assist device. Levosimendan was administered in 17 p (18.7%), well tolerated in all cases, without side effects. It was used more frequently in p with cardiogenic shock and high-risk percutaneous intervention indication, and in those with lower LVEF at the implant, without differences in other characteristics (table). No differences were found in the success of ECMO weaning despite worse LVEF in Levosimendan group. Survival at follow-up (23 [66] months) was higher in the group that received Levosimendan, although without finding statistically significant differences (47.1% vs. 32.4%, log rank p=0.176) (figure). Table 1. Characteristics, complications, survival. . All (n=91) . Levosimendan . P value . . All (n=91) . Levosimendan . P value . Yes (n=17) . No (n=74) . Yes (n=17) . No (n=74) . Age (years) (mean+ SD)  Male (n, %) 60,3±9.9 68 (74,7%) 60.6 (±8) 13 (76,5%) 61.4 (±10) 55 (74,3%) 0,72 0,56 Percuaneous implant (n,%) Intraaortic balloon pump 63 (69,2%) 44 (48,4%) 14 (82,4%) 11 (64,7%) 49 (66,2%) 33 (44,6%) 0,41 0,28 Indication (n,%)   Cardiogenic shock   Refractory cardiac arrest  Electrical storm  High-risk PCI   Postcardiotomy shock  Others 0,048 Noradrenaline  Dobutamine  Adrenaline 78 (85,7%) 77 (84,6%) 33 (36,3%) 14 (82,3%) 16 (94,1%) 7 (41,2%) 64 (86,4%) 61 (82,4%) 26 (35,1%) 0,37 0,29 0,5 41 (45,1%) 12 (13,2%) 7 (7,7%) 10 (24,4%) 1 (8,3%) 0 (0%) 31 (41,9%) 11 (91,7%) 7 (100%) 7 (7,7%) 22 (24,2%) 2 (2,2%) 4 (57,1%) 2 (10%) 0 (0%) 3 (42,9%) 18 (20%) 2 (100%) Time ECMO support (days) 4.9±3.9 6.3±4.3 4.5±3.8 0.068 Complications (n,%)   Vascular (bleeding, ischemia)  Bleeding   Critical care infections 19 (20,9%) 42 (46,2%) 42 (46,2%) 4 (23,5%) 11 (64,7%) 11 (64,7%) 15 (20,3%) 31 (41,9%) 31 (41,9%) 0,52 0,16 0,16 pH (mean+SD)   lactate (mmol/L) (mean+SD) 7.25±0,19 6.94±4,6 7.25±0,19 5.55±4,5 7.25±0,19 7.27±4,6 0.85 0.18 LVEF (%) (mean+SD)   RV dysfunction (n,%) 30.04±17 45 (49.5%) 18,6±7.8 9 (52,9%) 32.74±18 36 (48,6%) <0,001 0,79 Ischemic/hemorragic stroke   Renal replacement therapy  Tracheostomy 5 (5,5%) 20 (22%) 16 (17,6%) 1 (5,9%) 3 (17,6%) 5 (29,4%) 4 (5,4%) 17 (22,9%) 11 (14,9%) 0,34 0,45 0,16 Preimplant cardiac arrest (n,%)   Cardiac arrest duration (min) (n,%) 49 (53.8%) 30.8±24.2 8 (47%) 22.4±22 41 (55,4%) 32.6±24.5 0,50 0.27 Successful weaning (n,%) 39 (42,9%) 10 (58,8%) 29 (39,2%) 0,29 . All (n=91) . Levosimendan . P value . . All (n=91) . Levosimendan . P value . Yes (n=17) . No (n=74) . Yes (n=17) . No (n=74) . Age (years) (mean+ SD)  Male (n, %) 60,3±9.9 68 (74,7%) 60.6 (±8) 13 (76,5%) 61.4 (±10) 55 (74,3%) 0,72 0,56 Percuaneous implant (n,%) Intraaortic balloon pump 63 (69,2%) 44 (48,4%) 14 (82,4%) 11 (64,7%) 49 (66,2%) 33 (44,6%) 0,41 0,28 Indication (n,%)   Cardiogenic shock   Refractory cardiac arrest  Electrical storm  High-risk PCI   Postcardiotomy shock  Others 0,048 Noradrenaline  Dobutamine  Adrenaline 78 (85,7%) 77 (84,6%) 33 (36,3%) 14 (82,3%) 16 (94,1%) 7 (41,2%) 64 (86,4%) 61 (82,4%) 26 (35,1%) 0,37 0,29 0,5 41 (45,1%) 12 (13,2%) 7 (7,7%) 10 (24,4%) 1 (8,3%) 0 (0%) 31 (41,9%) 11 (91,7%) 7 (100%) 7 (7,7%) 22 (24,2%) 2 (2,2%) 4 (57,1%) 2 (10%) 0 (0%) 3 (42,9%) 18 (20%) 2 (100%) Time ECMO support (days) 4.9±3.9 6.3±4.3 4.5±3.8 0.068 Complications (n,%)   Vascular (bleeding, ischemia)  Bleeding   Critical care infections 19 (20,9%) 42 (46,2%) 42 (46,2%) 4 (23,5%) 11 (64,7%) 11 (64,7%) 15 (20,3%) 31 (41,9%) 31 (41,9%) 0,52 0,16 0,16 pH (mean+SD)   lactate (mmol/L) (mean+SD) 7.25±0,19 6.94±4,6 7.25±0,19 5.55±4,5 7.25±0,19 7.27±4,6 0.85 0.18 LVEF (%) (mean+SD)   RV dysfunction (n,%) 30.04±17 45 (49.5%) 18,6±7.8 9 (52,9%) 32.74±18 36 (48,6%) <0,001 0,79 Ischemic/hemorragic stroke   Renal replacement therapy  Tracheostomy 5 (5,5%) 20 (22%) 16 (17,6%) 1 (5,9%) 3 (17,6%) 5 (29,4%) 4 (5,4%) 17 (22,9%) 11 (14,9%) 0,34 0,45 0,16 Preimplant cardiac arrest (n,%)   Cardiac arrest duration (min) (n,%) 49 (53.8%) 30.8±24.2 8 (47%) 22.4±22 41 (55,4%) 32.6±24.5 0,50 0.27 Successful weaning (n,%) 39 (42,9%) 10 (58,8%) 29 (39,2%) 0,29 Open in new tab Table 1. Characteristics, complications, survival. . All (n=91) . Levosimendan . P value . . All (n=91) . Levosimendan . P value . Yes (n=17) . No (n=74) . Yes (n=17) . No (n=74) . Age (years) (mean+ SD)  Male (n, %) 60,3±9.9 68 (74,7%) 60.6 (±8) 13 (76,5%) 61.4 (±10) 55 (74,3%) 0,72 0,56 Percuaneous implant (n,%) Intraaortic balloon pump 63 (69,2%) 44 (48,4%) 14 (82,4%) 11 (64,7%) 49 (66,2%) 33 (44,6%) 0,41 0,28 Indication (n,%)   Cardiogenic shock   Refractory cardiac arrest  Electrical storm  High-risk PCI   Postcardiotomy shock  Others 0,048 Noradrenaline  Dobutamine  Adrenaline 78 (85,7%) 77 (84,6%) 33 (36,3%) 14 (82,3%) 16 (94,1%) 7 (41,2%) 64 (86,4%) 61 (82,4%) 26 (35,1%) 0,37 0,29 0,5 41 (45,1%) 12 (13,2%) 7 (7,7%) 10 (24,4%) 1 (8,3%) 0 (0%) 31 (41,9%) 11 (91,7%) 7 (100%) 7 (7,7%) 22 (24,2%) 2 (2,2%) 4 (57,1%) 2 (10%) 0 (0%) 3 (42,9%) 18 (20%) 2 (100%) Time ECMO support (days) 4.9±3.9 6.3±4.3 4.5±3.8 0.068 Complications (n,%)   Vascular (bleeding, ischemia)  Bleeding   Critical care infections 19 (20,9%) 42 (46,2%) 42 (46,2%) 4 (23,5%) 11 (64,7%) 11 (64,7%) 15 (20,3%) 31 (41,9%) 31 (41,9%) 0,52 0,16 0,16 pH (mean+SD)   lactate (mmol/L) (mean+SD) 7.25±0,19 6.94±4,6 7.25±0,19 5.55±4,5 7.25±0,19 7.27±4,6 0.85 0.18 LVEF (%) (mean+SD)   RV dysfunction (n,%) 30.04±17 45 (49.5%) 18,6±7.8 9 (52,9%) 32.74±18 36 (48,6%) <0,001 0,79 Ischemic/hemorragic stroke   Renal replacement therapy  Tracheostomy 5 (5,5%) 20 (22%) 16 (17,6%) 1 (5,9%) 3 (17,6%) 5 (29,4%) 4 (5,4%) 17 (22,9%) 11 (14,9%) 0,34 0,45 0,16 Preimplant cardiac arrest (n,%)   Cardiac arrest duration (min) (n,%) 49 (53.8%) 30.8±24.2 8 (47%) 22.4±22 41 (55,4%) 32.6±24.5 0,50 0.27 Successful weaning (n,%) 39 (42,9%) 10 (58,8%) 29 (39,2%) 0,29 . All (n=91) . Levosimendan . P value . . All (n=91) . Levosimendan . P value . Yes (n=17) . No (n=74) . Yes (n=17) . No (n=74) . Age (years) (mean+ SD)  Male (n, %) 60,3±9.9 68 (74,7%) 60.6 (±8) 13 (76,5%) 61.4 (±10) 55 (74,3%) 0,72 0,56 Percuaneous implant (n,%) Intraaortic balloon pump 63 (69,2%) 44 (48,4%) 14 (82,4%) 11 (64,7%) 49 (66,2%) 33 (44,6%) 0,41 0,28 Indication (n,%)   Cardiogenic shock   Refractory cardiac arrest  Electrical storm  High-risk PCI   Postcardiotomy shock  Others 0,048 Noradrenaline  Dobutamine  Adrenaline 78 (85,7%) 77 (84,6%) 33 (36,3%) 14 (82,3%) 16 (94,1%) 7 (41,2%) 64 (86,4%) 61 (82,4%) 26 (35,1%) 0,37 0,29 0,5 41 (45,1%) 12 (13,2%) 7 (7,7%) 10 (24,4%) 1 (8,3%) 0 (0%) 31 (41,9%) 11 (91,7%) 7 (100%) 7 (7,7%) 22 (24,2%) 2 (2,2%) 4 (57,1%) 2 (10%) 0 (0%) 3 (42,9%) 18 (20%) 2 (100%) Time ECMO support (days) 4.9±3.9 6.3±4.3 4.5±3.8 0.068 Complications (n,%)   Vascular (bleeding, ischemia)  Bleeding   Critical care infections 19 (20,9%) 42 (46,2%) 42 (46,2%) 4 (23,5%) 11 (64,7%) 11 (64,7%) 15 (20,3%) 31 (41,9%) 31 (41,9%) 0,52 0,16 0,16 pH (mean+SD)   lactate (mmol/L) (mean+SD) 7.25±0,19 6.94±4,6 7.25±0,19 5.55±4,5 7.25±0,19 7.27±4,6 0.85 0.18 LVEF (%) (mean+SD)   RV dysfunction (n,%) 30.04±17 45 (49.5%) 18,6±7.8 9 (52,9%) 32.74±18 36 (48,6%) <0,001 0,79 Ischemic/hemorragic stroke   Renal replacement therapy  Tracheostomy 5 (5,5%) 20 (22%) 16 (17,6%) 1 (5,9%) 3 (17,6%) 5 (29,4%) 4 (5,4%) 17 (22,9%) 11 (14,9%) 0,34 0,45 0,16 Preimplant cardiac arrest (n,%)   Cardiac arrest duration (min) (n,%) 49 (53.8%) 30.8±24.2 8 (47%) 22.4±22 41 (55,4%) 32.6±24.5 0,50 0.27 Successful weaning (n,%) 39 (42,9%) 10 (58,8%) 29 (39,2%) 0,29 Open in new tab Open in new tabDownload slide Kaplan-Meier survival analysis. Conclusion: Levosimendan can be safely administered during ECMO support. In our experience, its administration allowed the weaning of circulatory support in patients with worse LVEF. Its use did not influence in short and medium term survival. Randomized studies are needed to evaluate the usefulness of Levosimendan in this indication. P466 https://esc365.escardio.org/Presentation/221527/abstract Predictors of recovery and results in patients assisted with extracorporeal membrane oxygenation Veno-Arterial implanted as a bridge to recovery JE Lujan Valencia,1 V Burgos Palacios,1 M Ruiz Lera,1 N Royuela Martinez,1 B De Tapia Majado,1 J Sanchez Cena,1 S Catoya Villa,1 T Borderias Villaroel,1 S Gonzalez Lizarbe,1 I Cabrera Rubio,1 M Lozano Gonzalez,1 JA Sarralde Aguayo,1 A Canteli Alvarez1 and C Castrillo Bustamante1 1University Hospital Marques De Valdecilla, Santander, Spain Introduction: ECMO-VA is one of the main devices used as a bridge to recovery in patients with cardiogenic shock. However, identifying those who could achieve recovery of the myocardial function has been poorly evaluated. The objective is to analyze possible factors that could identify these patients before the implantation of the ECMO-VA. Methods: A retrospective study, analyzing our base of circulatory assist devices between 2009 and 2019, performing a descriptive analysis of the results and a multivariable analysis of the possible factors related to recovery. Results: Of all 145 patients with ECMO-VA, 108 cases were selected. In all of them the initial objective was the bridge to recovery, with a mean of 57.65 (± 13.40 SD) years of age and where 75 (69,4%) cases were male. The most frequent etiologies of cardiogenic shock were postcardiotomy shock 48 (44.4%), primary graft failure 21 (19.4%) and post acute myocardial infarction 15 (13.8%). The average duration of support was 5.92 (± 4.26 SD) days. The recovery of myocardial function was defined as an improvement of the initial LVEF up to 30%, in addition to the withdrawal of inotropic support and a favorable response to our ECMO-VA weaning protocol. We found recovery with the subsequent withdrawal of the device in 71 (65.7%) patients. In addition, a multivariable analysis was performed finding as possible predictors of recovery at the time of implantation of the ECMO-VA, a LVEF greater than 20% (OR 0.10; 95% CI 0.01-0.70; p <0.05) and a lactate levels less than 100 mg/dl (OR 21.84; 95% CI 3.80-125.56; p <0.05). Of the 71 patients who achieved recovery 20 (28%) died during a follow-up of 11.75 (2.87 ± SD) months. The final survival rate was 51 patients, 71.8% of the total number of patients who achieved recovery. Conclusions: In our series we found as possible predictors of recovery prior to implantation of the ECMO-VA having a LVEF greater than 20% and a lactate level <100 mg / dl. These factors could be taken into account when evaluating the implant of the devices with an initial goal of bridging to recovery. P467 https://esc365.escardio.org/Presentation/221519/abstract Evaluation of the weaning protocol of the venoarterial extracorporeal oxygenation membrane: Results in a tertiary center after 10 years of experience J Lujan Valencia,1 C Castrillo Bustamante,1 A Canteli Alvarez,1 M Lozano Gonzalez,1 I Cabrera Rubio,1 S Gonzalez Lizarbe,1 T Borderias Villaroel,1 D Serrano Lozano,1 B De Tapia Majado,1 J Sanchez Cena,1 I Olavarri Miguel,1 JA Sarralde Aguayo,1 M Ruiz Lera1 and V Burgos Palacios1 1University Hospital Marques De Valdecilla, Santander, Spain Introduction: Recovery is the goal of most patients who receive an ECMO-VA in cardiogenic shock. Once achieved recovery, the process of evaluation and withdrawal of support is a challenge and no protocol has demonstrated its superiority over others. Our objective is to evaluate our weaning protocol, describe the complications and the final results. Methods: Retrospective and descriptive study of our short weaning protocol of ECMO-VA on those patients who achieved recovery. Results: Since 2009, 145 ECMO-VA have been implanted, of which 108 (74.5%) were implanted as a bridge to recovery, this objective was achieved in 72 (49.7%) patients, with an average of 55.93 (± 12.54 SD) years of age and 53 (73.6%) cases were male. The most frequent etiologies were postcardiotomy shock 40.3%, primary graft failure 25% and post-acute myocardial infarction 13.9%. In our center, once sufficient support has been reached to reverse the organic failure, which allows the reduction of vasoactive drugs, daily weaning tests are carried out, consisting of a gradual reduction of the flow in the ECMO over 30 minutes, with the monitoring of hemodynamic and echocardiographic parameters. After 2 consecutive tests separated by 24 hours in which the LVEF reaches at least 30% and adequate hemodynamic and respiratory tolerance is maintained, the ECMO is withdrawn. In our series a successful weaning was achieved in 98.6% of cases, after an average support of 6.57 (± 3.59 SD) days. Weaning failure was defined as the presence of low cardiac output in the first 48 hours since the device was removed. This criteria was fulfilled only in one case (1.4%) or in 2 (2.8%) if we extend the criteria to 30 days. Furthermore, during weaning trials no complications have been described. Despite a successful weaning, mortality after ECMO-VA withdrawal was present in 20 (27.8%) patients. The main causes of mortality were infections 4 (5.6%) cases and neurological complications 4 (5.6%) cases. Finally, survival in patients who achieved weaning was 52 (72.2%) after a follow-up of 11.75 (2.87 ± SD) months. Conclusions: Based on the results presented, our weaning protocol seems to be a safe strategy with a high success rate when evaluating the withdrawal of ECMO-VA due to recovery P469 https://esc365.escardio.org/Presentation/217587/abstract Cardiogenic shock and coagulation profilenone H Santos,1 T Vieira,2 J Fernandes,2 AR Ferreira,2 M Rios2 and T Honrado2 1Hospital N.S. Rosario, Cardiology, Barreiro, Portugal 2Sao Joao Hospital, Intensive Care, Porto, Portugal Background: Cardiogenic shock (CS) remains the major cause of mortality in acute coronary syndrome. Some studies suggest that patients in shock have higher levels of nitric oxide, a known platelet aggregation inhibitor, that can influence the coagulation profile (CP) in CS. Objective: Evaluate and compare the hemostatic response between CS and ST-segment elevation myocardial infarction (STEMI) without CS, as well as between STEMI and non-ST segment elevation myocardial infarction (NSTEMI) presentation in CS patients. Methods: Single-centre retrospective study from a terciary hospital, engaging patients hospitalized for CS and STEMI between 1/01/2014-30/10/2018. All patients’ epidemiological and clinical data were extracted at the admission. From 214 patients admitted for CS, just 103 are included for had CP performed and none of them was on anticoagulation therapy. Chi-square test, T-student and Mann-Whitney U tests were used to compare categorical and continuous variables. Multiple linear regression analysis was performed to evaluate CP at admission, namely, platelet count (Pc), prothrombin time (PT), activated partial thromboplastin time (aPTT) and fibrinogen (Fi), was a predictor of mortality. Results: CS patients have a mean age of 62.63±12.74 and 76.7% are male. CS had higher prevalence of cardiovascular risk factors, except for smokers (44.7% vs 58.1% in STEMI, p=0.131), higher daily cardiovascular medications, and presented at admission more cardiac arrest (77.7% vs 51.6%, p=0.005) and mortality rates (49.5% vs 9.7%, p≤0.001) regarding non-CS STEMI (34 patients). CS presented higher values of Pc (230±80 vs 221±84, p=0.677), aPTT (28.10±5.90 vs 27.4±4.90, p=0.287) and TP (13.35±1.80 vs 12.50±1.50, p=0.850), and lower values of Fi (300±94 vs 309±65, p=0.850), but these findings are not significant. CP did not prove to be a predictor of mortality on CS, p=0.347. Among CS patients, NSTEMI had more prevalence of arterial hypertension (70.6% vs 47.8%, p=0.037) and dyslipidemia (64.7% vs 42.0% p=0.038). CP (Pc 213±93 vs 227±83, p=0.290; aPTT 30.95±8.80 vs 28.20±5.80, p=0.241; TP 14.05±2.60 vs 13.20±1.80, p=0.078; and Fi values 307±115 vs 300±89, p=0,844) had no significant differences between NSTEMI and STEMI, respectively, in CS patients and were not associated with mortality rates (p=0.687). Conclusions: CS patients had the same hemostatic response compared to STEMI patients and our study suggests that CP at admission is not a mortality predictor in CS. Between CS patients, its presentations as STEMI or NSTEMI did not reveal differences regarding the CP, and CP is not a mortality predictor. P471 https://esc365.escardio.org/Presentation/217583/abstract Anticoagulation in patients with VA-ECMO, is it safe to defer it? S Garcia Gomez,1 A Durante-Lopez,1 FJ Hernandez Perez,1 J Vazquez Lopez-Ibor,1 J Goirigolzarri Artaza,2 JM Escudier Villa,1 J Ortega Marcos,1 M Gomez Bueno,1 L Silva Melchor,1 A Gonzalez Roman,1 A Forteza Gil,1 D Garcia Rodriguez,1 P Remior Perez1 and J Segovia Cubero1 1University Hospital Puerta de Hierro Majadahonda, Madrid, Spain 2Hospital Clinico San Carlos, Madrid, Spain Introduction and purpose: Circulatory support with venoarterial extracorporeal membrane oxygenation (VA-ECMO) during cardiogenic shock (CS) requires systemic anticoagulation to avoid thrombotic events. However, there is no evidence about the best moment of onset. The objective of the present study was to analyse the incidence of thromboembolic and haemorrhagic complications according to anticoagulation onset. Methods: Retrospective observational study was performed. Consecutive 69 refractory CS patients with VA-ECMO support were analysed from 2014 to 2018. Population was divided into two groups based on the time of anticoagulation onset: before or after the first 48 hours (≤48h vs >48h). The primary aim was to analyse the incidence of systemic embolisms during the follow-up. The secondary aim was to know the incidence of major bleeding events (defined as cerebral bleeding or massive haemorrhage). Results: Our cohort were mostly male (69%) with a mean age of 52.5 (48.8-56.2) years old at diagnosis. 54% of them were in central cannulation group. Approximately 54% of patients had some cardiopathy known before admission to our centre and INTERMACS scale was 1 in the vast majority of them. Pre-surgery mean left ventricle ejection fraction was 50 (44.7-55.4) %. In different mortality predictors, mean values of our patients were: 44.6 (41.3-47.8) in SAPS II, 20 (18.4-21.6) in APACHE and 10.95 (10.4-11.6) in SOFA. 61 patients (88,4%) had enough information recorded about the timing of anticoagulation. Anticoagulation was started before the first 48 hours in 50 patients (82%) and after that in the remaining 11 patients (18%). After a follow up of 135.9 days (75.4-196.3), the incidence of thromboembolic events was similar between both groups (≤48h 18% vs >48h 22%, p=0.78). There were also no differences about the rate of major bleeding events (≤48h n=21, 42% vs >48h n=5, 45,5%, p=0.834). We found similar results analysing different subgroups based on the type of cannulation technique performed (central vs peripheral). Global in-hospital mortality was 60% (41 of 69 patients) and it was similar between the two subgroups studied. Conclusions: In our cohort, deferring the onset of anticoagulation beyond 48 hours was not associated with an increase in thromboembolic events. These results would support to delay onset of anticoagulation after 48 hours in patients with CS who require circulatory support with VA-ECMO, being especially useful in patients with the highest haemorrhagic risk (dual antiplatelet therapy, postcardiotomy CS or central cannulation). P472 https://esc365.escardio.org/Presentation/217605/abstract Thrombotic complications and results in patients with venoarterial extracorporeal membrane oxigenation and cardiac prosthetic valves M Torres Sanabria,1 FJ Hernandez Perez,1 A Durante Lopez,1 S Garcia Gomez,1 M Gomez Bueno,1 CE Martin,1 AI Gonzalez,1 J Vazquez Lopez-Ibor,1 JM Escudier Villa,1 J Ortega Marcos1 and J Segovia Cubero1 1University Hospital Puerta de Hierro Majadahonda, Madrid, Spain Introduction: patients with cardiac prosthetic valves (CPV) in cardiogenic shock (CS), circulatory support with venoarterial extracorporeal membrane oxigenation (VA-ECMO) may induce prosthetic valve trombosis due to an increased blood stasis in cardiac chambers. Our aim was to analyze the incidence of thrombotic complications in these patients and the results in our cohort of patients. Methods: from September 2014 until May 2019, 62 patients suffering from refractory cardiogenic shock were treated with VA-ECMO. 19 of these patients were carriers of CPVs. We analyzed the characteristics of these group of patients, the incidence of thrombotic events and other major complications and intrahospital mortality. Results: from our cohort of 19 patients, 14 (74%) had a central VA-ECMO and 5 (26%) had a peripheric VA-ECMO. In 95% of the cases the etiology of the CS was postcardiotomy shock. The median age was 57 years (IQR 48-71) and 53% were male. The median time recieving ECMO support was 6 days (IQR 4-10). From the 19 patients, 8 (42%) had an aortic mechanic prosthetic valve, 7 (37%) had a mitral mechanic prosthetic valve, 3 (16%) had an aortic biologic prothetic valve and 1 (5%) both aortic and mitral prosthetic valves. 4 of these patients (21%) suffered CPV thrombosis and all of these valves were mechanic (1 aortic, 2 mitral and 1 double CPV); from this group 3 patients (75%) died and one neede a heart trasplant, and one of the patients who died suffered an ischemic stroke as the main cause of death. In the univariant anaylisis, female sex was the only condition statistically related with a higher incidence of CPV thrombosis (p = 0,01), and we observed a non-significant trend to a higher mortality among the patients with CPV thrombosis (40 vs. 75%, median survival 22 vs. 5 days, figure 1). Open in new tabDownload slide Survival analysis. 47% of the patients with PCV died before hospital discharge and 68% suffered a major complication (significant bleeding, sepsis, ECMO disfunction, ischemic or hemorragic stroke). In comparison with the group of patients with VA-ECMO but without CPV, we observed a non-significant lower mortality (47 vs. 70%, p = 0,07) in the group of patients without CPV, mainly due to the fact that most of the patients with CPV suffered a postcardiotomy CS, in which we have a much lower incidence of death compared to the rest of causes of CS. We didn’t either observ a significant difference in the incidence of major complications between groups (68 vs. 56%, p = 0,35). Conclusions: thrombosis of CPV is a relatively frequent complitacion with a high mortality in patients requiring haemodinamic support with VA-ECMO, even though the mortality and the rate of major complications were not higher in CPV patients compared to the patients not carrying CPV in our experience. Multicentric studies with a bigger number of patients would be needed in order to disclose consistent risk factors and outcomes among this group of patients. P473 https://esc365.escardio.org/Presentation/216695/abstract A matter of time: identifying optimal surgical timing for ischemic ventricular septal rupture repair. JM Vieitez Florez,1 GL Alonso Salinas,1 JD Sanchez Vega,1 A Ariza Sole,2 E Lopez De Sa,3 R Sanz Ruiz,4 V Burgos Palacios,5 S Raposeiras Rubin,6 S Gomez Varela,7 J Sanchis Fores,8 L Malagon Lopez,9 L Silva Melchor,10 M Corbi Pascual,11 JL Zamorano Gomez1 and M Sanmartin Fernandez1 1University Hospital Ramon y Cajal de Madrid, Cardiology, Madrid, Spain 2UNIVERSITY HOSPITAL OF BELLVITGE, Hospitalet De Llobregat, Spain 3University Hospital La Paz, Madrid, Spain 4University Hospital Gregorio Maranon, Madrid, Spain 5University Hospital Marques de Valdecilla, Santander, Spain 6Hospital Universitario Alvaro Cunqueiro, Vigo, Spain 7Hospital de Cruces, Bilbao, Spain 8Hospital General Universitario de Valencia, Valencia, Spain 9HOSPITAL COMPLEX NAVARRA, Pamplona, Spain 10University Hospital Puerta de Hierro Majadahonda, Madrid, Spain 11Albacete University Hospital, Albacete, Spain Background: Post-infarction ventricular septal rupture (VSR) is a rare, but dreadful complication with an extraordinary high mortality rate despite the improvement observed in coronary care over the past decades. Surgical repair is usually indicated but the best timing for operation has not been extensively studied. Methods: This is an observational, retrospective and multicentre registry (2008-2018), enrolling 12 Spanish hospitals. The primary endpoint was in-hospital death or heart transplantation. Timing of surgery was analysed, and we identified the point in which mortality started to decrease (mortality turning time). Afterwards, we performed 3 groups according to clinical practice: immediate surgery after diagnosing VSR (first 24 hours), early surgery (between 24 hours and “mortality turning time”) and late surgery (further “mortality turning time”). The role of VA ECMO support was also analysed in this scenario. Results: A total of 132 patients were included in the registry, 84 (63.6%) of them underwent surgical repair, and in 82 patients we had complete information about the timing of the procedure. Patients that underwent surgical repair from day 4 had a significantly lower mortality rate than patients operated on in less than 24 hours or those with a delay of 1 to 3 days (OR 0.34; 95%CI 0.12-0.94) (Figure 1). Patients supported by VA ECMO (n=16; 19.5%) also had a lower mortality rate if surgery was performed after the 4th day (Table 1). Open in new tabDownload slide Table 1. In-hospital mortality patients receivin. Surgical Repair Timing . In-Hospital Mortality . P . First 24 hours 4 (100%) Between 1-3 days 3 (100%) NS From 4th day 3 (33.3%) 0.015 Surgical Repair Timing . In-Hospital Mortality . P . First 24 hours 4 (100%) Between 1-3 days 3 (100%) NS From 4th day 3 (33.3%) 0.015 Open in new tab Table 1. In-hospital mortality patients receivin. Surgical Repair Timing . In-Hospital Mortality . P . First 24 hours 4 (100%) Between 1-3 days 3 (100%) NS From 4th day 3 (33.3%) 0.015 Surgical Repair Timing . In-Hospital Mortality . P . First 24 hours 4 (100%) Between 1-3 days 3 (100%) NS From 4th day 3 (33.3%) 0.015 Open in new tab Conclusions: Survival of post-infarction VSR may be improved if surgery can be performed after the fourth day of presentation. These results are even more significant if ECMO were used for stabilization before the procedure. Acute Cardiac Care – Cardiogenic Shock P474 https://esc365.escardio.org/Presentation/217594/abstract Hypoalbuminemia in patients with VA-ECMO: incidence and prognostic value S Garcia Gomez,1 A Durante-Lopez,1 FJ Hernandez Perez,1 J Vazquez Lopez-Ibor,1 J Goirigolzarri Artaza,2 JM Escudier Villa,1 J Ortega Marcos,1 M Gomez Bueno,1 L Silva Melchor,1 M Vidal Fernandez,1 S Serrano Fiz Garcia1 and J Segovia Cubero1 1University Hospital Puerta de Hierro Majadahonda, Madrid, Spain 2Hospital Clinico San Carlos, Madrid, Spain Introduction: Hypoalbuminemia is a poor prognostic parameter in critically ill patients admitted to intensive care units. However, its prognostic value is unknown in cases of cardiogenic shock (CS) which require circulatory support with venoarterial extracorporeal membrane oxygenation(VA-ECMO). The main aim of the present study was to analyse the incidence of hypoalbuminemia and its prognostic significance in these patients. Methods: Retrospective observational study was performed. Consecutive 69 refractory CS patients with VA-ECMO support were analysed from 2014 to 2018. Hypoalbuminemia was defined as blood level of albumin below 3.5 mg/dl and its rate has been studied according to the lowest value in each patient during in-hospital stay. Apart from that, we analysed the prognostic value of it. Results: Our cohort were mostly male (69%) with a mean age of 52.5 (48.8-56.2) years old at diagnosis. 54% of them were in central cannulation group. Approximately 54% of patients had some cardiopathy known before admission to our centre and INTERMACS scale was 1 in the vast majority of them. Pre-surgery mean left ventricle ejection fraction was 50 (44.7-55.4) %. In different mortality predictors, mean values of our patients were: 44.6 (41.3-47.8) in Simplified Acute Physiology Score (SAPS II), 20 (18.4-21.6) in Acute Physiology And Chronic Evaluation (APACHE) and 10.95 (10.4-11.6) in Sepsis-Related Organ Failre Assessment (SOFA). 62 patients (88,4%) had enough information about albuminemia value and 58 (84.1%) of them had hypoalbuminemia based on the established definition. Global in-hospital mortality was 60% (41 of 69 patients). Blood levels of albumin were lower in deceased patients than in those who survived (2.36 ± 1.05 in deceased patients vs 2.72 ± 1.48 in survivors, p= 0.027). Conclusions: Hypoalbuminemia is quite frequent in patients who need circulatory support with VA-ECMO because of CS. According to our results, low blood levels of albumin are associated with higher in-hospital mortality. Acute Cardiac Care – Cardiogenic Shock P475 https://esc365.escardio.org/Presentation/216398/abstract A case series of left Impella-device as bridge from acute mitral regurgitation to MitraClip-procedure: a novel implementation of percutaneous mechanical circulatory support C Vandenbriele,1 J Wilson,2 T Adriaenssens,1 T Balthazar,1 S Davies,3 C Dubois,1 AF Caetano,2 K Goetschalckx,3 S Janssens,1 S Ledot,2 B Meyns,1 R Smith,3 JU Voigt1 and S Price2 1University Hospitals (UZ) Leuven, Leuven, Belgium 2Royal Brompton and Harefield NHS Foundation Trust, Adult Intensive Care, London, United Kingdom of Great Britain & Northern Ireland 3Royal Brompton and Harefield NHS Foundation Trust, Cardiology, London, United Kingdom of Great Britain & Northern Ireland Background: Acute mitral regurgitation (MR) is a medical and mostly surgical emergency. Severe acute MR presenting with hemodynamic collapse is usually related to an exceedingly rare mechanical complication such as papillary muscle rupture after AMI or chordae tendinae rupture, resulting in flail mitral leaflets. Preoperative stabilization is complex due to concomitant hemodynamic collapse and hypoxic respiratory failure. Finding the right balance between both preload and inotropic support is very challenging. Nowadays, when patients are too sick for immediate surgical intervention, mechanical circulatory support should be considered because of its decreasing effect on afterload and cardiac work while increasing coronary perfusion and cardiac output. Nevertheless, even after initial stabilization, the surgical risk remains high in critically ill acute severe MR patients and other technical modalities reducing the MR – such as MitraClip - should be explored. Methods: Between August 2017 and September 2019, five patients on 2 tertiary ICUs presenting with acute, moderate-to-severe or severe MR and considered too ill for immediate surgical intervention (EURO-II score > 11,2%, pulmonary edema necessitating mechanical ventilation and/or hemodynamic instability), were selected for Impella-assisted ventricular unloading as bridge to MitraClip. Results: The mean age was 72 years. The cause of MR was ischemic in 20% and all patients presented in cardiogenic shock state, necessitating mechanical ventilation. Only one patient was in multiple organ failure (late referral) at presentation. The overall cardiac operative risk assessment (Euro-II) score represented a 35% chance of in-hospital mortality after surgery. Cardiac output was severely impaired (mean LVOT VTI 8,2 cm). All patients were on inotropic support and supported by an Impella-CP pVAD (mean flow 2,5 Liter per minute; mean 6,3 days of support). In all cases, we managed reducing the LVEDP below 15 mmHg using medical therapy (afterload reduction, inotropes), mechanical ventilation and pVAD-therapy. The MR could be successfully reduced by a MitraClip-procedure in each patient. The overall survival at discharge was 80%. One patient with late referral and multiple organ failure at presentation deceased due to refractory cardiogenic shock. All four patients survived 6 months after discharge. Conclusions: A combined strategy of Impella and MitraClip appears to be a novel, feasible alternative for patients presenting with acute, severe MR unable to proceed to a corrective procedure at presentation due to cardiogenic shock requiring mechanical circulatory support. In these cases, the initiation of pVAD-support early is essential to reduce the risk of development of irreversible end organs damage and dysfunction. Given the limitations of this small, non-randomised case series, further exploration in a larger, randomised population is warranted to investigate this strategy further. Open in new tabDownload slide P476 https://esc365.escardio.org/Presentation/216481/abstract Revascularization strategies in cardiogenic shock after acute myocardial infarction V Ferreira,1 S Aguiar Rosa,1 A Timoteo,1 L Ferreira,1 D Cacela,1 L Morais,1 A Castelo,1 P Garcia Bras,1 T Mano,1 J Reis1 and R Cruz Ferreira1 1Hospital de Santa Marta, Lisbon, Portugal Introduction: The use of early revascularization of the culprit artery with percutaneous coronary intervention (PCI) has been shown to improve outcome in patients with acute myocardial infarction (AMI) complicated with cardiogenic shock (CS). However, most of patients with CS have multivessel (MV) disease, remaining under discussion the optimal timing of non-culprit revascularization and the best treatment strategy for patients with CS. Purpose: The aim of this study was to determine the impact of PCI of the culprit lesion only (CLO) or immediate multivessel (IMV) PCI on procedural and clinical outcomes in patients with CS. Methods: 150 consecutive patients with AMI, MV disease and CS treated with PCI admitted at a tertiary centre were retrospectly included. The primary endpoint was all-cause mortality within 30 days. Safety endpoints included bleeding and stroke. Clinical characteristics, procedural features, antithrombotic therapies and MACE, including hospitalization for heart failure, myocardial reinfarction and repeated revascularization were registered in-hospital, 30-day and 12-month follow-up (FU). Results: Mean age was 69.0±12.0 years (Y), 108 male (72.0%). 115 patients (76.7%) presented with ST-segment elevation myocardial infarction (STEMI) and 37.3% with anterior STEMI. The patient cohorts, 114 patients in CLO group and 36 patients in IMV group, were comparable in age, sex and cardiovascular risk factors. At 30 days, the primary endpoint had occurred in 48 patients (42.1%) in CLO PCI group and in 24 patients (66.7%) in the IMV PCI group (p=0.046), with an absolute 20.7 % reduction in 30-day mortality (40.4% vs 61.1%; p=0.031). Kaplan–Meier analysis showed that survival was significantly worse for patients in IMV group (log-rank 0.036). At 12-month FU, all-cause mortality was not statistically different between groups (51.8% vs 66.7%, p=0.120). Conclusions: Among patients presenting with CS in context of AMI and MV disease, 30-day outcomes were better in those who initially underwent PCI of the CLO comparing with IMV PCI. At 12 months, there was no difference in the incidence of ischemic events or death from any cause. These data are in line with recent publications that state culprit-lesion-only PCI with possible staged revascularization should be the preferred revascularization strategy. Open in new tabDownload slide Kaplan–Meier curves. P477 https://esc365.escardio.org/Presentation/216445/abstract Inadequate left ventricular unloading during venoarterial extracorporeal membrane oxygenation: a ten-year experience in a tertiary hospital S Gonzalez Lizarbe,1 T Borderias Villarroel,1 B De Tapia Majado,1 J Sanchez Cena,1 S Catoya Villa,1 E Lujan Valencia,1 M Lozano Gonzalez,1 I Cabrera Rubio,1 M Molina San Quirico,1 JA Sarralde Aguayo,1 M Cobo Belaustegui,1 M Ruiz Lera,1 A Canteli Alvarez,1 C Castrillo Bustamante1 and V Burgos Palacios1 1University Hospital Marques de Valdecilla, Santander, Spain Introduction: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a widely used form of mechanical circulation support in patients with refractory cardiogenic shock. A common disadvantage of VA-ECMO is a resultant increase in left ventricular (LV) afterload. Its main limitation is the inadequate LV unloading. Methods: Between 2009 and 2019, 145 VA-ECMO devices were implanted in 141 consecutive patients. The purpose of this observational study is to describe the incidence, predictors, prognosis and management of inadequate LV unloading. Results: Table 1 summarizes baseline characteristics of the patient population. The etiology of cardiogenic shock is detailed in figure 1. Table 1. Baseline characteristics. Age (years) - mean ± SD 57,48 ± 13.3 Sex - % (n) Male: 75,9 (107); female: 24.1 (34) INTERMACS - % (n) 1: 95.9 (139); 2: 4.1 (6) Cardiac arrest - % (n) - Non-cardiac arrest 66.9 (97) - ECMO post cardiac arrest 17.2 (25) - ECMO in refractory cardiac arrest 15.8 (23) Main objective of VA-ECMO - % (n) - Bridge to recovery 69 (100) - Bridge to decisión 22.8 (33) - Bridge to ventricular assist device 4.1 (6) - Bridge to heart transplant 2.8 (4) - Support for interventions 1.4 (2) Duration of VA-ECMO support (days) - mean ± SD 5 ± 4.3 Age (years) - mean ± SD 57,48 ± 13.3 Sex - % (n) Male: 75,9 (107); female: 24.1 (34) INTERMACS - % (n) 1: 95.9 (139); 2: 4.1 (6) Cardiac arrest - % (n) - Non-cardiac arrest 66.9 (97) - ECMO post cardiac arrest 17.2 (25) - ECMO in refractory cardiac arrest 15.8 (23) Main objective of VA-ECMO - % (n) - Bridge to recovery 69 (100) - Bridge to decisión 22.8 (33) - Bridge to ventricular assist device 4.1 (6) - Bridge to heart transplant 2.8 (4) - Support for interventions 1.4 (2) Duration of VA-ECMO support (days) - mean ± SD 5 ± 4.3 Open in new tab Table 1. Baseline characteristics. Age (years) - mean ± SD 57,48 ± 13.3 Sex - % (n) Male: 75,9 (107); female: 24.1 (34) INTERMACS - % (n) 1: 95.9 (139); 2: 4.1 (6) Cardiac arrest - % (n) - Non-cardiac arrest 66.9 (97) - ECMO post cardiac arrest 17.2 (25) - ECMO in refractory cardiac arrest 15.8 (23) Main objective of VA-ECMO - % (n) - Bridge to recovery 69 (100) - Bridge to decisión 22.8 (33) - Bridge to ventricular assist device 4.1 (6) - Bridge to heart transplant 2.8 (4) - Support for interventions 1.4 (2) Duration of VA-ECMO support (days) - mean ± SD 5 ± 4.3 Age (years) - mean ± SD 57,48 ± 13.3 Sex - % (n) Male: 75,9 (107); female: 24.1 (34) INTERMACS - % (n) 1: 95.9 (139); 2: 4.1 (6) Cardiac arrest - % (n) - Non-cardiac arrest 66.9 (97) - ECMO post cardiac arrest 17.2 (25) - ECMO in refractory cardiac arrest 15.8 (23) Main objective of VA-ECMO - % (n) - Bridge to recovery 69 (100) - Bridge to decisión 22.8 (33) - Bridge to ventricular assist device 4.1 (6) - Bridge to heart transplant 2.8 (4) - Support for interventions 1.4 (2) Duration of VA-ECMO support (days) - mean ± SD 5 ± 4.3 Open in new tab Figure 1. Open in new tabDownload slide Among a total of 145 VA-ECMO, inadequate LV unloading occurred in 53 cases (36.6%). An intra-aortic balloon pump (IABP) was used before the VA-ECMO implant in 33 of them (62.3%). LV unloading strategy was performed using medical treatment (11.3%), IABP (50.9%), left ventricular venting (17%) and bridging to a short-term ventricular assist device (20.8%). Regarding the etiology of cardiogenic shock, the main risk factors for inadequate LV unloading were dilated cardiomyopathy (OR 11.7; CI95% 2.4-55.5; p<0.05), ECMO in cardiac arrest (OR 8.2; CI95% 2.8-24.3; p<0.001) and postcardiotomy shock (OR 4.9; CI95% 2.1-11.9; p<0.001). In patients treated with VA-ECMO, inadequate LV unloading was associated with a significant increase in intrahospital mortality compared with patients without LV unloading (73.6% vs. 41.3%, p<0.001). Inadequate LV unloading was a predictive factor of intrahospital mortality (OR 3.8; CI95% 1.3-11.2; p<0.05), in addition to higher age (>65 years of age) (OR 3.9; CI95% 1.1-15; p<0.05) and the use of ECMO in refractory cardiac arrest (OR 15.6; CI95% 1.7-146.4; p<0.05). Intrahospital mortality in patients with inadequate LV unloading was 71.7% (n = 38). The causes of death were: multiple organ dysfunction syndrome (23.7%), inadequate hemodynamic support with VA-ECMO (15.8%), absence of recovery (15.8%), infection (10.5%), anoxic encephalopathy (10.5%), low cardiac output after ECMO removal (5.2%), mesenteric ischemia (5.2%) and others (13.3%). Conclusions: Inadequate left ventricular unloading remains a challenge and is associated with increased intrahospital mortality during VA-ECMO support. There was an association between this complication and the etiology of cardiogenic shock. It was more likely to happen in patients with dilated cardiomyopathy, ECMO in refractory cardiac arrest and postcardiotomy shock. It is in these cases in which we may implement left ventricular unloading strategies in the optimal timing. P480 https://esc365.escardio.org/Presentation/216721/abstract Mortality and futility in patients withvenoarterial extracorporeal oxygenation membrane in a high volume tertiary center M Lozano Gonzalez,1 JE Lujan Valencia,1 M Molina San Quirico,1 I Cabrera Rubio,1 D Serrano Lozano,1 S Gonzalez Lizarbe,1 T Borderias Villarroel,1 S Catoya Villa,1 B De Tapia Majado,1 J Sanchez Cena,1 A Canteli Alvarez,1 MC Castrillo Bustamante,1 M Ruiz Lera,1 JA Sarralde Aguayo1 and V Burgos Palacios1 1UNIVERSITY HOSPITAL MARQUES DE VALDECILLA, Santander, Spain Introduction: VA ECMO is a rescue therapy in patients with cardiogenic shock, with a described survival of 50%. The decision of therapeutic limitation and the recognition of patients in whom the implant of the device is futile is complex. Our goal is to describe the distribution of these cases. Methods: We retrospectively review adult patients treated with VA ECMO in a tertiary hospital between 2009 and 2019. Results: 142 patients were supported with a VA ECMO, with an overall survival of 48.5%, the mean age was 57.4 years (± 13.3 SD), of which 107 (73.8%) were male . The most frequent etiologies of cardiogenic shock were postcardiotomy shock in 55 cases (37.9%), acute post-myocardial shock in 27 cases (18.6%) and primary graft dysfunction in 22 cases (15.2%). The average length of the support was 5.07 days (4.28 ± DS). In our series, among the causes of death described in the attached figure, the most important were multiorgan failure (MOF) in 16 cases (21.05%), followed by neurological complications, which occurred in 11 patients (14, 48%) and thirdly, infections in 9 patients (11.84%). The limitation of therapeutic effort occurred in 4 cases due to the presence of futility (defined as the non-recovery of the ejection fraction in patients not candidates for transplantation). All of them were male patients, 3 cases underwent extracorporeal surgery that evolved to postcardiotomy shock and one case presented interventricular communication (IVC) after aninferior wall myocardial infarction. In the first 3 cases, assistance was established as a bridge to recovery and in the last one, as a bridge to decision. The mean age was 78.6 years (± 2.61 SD) and the average attendance time was 3.20 days (± 2.22 SD), the rest of the data are described in the attached table. Conclusions: Mortality in patients undergoing support with VA ECMO is very high and involves a significant consumption of resources. It is important to identify patients with potential for recovery or transplantability to try to prevent the therapy from being futile. Table 1. Patients with futility. Age . Sex . Shock Etiology . Surgery . Basal Cr . Dysfunction . INTERMACS . Days of VA ECMO . Goal . Transplant contraindications . 80 Male PostCT MVRand Bentall 0,81 biventricular 1 2,16 Bridge to recovery Age 85 Male PostCT Endocarditis onAoV 0,83 RV 1 6,17 Bridge to recovery Age 79 Male PostCT IVD, MVR y ACPx2 3,10 biventricular 1 1,12 Bridge to recovery Age 78 Male Inferior infarction IVD 0,88 LV 1 3,48 Bridge to decision Age Age . Sex . Shock Etiology . Surgery . Basal Cr . Dysfunction . INTERMACS . Days of VA ECMO . Goal . Transplant contraindications . 80 Male PostCT MVRand Bentall 0,81 biventricular 1 2,16 Bridge to recovery Age 85 Male PostCT Endocarditis onAoV 0,83 RV 1 6,17 Bridge to recovery Age 79 Male PostCT IVD, MVR y ACPx2 3,10 biventricular 1 1,12 Bridge to recovery Age 78 Male Inferior infarction IVD 0,88 LV 1 3,48 Bridge to decision Age PostCT: postcardiotomy, MVR: mitral valve replacement, AoV: Aortic valve. IVD: Interventricular defect, RV: right ventricule, LV: left ventricule. Open in new tab Table 1. Patients with futility. Age . Sex . Shock Etiology . Surgery . Basal Cr . Dysfunction . INTERMACS . Days of VA ECMO . Goal . Transplant contraindications . 80 Male PostCT MVRand Bentall 0,81 biventricular 1 2,16 Bridge to recovery Age 85 Male PostCT Endocarditis onAoV 0,83 RV 1 6,17 Bridge to recovery Age 79 Male PostCT IVD, MVR y ACPx2 3,10 biventricular 1 1,12 Bridge to recovery Age 78 Male Inferior infarction IVD 0,88 LV 1 3,48 Bridge to decision Age Age . Sex . Shock Etiology . Surgery . Basal Cr . Dysfunction . INTERMACS . Days of VA ECMO . Goal . Transplant contraindications . 80 Male PostCT MVRand Bentall 0,81 biventricular 1 2,16 Bridge to recovery Age 85 Male PostCT Endocarditis onAoV 0,83 RV 1 6,17 Bridge to recovery Age 79 Male PostCT IVD, MVR y ACPx2 3,10 biventricular 1 1,12 Bridge to recovery Age 78 Male Inferior infarction IVD 0,88 LV 1 3,48 Bridge to decision Age PostCT: postcardiotomy, MVR: mitral valve replacement, AoV: Aortic valve. IVD: Interventricular defect, RV: right ventricule, LV: left ventricule. Open in new tab Open in new tabDownload slide Causes of mortality in support with ECMO. Acute Cardiac Care – Cardiac Arrest P482 https://esc365.escardio.org/Presentation/216413/abstract Characterization, management and prognosis of elderly patients admitted with sudden cardiac death M Vidal Burdeus,1 J Sans Rosello,1 J Carreras Mora,1 M Padilla Lopez,1 C Moliner Abos,1 J Pamies-Besora,1 A Duran Cambra,1 M Vila Perales,1 V Garcia Hernando,1 J Fernandez Martinez,1 A Maestro Benedicto1 and A Sionis1 1Hospital de la Santa Creu i Sant Pau, Cardiology - Coronary Care Unit, Barcelona, Spain Introduction and Objectives: Sudden cardiac death (SCD) is an entity of increasing incidence in clinical practice associated with high morbidity and in-hospital mortality. Elderly patients who were admitted with SCD present additional risks related to their baseline functional status, fragility and comorbidity. Our objective was to characterize elderly patients admitted with sudden cardiac death and compare management and prognosis during hospitalization in a cohort of patients with SCD in a tertiary hospital. Methods: We analysed 377 patients admitted to our hospital with diagnosis of SCD from April 2011 to July 2019. We divided them into subgroups: elderly (age ≥80) and non-elderly (age <80). Clinical, haemodynamic and analytical parameters, management, as well as neurological status at discharge using the Cerebral Performance Category scale: Glasgow-Pittsburgh (CPC) were determined. In patients treated with therapeutic hypothermia, it was performed with ArcticSun® and ThemoGard® devices with a target temperature of 33°C during 24h. Results: 38 patients were classified in elderly group (10.13%). Mean age in elderly and non-elderly groups were 84.23±3 years and 60.4+12.7 respectively (p<0.001). Among elderly patients, there were more women (39.47% vs 21.36%; p:0.012) and hypertensive (84.21% vs 54.01%; p<0.001) but less smokers (7.89% vs 35.31%: p:0.002). Shockable rhythms were less frequent in elderly patients (44.74% vs 67.36%; p:0.006). Witnessed SCD, time to return of spontaneous circulation, ejection fraction and pH-lactate at admittance were similar in both groups. Although no differences were found in percentage of ischemic SCD and acute coronary syndromes, emergent cardiac catheterization (ECC) was performed less frequently in elderly (37.84% vs 76.67%; p<0.001). Nonetheless, among patients with ECC, elderly patients presented high prevalence of multivessel disease (66.67% vs 36.63%; p:0.011) and a comparable rate of coronary angioplasty (69.23% vs 72.16%; p:0.82). Moderate therapeutic hypothermia was also less carried out in elderly (35.14% vs 58.08%; p:0.008). No differences in neuron specific enolase levels between groups were found. Swan-Ganz catheter was less used in elderly patients (0% vs 18.01%; p:0.008) whilst use of inotrope drugs and intra-aortic balloon pump were comparable between groups. Elderly patients were associated with a higher in-hospital mortality (73.68% vs 45.24%; p:0.002). Heart failure in elderly group and anoxic encephalopathy in non-elderly group were main causes of death (42.86% and 56.29%, respectively). Among patients who were discharged from hospital, a worse neurologic outcome (CPC 3-4) was found in elderly group (57.89% vs 36.12%; p:0.04). Conclusions: Differences in clinical profile and management of elderly patients admitted with a SCD could determine a higher mortality and a poorer neurologic outcome. P483 https://esc365.escardio.org/Presentation/216461/abstract Neurologic evolution and prognosis in patients discharged from hospital after sudden cardiac death. 1 year-follow-up J Sans Rosello,1 M Vidal Burdeus,1 J Carreras Mora,1 V Garcia Hernando,1 J Fernandez Martinez,1 A Maestro Benedicto,1 M Padilla Lopez,1 J Pamies-Besora,1 C Moliner Abos,1 A Duran Cambra,1 M Vila Perales1 and A Sionis1 1Hospital de la Santa Creu i Sant Pau, Cardiology - Coronary Care Unit, Barcelona, Spain Introduction and Objectives: Sudden cardiac death (SCD) is the most common cause of death in patients with ischaemic heart disease and could be the first manifestation of it in around 20% of cases. Consequences of cerebral anoxia are the most disabling impairments in patients who were discharged after SCD. Our objective was to characterize neurologic evolution and prognosis of patients after SCD discharge in a tertiary hospital. Methods: We analyzed 171 patients discharged from our hospital from April 2011 to July 2018 with diagnosis of SCD. We checked neurological status at discharge and at 1-year follow-up using Cerebral Performance Category scale: Glasgow-Pittsburgh (CPC). We divided them into 5 groups depending on CPC at hospital discharge. CPC and cause of death during follow-up (if applicable) were determined using medical records and/or phone interviews. Results: 171 patients with a mean age of 58.97+11.24 years, 77.78% were men. SCD was witnessed in 93.57% and 84.21% of them had presented a shockable rhythm. Moderate therapeutic hypothermia had been performed in 65.5% of cases. At discharge, 69% of patients were in CPC1 (118), 18.7% in CPC2 (32), 10% in CPC3 (17) and 2.3% in CPC4 (4). 20 patients (2.7%) were lost in follow-up (19 with initial CPC1 and 1 with initial CPC2). At 1-year follow-up, 94.95% of CPC1 patients (94) remained in CPC1 and other 4.3% (5) died (2 for unknown causes, 1 septic shock, 1 stroke, 1 heart failure). Among CPC2 patients: 54.8% improved to CPC1 (17), 25.85% maintained CPC2 (8) and 19.35% (6) died (2 fatal acute myocardial infarction, 1 heart failure, 1 septic shock, 1 unknown, 1 malignancy). Among CPC3 patients: 23.53% improved to CPC1 (4), 29.41% improved to CPC2 (5), 17.65% remained in CPC3 (3) and 29.41% (5) died (2 heart failure, 1 unknown, 1 septic shock, 1 malignancy). Finally, all CPC4 patients died during 1-year follow-up due to respiratory failure. Conclusions: Unlike CPC 1-2 patients who mostly present good evolution and CPC 4 patients who present very poor outcome, about half of CPC 3 patients considered initially as poor neurological prognosis, could improve their neurological performance at 1-year follow-up. P484 https://esc365.escardio.org/Presentation/217586/abstract Cardiac arrest in cardiogenic shocknone H Santos,1 T Vieira,2 J Fernandes,2 AR Ferreira,2 M Rios2 and T Honrado2 1Hospital N.S. Rosario, Cardiology, Barreiro, Portugal 2Sao Joao Hospital, Intensive Care, Porto, Portugal Introduction: Cardiac arrest (CA) in cardiogenic shock (CS) is associated with worse prognosis, not just because the elevated mortality rates of CS but also because CA can affect other vital organs and cause irreversible damages. Objective: Evaluate the impact of cardiovascular previous history, clinical signs and diagnosis procedures at admission as predictors of mortality in CS and if the same variables can predict CA in CS patients. Methods: Single-centre retrospective study, engaging patients hospitalized for CS between 1/01/2014-30/10/2018. From 214 patients, 177 in CS are included. Chi-square test, T-student test and Mann-Whitney U test were used to compare categorical and continuous variables. Multiple linear regression analysis was performed to evaluate mortality predictors of CS. Linear regression was used in CA patients to establish the relation between the variables and the CA occurrence. Results: CS patients had a mean age of 62.43±13.98 years and 78.5% were male. Regarding CS mortality, multiple linear regression, reveal arterial hypertension and moderate alcohol consumption as the best predictors, with an R2a 0.081. CS that suffer CA (124 patients) had a mean age of 58.58±12.50 years, 81.5% were male, had a similar prevalence of cardiovascular risk factors, but less previous history of acute coronary syndrome (16.7% vs 37.7%, p=0.002) compared to non-CA patients. Cardiovascular medication was more prevalent on non-CA, namely BB (42.0% vs 23.1%, p=0.013), ACE inhibitors (59.2% vs 41.0%, p=0.004) and platelet antiaggregant (42.0% vs 23.1%, p=0.013). Regarding blood work at admission, no significant differences to report, except for higher values of C reactive protein in non-CA patients (13.3±46.7 vs 2.7±5.5, p<0.001). CA patients had less time until coronary angiography procedure (2.50±2.13 vs 5.00±5.75 hours, p<0.001), but higher left ventricular ejection fraction (35.0±20.0 vs 25.0±12.5, p<0.001). Respect to all causes of mortality, no differences between CA and non-CA (50.0% vs 41.5%, p=0.300), however, if considered only brain death, CA had a significant higher prevalence (28.2% vs 5.7%, p=0.001). Culprit lesion are the best predictor of CA in CS patients (R2 0.113). Conclusions: Arterial hypertension and moderate alcohol consumption are the best predictors of all causes of mortality in CS. Culprit lesion is the best predictor of CA in CS patients. CA was not associated with higher cardiac mortality rates, but produce more brain deaths. P485 https://esc365.escardio.org/Presentation/217590/abstract Diabetes mellitus and out-of-hospital cardiac arrest: single center experience M Pavlov,1 Z Babic,1 A Djuzel,1 K Crljenko,1 M Nedic1 and D Delic Brkljacic1 1University Hospital Sestre Milosrdnice, Cardiac intensive care unit, Zagreb, Croatia Introduction: Diabetes mellitus (DM) is associated with worse outcomes of majority of the cardiovascular disease spectrum. We wondered whether DM has an impact on neurological outcome and mortality of the patients treated for out-of-hospital cardiac arrest (OHCA). Methods: Patients treated for OHCA in whom the return of spontaneous circulation was accomplished and who were admitted to Cardiac intensive care unit from October 2000 until March 2019 were included in the study. Relevant data were collected from medical archives. Results: A total of 149 patients were included in the study, out of whom 33 (21.7%) patients were diagnosed with DM. Patients with DM were older (69 (60.5-75) vs. 60 (48.25-70), P=0.02), more often had a history of hypertension (78.8% vs. 51.3%, P=0.005), presented with non-shockable rhythm (30.0% vs. 14.4%, P=0.047), experienced recurrent arrest (57.6% vs. 37.6%, P=0.042), shock (60.6% vs. 27.9%, P=0.001), and were treated with noradrenalin (39.4% vs. 17.2%, P=0.001). In DM group, intrahospital mortality (63.6% vs. 33.6%, P=0.001) and worse neurological outcome (cerebral performance category >2: 81.8% vs. 45.7%, P=0.001) occurred more often. In regression, predictors of intrahospital death were use of noradrenalin (exponentiation of b (eb)=10.3; P=0.003), initial GCS score 3 (eb=8.0; P<0.001) and use of therapeutic hypothermia (eb=0.157; P=0.013), but not DM. Conclusion: In this single centre observational retrospective study, DM was associated with worse features, survival and neurological outcome of OHCA patients in univariate analyses. Table 1. Basic patient characteristics. . No diabetes mellitus . Diabetes mellitus . . n . % . n . % . Transferred patients 19 16.4% 4 12.1% Female 28 24.1% 8 24.2% Urgent coronary angiography 65 57.0% 16 48.5% Witnessed arrest 82 94.3% 21 87.5% Layperson resuscitation 43 58.9% 11 55.0% On-field intubation 65 56.5% 14 43.8% Therapeutic hypothermia 44 37.9% 13 39.4% Heart failure during hospital stay 31 28.4% 13 41.9% Pneumonia 39 34.2% 12 37.5% Sepsis 14 12.3% 6 18.8% Use of antibiotics 54 47.4% 19 61.3% . No diabetes mellitus . Diabetes mellitus . . n . % . n . % . Transferred patients 19 16.4% 4 12.1% Female 28 24.1% 8 24.2% Urgent coronary angiography 65 57.0% 16 48.5% Witnessed arrest 82 94.3% 21 87.5% Layperson resuscitation 43 58.9% 11 55.0% On-field intubation 65 56.5% 14 43.8% Therapeutic hypothermia 44 37.9% 13 39.4% Heart failure during hospital stay 31 28.4% 13 41.9% Pneumonia 39 34.2% 12 37.5% Sepsis 14 12.3% 6 18.8% Use of antibiotics 54 47.4% 19 61.3% No significant differences were found for entlisted variables Open in new tab Table 1. Basic patient characteristics. . No diabetes mellitus . Diabetes mellitus . . n . % . n . % . Transferred patients 19 16.4% 4 12.1% Female 28 24.1% 8 24.2% Urgent coronary angiography 65 57.0% 16 48.5% Witnessed arrest 82 94.3% 21 87.5% Layperson resuscitation 43 58.9% 11 55.0% On-field intubation 65 56.5% 14 43.8% Therapeutic hypothermia 44 37.9% 13 39.4% Heart failure during hospital stay 31 28.4% 13 41.9% Pneumonia 39 34.2% 12 37.5% Sepsis 14 12.3% 6 18.8% Use of antibiotics 54 47.4% 19 61.3% . No diabetes mellitus . Diabetes mellitus . . n . % . n . % . Transferred patients 19 16.4% 4 12.1% Female 28 24.1% 8 24.2% Urgent coronary angiography 65 57.0% 16 48.5% Witnessed arrest 82 94.3% 21 87.5% Layperson resuscitation 43 58.9% 11 55.0% On-field intubation 65 56.5% 14 43.8% Therapeutic hypothermia 44 37.9% 13 39.4% Heart failure during hospital stay 31 28.4% 13 41.9% Pneumonia 39 34.2% 12 37.5% Sepsis 14 12.3% 6 18.8% Use of antibiotics 54 47.4% 19 61.3% No significant differences were found for entlisted variables Open in new tab P488 https://esc365.escardio.org/Presentation/216416/abstract Clinical, angiographic and treatment characteristics of patients discharged alive after acute myocardial infarction and cardiac arrest S Righetti,1 E Montemerlo,2 F Soffici,2 A Piemonti,3 E Scanziani,2 F Cesana,2 S Tresoldi,1 A Mauro,2 A Bozzano,2 L Avalli,4 F Achilli,5 E Maggioni,4 P Vandoni,1 M Lettino2 and I Calchera1 1San Gerardo Hospital, Interventional Cardiology Department, Monza, Italy 2San Gerardo Hospital, Cardiology Department, Monza, Italy 3University of Milan-Bicocca, Monza, Italy 4San Gerardo Hospital, Cardiac Surgery Intensive Care, Monza, Italy 5Desio Hospital, Cardiology Department, Desio, Italy Background: Patients with an acute myocardial infarction (AMI) complicated by cardiac arrest might still have a very poor outcome, despite an increased use of extracorporeal membrane oxygenation (ECMO). Predictors of survival in these patients are not well defined and deserve further elucidation. Open in new tabDownload slide Purpose: The aim of our study was to investigate whether the baseline characteristics and the in-hospital treatment of AMI patients surviving a cardiac arrest could be predictive of in-hospital mortality. Methods: We retrospectively collected data from 123 adult cardiac arrest patients with a proved myocardial infarction (STEMI at ECG after ROSC and/or culprit coronary plaque visualized during urgent angiography), admitted to our hospital between January 2013 and March 2017. The demographic, clinical and angiographic characteristics of patients discharged alive from the hospital were compared with those of patients who died during the in-hospital stay. Results: Patients were 61 ±10.5 years old and 82.1% (101) were male. 51 (41.5%)patients were treated with Ticagrelor, 14 (11.4%)with Prasugrel, and 22 (17.9%)with Clopidogrel; a P2Y12 Inhibitor in adjunct to aspirin was not administered to 36 patients, due to their high bleeding risk. 43 (35%) patients had a refractory cardiac arrest requiring ECMO implantation. 52 of 123 (42.3%) patients were discharged alive. The surviving patients had a higher incidence of smoking habit (42.3% vs. 25.4%, p-value 0.047), less need of ECMO support ( 21.2% vs. 45.1%, p-value 0.006) and less incidence of left main as culprit lesion (11.5% vs. 23.9%, p-value 0.009). On admission they also had a better Killip Class (Killip I-II 47.1% vs. 22.6%; p-value 0.002), a higher systolic blood pressure (111.76 ±49.14mmHg vs. 73.68mmHg ±47.14; p-value>0.001), a lower serum creatinine (1.01 mg/dl ±0.29 vs. 1.31g/dl ±0.96; p-value 0.035) and were more frequently treated with Ticagrelor (53.8% vs. 32.4%, p-value 0.046). Conclusion: The study shows that patients discharged alive from the hospital after an acute myocardial infarction complicated by a cardiac arrest had better clinical and angiographic characteristics at baseline, and were more frequently treated with Ticagrelor. P489 https://esc365.escardio.org/Presentation/221529/abstract Pronostic implication of therapeutic hypothermia after cardiac arrest in patients older than 75 years MI Barrionuevo-Sanchez,1 R Ramos-Martinez,1 L Exposito-Calamardo,1 S Calero-Nunez,1 S Diaz-Lancha,1 C Ramirez-Guijarro,1 G Gallego-Sanchez,1 JJ Portero-Portaz,1 C Urraca-Espejel,1 J Navarro-Cuartero,1 C Llanos-Guerrero,1 FM Salmeron-Martinez,1 I Lopez-Neyra,1 J Jimenez-Mazuecos1 and M Corbi-Pascual1 1GENERAL UNIVERSITY HOSPITAL OF ALBACETE, Albacete, Spain Introduction: Nowadays the controversy about performance of therapeutic hypothermia (TH) after cardiac arrest (CA) is still valid today. The risk-benefit balance suffers a particularly fragile balance in elderly patients because they, on the one hand, have greater vulnerability to developing more neurological sequelae after CA, but also more risk of complications arising from HT. Purpose: The objective of this study is describe the results of HT in patients older than 75 years in our center. Methods: 115 patients undergoing TH (34°C for 24 hours) were included between March 2006 and April 2019 in our center. 27 patients (23.5%) were ≥ 75 years old. We assessed the characteristics of this subgroup of patients. Results: The average age was 79.53 years. There were greater number of men (64%). 88.9% of the patients were diabetic, 37% hipertensive, 18% dyslipidemic and only 14.8% of the patients were active smokers. In 66.7% of patients there was no history of previous coronary artery disease. In 13 patients (48.1%) the initial rhythm was a defibrillable rhythm performing urgent coronary angiographyin a high percentage (8 patients representing 61.5%). Percutaneous coronary intervention was performed in 5 patients, all with conventional stent implants. 18.5% required renal replacement therapy, in no case was used intra-aortic balloon pump (IABP) or other ventricular assist devices. The average stay in intensive cardiac care unit was 9 days. There were no cases of strokes although infectious complications (sepsis) were frequent (7 patients, 25.9%). There were no cases of major bleeding (TIMI> 2). Only 8 patients (29.6%) were discharged without significant neurological sequelae (CPC 1-2). Hospital mortality was 70.4%. Conclusions: TH in patients> 75 years old is associated with worse results mainly due to aworse neurological prognosis. All who survive do so with good neurological outcome. P491 https://esc365.escardio.org/Presentation/216703/abstract Cardiac arrest and non-diagnostic ECG: analysis of the usual practice of a tertiary care hospital MI Barrionuevo,1 L Exposito,2 R Ramos,2 S Calero,2 C Ramirez,2 S Diaz,2 C Urraca,2 JJ Portero,2 J Navarro,2 C Llanos,2 I Lopez,2 MA Simon,2 FM Salmeron,2 J Jimenez2 and MJ Corbi2 1University Hospital Bellvitge, Barcelona, Spain 2GENERAL UNIVERSITY HOSPITAL OF ALBACETE, Albacete, Spain Introduction: The performance of an urgent coronary angiography (UCA) in patients recovered from an extra-hospital cardiorespiratory arrest (CRA) with non-diagnostic ECG remains a controversial issue in daily clinical practice without solid recommendations in clinical practice guidelines. Recent data with the COACT trial seem to suggest that there is no benefit in performing a UCA, which is a change compared to previous data obtained from observational studies that did suggest this benefit. Purpose: The objective of our study was to analyse the characteristics and evolution of patients recovered from a CRA that were treated in our centre with a non-diagnostic ECG, according to whether an UCA was performed or not. Methods: We performed a retrospective analysis of all patients admitted by out-of-hospital with CRA between March 2006 and April 2019. Patients with ST elevation in the ECG were excluded. In the remaining sample, t-student tests were applied for the comparison of means and chi square for the comparison of proportions. Results: A total of 115 patients were collected, 50 (43.3%) of them presented ST elevation and were excluded. In the remaining 65p UCA was performed in 38.5% of the cases (25 patients), at the discretion of the doctor. 25,25% (6 patients) of these presented coronary disease that required angioplasty (PCI). The most frequent was the involvement of the right coronary artery (4 patients), one patient required PCI on the anterior descending and another on the circumflex artery. In the comparative analysis between both groups there were no differences in baseline characteristics (age: 68±5 vs 60±18,5; women 40% vs 35%; Diabetes 44 % vs 32.5%; arterial hypertension 68% vs 55%) except in dyslipidemia (more frequent in the UCA group, 48% vs 22,5%; p=0.03). There were differences in the initial rhythm (more frequently defibrillable rhythm in UCA, 58,3% vs 17,5%; p=0.01). Neurological prognosis was better (CPC 1-2: 39,1% vs 25,6%; p=0.06) and mortality were lower in the UCA group (27,8% vs 72,2%; p=0.04). Performing UCA was not associated with an increased need for dialysis or bleeding. Conclusion: Ischemic heart disease is the main etiology of CRA, especially in defibrillable rhythm. In our analysis, the presence of a defibrillable rhythm was significantly related to the request for an UCA, and in up to 25% of cases a PCI was performed. Performing UCA did not increase the risk of dialysis or bleeding and resulted in a better prognosis for that group of patients. P492 https://esc365.escardio.org/Presentation/216409/abstract Biomarkers of brain injury measured at admission after out-of-hospital-cardiac-arrest have similar prognostic accuracy as wildly known intensive care scoresThe study was supported by Ministry of Science and Higher Education/Military Institute of Medicine, Warsaw, Poland (grant no 474/WIM). R Ryczek,1 PJ Kwasiborski,2 A Rzeszotarska,3 J Korsak,3 M Buksinska-Lisik,2 M Mielniczuk,1 A Karasek,1 A Kazmierczak-Dziuk,1 A Galas1 and P Krzesinski1 1Military Institute of Medicine, Cardiology And Internal Medicine Department, Warsaw, Poland 2Medical University of Warsaw, 3rd Department of Internal Medicine and Cardiology, Second Faculty of Medicine, Warsaw, Poland 3Military Institute of Medicine, Department of Clinical Transfusiology, Warsaw, Poland Background: Prognostication in comatose patients after out-of-hospital-cardiac-arrest (OHCA) is challenging. Despite all advances in intensive care, the prognostic tools in the first 48 hours after admission are scarce. The recently introduced biomarkers of brain injury such as neuron specific enolase (NSE) and glial S-100B protein have the advantage of being independent of clinicians bias, or influence of the sedatives, neuromuscular blocking drugs or targeted temperature management. Thus, it may be applicated at an early hours of managing the patients. Purpose of the study was to compare prognostic accuracy of early measured concentrations of biomarkers of brain injury with wildly acknowledged intensive care scores in predicting bad clinical outcome in the group of OHCA patients. Methods: 74 consecutive comatose patients after OHCA (52male, mean age 64.4±14.7years) admitted to intensive care unit between September 2016 and July 2019 were enrolled to the study. In addition to standard clinical and laboratory assessment neuron NSE and glial S-100B protein were measured at admission. Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores were calculated subsequently. Death or poor neurologic status at discharge (Cerebral Performance Category ≥4) were considered as bad clinical outcome (n=49). In statistical analysis the logistic regression models were set up for NSE and S-100B. Both models were separately compared with the SOFA and APACHE II score using ROC analysis. Results: Both biomarkers: NSE [OR 1.006 (1.002-1.110)] and S-100B [OR 1.098 (1.025-1.175)] measured once, at admission, may be considered as independent predictors of bad clinical outcome. The ROC analysis revealed that the predictive value of both biomarkers solely was similar to the APACHE II and SOFA scores (Figure). The AUC of the NSE and S-100B measured at admission are 0.796 (0.682-0.910) and 0.789 (0.677-0.901) respectively. Those values were similar to the AUC calculated for SOFA - 0.749 (0.633-0.864) and APACHE II - 0.856 (0.768-0.943). Direct comparisons showed no significant difference in terms of bad clinical outcome prediction between single NSE measurement and the SOFA (p=0.6) or the APACHE II (p=0.3) scales. Similar results were achieved for the S-100B in comparison with the results of SOFA (p=0.7) or the APACHE II (p=0.1). Open in new tabDownload slide The ROC curves for analysed predictors. Conclusions: Prognostic ability of early measured concentrations of NSE and S-100B seems similar to SOFA and APACHE II scores in predicting bad clinical outcome after OHCA. This simple, single-step prognostic approach have equal accuracy as multimodal, advanced intensive care risk score calculators. P494 https://esc365.escardio.org/Presentation/217214/abstract Cardiac arrest: which patients can benefit from coronary angiography? S Couto Pereira,1 J Nunes Rigueira,1 P Carrilho-Ferreira,1 I Aguiar-Ricardo,1 P Simoes Morais,1 P Silverio Antonio,1 R Santos,1 T Rodrigues,1 N Cunha,1 F J Pinto1 and P Canas Da Silva1 1Santa Maria University Hospital CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Lisbon, Portugal Background: The identification of the cardiac arrest’s (CA) etiology and the survival probability is challenging. Studies show an association between coronary angiography (CAT) and survival, but the available data are limited and incomplete with respect to the selection of these patients(pts). Purpose: to identify predictors of coronary disease(CD) in a sample of pts submitted to CAT in the context of CA and look for relationship between CD and death. Methods: A single-center retrospective study including consecutive pts submitted to CAT in the context of CA from January 2015-July 2018. Demographic, clinical, echocardiographic, ECG and angiographic data were evaluated. The results were obtained using logistic regression. Results: 121 pts (mean age 63.2 ± 13 years, 76% men) were included. The most frequent comorbidities were: hypertension (63.2%) and dyslipidemia (42.2%). Most of CAs have shockable-rythms (69.4%) and the mean CA duration was 16 ± 17 min. On average, patients underwent CAT 1.3 ± 3 days after CA. The most common cause of CA was myocardial infarction (MI) (65.3%), type 1 in 59.4%, and with ST elevation in 36.4%. 70.6% of the pts had significant elevation (> 5x the upper limit of normality) of troponin (Tn) and 53.7% had wall motion abnormalities (WMA) on the echocardiogram. Significant CD was recorded in 75.4%pts, predominantly involving the anterior descending (55%) and the right coronary (44.9%) arteries. The Tn value presented moderate capacity to predict CD (AUC 0.67 p = 0.022), best cut-off was 168ng / L (Sens=60.4%, Spec=72.7%). There were independent predictors of CD: hypertension (OR 2.43, p = 0.045), post-CA rhythm other than AF/flutter (OR 4.77 p = 0.032), presence of WMA (OR 36.27, p = 0.001), ST elevation (OR 11.1, p = 0.002) and TnThs> 168ng / L (OR 4.06, p = 0.012). There was no association between the presence of CD and mortality, however, a trend towards higher mortality was observed in the group of patients with left main and circumflex disease (p = 0.085 and 0.065, respectively). In patients with CD, angioplasty had no impact on prognosis. Conclusion: This study supports the current recommendations, suggesting that patients with the highest suspicion of MI (Tn elevation, especially TnThs> 168ng / L, WMA and ST elevation) are those who will benefit most from CAT. In our population, hypertensive pts with post-CA rhythm other than AF/flutter had a higher probability of significant CD. On the other hand, there was no relationship between the presence of CD and death suggesting the need for prospective studies with a greater number of pts to assess the value of CAT in this population. P495 https://esc365.escardio.org/Presentation/216462/abstract Novel logistic risk score combining clinical assessment and neuron specific enolase in early prediction of death after out-of-hospital cardiac arrest. The study was supported by Ministry of Science and Higher Education/Military Institute of Medicine, Warsaw, Poland (grant no 474/WIM). P Kwasiborski,1 R Ryczek,2 A Rzeszotarska,3 M Mielniczuk,2 A Galas,2 A Kazmierczak-Dziuk,2 A Karasek,2 M Buksinska-Lisik,1 J Korsak3 and P Krzesinski2 1Medical University of Warsaw, 3rd Department of Internal Medicine and Cardiology, Second Faculty of Medicine, Warsaw, Poland 2Military Institute of Medicine, Cardiology And Internal Medicine Department, Warsaw, Poland 3Military Institute of Medicine, Department of Clinical Transfusiology, Warsaw, Poland Background: Rate of death after out-of-hospital cardiac arrest (OHCA) remains high. Early and accurate prognostication is crucial for withdrawal or escalation of life sustaining therapy. There is no dedicated risk score to evaluate the prognosis in OHCA population. Purpose of the study was to evaluate the novel risk score combining clinical and biochemical parameters measured at admission, in predicting the outcome after OHCA. Methods: 74 unconscious patients after OHCA (mean age 64.4±14.8 years, 52 males) were enrolled to the study. Death was considered as the primary endpoint. Clinical and laboratory data including biomarkers of brain injury (neuron specific enolase (NSE) and glial S-100B protein) were collected at admission. APACHE II and SOFA scores were calculated. A novel Cardiac Arrest Risk Score (CA-RS) was developed using multivariate logistic regression analysis. Table 1. The CA-RS model. . ±std error . OR 95%CI . p . NSE at admission [ng/ml] 0,059±0,023 1,060 (1,014-1,109) 0,010 Creatinine in blood [mg/dl] 2,651±0,980 1,304 (1,076-1,580)* 0,007 OHCA to CPR time [min] 0,166±0,076 1,180 (1,018-1,369) 0,028 Rectal temperature at admission [C] -1,094±0,438 0,335 (0,142-0,791) 0,013 . ±std error . OR 95%CI . p . NSE at admission [ng/ml] 0,059±0,023 1,060 (1,014-1,109) 0,010 Creatinine in blood [mg/dl] 2,651±0,980 1,304 (1,076-1,580)* 0,007 OHCA to CPR time [min] 0,166±0,076 1,180 (1,018-1,369) 0,028 Rectal temperature at admission [C] -1,094±0,438 0,335 (0,142-0,791) 0,013 Variables included in the logistic CA-RS model, the final results of multivariate, reverse stepwise logistic regression analysis. *per 0.1mg/dl.. Open in new tab Table 1. The CA-RS model. . ±std error . OR 95%CI . p . NSE at admission [ng/ml] 0,059±0,023 1,060 (1,014-1,109) 0,010 Creatinine in blood [mg/dl] 2,651±0,980 1,304 (1,076-1,580)* 0,007 OHCA to CPR time [min] 0,166±0,076 1,180 (1,018-1,369) 0,028 Rectal temperature at admission [C] -1,094±0,438 0,335 (0,142-0,791) 0,013 . ±std error . OR 95%CI . p . NSE at admission [ng/ml] 0,059±0,023 1,060 (1,014-1,109) 0,010 Creatinine in blood [mg/dl] 2,651±0,980 1,304 (1,076-1,580)* 0,007 OHCA to CPR time [min] 0,166±0,076 1,180 (1,018-1,369) 0,028 Rectal temperature at admission [C] -1,094±0,438 0,335 (0,142-0,791) 0,013 Variables included in the logistic CA-RS model, the final results of multivariate, reverse stepwise logistic regression analysis. *per 0.1mg/dl.. Open in new tab Results: In an univariate logistic regression analyses the following predictors of death were identified as significant: bystander presence during OHCA, coronary catheterization, shockable rhythm, age, OHCA to CPR time, time to recovery of spontaneous circulation (ROSC), GCS at admission, rectal temperature at admission, pH, lactates, pCO2, creatinine, mean arterial pressure, NSE and S-100B. In multivariable logistic regression only NSE, OHCA to CPR time, creatinine and rectal temperature appeared to be independent predictors of death (Table). In ROC analysis (Figure) the simple CA-RS model was not inferior to more complicated SOFA (p=0,9) or APACHE II (p=0,16) scores in terms of death prediction. Although AUC of APACHE II score is relatively high, its specificity in OHCA population is unacceptably low (Figure). APACHE II cut-off value for death prediction in ICU is 24-25, whilst in analyzed group the optimal cut-off for death prediction should be 34. Open in new tabDownload slide ROC of CA-RS, APACHE II and SOFA. Conclusions: The simple, logistic CA-RS risk model based upon four parameters, may be useful in early prediction of death after OHCA. The addition of NSE brings extra prognostic value to the clinical assessment. The APACHE II risk score overestimates the death probability in OHCA patients, thus it should not be recommended in that population. P496 https://esc365.escardio.org/Presentation/221533/abstract Veno-arterial extracorporeal membrane oxygenation with or without left ventricular unloading devices for cardiac arrest: a retrospective analysis M Pellegrino,1 M Briani,1 P Leone1 and E Corrada1 1Humanitas Research Hospital, Rozzano, Italy Background: Observational trials suggest improved survival and neurological outcomes of cardiac arrest (CA) patients treated with extracorporeal membrane oxygenation (ECMO). Intra-aortic balloon pump (IABP) or Impella may be used to promote left ventricle (LV) unloading and recovery during ECMO. No evidence is available about the benefit of the association of ECMO with LV venting devices in the context of CA. Aim of this study was to analyse the effects of the association of LV unloading devices with ECMO in CA patients. Methods: This was a retrospective single-centre study that included patients treated with ECMO for witnessed CA between January 2015 and 2019. Primary EP: hemodynamic and biochemical differences at 6-12-24 hours between patients treated with ECMO alone or ECMO + LV unloading device (IABP or Impella). Secondary EPs: 30-day survival and complications (renal replacement therapy, bleeding requiring transfusions, stroke, vascular complications). Results: 33 patients were included. Presumed CA cause was ACS in 21 patients (63.6%), with initial shockable rhythm documented in 19 patients (57.6%). Time from CA to ECMO initiation was 54±20 minutes. In 10 (30.3%) patients ECMO was associated with LV unloading devices. PH at 24 hours was higher for ECMO alone group; lactate clearance at 48 hours and haemoglobin at 48 hours were more favourable for ECMO alone group (see Table). 30-day survival (ECMO alone: n = 4, 17.4% vs ECMO+LV unloading: n = 0; χ2 1.98, p 0.16, fisher 0.29) and complications rate (RR 1.1, 95% CI 0.58-2.07) were not significantly different. Conclusion: In our small cohort, the association of a LV unloading device to ECMO in CA patients did not confer short term hemodynamic, biochemical or 30-day survival benefits. Larger trials are needed to confirm these preliminary findings. . ECMO (n = 23) . ECMO + LV unloading (n = 10) . P value . CA-to-ECMO time, minutes 57 ± 17 51 ± 25 0.22 Mean BP at 12 hours, mmHg 72 ± 20 60 ± 20 0.071 Haemoglobin at 12 h, g/dL 10.5 ± 1.7 9.4 ± 2.4 0.082 Mean BP at 24 hours, mmHg 70 ± 15 69 ± 11 0.456 pH at 24 hours 7.37 ± 0.12 7.24 ± 0.19 0.0374 Mean BP at 48 h, mmol/L 76 ± 23 71 ± 18 0.3627 Lactate at 48 h, mmol/L 2.5 ± 1.6 5.2 ± 3.0 0.03 Haemoglobin at 48 h, g/dL 8.8 ± 0.8 7.8 ± 1.1 0.0438 pH at 48 h 7.45 ± 0.6 7.40 ± 0.05 0.0457 . ECMO (n = 23) . ECMO + LV unloading (n = 10) . P value . CA-to-ECMO time, minutes 57 ± 17 51 ± 25 0.22 Mean BP at 12 hours, mmHg 72 ± 20 60 ± 20 0.071 Haemoglobin at 12 h, g/dL 10.5 ± 1.7 9.4 ± 2.4 0.082 Mean BP at 24 hours, mmHg 70 ± 15 69 ± 11 0.456 pH at 24 hours 7.37 ± 0.12 7.24 ± 0.19 0.0374 Mean BP at 48 h, mmol/L 76 ± 23 71 ± 18 0.3627 Lactate at 48 h, mmol/L 2.5 ± 1.6 5.2 ± 3.0 0.03 Haemoglobin at 48 h, g/dL 8.8 ± 0.8 7.8 ± 1.1 0.0438 pH at 48 h 7.45 ± 0.6 7.40 ± 0.05 0.0457 BP:blood pressure. Open in new tab . ECMO (n = 23) . ECMO + LV unloading (n = 10) . P value . CA-to-ECMO time, minutes 57 ± 17 51 ± 25 0.22 Mean BP at 12 hours, mmHg 72 ± 20 60 ± 20 0.071 Haemoglobin at 12 h, g/dL 10.5 ± 1.7 9.4 ± 2.4 0.082 Mean BP at 24 hours, mmHg 70 ± 15 69 ± 11 0.456 pH at 24 hours 7.37 ± 0.12 7.24 ± 0.19 0.0374 Mean BP at 48 h, mmol/L 76 ± 23 71 ± 18 0.3627 Lactate at 48 h, mmol/L 2.5 ± 1.6 5.2 ± 3.0 0.03 Haemoglobin at 48 h, g/dL 8.8 ± 0.8 7.8 ± 1.1 0.0438 pH at 48 h 7.45 ± 0.6 7.40 ± 0.05 0.0457 . ECMO (n = 23) . ECMO + LV unloading (n = 10) . P value . CA-to-ECMO time, minutes 57 ± 17 51 ± 25 0.22 Mean BP at 12 hours, mmHg 72 ± 20 60 ± 20 0.071 Haemoglobin at 12 h, g/dL 10.5 ± 1.7 9.4 ± 2.4 0.082 Mean BP at 24 hours, mmHg 70 ± 15 69 ± 11 0.456 pH at 24 hours 7.37 ± 0.12 7.24 ± 0.19 0.0374 Mean BP at 48 h, mmol/L 76 ± 23 71 ± 18 0.3627 Lactate at 48 h, mmol/L 2.5 ± 1.6 5.2 ± 3.0 0.03 Haemoglobin at 48 h, g/dL 8.8 ± 0.8 7.8 ± 1.1 0.0438 pH at 48 h 7.45 ± 0.6 7.40 ± 0.05 0.0457 BP:blood pressure. Open in new tab Pericardial Disease – Clinical P500 https://esc365.escardio.org/Presentation/216414/abstract Clinical characteristics of pericarditis and myopericarditis diagnosed in the emergency department: factors associated with myocardial involvement and the need for hospitalization. Gemma Martínez-Nadal is granted by Ajuts en la recerca Josep Font in Hospital Clínic de Barcelona. G Martinez-Nadal,1 A Prepoudis,2 O Miro,1 A Matas,1 P Cepas,1 A Aldea,1 M Izquierdo,1 JR Alonso,1 D Flores,2 DM Gualandro,2 C Mueller2 and B Lopez-Barbeito1 1HOSPITAL CLINIC OF BARCELONA, Barcelona, Spain 2University Hospital Basel, Basel, Switzerland Background: In 1966 Smith proposed the term myopericarditis (MyoP) to talk about P with myocardial involvement. This diagnosis was performed with the data provided by anamnesis, physical assessment and electrocardiogram (ECG), while the analysed cardiac enzymes were limited to aspartate and alanine aminotransferases. In 80’s, the assessment of MB fraction creatincinase was suggested to confirm the myocardial involvement in patients diagnosed with P. At the beginning of the XXI century, cardiac troponins (cTn) were introduced as the first line biomarker. Current European Society of Cardiology (ESC) guidelines for the diagnosis and management of pericardial diseases (2015) define P as an acute pericardial inflammatory syndrome. The diagnosis can be made with clinical, electrocardiographic and ecographic criteria; moreover it is recommended the assessment of cTn in order to exclude a MyoP in this scenario. The most common symptom in P is chest pain (CP), and the main concern about this syndrome is set in Emergency Departments (ED). However, there are few studies performed in this area in ED in the last decade. Purpose: To analyse the clinical characteristics of episodes of P diagnosed in ED based on age and the presence of myocardial involvement (MyoP) and determine the factors associated with the need for hospital admission (in P and MyoP). Methods: This is an observational unicentric study. We retrospectively analysed all the cases diagnosed with P in the ED from 2008-2017 and recorded the clinical, electrocardiographic, analytical and ultrasound (US) characteristics. The clinical characteristics were compared according to age (<50 and ≥50 years) and the presence of MyoP. Factors associated with hospitalization (for P and MyoP) were identified as crude and adjusted for clinical differences between groups. Results: During the 10-year study period, 983 P were diagnosed (34% women, median age: 42 years). Younger patients more frequent referred stabbing CP that worsened with respiration or postural changes, whereas older patients had more cardiovascular comorbidities, CP was more frequently oppressive and generated greater suspiciousness of an acute coronary syndrome. The only variable independently associated with MyoP (72 cases, 7%) was electrocardiographic alterations (OR=4.26; CI95%=1.89-9.59). 62 P (6%) were admitted in association with a history of chronic kidney disease (OR=4.83; CI95%=1.66-14.05), CP increasing with respiratory/postural movement (OR=0.54, CI95%=0.29-0.99), tachycardia (OR=2.29, CI95%=1.15-4.55) and MyoP (OR=8.73, CI95%=4.65-16.38). 24 MyoP were admitted (33%), based on alterations found in US (OR=13.72, CI95%=1.80-104). Conclusions: Age may condition the clinical presentation of patients with P. Alterations in the ST segment in the ECG are suggestive of myocardial involvement. Chronic kidney disease, tachycardia and MyoP increase the need of hospitalization in P, and the alterations in US in MyoP cases. P501 https://esc365.escardio.org/Presentation/216427/abstract Dynamic changes of troponin and creatinine phosphokinase in acute myocarditis and non-ST elevation myocardial infarction O Koren,1 I Abu-Daoud,2 B Elad,2 E Rozner3 and Y Turgeman3 1Emek Medical Center, Kfar tavor, Israel 2Haemek Medical Center, Internal Medicine C, Afula, Israel 3Haemek Medical Center, Heart Institute, Afula, Israel Background: Myocarditis and acute Myocardial Infarction pose a daily diagnostic dilemma. Magnetic resonance imaging and endomyocardial biopsy are the gold standard for definite diagnosis but are rarely performed routinely. Troponin and Creatine phosphokinase (CPK) are elevated in both diseases and could not be used for proper discrimination. We analyzed the dynamics of these serum markers during acute setting by analyzing the tangent slope of their level curve over time. Method: We conducted a retrospective cohort study in our medical center. Records of approximately 1,300 patients hospitalized from January 2011 to December 2016 were examined. A total of 193 patients were found to be eligible for the study and were divided into two groups: Myocarditis group (n=133, 69%) and non-ST elevation myocardial infarction group (n=60, 31%). Results: The non-ST elevation myocardial infarction group was significantly older than the myocarditis group (mean age 68.7 vs 35.6 years, p<.001). Median troponin and CPK levels were significantly higher in the myocarditis group (p<.001). The tangent slope of troponin curve was significantly lower and CPK curve significantly higher in the myocarditis group (p<.002 and p<.04, respectively). Troponin-to-CPK ratio was lower within the first 48 hours from admission in the myocarditis group. Conclusion: Our study demonstrates a unique discriminating pattern of serum markers curve in acute Myocarditis and acute Non-ST myocardial infarction. In acute myocarditis, troponin progress moderately while CPK progress steeply, both to higher peak, resulting in lower troponin to CPK ratio in the first 48 hours of admission. Table 1. P-value . NSTEMI (n=60) . Myocarditis (n=133) . . .001 330.3±293.2 (181; 22-1432) 644.0±651.4 (440; 0-3050) Troponin values (mean ± standard deviation, median, range) .02 1630.20±402.77 (1041.9; 231.9-12941.8) 937.18±407.05 (742.2; 145.2, 7376.9) Tangent Slope Troponin curve (ng * time (hours)/ml) .001 365.4±268.1 (155.9; 43-2360) 643.5±436.9 (290.3; 24-6362) Tangent Slope CPK curve (ng * time (hours)/ml) <.05 3.59 1.8 Troponin and CPK ratio in the first 24 hours P-value . NSTEMI (n=60) . Myocarditis (n=133) . . .001 330.3±293.2 (181; 22-1432) 644.0±651.4 (440; 0-3050) Troponin values (mean ± standard deviation, median, range) .02 1630.20±402.77 (1041.9; 231.9-12941.8) 937.18±407.05 (742.2; 145.2, 7376.9) Tangent Slope Troponin curve (ng * time (hours)/ml) .001 365.4±268.1 (155.9; 43-2360) 643.5±436.9 (290.3; 24-6362) Tangent Slope CPK curve (ng * time (hours)/ml) <.05 3.59 1.8 Troponin and CPK ratio in the first 24 hours Primary and Secondary End Points among study groups Open in new tab Table 1. P-value . NSTEMI (n=60) . Myocarditis (n=133) . . .001 330.3±293.2 (181; 22-1432) 644.0±651.4 (440; 0-3050) Troponin values (mean ± standard deviation, median, range) .02 1630.20±402.77 (1041.9; 231.9-12941.8) 937.18±407.05 (742.2; 145.2, 7376.9) Tangent Slope Troponin curve (ng * time (hours)/ml) .001 365.4±268.1 (155.9; 43-2360) 643.5±436.9 (290.3; 24-6362) Tangent Slope CPK curve (ng * time (hours)/ml) <.05 3.59 1.8 Troponin and CPK ratio in the first 24 hours P-value . NSTEMI (n=60) . Myocarditis (n=133) . . .001 330.3±293.2 (181; 22-1432) 644.0±651.4 (440; 0-3050) Troponin values (mean ± standard deviation, median, range) .02 1630.20±402.77 (1041.9; 231.9-12941.8) 937.18±407.05 (742.2; 145.2, 7376.9) Tangent Slope Troponin curve (ng * time (hours)/ml) .001 365.4±268.1 (155.9; 43-2360) 643.5±436.9 (290.3; 24-6362) Tangent Slope CPK curve (ng * time (hours)/ml) <.05 3.59 1.8 Troponin and CPK ratio in the first 24 hours Primary and Secondary End Points among study groups Open in new tab Open in new tabDownload slide Cardic markers pattetn in myocarditis. Pulmonary Circulation, Pulmonary Embolism, Right Heart Failure: Pharmacotherapy P503 https://esc365.escardio.org/Presentation/216744/abstract Thrombolytic therapy in patients with high and intermediate risk pulmonary embolism M Teterina,1 AS Pisaryuk,1 OI Lukina,1 LA Babaeva,1 AF Safarova,1 I Meray1 and ZHD Kobalava1 1Peoples Friendship University of Russia (PFUR), Moscow, Russian Federation Introduction: Thrombolytic therapy leads to faster improvement of clinical symptoms and reduction of pulmonary hypertension in patients with severe pulmonary embolism. However, there is less information regarding the efficacy and safety of such therapy in patients in the intermediate risk group. Objective: Evaluation of clinical course of patients admitted to ICU department with pulmonary embolism, treated by thrombolytic therapy. Methods: 78 consecutive patients with acute pulmonary embolism who were hospitalized in ICU were conducted to the study. Hospital mortality and complications were assessed, as well as outcomes after 6 and 12 months. The mean age of patients was 63 (IQR 55–72), 38% of them were men. 70% (n = 55) of patients were in the intermediate risk group, 18% (n = 14) were low risk group and 12% (n = 9) - high risk (2019 ESC Guidelines). Thrombolysis was performed on 42 patients: 21,4% in the high (n = 9), 78.6% in the intermediate (n = 33) risks group. Results: Patients who underwent thrombolysis had significantly lower oxygen saturation (90.3% [IQR 88-95]) versus patients without thrombolysis (92.5% [IQR 90-95.7]), p <0.05. According to CT pulmonary angiography, the Miller indices was significantly higher in the group of patients with thrombolysis (19.9 [IQR18.0-21.6]) than in the group without thrombolysis (15.5 [IQR 12.8-18.8]), p <0.05. Mortality after a 12-month follow-up period was 22% in the general group (n = 17): 67% (n = 11) in high risk group and 11% (n=6) in the intermediate risk group. In the thrombolysis group only 2 patients have died (1 with high risk and 1with intermediate risk). Thrombolysis was associated with a decrease in mortality [OR 0.1 (95% CI 0.0-0.3)]. The presence of past history of chronic heart failure [OR 5.3 (95% CI 1.2-22.7)] and SBP less than 100 mm Hg [OR 9.1 (95% CI 2.4-34.2)] were associated with a higher death rate. Hemorrhagic complications were found only in the group of patients with a thrombolysis: hemorrhagic stroke in 1 (1.3%) case and subcutaneous hematoma (minor bleeding) in 2 (2.6%) cases. Conclusion. In our study, thrombolytic therapy in patients with pulmonary embolism was associated with decreased mortality. P505 https://esc365.escardio.org/Presentation/216482/abstract Right heart thrombi in pulmonary embolism patients RL Avram,1 AC Nechita,1 C Delcea,2 AM Andronescu,1 G Vladu,1 S Andrucovici,1 MM Baluta1 and SC Stamate1 1St. Pantelimon Emergency Hospital, Bucharest, Romania 2Colentina University Hospital, Bucharest, Romania Introduction: There is a lack of comprehensive data on the prevalence, predictors and prognostic significance of right heart thrombi (RHT) in acute pulmonary embolism (APE). Therapeutic options in these patients consist of anticoagulation, thrombolysis or surgical embolectomy, but the optimal management remains controversial. Material and methods: The lot consisted of 130 patients consecutively hospitalized in the Cardiology Clinic of an Emergency Clinical Hospital between January 2014 and September 2019. Results: The mean age of the study group was 67.7 ± 12.7 years, with 62.3% female patients. Of the 130 patients with APE, 13.7% (n = 16) presented with RHT. The mean age of RHT patients was 69.2 ± 12.6 years, with no differences in gender distribution. We have not identified significant differences in risk factors, onset symptoms or hemodynamic status. The values of troponin I or natriuretic peptides were similar along with electrocardiographic and echocardiographic data. The presence of DVT was significantly higher in patients with RHT (OR = 10.5, CI 95% 2.2-48.8, p = 0.001). PESI score was higher in the RHT group but without statistical significance (112.2 vs. 107.4, p = 0.6). In the group of patients with RHT the mean duration of hospitalization was significantly higher (14.6 days vs 10.9 days, p = 0.008) and thrombolysis was administered to 4 patients, similar to those without chamber thrombosis. In our group, RHT did not associate with a higher mortality during hospitalization. Conclusion: Right heart thrombi in patients with APE are relatively rare finding in current practice. Beyond the ease of diagnosis using echocardiography, there remains uncertainty about their role in the therapeutic decision. We recommend individual risk assessment and the subsequent adjustment of the intensity and type of therapy. P506 https://esc365.escardio.org/Presentation/216426/abstract Duration of hospitalization in acute pulmonary embolism R Avram,1 AC Nechita,1 C Delcea,2 G Vladu,1 S Andrucovici,1 AM Andronescu,1 MM Baluta1 and SC Stamate1 1St. Pantelimon Emergency Hospital, Bucharest, Romania 2Colentina University Hospital, Bucharest, Romania Introduction: A series of clinical scores were developed to assess the risk of complications in patients with acute pulmonary embolism (APE), in order to better select those with short-term reduced risk that can be treated as outpatients or rapidly discharged from the hospital, if circumstances are adequate. Still, most APE patients are admitted to the hospital for initiation of treatment, independent of correlation to lower risk of complications. Our aim was to evaluate the parameters associated with prolonged hospitalization of APE patients, for optimizing the selection of patients to be treated as inpatients. Materials and methods: We prospectively evaluated all consecutive adult patients diagnosed with APE admitted to our Cardiology Department from January 2014 to September 2019. Patients with in-hospital mortality were excluded. We considered an extended length of hospital stay (LOS) a duration longer than the median time of hospitalization of our study group. Results: The study cohort included 111 patients with a mean age of 66.8 ±12.4 years. 63.1% were female. The median LOS was 10 (interquartile range 8-13) days. An extended LOS was considered to be longer than 10 days. Female patients had a similar LOS compared to male patients. Clinical parameters such as heart rate (r=0.238, p=0.012) and shock index (r=0.274, p=0.004) were correlated to LOS. Higher leucocyte count (r=0.242, p=0.011) and lower hemoglobin levels (r=0.211, p=0.027) were also associated with an extended hospitalization, as was an increased diameter of the inferior vena cava (r=0.299, p=0.011). Patients with prior prolonged immobilization had a higher risk of an extended LOS (RR 1.60, 95%CI 1.25-2.06, p=0.008). Patients with a new right bundle branch block (1.53, 95%CI 1.03-2.25, p=0.037), deep vein thrombosis (1.41, 95%CI 1.04-1.91, p=0.03) and a free floating right heart thrombus (1.45, 95%CI 1.10-1.92, p=0.05) had a higher risk for prolonged hospitalization. Increased troponin levels associated the highest risk of extended LOS (2.07, 95%CI 1.34-3.21, p<0.001). No significant correlation was found between PESI score and LOS. Conclusions: The median duration of hospitalization of APE patients is still prolonged, which carries a significant economic burden. The highest risk of prolonged LOS was found for patients with increased troponin levels and prior prolonged immobilization. Deep vein thrombosis and free floating right heart thrombus were also associated with longer LOS. We consider the development of a discharge criteria chart relevant in guiding the physician while choosing the optimal duration of hospitalization using frequent clinical and paraclinical evaluations. P507 https://esc365.escardio.org/Presentation/216497/abstract The role of invasive diagnostics in the era of multi modality imaging.None G Besis,1 T Kakoudaki2 and Z Yousef2 1Fondazione Policlinico Universitario Gemelli IRCCS, Catholic University, Rome, Italy 2University Hospital of Wales, Cardiology, Cardiff, United Kingdom of Great Britain & Northern Ireland Introduction: We retrospectively reviewed the medical records of patients that underwent right heart (RH) catheterisation and/or cardiac biopsy in our institution from 2017 until June 2019.We concluded that in a significant percentage of cases the diagnosis and subsequent management changed following the results of the invasive diagnostic procedure ( right heart catheterisation and/or cardiac biopsy).In the era of modern non invasive multi modality imaging it is unclear if the use of invasive diagnostic procedures is still warrantied and justified from a patient safety perspective. Purpose: We sought to investigate if the use of invasive diagnostics will influence management in the era of multi modality imaging with an acceptable complication rate. Methods: The medical records of patients that underwent right heart catheterisation and/or cardiac biopsy at the University Hospital of Wales in Cardiff, United Kingdom, between January 2017 and June 2019 were reviewed.For each patient, the diagnosis and management plan before and after the invasive diagnostic procedure were compared.Data regarding the non invasive diagnostic modalities performed in each patient were collected.The database of our cardiac catheterisation laboratory was used to collect data regarding indication of the procedure, complications and access site( ie femoral brachial etc).First two authors were involved in protocol writing and data collection.The last author had the overall supervision. Results: In 82% of patients that underwent an invasive diagnostic procedure, the diagnosis and management plan changed post procedure.The vast majority of the invasive procedures were performed via the femoral route with an overall complication rate of 2%.No fatal complications were encountered.All patients underwent a comprehensive transthoracic echocardiographic study.26.6% of patients underwent computed tomography,10.8% underwent cardiac magnetic resonance study and 7.5 % had a nuclear medicine test. Table 1. Table depicting the types of non invasive imaging modalities used and the percentage of patients that underwent each investigation. Non invasive modalities . Number of cases . Percentage (%) . CT 32 26.6 CMR 13 10.8 Nuclear 9 7.5 Echo 120 100 Non invasive modalities . Number of cases . Percentage (%) . CT 32 26.6 CMR 13 10.8 Nuclear 9 7.5 Echo 120 100 Open in new tab Table 1. Table depicting the types of non invasive imaging modalities used and the percentage of patients that underwent each investigation. Non invasive modalities . Number of cases . Percentage (%) . CT 32 26.6 CMR 13 10.8 Nuclear 9 7.5 Echo 120 100 Non invasive modalities . Number of cases . Percentage (%) . CT 32 26.6 CMR 13 10.8 Nuclear 9 7.5 Echo 120 100 Open in new tab Open in new tabDownload slide Impact of RH study to patient management. Conclusions: Right heart catheterisation and cardiac biopsy add incremental information and influence the management of patients that have been investigated with non invasive diagnostic modalities with a very low complication rate. Pulmonary Embolism P509 https://esc365.escardio.org/Presentation/216492/abstract Systemic to pulmonary systolic pressure ratio as a predictor for in-hospital mortality in intermediate- or high-risk pulmonary embolism - a retrospective analysis from a single center. V Grigorov,1 E Dimitrova,1 E Trendafilova,1 A Alexandrov,1 H Mateev,1 E Kostova,1 N Gotcheva1 and B Georgiev1 1National Heart Hospital, Sofia, Bulgaria Background: Risk stratification of patients with acute pulmonary embolism (PE) is crucial in deciding appropriate therapy management. The systemic to pulmonary systolic pressure ratio (SPR) is an easily obtained parameter using conventional sphygmomanometry and basic echocardiography. Purpose: The objectives of this analysis were: 1) to investigate the association of SPR with in-hospital mortality in a population of patients with intermediate- or high-risk PE; and 2) to compare SPR to shock index (SI; defined as heart rate to systolic pressure ratio), high-sensitivity troponin I (hs-TnI) at admission and Pulmonary Embolism Severity Index (PESI) for prediction of in-hospital mortality. Methods: We performed a retrospective analysis of consecutive patients with intermediate or high-risk PE (presenting with shock or evidence of right ventricular overload and/or elevated high-sensitivity troponin I) who were hospitalized in our ICU between January 2018 and August 2019. Systolic pulmonary pressure was obtained using peak tricuspid regurgitation velocity from echocardiography at admission. Results: Out of 60 patients admitted to the ICU during the study period, 42 subjects had all data available and were included in the analysis (54.8% were males and mean age was 65.7 ± 14.1 years). The overall in-hospital mortality rate was 11.9% (5 subjects). Subject who died had significantly lower mean SPR (1.56 ± 0.49 vs 2.19 ± 0.51, p = 0.014) and higher median hs-TnI (0.49 [IQR: 0.24 – 1.59] vs 0.10 [IQR: 0.036 -0.31] ng/ml, p = 0.026) whereas there was no statistically significant difference in median PESI (106 [IQR: 85 - 179] vs 107 [IQR: 90 – 134], p = NS) and median SI (0.75 [IQR: 0.59 – 1.27] vs 0.76 [IQR: 0.59 – 0.95], p = NS) between the groups. Both SPR (OR 0.06, 95% CI: 0.005 – 0.740, p = 0.028) and hs-TnI (OR 5.747, 95% CI:1.147 – 28.785, p = 0.033) were associated with in-hospital mortality whereas there was no statistically significant association between both PESI and SI with mortality (OR 1.102, 95% CI: 0.987 – 1.037 and OR 4.230, 95% CI: 0.156 – 114.546, respectively). A receiver operator curve (ROC) analysis was used to evaluate the predictive power of SPR and hs-TnI for in-hospital mortality – it demonstrated AUC of SPR 0.819 (95% CI: 0.656 – 0.982, p = 0.022) and AUC of hs-TnI 0.811 (95% CI: 0.617 – 1.000, p = 0.026). Both PESI and SI had no predictive value (AUC 0.505, 95%CI 0.213 – 0.798 and 0.576, 95%CI: 0.284 – 0.867 respectively, p = NS for both). The optimal cut-off value of SPR for predicting in-hospital mortality was < 2.15 with sensitivity 100% and specificity 62.2%. Conclusion: Systemic to pulmonary systolic pressure ratio is a significant predictor of in-hospital mortality in patients with intermediate- or high-risk PE. The predictive value of SPR for in-hospital mortality is high with an optimal cut-off value of 2.15 to identify PE patients at increased risk of death during the acute PE event. P511 https://esc365.escardio.org/Presentation/216484/abstract Risk stratification of patients with acute pulmonary embolism and a low-moderate risk as per PESI score R Ventura Gomes,1 R Santos,1 J Neiva,1 S Almeida,2 C Mendonca1 and C Rabacal1 1Hospital de Vila Franca de Xira, Cardiology, Vila Franca de Xira, Portugal 2Hospital N.S. Rosario, Cardiology, Barreiro, Portugal Introduction: The risk stratification of patients with acute pulmonary embolism (EP) has implications in their short-term management. Patients with a low-moderate risk of adverse events can be candidates to an early discharge and continuation of anticoagulation on an ambulatory basis or to a shorter in-hospital monitorization, however this should be a risk-adjusted decision. This further stratification ideally would be performed through simple and inexpensive markers, easily accessible in the daily practice. Purpose: To identify, in patients with acute EP and a PESI score ≤105, the predictors of 30-day mortality, not included in that score. Methods: Retrospective cohort study of consecutive hospitalized patients with acute EP and a PESI score ≤105, admitted between January 2012 and December 2016. Patients with haematologic or infectious diseases were excluded. The demographic, lab, electrocardiographic and echocardiographic data were collected and analysed as predictors of 30-day mortality. Results: 84 patients with acute EP and a PESI score ≤105 were included (age 63±16 years, 34.5%men). Mean PESI score was 79±17 (low risk) and the 30-day mortality was 6.0% (n=5). Patients who died were older (73±8 vs 62±16years old, p=0.034); had higher PESI score (103±2 vs 77±16, p<0.0001), percentage of active cancer (40.0% vs 3.8%, p=0.027), neutrophil counts (8.8±1.8x10^9/L vs 6.1±2.2x10^9/L, p=0.029), neutrophil to lymphocyte ratio (NLR; 9.7, IQR 6.0-15.8, vs 3.9, IQR 2.5-5.0, p=0.006) and platelets to lymphocyte ratio (PLR; 340.7, IQR 204.7-561.5, vs 126.1, IQR 86.8-164.2, p=0.011) and lower lymphocyte counts (0.9x10^9/L, IQR 0.6-1.5, vs 1.8x10^9/L, IQR 1.4-2.3, p=0.018). In the multivariate analysis, excluding from the model the variables included in PESI score, only RNL was predictor of 30-day mortality (OR 1.19; CI 95%: 1.024-1390; p=0.023). ROC curve analysis showed an excellent discriminative capacity for RNL (AUC 0.866, p<0.0005, IC 0.774-0.930), with an optimal cut-off value of 7.5 (sensitivity 80.0%, specificity 94.9%). Conclusion: The present study showed that the RNL, obtained from a simple complete blood count test on hospital admission, was a predictor of 30-day mortality in patients with acute EP and low-moderate risk according to PESI score. This marker of systemic inflammation warrants further investigation in the risk stratification of acute EP patients, due to its simplicity, widespread availability and the lack of scoring systems to predict the prognosis of these low-moderate risk patients. P513 https://esc365.escardio.org/Presentation/216434/abstract First russian registry of pulmonary embolism sirena D Duplyakov,1 O Barbarash,2 S Berns,3 A Erlikh,4 E Shmidt3 and V Kheraskov2 1Samara Regional Cardiology Center, Samara, Russian Federation 2Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo, Russian Federation 3Moscow State Medical and Dental University, Moscow, Russian Federation 4City Hospital 29, Moscow, Russian Federation Backgrounds: The acute pulmonary embolism (PE) is one of key causes of cardiovascular death in the world. There are no contemporary registries with complete information about treatment and outcomes of patients (pts) with PE. The AIM of our study was to assess characteristics of acute PE treatment in hospitals around Russia. Methods: RusSIan REgistry of acute pulmoNAry embolism (SIRENA) was investigator-initiated, nonrandomized, open-label, multicenter registry. From Apr 2018 till Apr 2019 year 20 hospitals from 15 cities around Russia enrolled all consecutive pts with acute PE diagnosed in accordance with routine practice. Nine hospitals were University/Tertiary Hospitals, 10 were city hospitals, and 1 private. The in-hospital death from all causes was the primary endpoint. Results: 609 pts (mean age 63.0±14.5 years, minimum-maximum 19-94 years, women 50.7%) were enrolled in SIRENA registry altogether. Dyspnea, syncope/presyncope, chest pain/discomfort and cough/hemoptysis as PE symptoms were observed in 540 (88.7%), 179 (30.0%), 178 (29.8%) and 105 (17.2%) pts, respectively. The median time from symptoms onset to PE confirmation was 4 days (1-3 quartiles 1-8 days). Thirty pts (4.9%) had low systolic blood pressure [BP] (<90 mmHg) at admission. Index sPESI ≥1 was in 381 (65.0%) pts. The D-dimer was measured in 314 (51.6%) and troponin I in 345 (56.7%) patients. The vein ultrasonography was performed in 523 (85.9%) pts, and vein thrombosis was revealed in 57.7% of them. CT with pulmonary angiography, pulmonary scintigraphy and angiography for PE confirmation were performed in 298 (49.0%), 5 (0.8%) and 5 (0.8%) patients, respectively. Thrombolysis was used in 152 (25.0%) pts (TAP 61.6%), but only in 44% of them was performed due to high risk (low BP/shock). Anticoagulants were used in 553 (90.8%) pts: unfractionated heparin – in 279 (45.8%) pts (the target APTT was achieved in 119 [42.7%]), LMWH – in 354 (56.6%) [only in 92 (32.2%) pts the LMWH was used in body mass adjusted dose], oral anticoagulants – in 447 (73.4%) patients (apixaban – 47 [7.7%], dabigatran – 133 [21.8%], rivaroxaban – 193 [31.7%], warfarin – 122 [20.0%] patients [the target INR level was achieved in 48% of pts on warfarin]). The non-vitamin K oral anticoagulants (NOACs) was used in 360 (65.1%) and in 76 (13.7%) pts at the onset of anticoagulant therapy. The implantation of inferior vena cava filter or thrombectomy was performed in 16 (2.6%) pts. In-hospital death occurred in 60 (9.9%) pts, severe bleeding (BARC 3-5) – in 6 (0.9%) pts. Conclusions: The data of first Russian registry SIRENA showed some features of in-hospital treatment of pts with acute PE: 1) the diagnosis of PE was confirmed by CT angiography only in half of cases; 2) Thrombolysis was used in 25% of pts, but only in 44% due to shock/hypotension. However, without severe bleeding events; 3) NOACs were the most widely used among all anticoagulants P514 https://esc365.escardio.org/Presentation/217607/abstract Troponin I in pulmonary thromboembolism: the power of discrimination A Azul Freitas,1 S Martinho,1 J Almeida,1 C Ferreira,1 J Ferreira,1 J Milner,1 E Jorge1 and L Goncalves1 1University Hospitals of Coimbra, Cardiology, Coimbra, Portugal Introduction: High sensitivity troponin (HsTn) is the standard method for the diagnosis of acute myocardial infarction and has prognostic value in other contexts, such as pulmonary thromboembolism (PTE), where it should be dosed to allow risk stratification of short-term hemodynamic decompensation. Purpose: In this study, we aimed to evaluate the value of HsTn on the prognosis of patients with PTE. Methods: We included all patients with PTE diagnosed by thoracic computed tomography in the year 2016 at our hospital. The anatomic extension of PTE was categorized into subsegmental, segmental, lobar and central. It was used a Troponin I assay with a detection threshold of 0.017 μg/L and a 99% percentile (P) of 0.056 μg/L. The outcomes were mortality at 1, 3 and 6 months. Results: The mean age of the 154 patients included was 73.8 years (SD ± 16) with a female preponderance (64.3%). Regarding the anatomical location, 5.8% of PTE were subsegmental, 29.2% segmental, 35.1% lobar and 29.9% central. Overall mortality was 14.3% at 1 month, 22.1% at 3 months and 28.6% at 6 months. Compared to patients with negative HsTn test (inferior to P99%), patients with a positive HsTn test (equal or superior to P99%) had an increased mortality at 1 month (17.7% vs. 6.8%, OR 3.04, 95% CI 0.99-9.28, P = 0.044) but not at 6 months (27.9% vs. 24.3%, OR 1.20, 95% CI 0.56-2.60, P = 0.640). For the 1-month mortality outcome, c-statistic was moderate, 0.641, with a sensitivity of 69% and a specificity of 61% for a calculated threshold of 0.0795 μg/L. HsTn presented a moderate positive correlation with the anatomical location (ρ = 0.517, P <0.001), presenting a mean of 0.019 ± 0.004 μg / L in the subsegmental location, 0.065 ± 0.2 μg / L in the segmental, 0.29 ± 0.53 μg / L in the lobar and 0.58 ± 0.83 μg / L in the central. Conclusions: Mortality at 1 month and 6 months after PTE remains very high. The even marginal increase in HsTn is associated with triple mortality at 1 month, but not at 6 months. This may indicate that HsTn is a good marker of acute myocardial stress, but not of long-term events, where other competing causes of death may play a more relevant role. The HsTn calculated threshold is slightly higher than that established for the 99%P, so we assume this is a good threshold to identify which patients have an adverse prognosis. Atrial Fibrillation - Epidemiology, Prognosis, Outcome P517 https://esc365.escardio.org/Presentation/217229/abstract Triggers of atrial fibrillation in the postoperative period in patients who died after non-cardiac surgery O Dzhioeva,1 D Orlov1 and V Shvartz2 1Russian National Research Medical University, Moscow, Russian Federation 2Bakulev Scientific Research center, Moscow, Russian Federation Atrial fibrillation is the most frequent postoperative heart rate disorder in patients who have undergone non-cardiac surgery. The aim of our research is to identify the main triggers for the development of atrial fibrillation, which affected the death outcome after non-cardiac surgery. In retrospect, we examined the medical records of 83 patients who died after an non-cardiac surgery. In comparing the incidence of atrial fibrillation in the postoperative period in patients with non-cardiac surgery, statistically significant differences were obtained depending on the development of sepsis in patients (p<0.001, Pearson x2) and thromboembolic complications (p=0.046, Pearson x2). The chances of AF increased in the presence of sepsis in the postoperative period by 7.25 times (95% CI: 2.22-23.67), in the presence of FS in the postoperative period by 2.84 times (95% CI: 0.997-8.11). When comparing the incidence of atrial fibrillation in the postoperative period in patients with extracardiac surgery, depending on the presence of other factors, no statistically significant differences were obtained. Table 1. Factors . absence . presence . n. . % . n. . % . DM 55 66,3 28 33,7 CHD 66 79,5 17 20.5 COPD 76 91,6 7 8,4 Sepsis in postoperative period 50 60,2 33 39,8 Bleeding in postoperative period 64 77,1 19 22,9 VTE 54 65,1 29 34,9 AF before surgery 58 69,9 25 30,1 Pneumonia in postoperative period 30 36,1 53 63,9 AF in postoperative period 29 34,9 54 65,1 Factors . absence . presence . n. . % . n. . % . DM 55 66,3 28 33,7 CHD 66 79,5 17 20.5 COPD 76 91,6 7 8,4 Sepsis in postoperative period 50 60,2 33 39,8 Bleeding in postoperative period 64 77,1 19 22,9 VTE 54 65,1 29 34,9 AF before surgery 58 69,9 25 30,1 Pneumonia in postoperative period 30 36,1 53 63,9 AF in postoperative period 29 34,9 54 65,1 Open in new tab Table 1. Factors . absence . presence . n. . % . n. . % . DM 55 66,3 28 33,7 CHD 66 79,5 17 20.5 COPD 76 91,6 7 8,4 Sepsis in postoperative period 50 60,2 33 39,8 Bleeding in postoperative period 64 77,1 19 22,9 VTE 54 65,1 29 34,9 AF before surgery 58 69,9 25 30,1 Pneumonia in postoperative period 30 36,1 53 63,9 AF in postoperative period 29 34,9 54 65,1 Factors . absence . presence . n. . % . n. . % . DM 55 66,3 28 33,7 CHD 66 79,5 17 20.5 COPD 76 91,6 7 8,4 Sepsis in postoperative period 50 60,2 33 39,8 Bleeding in postoperative period 64 77,1 19 22,9 VTE 54 65,1 29 34,9 AF before surgery 58 69,9 25 30,1 Pneumonia in postoperative period 30 36,1 53 63,9 AF in postoperative period 29 34,9 54 65,1 Open in new tab Based on the values of regression coefficients, the factors of VTE and sepsis in the postoperative period have a direct connection with the probability of developing paroxysms of atrial fibrillation in the postoperative period in patients who have non-cardiac surgery. The resulting regression model is statistically significant (p < 0.001). Model takes into account 27.1% of factors determining the probability of developing paroxysms of atrial fibrillation in postoperative period. The sensitivity and specificity of this model were 69.0% and 75.9%, respectively. The diagnostic value of this model was 73.5%. Conclusion: sepsis and VTE are triggers of AF after non-cardiac surgery. P518 https://esc365.escardio.org/Presentation/216470/abstract Polymorphic allelic variant of a gene of a MTHFR with development of an ischemic stroke in patients with an arterial hypertension A Chernova,1 S Nikulina,1 S Tretyakova,1 DA Nikulin,1 V Maksimov2 and A Kelemeneva1 1Krasnoyarsk State Medical University named prof. V. F. Voino-Yasenecky, Krasnoyarsk, Russian Federation 2Institute of Internal Medicine SB RAMS, Novosibirsk, Russia, Novosibirsk, Russian Federation Introduction: The gene of MTHFR is located on 1 chromosome (1p36.3) and consists of 11 ekzon. The gene of MTHFR codes enzyme a metilentetragidrofolatreduktaza which catalyzes transition of the 5.10-metilentetragidrofolat in 5-metiltetragidrofolat. This reaction represents multistage process which will transform amino acid homocysteine to methionine. Purpose: Studying of a contribution of rs619203 polymorphism of a gene ROS1 to development of ischemic stroke at patients with an arterial hypertension. Methods: Examination of 124 patients with an ischemic stroke with an arterial hypertension is conducted. Age median – 60[51; 66.75] years from which there were 75 men, an age median – 57[50; 64.5] years and 49 women, an age median – 63[54; 70] years. Clinical investigation included assessment of neurologic symptoms, a research of the somatic status, control of the ABP, record ECG, an echocardiography, a X-ray analysis, the general and biochemical blood tests, ultrasonic examination of carotid arteries, brain computer tomography. Duration, weight and the sequence of development of the accompanying somatopathies and risk factors were analyzed. The family anamnesis including assessment of existence of disturbances of cerebral circulation in the anamnesis, existence of arterial hypertension, heart diseases (a MI, cardiac arrhythmia, HFA), existence of risk factors was studied. Results Frequency of a homozygous genotype of AA on a widespread allele at patients with an ischemic stroke was 81.5%±3.5, a heterozygous genotype of AG – 16.1%±3.3 and a homozygous genotype of GG on a rare allele-2.4%±1.4. In control group 72.9%±4.1 were carriers of a homozygous genotype of AA on a widespread allele, 26.3%±4.1 – carriers of a heterozygous genotype of AG and 0.8%±0.8 – carriers of a homozygous genotype of GG on a rare allele of a gene of MTHFR. Conclusions: Thus, by results of a research some prevalence of carriers of a homozygous genotype of AA on a widespread allele among patients with an ischemic stroke (81.5%±3.5) in comparison with group of control (72.9%±4.1) is established, but this distinction was statistically not significant. Also it is not established statistically significant distinctions on MTHFR gene alleles. P519 https://esc365.escardio.org/Presentation/216469/abstract Polymorphic allelic variant 9 of a chromosome in association with development of an ischemic stroke A Chernova,1 S Nikulina,1 S Tretyakova1 and DA Nikulin1 1Krasnoyarsk State Medical University named prof. V. F. Voino-Yasenecky, Krasnoyarsk, Russian Federation Introduction: Rs1333049 is located on a chromosome 9r21.3 in the so-called ANRIL area (area of not coding RNA). Purpose: To study a role of polymorphic allelic rs1333049 options (a chromosome 9p 21.3) in development of a stroke in patients with cardiovascular pathology. Methods: Examination of 124 patients with an ischemic stroke with an arterial hypertension is conducted. Age median – 60[51; 66.75] years from which there were 75 men, an age median – 57[50; 64.5] years and 49 women, an age median – 63[54; 70] years. Clinical investigation included assessment of neurologic symptoms, a research of the somatic status, control of the ABP, record ECG, an echocardiography, a X-ray analysis, the general and biochemical blood tests, ultrasonic examination of carotid arteries, brain computer tomography. Duration, weight and the sequence of development of the accompanying somatopathies and risk factors were analyzed. The family anamnesis including assessment of existence of disturbances of cerebral circulation in the anamnesis, existence of arterial hypertension, heart diseases (a MI, cardiac arrhythmia, HFA), existence of risk factors was studied. Results: Frequency of a homozygous genotype of GG on a widespread allele at patients with an ischemic stroke was 23.1%±3.8, a heterozygous genotype of CG – 47.1%±4.5 and a homozygous genotype of CC in rare alleles-29.8%±4.2. In control group 26.4%±2.0 were carriers of a homozygous genotype of GG on a widespread allele, 54.9%±2.2 – carriers of a heterozygous genotype of CG and 18.7%±1.7 – carriers of homozygous genotype СС to a rare allele. Thus, statistically significant prevalence of carriers of a homozygous genotype of CC in rare alleles among patients with an ischemic stroke (29.8%±4.2) in comparison with group of control (18.7%±1.7), p=0.011 and also allele with in group of patients (53.3%±3.2) in comparison with control (46.2%±1.6), p=0.046 is established. Conclusions: Statistically significant prevalence of a homozygous genotype of the CC in rare allele gene of rs 1333049 of a chromosome 9r21.3 (29.8±4.2) in group of patients with an ischemic stroke in comparison with the faces of control group (18.7±1.7) and an allele C (53.3±3.2) in comparison with group of control is established (46.2±1.6). Atrial Fibrillation - Epidemiology, Prognosis, Outcome P520 https://esc365.escardio.org/Presentation/216700/abstract Association Met235Thr polymorphism of a gene AGT in development of atrial fibrillation A Chernova,1 S Nikulina1 and A Kuskaeva1 1Krasnoyarsk State Medical University named prof. V. F. Voino-Yasenecky, Krasnoyarsk, Russian Federation Introduction: The polymorphism of Met235Thr (replacement of methionine by threonine in the 235th position) is responsible for increase in level of angiotensinogen in a blood plasma that it can cause hyperactivity of renin-angiotensin-aldosterone system, leads to increase in content of angiotensin II and increase in risk of cardiovascular disease. In some European and Asian populations existence of this polymorphism results in the increased risk of developing of an arterial hypertension. During studying of M235T of polymorphism it was revealed that existence of one or two T of alleles leads to significant increase in content of angiotensin II in a blood plasma, and concerning polymorphism of Thr174Met on the contrary, existence conducts With an allele to the increased angiotensin II level. Purpose: Studying of a contribution of Thr174Met polymorphism of a gene AGT to development of atrial fibrillation. Methods: Research object – the main group of a research was made by 234 persons, from them 86 men (36.8%) and 148 women (63.2%). Average age of men was 39.60±18.65 years, women of 50.93±16.78 years. In group of patients with primary AF of 40 patients, from them 26 (65.0%) men and 14 (35.0%) women. From them 90 probands with the confirmed diagnosis of AF. From them it was distinguished: 40 probands with primary AF (this group of patients had no communication of developing of arrhythmia with cardiovascular pathology); 50 probands with secondary AF (in this group the accurate interrelation of emergence of an attack of arrhythmia with existence of the accompanying cardiovascular pathology prolezhivatsya). Examination of 144 relatives of I, II, III degrees of relationship is conducted. Methods of a research of patients with primary and secondary atrial fibrillationand their relatives: ECG, echocardiography, magnetic resonance tomography, cycle ergometer test, isotope scanning, coronary angiography, release of DNA and diagnostics of the studied polymorphisms of genes. Results: Distribution among proband with the primary f AF and the control group of frequencies of genotypes and alleles of M235T of polymorphism of a gene of AGT is shown. Among proband with the primary AF the frequency of occurrence of carriers of a heterozygotic genotype of the TC 40.0%±7.7 prevailed. The homozygous genotype of a TT made 32.5%±7.4, and a homozygous genotype of CC – 27.5%±7.1. In a check group carriers of a heterozygotic genotype of the CU – 53.0%±5.0 also prevailed. Frequency of occurrence of a homozygous genotype of a TT was 30.0%±4.6, the smallest frequency of occurrence was a homozygous genotype of CC – 17.0%±3.8. Conclusions: The polymorphism M235Tof a gene of AGT is not associated with predisposition to development of primary and secondary AF. P521 https://esc365.escardio.org/Presentation/216701/abstract Association T174M polymorphism of a gene AGT in development of atrial fibrillation A Chernova,1 S Nikulina1 and A Kuskaeva1 1Krasnoyarsk State Medical University named prof. V. F. Voino-Yasenecky, Krasnoyarsk, Russian Federation Introduction: The gene of AGT codes protein angiotenzinogen. This protein is formed in a liver and under the influence of enzyme of renin is split to angiotensin I. Which, in turn, under the influence of ACE is split to physiologically active angiotensin II. Now some of the most studied mutations connected with change in plasma of blood of level of an angiotenzinogen and leading to replacement of amino acids are: replacement in the 235th codon of methionine on treonin (Меt235Thr, Т>С; rs 699) and replacement in the 174th codon of a treonin by methionine ((Thr174Met, C>T; rs 4762). To activation of the renin-angiotensin-aldosterone system active elements gives existence mutant allel in a genotype (235T and 174M) of a gene of AGT. Purpose: Studying of a contribution of ID polymorphism of a gene ACE to development of atrial fibrillation. Methods: Research object – the main group of a research was made by 234 persons, from them 86 men (36.8%) and 148 women (63.2%). Average age of men was 39.60±18.65 years, women of 50.93±16.78 years. In group of patients with primary AF of 40 patients, from them 26 (65.0%) men and 14 (35.0%) women. From them 90 probands with the confirmed diagnosis of AF. From them it was distinguished: 40 probands with primary AF (this group of patients had no communication of developing of arrhythmia with cardiovascular pathology); 50 probands with secondary AF (in this group the accurate interrelation of emergence of an attack of arrhythmia with existence of the accompanying cardiovascular pathology prolezhivatsya). Examination of 144 relatives of I, II, III degrees of relationship is conducted. Methods of a research of patients with primary and secondary atrial fibrillationand their relatives: ECG, echocardiography, magnetic resonance tomography, cycle ergometer test, isotope scanning, coronary angiography, release of DNA and diagnostics of the studied polymorphisms of genes. Results: Distribution among proband with the primary AF and the control group of frequencies of genotypes and alleles of T174M of polymorphism of a gene of AGT. In the main group increase in number of carriers of a widespread homozygous genotype of CC – 72.5%±7.1 is revealed. The smallest quantity was made by a homozygous genotype of a TT – 2.5%±2.5. A heterozygotic genotype – 25.0%±6.8. Among persons of a check group increase in number of carriers of a homozygous genotype of CC – 70.0%±4.6 is revealed. The minimum quantity was revealed among a homozygous genotype of a TT – 3.0%±1.7. The heterozygotic genotype of ST made 27.0%±4.4 Conclusions: The polymorphism T174M of a gene of AGT is not associated with predisposition to development of primary and secondary AF. Sexual differences in association the polymorphism T174M of a gene of AGT with risk of development of primary and secondary AF forms are not established. P522 https://esc365.escardio.org/Presentation/216408/abstract Association polymorphism A/C of a gene AGTR1 in development of atrial fibrillation A Chernova,1 S Nikulina,1 A Kuskaeva1 and A Tohtobina1 1Krasnoyarsk State Medical University named prof. V. F. Voino-Yasenecky, Krasnoyarsk, Russian Federation Introduction:The gene of AGTR1 was mapped on a long shoulder 3 chromosomes in the 24th locus (3q24). A large number of polymorphisms of a gene of AGTR1 was described, but and being of the greatest clinical interest A/C polymorphism in 3’ – an untranslated region, representing replacement of adenine on cytosine in 1166 positions is the most studied now (A1166C, rs 5186). Strengthening of degree of an expression of a gene of AGTR1 happens in a consequence of replacement in adenine position 1166 on cytosine that leads to change of nature of regulation of broadcast of a gene by means of microrNA (miR155). Purpose: Analyze polymorphism frequencies A/C of a gene AGTR1 at patients from primary and secondary AF and their relatives of the I-III degree of relationship and persons of a control group. Methods: Research object – the main group of a research was made by 234 persons, from them 86 men (36.8%) and 148 women (63.2%). Average age of men was 39.60±18.65 years, women of 50.93±16.78 years. In group of patients with primary AF of 40 patients, from them 26 (65.0%) men and 14 (35.0%) women. From them 90 probands with the confirmed diagnosis of AF. From them it was distinguished: 40 probands with primary AF (this group of patients had no communication of developing of arrhythmia with cardiovascular pathology); 50 probands with secondary AF (in this group the accurate interrelation of emergence of an attack of arrhythmia with existence of the accompanying cardiovascular pathology prolezhivatsya). Examination of 144 relatives of I, II, III degrees of relationship is conducted. Methods of a research of patients with primary and secondary atrial fibrillationand their relatives: ECG, echocardiography, magnetic resonance tomography, cycle ergometer test, isotope scanning, coronary angiography, release of DNA and diagnostics of the studied polymorphisms of genes. Results: Distribution among proband with the primary AF and the control group of frequencies of genotypes and alleles of A/C of polymorphism of a gene of AGTR1. Frequency of definition of a homozygous genotype on allele A among of the main group was 55.0%±7.9. On a heterozygotic genotype the AGTR1 – 40.0%±7.7, and on a homozygous genotype of CC – 5.0%±3.4. In a check group dominance of a homozygous genotype of AA – 61.0%±4.9 was also registered. The smallest number of persons appeared with a homozygous genotype of CC – 4.0%±2.0. A heterozygotic genotype the AC - 35.0%±4.8 Conclusions: It is not established associations on polymorphism A/C of a gene AGTR1 at patients from primary AF and secondary AF. P523 https://esc365.escardio.org/Presentation/216699/abstract Association id polymorphism of a gene angiotension-converting enzyme in development of atrial fibrillation A Chernova,1 S Nikulina1 and A Kuskaeva1 1Krasnoyarsk State Medical University named prof. V. F. Voino-Yasenecky, Krasnoyarsk, Russian Federation Introduction: The gene the ACE was found in the 23rd locus on a long shoulder of the 17th chromosome (17q23.3). The gene the ACE codes the angiotension-converting enzyme which catalyzes simultaneous transformation of inactive angiotensin-I (represents decapeptide – the sequence from 10 Asp-Arg-Val-Tyr-Ile-His-Pro-Phe-His-Leu amino acids) in vazokonstriktorny peptide — angiotensin-II (by removal of 2 amino acids-His-Leu) and splitting of a bradikinin to inactive peptides. Its I/D polymorphism (rs 4646994) which represents existence (Insertion, I) or absence (Deletion, D) in the 16th intron of the sequence from 287 couples of nucleotides. The polymorphism of a gene of ACE is associated by I/D with the ACE level in plasma of blood and as a result, development of the cardiovascular diseases. Purpose: Studying of a contribution of ID polymorphism of a gene ACE to development of atrial fibrillation. Methods: Research object – the main group of a research was made by 234 persons, from them 86 men (36.8%) and 148 women (63.2%). Average age of men was 39.60±18.65 years, women of 50.93±16.78 years. In group of patients with primary AF of 40 patients, from them 26 (65.0%) men and 14 (35.0%) women. From them 90 probands with the confirmed diagnosis of AF. From them it was distinguished: 40 probands with primary AF (this group of patients had no communication of developing of arrhythmia with cardiovascular pathology); 50 probands with secondary AF (in this group the accurate interrelation of emergence of an attack of arrhythmia with existence of the accompanying cardiovascular pathology prolezhivatsya). Examination of 144 relatives of I, II, III degrees of relationship is conducted. Methods of a research of patients with primary and secondary atrial fibrillationand their relatives: ECG, echocardiography, magnetic resonance tomography, cycle ergometer test, isotope scanning, coronary angiography, release of DNA and diagnostics of the studied polymorphisms of genes. Statistically significant prevalence of carriers of a homozygous genotype of the II gene the ACE among proband with primary AF and non-heritable AF in comparison with the control group was revealed. Also statistically significant prevalence of carriers of a homozygous genotype of the II gene the ACE among women of proband from primary and secondary AF in relation to women of group of control is established. Statistically significant reduction of carriers of a homozygous genotype of the DD gene the ACE among proband with primary AF and non-heritable AF in relation to group of control is established. Conclusions: The homozygous genotype of the II gene of ACE is associated with predisposition to development of primary and secondary AF. Sexual differences (female prevalence) in association of a homozygous genotype of the II gene of ACE with risk of development of primary and secondary AF forms are established. Atrial Fibrillation - Epidemiology, Prognosis, Outcome P524 https://esc365.escardio.org/Presentation/216730/abstract Predictors of de novo atrial fibrillation in patients with septic shock AF Esteves,1 R Varudo,2 R Gomes2 and A Fernandes2 1Hospital Center of Setubal, Setubal, Portugal 2Hospital Garcia de Orta, Lisbon, Portugal Background: atrial fibrillation (AF) is the most common arrhythmia encountered in the intensive care unit (ICU). Recent literature suggests that far from a transient complication of sepsis, new-onset AF is associated with worse short- and long-term outcomes. Exploring its potential causes is warranted in hopes to better prevent and treat AF and improve outcomes for patients with sepsis. Purpose: to assess incidence and predisposing factors for de novo AF in patients with sepsis and septic shock. Methods: we performed a retrospective analysis of all patients admitted to the ICU with septic shock between June 2018 and December 2018. We analyzed a number of clinical, analytical and echocardiographic parameters and reviewed patients’ outcomes. Results: 43 patients were admitted with septic shock, 23 (53.5%) male, median age 70 years (IQR 12.5). Median SAPS II and APACHE II scores was 55 (IQR 22) and 25 (IQR 13), respectively. Eighteen patients (41.9%) developed de novo rapid AF during hospitalization: 4 patients remained in AF rhythm and amiodarone was administered in 16 patients (88.9%). Only 2 patients received therapeutic anticoagulation. Global in-hospital mortality was 55.8% and mortality rate at 6 months was 67.4%. Patients’ characteristics are described in the Table. Table 1. . With de novo AF . Without de novo AF . p-value . Age in years, median (IQR) 73.5 (15) 70.0 (21) 0.014 SAPS II score, median (IQR) 53.5 (20) 61.0 (82) 0.027 Time under invasive ventilation in days, median (IQR) 3.5 (9) 3.0 (9) 0.819 Maximum norepinephrine dose in μg/min, median (IQR) 108.0 (136) 160.0 (244) 0.015 Use of 3 or more antibiotics, n (%) 12 (66.7) 9 (36.0) 0.031 Renal replacement therapy, n (%) 13 (72.2) 12 (48.0) 0.132 Maximum procalcitonin in ng/mL, median (IQR) 14.9 (45) 18.0 (91) 0.025 Length of ICU stay in days, median (IQR) 4.5 (11) 4.0 (12) 0.824 Length of hospital stay in days, median (IQR) 28 (30) 16 (39) 0.703 . With de novo AF . Without de novo AF . p-value . Age in years, median (IQR) 73.5 (15) 70.0 (21) 0.014 SAPS II score, median (IQR) 53.5 (20) 61.0 (82) 0.027 Time under invasive ventilation in days, median (IQR) 3.5 (9) 3.0 (9) 0.819 Maximum norepinephrine dose in μg/min, median (IQR) 108.0 (136) 160.0 (244) 0.015 Use of 3 or more antibiotics, n (%) 12 (66.7) 9 (36.0) 0.031 Renal replacement therapy, n (%) 13 (72.2) 12 (48.0) 0.132 Maximum procalcitonin in ng/mL, median (IQR) 14.9 (45) 18.0 (91) 0.025 Length of ICU stay in days, median (IQR) 4.5 (11) 4.0 (12) 0.824 Length of hospital stay in days, median (IQR) 28 (30) 16 (39) 0.703 SAPS II: Simplified Acute Physiology Score II; IQR: interquartile range. Open in new tab Table 1. . With de novo AF . Without de novo AF . p-value . Age in years, median (IQR) 73.5 (15) 70.0 (21) 0.014 SAPS II score, median (IQR) 53.5 (20) 61.0 (82) 0.027 Time under invasive ventilation in days, median (IQR) 3.5 (9) 3.0 (9) 0.819 Maximum norepinephrine dose in μg/min, median (IQR) 108.0 (136) 160.0 (244) 0.015 Use of 3 or more antibiotics, n (%) 12 (66.7) 9 (36.0) 0.031 Renal replacement therapy, n (%) 13 (72.2) 12 (48.0) 0.132 Maximum procalcitonin in ng/mL, median (IQR) 14.9 (45) 18.0 (91) 0.025 Length of ICU stay in days, median (IQR) 4.5 (11) 4.0 (12) 0.824 Length of hospital stay in days, median (IQR) 28 (30) 16 (39) 0.703 . With de novo AF . Without de novo AF . p-value . Age in years, median (IQR) 73.5 (15) 70.0 (21) 0.014 SAPS II score, median (IQR) 53.5 (20) 61.0 (82) 0.027 Time under invasive ventilation in days, median (IQR) 3.5 (9) 3.0 (9) 0.819 Maximum norepinephrine dose in μg/min, median (IQR) 108.0 (136) 160.0 (244) 0.015 Use of 3 or more antibiotics, n (%) 12 (66.7) 9 (36.0) 0.031 Renal replacement therapy, n (%) 13 (72.2) 12 (48.0) 0.132 Maximum procalcitonin in ng/mL, median (IQR) 14.9 (45) 18.0 (91) 0.025 Length of ICU stay in days, median (IQR) 4.5 (11) 4.0 (12) 0.824 Length of hospital stay in days, median (IQR) 28 (30) 16 (39) 0.703 SAPS II: Simplified Acute Physiology Score II; IQR: interquartile range. Open in new tab Logistic regression analysis showed that age and use of 3 or more antibiotics was significantly associated with the possibility of de novo AF development (respectively, OR 1.082, 95% CI 1.007-1.162 and OR 4.622, 95% CI 1.240-17.226). Conclusion: in this group of patients with septic shock, the development of de novo AF was predicted by patients’ age and use of 3 or more antibiotics during ICU hospitalization. In this population, in-hospital and 6-month mortality rates did not differ significantly between the two groups. P525 https://esc365.escardio.org/Presentation/217228/abstract The incidence of postoperative atrial fibrillation after coronary artery bypass graft E Sigala,1 N Koumallos,1 D Aragiannis1 and K Triantafyllou1 1Hippokration General Hospital, Cardiac Surgery Department, Athens, Greece Introduction: Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. It is defined as the evidence of new atrial fibrillation that requires treatment by electrocardiography or continuous monitoring during the postoperative period. After cardiac surgery, it occurs in 30-50% of the patients. The cause of AF after open-heart surgery has not yet been completely elucidated. The aim of the present study was to evaluate clinical predictors of AF after CABG with cardiopulmonary bypass. Methods: The study consisted of 350 patients undergoing CABG with cardiopulmonary bypass (aged 65.4±0.95 years old). Patients were monitored for 10 days postoperatively for the development of AF. To establish the predictors for post-operative AF, we performed linear regression analysis. Results: Hundred and thirty-three (38%) of the total study population developed AF during the postoperative period. The development of AF was positively correlated with age (r=0.261, p=0.003), chronic obstructive pulmonary disease (r=0.325, p=0.0001) and postoperative fever (r=0.179, p=0.081). Gender, body mass index, cardiopulmonary bypass time and increased cross-clamp time were not predictive for the complication. In multivariate analysis, AF was significantly correlated with age [β(SE)=0.15(0.005), p=0.017] and to a lesser degree with obstructive pulmonary disease [β(SE)=0.279(0.149), p=0.065]. Conclusions:Postoperative AF remains the most common complication after cardiac surgery. In this study we showed that advanced age and obstructive pulmonary disease are independent risk factors for the development of AF after CABG with cardiopulmonary bypass. Atrial Fibrillation - Treatment P526 https://esc365.escardio.org/Presentation/216465/abstract Outcomes and implications for clinical management of atrial fibrillation in critically ill patients admitted to a medical stepdown unit.N/A L Falsetti,1 M Proietti,2 V Zaccone,1 F Riccomi,1 M Sampaolesi,1 C Nitti,1 A Salvi1 and A Capucci3 1Hospital University "Ospedali Riuniti" Ancona - Subintensive Internal Medicine Department, Ancona, Italy 2Milan Polytechnic, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy, Milan, Italy 3Marche Polytechnic University of Ancona, Cardiology and Arrhythmology Clinic, Department of Biomedical Sciences and Public Health, Ancona, Italy Background: data on clinical course and optimal treatment of critically-ill patients with atrial fibrillation(AF) history are limited. Aims: to describe major adverse events occurrence in critically-ill AF patients admitted to a stepdown care unit(SDU);to analyse (i)clinical factors associated with outcomes,(ii)impact of oral anticoagulant(OAC) therapy and (iii)performance of clinical risk-scores in this setting. Materials and Methods: single-center,retrospective analysis on subjects with AF history,admitted to a SDU.Therapeutic failure, the composite of ICU transfer or death, was the main outcome(MO).Stroke and major bleeding(MH) were secondary outcomes.Clinical risk-scores performance was evaluated. Table 1. baseline characteristics of the sample. . No Therapeutic Failure . Therapeutic Failure . p . Age, years, median [IQR] 81 [75-85] 83 [77-89] <0.001 Female Sex, n (%) 753 (49.9) 90 (46.2) 0.329 LV Function, n (%) 0.001 - Preserved 326 (67.4) 17 (42.5) - Reduced 158 (32.6) 23 (57.5) Type of AF, n(%) 0.077 - Paroxysmal 220 (18.6) 24 (12.8) - Persistent 292 (24.7) 57 (30.3) - Permanent 668 (56.6) 107 (56.9) CHA2DS2-VASc, median [IQR] 4 [3-5] 4 [3-5] 0.057 CHA2DS2-VASc ≥2, n (%) 1170 (94.7) 180 (92.8) 0.290 HAS-BLED, median [IQR] 2 [2-3] 2 [1-3] <0.001 HAS-BLED ≥3, n (%) 563 (45.6) 55 (28.4) <0.001 . No Therapeutic Failure . Therapeutic Failure . p . Age, years, median [IQR] 81 [75-85] 83 [77-89] <0.001 Female Sex, n (%) 753 (49.9) 90 (46.2) 0.329 LV Function, n (%) 0.001 - Preserved 326 (67.4) 17 (42.5) - Reduced 158 (32.6) 23 (57.5) Type of AF, n(%) 0.077 - Paroxysmal 220 (18.6) 24 (12.8) - Persistent 292 (24.7) 57 (30.3) - Permanent 668 (56.6) 107 (56.9) CHA2DS2-VASc, median [IQR] 4 [3-5] 4 [3-5] 0.057 CHA2DS2-VASc ≥2, n (%) 1170 (94.7) 180 (92.8) 0.290 HAS-BLED, median [IQR] 2 [2-3] 2 [1-3] <0.001 HAS-BLED ≥3, n (%) 563 (45.6) 55 (28.4) <0.001 Open in new tab Table 1. baseline characteristics of the sample. . No Therapeutic Failure . Therapeutic Failure . p . Age, years, median [IQR] 81 [75-85] 83 [77-89] <0.001 Female Sex, n (%) 753 (49.9) 90 (46.2) 0.329 LV Function, n (%) 0.001 - Preserved 326 (67.4) 17 (42.5) - Reduced 158 (32.6) 23 (57.5) Type of AF, n(%) 0.077 - Paroxysmal 220 (18.6) 24 (12.8) - Persistent 292 (24.7) 57 (30.3) - Permanent 668 (56.6) 107 (56.9) CHA2DS2-VASc, median [IQR] 4 [3-5] 4 [3-5] 0.057 CHA2DS2-VASc ≥2, n (%) 1170 (94.7) 180 (92.8) 0.290 HAS-BLED, median [IQR] 2 [2-3] 2 [1-3] <0.001 HAS-BLED ≥3, n (%) 563 (45.6) 55 (28.4) <0.001 . No Therapeutic Failure . Therapeutic Failure . p . Age, years, median [IQR] 81 [75-85] 83 [77-89] <0.001 Female Sex, n (%) 753 (49.9) 90 (46.2) 0.329 LV Function, n (%) 0.001 - Preserved 326 (67.4) 17 (42.5) - Reduced 158 (32.6) 23 (57.5) Type of AF, n(%) 0.077 - Paroxysmal 220 (18.6) 24 (12.8) - Persistent 292 (24.7) 57 (30.3) - Permanent 668 (56.6) 107 (56.9) CHA2DS2-VASc, median [IQR] 4 [3-5] 4 [3-5] 0.057 CHA2DS2-VASc ≥2, n (%) 1170 (94.7) 180 (92.8) 0.290 HAS-BLED, median [IQR] 2 [2-3] 2 [1-3] <0.001 HAS-BLED ≥3, n (%) 563 (45.6) 55 (28.4) <0.001 Open in new tab Results: 1430 consecutive patients were enrolled.194 (13.6%) reported MO.Multivariate logistic regression: age(OR:1.03, 95%CI:1.01-1.05),acute coronary syndrome (OR:3.10,95%CI:1.88-5.12),cardiogenic shock(OR:10.06, 95%CI:5.37-18.84),septic shock(OR:5.19,95%CI:3.29-18.84),acute respiratory failure(OR:2.49,95%CI:1.67-3.64) and OAC(OR:1.61,95%CI:1.02-2.55) were independently associated with MO.OAC were associated with stroke risk reduction but to an increased MH and MO risk.CHA2DS2-VASc(c-index:0.545,p=0.117) and HAS-BLED(c-index: 0.503,p=0.900) did not predict events. Conclusions: in critically-ill AF patients adverse outcomes are common.OAC are associated to an increased MO risk.Clinical risk scores seem unhelpful in predicting stroke and MH.An individualized approach in evaluating risks and anticoagulant prescription is strongly recommended. Syncope and Bradycardia - Pathophysiology and Mechanisms P527 https://esc365.escardio.org/Presentation/217213/abstract Are the risk criteria for syncope ultimately applied in real life? A Briosa,1 A Esteves,1 AL Broa,1 R Miranda,1 S Almeida,1 L Brandao1 and H Pereira1 1Hospital Garcia de Orta, Lisbon, Portugal Introduction: The European Society of Cardiology launched the new guidelines of syncope in 2018. Risk stratification should be an integral part of the emergency approach in these patients (pts) in order to allow more careful guidance. Objective: To evaluate the application of the risk criteria for patients with syncope in the emergency department. Methods: Retrospective single center study, including pts who came to the emergency department (ED) with the diagnosis of syncope in the first 3 months of 2018 (January-March 2018). Clinical and electrocardiographic changes, risk criteria and final destination were evaluated. Results: We analyzed a total of 314 pts. 151 pts were excluded either because they did not meet the diagnostic criteria for syncope or did not have available clinical information. We included 163 pts, of which 56.4% were female, with a mean age of 67 ± 20 years. 65.6% had hypertension, 22.2% diabetes mellitus, 7.1% had heart failure, 5.4% history of coronary artery disease, 1.9% known aortic stenosis, 13.3% had had an episode of atrial fibrillation (AF) in the past and 14.7% had a history of recurrent syncope. Characteristics of the syncopal episode: 68.7% reported having prodrome, 16.8% attributed to effort after defecation or vomiting, 14.7% reported prolonged standing position, 13.9% during or after meal and 11.2% after a situation considered unpleasant (heat, smell, sound or pain). Only 0.7% reported syncope during exercise. 6.3% had angor (n = 9) or associated headaches (n = 9), 5.6% reported palpitations, 4.9% abdominal pain and 2.1% sensation of dyspnea. On examination, 19.7% of patients had abnormalities such as hypotensive profile (11.1%), heart murmur (3.1%), bradycardia (3.1%) or signs of gastrointestinal bleeding (1.2 %). Electrocardiographically, the majority (66.3%) had no alterations. Of the remaining, 18 had bundle branch block, 12 were in AF rhythm, 8 had 1st degree atrioventricular block, 3 had complete atrioventricular block, 3 had a pause longer than 3 seconds, 2 had signs of ischemia and 1 had QT interval prolongation. Although only 27 patients reported associated head injury, 64 CT-head injuries were requested, but only 2 had abnormalities. Most patients were diagnosed with reflex syncope (54.9% of cases), 11.1% had orthostatic hypotension and 10.5% cardiac syncope. Of the 33.8% of patients who met 1 or more high-risk criteria (n = 49), only 10.2% (n = 5) were admitted, and 5 were re-admitted to the ED within 1 month or less. Only one patient with low risk criteria was admitted. Conclusion: In the present study, we concluded that the risk stratification proposed by the European Society of Cardiology is not always applied in the ED, leading to some orientation errors. However, it is important to note that, despite their importance in the assessment of the patient, they should always be integrated with the clinical judgment as well as with the clinical history and physical examination of the pts. Syncope and Bradycardia - Clinical P529 https://esc365.escardio.org/Presentation/221183/abstract Conduction abnormalities after transcatheter aortic valve replacement. Are we overstating the need of permanent pacemaker? G Caldentey,1 R Millan,1 N Ribas,1 A Sanchez-Carpintero,1 A Calvo,1 N Farre,1 C Roqueta,1 M Tornus,1 A Mas-Stachurska,1 N Salvatella,1 H Tizon,1 J Jimenez,1 T Giralt,1 X Quiroga1 and B Vaquerizo1 1Hospital del Mar, Barcelona, Spain Introduction: Although advances in valve technology, conduction disturbances (CD) remain a common complication of transcatheter aortic valve replacement (TAVR). Purpose: We sought to determine the incidence, type and predictors of CD and need of pacemaker (PM) at 12-month follow-up after percutaneous valve implantation. Methods: Seventy-seven transfemoral aortic valves [Edwards Sapiens (n=33), Portico (n=16) and Corevalve (n 28)] were implanted in patients at high risk or contraindication for surgery or patients categorized as moderate frailty on geriatric evaluation. Mean age was 83 years; range 70-94; 64% women. Basal and post procedure CD and clinical characteristics were registered. Logistic regression analysis was used to compare clinical and procedural variables to predict CD. Clinical outcomes were assessed during a follow-up period of 17.4 ± 13.2 months. Results: After valve implantation, six (7.8%) patients developed HAVB, regardless of prosthesis type (p 0.57). Patients who developed HAVB were older (86.7 ± 3.2 vs 83.4 ± 5.1 years; p 0.08), had longer baseline QRS duration (133 ± 30 vs 104 ± 22 ms, p 0.009), and more frequently previous LBBB (29 vs 8%, p 0.087). Thirty-two patients (42%) developed new-LBBB, that was related to balloon pre-dilation (56% vs 22 %, p 0.003) and prosthesis type (32% Corevalve, 39% Edwards and 67% Portico; p 0.039). In-hospital permanent PM implantation was performed in 11 patients (14%): 6 for HAVB, 2 for slow atrial fibrillation and 3 for asymptomatic new-LBBB after being considered of high risk on electrophysiology study. The need for in-hospital PM differed based on prosthesis type (Corevalve 7%, Edwards-Sapien 15 % and Portico 33%; p 0.037). In a logistic regression analysis including age, pre-procedure QRS duration, previous LBBB, type of prosthesis, and balloon pre-dilation, only QRS length and type of prosthesis were independent predictors of PM need (p 0.007, p 0.037 respectively). At follow-up, two patients developed late (>6m after procedure) CD needing PM insertion, one because of HAVB (previous AF, normal QRS) and another because of symptomatic bradycardia (Sinus rhythm, LBBB; already present pre-procedure). Among new-LBBB patients to whom a PM was implanted (n=3), <1% ventricular pacing was observed during follow-up. Moreover, 10 (31%) new-LBBB normalized QRS (6 in-hospital and 4 at follow-up) and no progression to HABV was noticed. Conclusion: CD remains a noteworthy issue after TAVR. Baseline QRS duration and type of prosthesis were predictors of permanent PM implantation. A high incidence of new-LBBB was observed after TAVR, without progression to HABV. In addition, in those cases with PM implantation for new-LBBB, <1% ventricular pacing was evidenced. Device Treatment of Ventricular Arrhythmias and SCD P530 https://esc365.escardio.org/Presentation/216704/abstract Cardiac arrhythmias do not predict the outcome in patients with cardiogenic shock and an impella assist devicenone K Abdullah,1 J Roedler,1 J Vom Dahl,1 I Szendey,1 H Haake,1 L Eckardt,1 B Ohnewein,1 P Jirak,1 L Motloch,1 B Wernly1 and R Larbig1 1Kliniken Maria Hilf GmbH, Moenchengladbach, Germany Aims: To evaluate the impact of cardiac arrhythmias and further lab parameters on survival in patients with cardiogenic shock and an Impella assist device. Background: Intensive care patients in cardiogenic shock often need ventricular assist device support. The Impella microaxial blood pump is a commonly used assist device in this population. Impella supports hemodynamic stabilization. In these patients, cardiac arrhythmias are frequently observed. However, whether the occurrence of cardiac arrhythmias is a predictor of an impaired survival in this collective was not yet evaluated. Methods: In this retrospective single-center trial we analyzed 147 patients (47 female, median 69±18 years, left ventricular ejection fraction 25±24 %) with cardiogenic shock. Patients were included between 2008 and 2018. The primary endpoint was hospital mortality. Associations with cardiac arrhythmias and lactate concentrations were assessed by logistic regression. Results: Hospital mortality was 75%. Baseline lactate was 4.7±2.1 mmol/L, 30 patients suffered from ventricular tachycardia, 37 patients from atrial fibrillation, 59 from intermittent asystole. Baseline lactate was associated with mortality (OR 1.60 95%CI 1.16-2.21; p=0.004), whereas AF (OR 1.30 95%CI 0.53- 3.17; P=0.57) and VT (OR 1.13 95%CI 0.44-2.91; p=0.80) were not associated with mortality. We observed a trend in patients with asystole towards an adverse outcome (OR 2.17 95%CI 0.96-4.91; p=0.06) in our collective. Conclusion: The mortality was high in these severely sick patients. Cardiac arrhythmias do not predict hospital mortality in patients with cardiogenic shock treated with Impella. However, baseline lactate concentrations were associated with the outcome in this collective. Device Complications and Lead Extraction P531 https://esc365.escardio.org/Presentation/221089/abstract Absorbable antibacterial envelope for the prevention of cardiac implantable electronic device infection in high risk patients: what is our reality? H Miranda,1 A Goncalves,2 B Valente,2 P Cunha,2 A Monteiro,2 A Delgado,2 M Braz,2 R Ferreira2 and M Oliveira2 1Hospitalar Center Barreiro-Montijo, Lisbon, Portugal 2Hospital de Santa Marta, Cardiology, Lisbon, Portugal Introduction: Infection of cardiac implantable electronic devices (CIED) have increased in recent years and are associated with longer hospital stays, need for device extraction and high morbidity and mortality rates. Absorbable antibacterial envelope has emerged with the aim of preventing infections associated with CIED, stabilizing the generator and reducing the likelihood of skin erosion. We aimed to study CIED infection rates in patients receiving an antibacterial envelope. Methods: Observational, longitudinal study over a period of 2,5 years (November 2015 - April 2018) in patients with ≥2 risk factors for infection undergoing a CIED implant, treated with the absorbable antibacterial envelope. Patients were evaluated at 3, 6 and 12 months after intervention. Results: A total of 44 patients were included (72.7% males, 65±16 years). Hypertension (77.3%), Replacement/Revision of CIED (77.3%) and Congestive Heart Failure (52.3%) were the most frequent risk factors for infection in our population. Of note is the presence of previous device infections in 20.46% of the cases. We found that 36.4% and 27.7% presented, respectively, an intermediate or high infectious risk (Mittal score), and 59.1% presented a high risk of infection (Shariff score). Mean Mittal and Shariff scores of 10.95±5.89 and 3.05±1.75, respectively, revealed a population with high infectious risk. Regarding infectious complications we documented one case of pocket infection (2.27%). One patient died due to complications of a cardiac valve surgery. Conclusion: In patients identified at high risk for CIED infection, use of an antibacterial envelope was associated with a low incidence of infection according to previously published literature. Acute Heart Failure– Treatment P641 https://esc365.escardio.org/Presentation/217419/abstract Preoperative angiotensin receptor-neprilysin inhibitors in patients undergoing Mitraclip implantation L Baldetti,1 F Melillo,2 A Beneduce,3 E Visco,3 S Khawaja,3 M Ancona,3 C Godino,4 P Denti,5 M De Bonis,5 O Alfieri5 and M Montorfano3 1San Raffaele Hospital, Cardiac Intensive Care Unit, Milan, Italy 2San Raffaele Hospital, Echocardiography Unit, Milan, Italy 3San Raffaele Hospital, Cardiovascular Interventions Unit, Milan, Italy 4San Raffaele Hospital, Cardiology Unit, Milan, Italy 5San Raffaele Hospital, Cardiac Surgery Unit, Milan, Italy Background: the angiotensin receptor-neprilysin inhibitor (ARNI) sacubitril/valsartan is a potent HF disease-modifying drug that also showed promising results in functional MR; thus, a progressively greater proportion of patients undergoing TMVR will present on chronic ARNI therapy. Purpose: we aimed to assess the hemodynamic impact of preoperative ARNI therapy in MitraClip prcedure. Methods: patients to undergo MitraClip procedure for severe secondary MR who were on a chronic ARNI therapy and without a >36 hours preoperative drug discontinuation constituted the cohort of interest (n=11). This group was compared to patients who underwent TMVR without a background of chronic ARNI therapy (n=54). Results: baseline clinical and echocardiographic characteristics were well balanced between groups. Total cohort demonstrated a net ischemic HF etiology prevalence (~70%). Overall, a number of 1.5 (1.0-2.0) clips was implanted. More patients in the ARNI received periprocedural mechanical circulatory support (MCS) due to hypotension (45.5 vs 11.5%; p=0.017). After TMVR all patients in the ARNI group needed admission to the ICU for prolonged hemodynamic support (100 vs 28.3%; p<0.001). Indeed, ARNI patients experienced a higher rate of refractory hypotension (36.4 vs 5.8%; p=0.014), associated with higher need for inotropic support (90.9 vs 38.6%; p=0.002) and MCS (90.9 vs 26.2%; p<0.001). Hemodynamic compromise in the ARNI cohort was also reflected by higher serum lactate peak [5.2(2.4-6.8) vs 1.4 (1.2-2.2) mmol/l; p=0.010]. No significant differences were found in rates of pulmonary edema, afterload mismatch or cardiogenic shock between groups (Figure 1). Figure 1. Open in new tabDownload slide Post-procedural echocardiographic parameters were similar in the two groups, with the exception of LVEF that was significantly lower in the ARNI group (24.0±5.3 vs 31.7±8.4%; p=0.005). A total of 4 (6.2%) cases of MitraClip failure were recorded. Median hospital stay was 8 (6-12) days, with no differences between cohorts. At 30-day, among survivors, no deaths were recorded in either group. This study highlighted unfavorable perioperative hemodynamics for patients undergoing TMVR without a >36 hours wash-out from sacubitril/valsartan. This detrimental post-operative course, however, did not translate in longer hospitalization or into higher 30-day mortality. To our knowledge, no data exists on optimal management on RAAS inhibitors in patients undergoing TMVR. Sacubitril/valsartan combines the effects of RAAS inhibition to those of neprilysin inhibition, ultimately leading to potent vasodilatation. The acute 20-30% decrease in systemic vascular resistances after clip implantation MitraClip may be synergistic and amplify ARNI-mediated vasodilation. Conclusions: Withholding ARNI drug to revert RAAS and neprilysin inhibition before MitraClip implant for secondary MR may prevent subsequent hemodynamic deterioration and avoid the need of circulatory inotropic or mechanical support. Acute Heart Failure: Pharmacotherapy P642 https://esc365.escardio.org/Presentation/216450/abstract Levosimendan in acute heart failure: a single-center experience R Ventura Gomes,1 B Rocha,2 G Cunha,2 R Morais,3 L Fernandes,3 L Campos,4 I Araujo3 and C Fonseca3 1Hospital de Vila Franca de Xira, Vila Franca de Xira, Portugal 2Hospital de Santa Cruz, Cardiology, Carnaxide, Portugal 3Hospital de Sao Francisco Xavier, Clínica de Insuficiência Cardíaca, Lisbon, Portugal 4Hospital de Sao Francisco Xavier, Medicine, Lisbon, Portugal Background: Levosimendan (LS), an inotropic agent, may be indicated for the management of acute Heart Failure (HF) in well selected patients (pts). Monitoring electrolytes, rhythm and end-organ function is paramount during LS infusion to ensure safety. The purpose of this study was to investigate the variation of clinical and laboratory parameters and to assess adverse events during the 24-hour LS infusion. Methods: A single-center retrospective cohort of pts admitted for acute HF who received LS in a HF care Unit from 2012-2018. During LS infusion, mean arterial pressure (MAP), estimated glomerular filtration rate by MDRD formula (eGFR), total bilirubin (TB), alkaline phosphatase (AP) and ALT were systematically collected, as were adverse events (AE). All definitions are in accordance to the European Society of Cardiology Recommendations. Acute kidney injury (AKI) was defined as per KDIGO guidelines. Results: Overall, 88 pts received LS (aged 66.7±12.0years; 70.5% male; 87 with left ventricular ejection fraction <40%), of which, 26.2% received LS with another inotrope (LSc). At 24-hours after starting LS, pts had lower MAP (80 ± 10 1sth vs 75 ± 11mmHg 24thh, p=0.001) and stable laboratory evaluation (before vs after: eGFR 51.5±26.5 vs 50.9±31.4mL/min/1.73m2, p=0.762; AP 89.3±33.9 vs 84.3±42.8 IU/L, p=0.561; ALT 166.6 ±274.1U/L vs 92.7±131.2, p=0.277). Similar results were observed when pts who had received LS were compared to those receiving LS combined with another inotrope. A loading dose was administered in 16 (18.2%) pts. Most (70.5%) pts tolerated the maximum LS dose. Eleven (12.5%) pts had LS infusion suspended, mainly due to hypotension (n=8). Tachyarrhythmias were the most often documented AEs (i.e., supraventricular tachycardia, n=21; ventricular tachycardia, n=1), and AKI (n=10). Finally, 61 (69.3%) pts received K+ supplementation and 71 (80.7%) Mg2+, frequently to prevent depletion and arrhythmia. After 24h of LS, hypermagnesemia was the only electrolyte disturbance (2.0±0.4 vs 2.6±1.1mg/dL, p=0.001). Conclusion: LS was well-tolerated, with few documented AE during 24h infusion. Preventing electrolyte depletion can be an essential measure to prevent malignant arrhythmia. Despite observed lower MAP after completing LS, an expected event due to its vasodilator properties, surrogate markers of organ perfusion pertained stability. LSc allowed LS use in a broader population, yet this analysis is limited by a small number of pts. P643 https://esc365.escardio.org/Presentation/221091/abstract Antithrombotic therapy in cardiogenic shock: a Portuguese National analysis H Miranda,1 H Santos,1 C Sousa,1 I Almeida1 and J Tavares1 1Hospitalar Center Barreiro-Montijo, Lisbon, Portugal Introduction: Antithrombotic therapy is crucial, during and after PCI, in patients (P) admitted with cardiogenic shock (CS). Despite that, there are no specific trials about the use of oral antiplatelet in these patients. Objectives: Evaluate the impact of the used antiplatelet therapy (APT) on the outcome (MACE/death) of P admitted with CS. Methods: Retrospective study, based on the Portuguese National Registry of Acute Coronary Syndrome (ACS), from 01/10/2010 to 9/01/2019. Exclusion criteria: Killip class I-III, lack of information about APT during hospital length (HL). We created 3 groups based in antiplatelet used during HL (1° group: 1 antiplatelet (29 P); 2ª group: 2 antiplatelets (209 P); 3ª group: 2 antiplatelets + glycoprotein IIb/ IIIa inhibitors (91 P)) and compare them. Results: 329 P included. Male predominance (63,8%). Mean age 70±13 years. Hypertension (67,7%), diabetes (34,2%) and dyslipidaemia (49,8%) were the most frequent comorbidities. Mean Systolic and diastolic pressure at admission of 96±33 and 59±21 mmHg, respectively. Mean BNP of 895±1194 pg/ml. Mean LVEF of 41±14%. We found single antiplatelet therapy was preferred in older P (p<0,001) with CKD (p=0,022) and with lower levels of haemoglobin at admission (p=0,031). In those P coronary angiography was less performed (p=0,001). The APT (with 3 drugs) was preferred in younger P and was associated with higher use of intra-aortic balloon (p=0,007). Comparing the occurrence of MACE/death during HL we only found differences at cardiac arrest (higher in the group with 3 APT, p-value 0,003) and mortality (higher in P with only one APT, p=0,025) - Table 1 Table 1. MACE/Death: comparison between the 3 groups. . Total . 1 APT . 2 APT . 3APT . p-value . Nº Patients (%) 329 (100%) 29 (8,8%) 209 (63,5%) 91 (27,7%) - Age (years) 70 ± 13 77 ± 10 72 ± 13 63±12 < 0,001 A.Fib (%) 13,1 6,9 11 19,8 0,068 Mechanical complication (%) 4,9 6,9 5,3 3,3 0,725 AV block (%) 20,4 6,9 21,2 23,1 0,155 Cardiac arrest (%) 27,7 13,8 23,9 40,7 0,003 Stroke (%) 1,8 0 2,9 0 0,202 Major haemorrhage (%) 6,1 3,4 5,3 8,8 0,413 Blood transfusion (%) 5,2 3,4 4,8 6,6 0,734 Death (%) 34 55,2 30,1 36,3 0,025 . Total . 1 APT . 2 APT . 3APT . p-value . Nº Patients (%) 329 (100%) 29 (8,8%) 209 (63,5%) 91 (27,7%) - Age (years) 70 ± 13 77 ± 10 72 ± 13 63±12 < 0,001 A.Fib (%) 13,1 6,9 11 19,8 0,068 Mechanical complication (%) 4,9 6,9 5,3 3,3 0,725 AV block (%) 20,4 6,9 21,2 23,1 0,155 Cardiac arrest (%) 27,7 13,8 23,9 40,7 0,003 Stroke (%) 1,8 0 2,9 0 0,202 Major haemorrhage (%) 6,1 3,4 5,3 8,8 0,413 Blood transfusion (%) 5,2 3,4 4,8 6,6 0,734 Death (%) 34 55,2 30,1 36,3 0,025 Open in new tab Table 1. MACE/Death: comparison between the 3 groups. . Total . 1 APT . 2 APT . 3APT . p-value . Nº Patients (%) 329 (100%) 29 (8,8%) 209 (63,5%) 91 (27,7%) - Age (years) 70 ± 13 77 ± 10 72 ± 13 63±12 < 0,001 A.Fib (%) 13,1 6,9 11 19,8 0,068 Mechanical complication (%) 4,9 6,9 5,3 3,3 0,725 AV block (%) 20,4 6,9 21,2 23,1 0,155 Cardiac arrest (%) 27,7 13,8 23,9 40,7 0,003 Stroke (%) 1,8 0 2,9 0 0,202 Major haemorrhage (%) 6,1 3,4 5,3 8,8 0,413 Blood transfusion (%) 5,2 3,4 4,8 6,6 0,734 Death (%) 34 55,2 30,1 36,3 0,025 . Total . 1 APT . 2 APT . 3APT . p-value . Nº Patients (%) 329 (100%) 29 (8,8%) 209 (63,5%) 91 (27,7%) - Age (years) 70 ± 13 77 ± 10 72 ± 13 63±12 < 0,001 A.Fib (%) 13,1 6,9 11 19,8 0,068 Mechanical complication (%) 4,9 6,9 5,3 3,3 0,725 AV block (%) 20,4 6,9 21,2 23,1 0,155 Cardiac arrest (%) 27,7 13,8 23,9 40,7 0,003 Stroke (%) 1,8 0 2,9 0 0,202 Major haemorrhage (%) 6,1 3,4 5,3 8,8 0,413 Blood transfusion (%) 5,2 3,4 4,8 6,6 0,734 Death (%) 34 55,2 30,1 36,3 0,025 Open in new tab Conclusion: Despite our findings we still need to perform more rigours trials to find out which is the best pharmacological option for these patients. P644 https://esc365.escardio.org/Presentation/217602/abstract Repetitive use of levosimendan in outpatients with end-stage heart failure: is this a bridging or palliative therapy? K Wilk,1 R Kazimierczyk,1 A Szyszkowsa,1 P Lopatowska,1 M Gil-Klimek,1 A Lisowska,1 A Tycinska,1 M Gierlotka,2 K Kaminski1 and B Sobkowicz1 1Medical University of Bialystok, Bialystok, Poland 2Opole Medical University, Department of Cardiology, Opole, Poland Purpose: In a pilot study, we aimed to compare single versus double levosimendan infusion in end-stage heart failure (HF) outpatients on the occurrence of composite end point (CEP) - death, hospitalization due to heart failure (HHF) or reached heart transplantation (HTx). Methods: In 16 males with HF in stable ambulatory NYHA III/IV (mean age 62±9.2 years, mean left ventricle ejection fraction 16±6.6%, mean NT-proBNP 7250±4563 pg/mL, 75% ischemic etiology, 63% after CRT-D implantation) levosimendan (12.5 mg for each administration, with starting dose of 0.05 ug/kg/min.) was given once (n=6) or twice (mean 2.7±1.7 months apart, n=10). All patients received the most optimal ESC-guided pharmacotherapy. Results: Altogether CEP occurred in 9 patients (56%)- 7 in a group of repetitive (including 2 HTx) and 2 in a group of single levosimendan use. Mean time of CEP occurrence (after the last drug administration) was 5.8±3.2 months. CEP patients had significantly higher baseline NT-proBNP concentrations- median 10767 [4744-11070] pg/mL vs. 2247 [1582-5552] pg/mL, p=0.05. Mean time to CEP occurrence was longer in patients with double levosimendan administration as compared to single (7.1±3.1 months vs. 3.6±1.9 months, p=0.02, figure). No significant differences regarding survival analysis was found (log-rank test, p=0.48). Conclusions: Repetitive levosimendan infusion in a group of no-option end-stage HF patients delays the occurrence of HHF, death or allows to extent the time needed to HTx. Further studies on larger patients’ population are needed to confirm this finding. figure. Open in new tabDownload slide Acute Heart Failure: Non-pharmacological Treatment P646 https://esc365.escardio.org/Presentation/216451/abstract Long-term IABP in end-stage CHF : a forgotten bridge? M Stratinaki,1 E Bousoula,2 I Malakos,2 O Kadda,2 S Chatzi,2 A Karagiannis,2 C Panagiotou,2 M Zymatoura,2 E Fountas,2 A Tsiampalis,2 I Armenis,2 N Aravanis2 and E Sbarouni2 1Venizelio General Hospital, Heraklion, Greece 2Onassis Cardiac Surgery Center, Cardiac intensive care unit, Athens, Greece Background: Intra-aortic balloon pump (IABP) provides circulatory support, although its use has been debated recently, especially in post-AMI cardiogenic shock. Its use is usually limited to two weeks and longer application has not been extensively studied. Purpose: To review the effects of long term IABP in haemodynamic and laboratory parameters. Methods: We retrospectively analyzed the data from 24 consecutive patients with end-stage heart failure (ESHF) on long-term IABP support. We report renal and hepatic function as well as NT-proBNP on days 0, 6, 30 and 60. We also recorded right atrial pressure (RA), pulmonary capillary wedge pressure (PCWP) and cardiac index (CI,) measured with right heart catheterization on days 0 and 30. Results are shown as mean ± standard deviation and comparisons were made using one-way ANOVA; p<0.05 was considered statistically significant. Results: 24 patients (14 male and 10 female) were included, with mean age of 45.6±14 years, of whom 5 had ischemic cardiomyopathy and 19 dilated cardiomyopathy. The mean duration of IABP support was 70.2 days (range 30-192 days). Most patients were on inotropes, in addition to IABP.Renal function improved and billiburin, NT-proBNP and filling pressures decreased. Cardiac Index and ejection fraction did not change significantly. 7/24 underwent heart transplantation, 5/24 received left ventricular assist device (LVAD) and 6/24 biventricular assist device (BiVAD), 2/24 were successfully weaned from IABP and 4/24 died. Conclusions: Long-term IABP support in end-stage heart failure is associated with clinical improvement, representing a viable alternative mid-term option as bridge to mechanical support or transplant. Table 1. . Day 0 . Day 6 . Day 30 . Day 60 . p-value . Urea(mg/dl) 100±64.75 71.29±34.07 73.16±50.83 59.29±41.8 <0.0001 Creatinine(mg/dl) 1.8±0.81 1.19±0.47 1.223±0.62 1.13±0.35 <0.0001 Bilirubin(mg/dl) 1.88±1.03 1.2±0.67 1.01±0.65 0.91±0.35 <0.0001 AST(IU/L) 320.41±192 68.79±33.09 38.75±42.84 31.54±18.65 0.205151 ALT(IU/L) 218.7±70 120.5±96.2 32.87±25.12 32.87±25.12 0.18993 NT-proBNP(pg/ml) 9726±7196 3770±3296 4153±726.8 3063±5655 <0.0001 RA(mmHg) 15.66±7.5 10.88±8.06 0.039 PCWP (mmHg) 25.66±13.8 18.55±9.31 0.68 CI(l/min/m2) 1.77±0.66 1.72±0.41 0.75 . Day 0 . Day 6 . Day 30 . Day 60 . p-value . Urea(mg/dl) 100±64.75 71.29±34.07 73.16±50.83 59.29±41.8 <0.0001 Creatinine(mg/dl) 1.8±0.81 1.19±0.47 1.223±0.62 1.13±0.35 <0.0001 Bilirubin(mg/dl) 1.88±1.03 1.2±0.67 1.01±0.65 0.91±0.35 <0.0001 AST(IU/L) 320.41±192 68.79±33.09 38.75±42.84 31.54±18.65 0.205151 ALT(IU/L) 218.7±70 120.5±96.2 32.87±25.12 32.87±25.12 0.18993 NT-proBNP(pg/ml) 9726±7196 3770±3296 4153±726.8 3063±5655 <0.0001 RA(mmHg) 15.66±7.5 10.88±8.06 0.039 PCWP (mmHg) 25.66±13.8 18.55±9.31 0.68 CI(l/min/m2) 1.77±0.66 1.72±0.41 0.75 Laboratory values and haemodynamic data. Open in new tab Table 1. . Day 0 . Day 6 . Day 30 . Day 60 . p-value . Urea(mg/dl) 100±64.75 71.29±34.07 73.16±50.83 59.29±41.8 <0.0001 Creatinine(mg/dl) 1.8±0.81 1.19±0.47 1.223±0.62 1.13±0.35 <0.0001 Bilirubin(mg/dl) 1.88±1.03 1.2±0.67 1.01±0.65 0.91±0.35 <0.0001 AST(IU/L) 320.41±192 68.79±33.09 38.75±42.84 31.54±18.65 0.205151 ALT(IU/L) 218.7±70 120.5±96.2 32.87±25.12 32.87±25.12 0.18993 NT-proBNP(pg/ml) 9726±7196 3770±3296 4153±726.8 3063±5655 <0.0001 RA(mmHg) 15.66±7.5 10.88±8.06 0.039 PCWP (mmHg) 25.66±13.8 18.55±9.31 0.68 CI(l/min/m2) 1.77±0.66 1.72±0.41 0.75 . Day 0 . Day 6 . Day 30 . Day 60 . p-value . Urea(mg/dl) 100±64.75 71.29±34.07 73.16±50.83 59.29±41.8 <0.0001 Creatinine(mg/dl) 1.8±0.81 1.19±0.47 1.223±0.62 1.13±0.35 <0.0001 Bilirubin(mg/dl) 1.88±1.03 1.2±0.67 1.01±0.65 0.91±0.35 <0.0001 AST(IU/L) 320.41±192 68.79±33.09 38.75±42.84 31.54±18.65 0.205151 ALT(IU/L) 218.7±70 120.5±96.2 32.87±25.12 32.87±25.12 0.18993 NT-proBNP(pg/ml) 9726±7196 3770±3296 4153±726.8 3063±5655 <0.0001 RA(mmHg) 15.66±7.5 10.88±8.06 0.039 PCWP (mmHg) 25.66±13.8 18.55±9.31 0.68 CI(l/min/m2) 1.77±0.66 1.72±0.41 0.75 Laboratory values and haemodynamic data. Open in new tab P647 https://esc365.escardio.org/Presentation/221093/abstract Comparison of the course and clinical events in patients with acute heart failure in the context of acute coronary syndrome depending on the use of artificial ventilation A Solomonchuk,1 L Rasputina,2 T Danilevich,2 V Rasputin1 and A Tomashkevych1 1Vinnytsia Regional Center of Cardiovascular Pathology, Vinnytsia, Ukraine 2Vinnytsya National Medical University named after M.I. Pyrogov, Propedeutics of Internal Medicine, Vinnytsia, Ukraine Acute heart failure (AHF) is one of the most common cause of death in patients with acute coronary syndrome (ACS). The respiratory support of AHF patients can improve the prognosis in this group, including those patients, who have been selected for urgent coronary angiography. Objectives: Comparison of clinical features and endpoints during hospitalization among patients with acute coronary syndrome (ACS) undergoing urgent revascularization with pre-hospital complication presented on AHF (Killip III-IV) depending on the use of artificial ventilation (AV). Methods and materials: 244 patients, hospitalized in myocardial infarction cardiology unit with ACS for urgent coronary angiography, were examined. AHF signs (Killip III-IV) were present in all patients before the onset of the coronary angiography. The average age of the examined patients was 69.5 ± 1.3 years, included 134 (54.9%) males with the average age of 67.2 ± 1.3 years, and 110 (45.1%) females, whose average age was 74 ± 1.5 years. They were divided into 2 groups: the I group included 224 patients, who had not been treated with artificial ventilation; the II group (20 patients) was undergoing artificial ventilation. Relatively younger were patients in the group II (p = 0.005). Results: It revealed, that the comparison groups did not differ significantly at the ACS hospitalization time intervals. In the group I 156 (69,6%) patients had STEMI, while in the group II it were 12 (85%) patients, (p = 0,11). In the second group there were significantly more patients with co-morbidities, included arterial hypertension (p = 0.038) and diabetes mellitus (p = 0.005); also at the time of hospitalization these patients had higher level of white blood cells, glycemia and creatinine. In the group I 73 (32,6%)persons died, in the group II 12 (60%)patients died, p = 0,014. A negative correlation between the artificial ventilation duration and the age of patients (r = -0.32, p = 0.01), creatinine level (r = -0.49, p = 0.05) and positive correlation with glomerular filtration rate (GFR) (r = 0.78, p = 0.0001) were identified. The presence of artificial ventilation correlated with the male sex (r = 0.19, p = 0.001) and white blood cells level (r = 0.27, p = 0.009). Conclusion: In 20 patients with AHF (Killip III-IV) during the urgent coronary angiography, artificial ventilation was applied. In this group of patients co-morbidities, as diabetes mellitus and arterial hypertension, were significantly more likely to be detected. The artificial ventilation and it duration correlate with the age of patients, the level of creatinine and glomerular filtration rate. P648 https://esc365.escardio.org/Presentation/217415/abstract Impella RP support in refractory right ventricular failure complicating acute myocardial infarction with unsuccessful right coronary artery revascularization M Gramegna,1 A Beneduce,2 LF Bertoldi,3 M Pagnesi,3 C Marini,3 V Pazzanese,3 PG Camici,3 A Chieffo2 and F Pappalardo3 1San Raffaele Scientific Institute, Milan, Italy 2San Raffaele Scientific Institute, Interventional Cardiology Unit, Milan, Italy 3San Raffaele Scientific Institute, Intensive Cardiac Care Unit, Advanced Heart Failure and Mechanical Circulatory Support Program, Milan, Italy Backgrounds: Impella RP has been used to treat right ventricular failure (RVF) developing in various clinical settings that underlay different pathological mechanisms and lead to distinct prognostic implications. Food and Drug Administration encourages to use the Impella RP selection criteria checklist. In this checklist, unsuccessful right coronary artery (RCA) revascularization is considered a contraindication. Purpose: We aim to evaluate Impella RP in patients with refractory RVF due to acute myocardial infarction (AMI) complicated by unsuccessful RCA primary revascularization. Methods: This is a single-center retrospective study including all consecutive patients, from January 2015 to December 2018, with inferior ST-segment elevation myocardial infarction (STEMI) due to acute thrombotic occlusion of RCA and unsuccessful primary percutaneous coronary intervention (PCI) complicated by refractory RVF managed with an Impella RP device. Results: A total of 5 patients have been treated. The mean age was 73±9 years, 80% were males. All patients, except one, were hemodynamically stable at hospital admission. In all patients, primary percutaneous coronary intervention (PCI) resulted unsuccessful (final TIMI flow <3), with subsequent development of refractory RVF and cardiogenic shock in the catheterization laboratory, despite the use of inotropes and intra-aortic balloon pump (IABP). In 80% of the cases Impella RP was placed immediately after PCI, in one case it was placed 24h later. Hemodynamics improved immediately after initiation of Impella RP support, with an increase in systolic blood pressure from 91±17 to 136±13 mmHg, a decrease in central venous pressure from 16±2.5 to 12±4 mmHg and a resolution in lactates from 4.5±2.5 to 1.6±0.7 mg/dL. Mean duration of IABP and Impella RP support were 4 and 7 days, respectively. RV recovery occurred in 80% of the cases. All patients survived at 30 days. Conclusions: To the best of our knowledge, this is the first series focused on Impella RP implanted in patients with AMI complicated by unsuccessful revascularization of RCA and refractory RVF. The use of Impella RP device resulted in immediate hemodynamic benefit with reversal of shock and favorable survival at 30 days. P649 https://esc365.escardio.org/Presentation/217417/abstract Intra-aortic balloon counterpulsation: experience in a center without advanced mechanical circulatory support devices L Matute Blanco,1 J Gayan Ordas,1 P Pastor Pueyo,1 C Tomas Querol,1 I Hernandez Martin,1 A Aldoma Balasch,1 E Blanco Ponce,1 R Gomez Dominguez,1 A Bosch Gaya,1 M Zofia Zielonka,1 E Pereyra Acha,1 I Calaf Vall,1 N Pueyo Balsells,1 I Barriuso Barrado1 and F Worner Diz1 1Hospital Arnau de Vilanova, Lleida, Spain Introduction: Nowadays we have advanced mechanical circulatory support (MCS) devices for cardiogenic shock and the use of intra-aortic balloon counterpulsation (IABC) is not routinely recommended. Purpose: Our objective is to describe the experience of using IABC in a center without MCS devices. Methods: An observational, retrospective, single-center study that consecutively includes patients who underwent IABC implantation between October / 2016 and February / 2019. Table 1. Baseline characteristics. . Total population (N=76) . Age (years) 68±13 Males, N (%) 54 (71.1) Diabetes, N (%) 29 (38.2) Arterial hypertension, N (%) 46 (60.5) Cardiorespiratory arrest 19 (25) Support time (days) 2 (1-7) . Total population (N=76) . Age (years) 68±13 Males, N (%) 54 (71.1) Diabetes, N (%) 29 (38.2) Arterial hypertension, N (%) 46 (60.5) Cardiorespiratory arrest 19 (25) Support time (days) 2 (1-7) Correl. sST2/IL-33 % DC/Leucocytes/CRP. Open in new tab Table 1. Baseline characteristics. . Total population (N=76) . Age (years) 68±13 Males, N (%) 54 (71.1) Diabetes, N (%) 29 (38.2) Arterial hypertension, N (%) 46 (60.5) Cardiorespiratory arrest 19 (25) Support time (days) 2 (1-7) . Total population (N=76) . Age (years) 68±13 Males, N (%) 54 (71.1) Diabetes, N (%) 29 (38.2) Arterial hypertension, N (%) 46 (60.5) Cardiorespiratory arrest 19 (25) Support time (days) 2 (1-7) Correl. sST2/IL-33 % DC/Leucocytes/CRP. Open in new tab Results: 76 patients with a mean age of 68 ± 13 years were included, mainly men. The implant was performed mainly at the time of admission (79%). The main indication of the implant was pre-shock/cardiogenic shock, with the predominant etiology being acute coronary syndrome (83%). In the remaining 16%, it was due to refractory angina or as support for very high-risk angioplasty. Among patients with pre-shock/cardiogenic shock due to ACS, 19% suffered mechanical complications. 53.2% of the pre-shock/cardiogenic shock group presented a CardShock Risk Score ≥ 4 points upon admission. The overall hospital mortality was 25%, while in the group of pre-shock/cardiogenic shock the hospital mortality was 29.7%. Of 21 patients transferred to a tertiary hospital under IABC support, all arrived alive and none presented complications related to the device during the transfer: 4 received advanced MCS devices, 2 underwent heart transplantation and 5 underwent surgery. In the total sample, 12% had minor complications related to the implant and 2 patients had major complications, none of them fatal: one major bleeding that required transfusion and percutaneous treatment; and acute ischemia of the lower limb that required surgical intervention. Conclusions: Currently, the rate of major complications of IABC is low and acceptable. IABC remains a mechanical circulatory support option widely used in our center. Our experience and the mortality in our population suggests that IABC is a useful tool as a bridge to recovery and as support for transfer in centers without advanced MCS devices. P650 https://esc365.escardio.org/Presentation/221097/abstract Management of right ventricular failure in patients with short-term left ventricular support devices. One-center experience. S Catoya Villa,1 B Tapia Majado,1 J Sanchez Cena,1 T Borderias Villaroel,1 S Gonzalez Lizarbe,1 D Serrano Lozano,1 I Cabrera Rubio,1 M Lozano Gonzalez,1 V Burgos Palacios,1 A Canteli Alvarez,1 C Castrillo Bustamante,1 M Ruiz Lera,1 M Cobo Belaustegui,1 E Lujan Valencia1 and A Sarralde Aguayo1 1University Hospital Marques de Valdecilla, Santander, Spain Introduction: One of the most frequent complications during the management of left ventricular support devices (LVAD) is the development of right ventricular failure (RVF). There are several scores that have been used in the prevention and early diagnosis of RVF in patients with long-term devices. The usefulness of these in patients with short-term LVAD is not validated. Our goal is to describe the results of those patients with short-term LVAD who developed RVF. Methods: Since 2009, 252 short-term circulatory support devices were implanted in our hospital, of which 98 were Levitronix Centrimag® VAD. 59 of these were LVAD, and of these, 33 developed RVF. We present a descriptive analysis of these cases. Results: Mean age was 51.9 years, and 90.9% were male. Implant was performed in an INTERMACS 2 or 3 situation in 75.8% of the patients. 18.2% of cases had had circulatory support with VA-ECMO previously. 8 patients had liver failure prior to implantation, and only 4 had renal failure. 36.4% had moderate or severe right ventricular systolic dysfunction, and 34.6%, tricuspid insufficiency. In 27.3% of the patients pulmonary vascular resistance was higher than 3 Wood Units. Pulmonary capillary pressure was higher than 18 mmHg in 86.4%, and central venous pressure higher than 15 mmHg in 26.9%. The RVF was resolved with conservative management (inotropic support and pulmonary vasodilators) in 90.9% of the cases. In 3 patients it was necessary to reconvert to biventricular support, and all of them are alive at the present time. 6 patients died before being included in Grade 0 emergency list, and the remaining 27 were transplanted. Finally, the overall survival at one year was 81.8%, similar to the LVAD series. Open in new tabDownload slide VAD Survival. Conclusions: When we use a short-term LVAD, we move in a different scenario than with long-term devices. Keeping patients in an Intensive Care Unit (ICU) until the device is removed allows us to be more lax when indicating isolated left ventricular assistance. This strategy in our center is accompanied by a prolonged time of support and length of stay in the ICU, but this do not have a negative effect on survival. Acute Coronary Syndromes – Diagnostic Methods P654 https://esc365.escardio.org/Presentation/217227/abstract The importance of the 15-lead ECG recording in the diagnosis and treatment of acute myocardial infarction. IA Vogiatzis,1 EFSTATHI Koulouris,1 EVANGELO Sdogkos,1 MARIA Pliatsika,1 PAVLOS Roditis,1 MARKOS Goumenakis1 and ANTONIS Papadopoulos1 1General Hospital of Veria, Department of Cardiology,, Veria, Greece Introduction: The 12-lead ECG at admission of patients suffering from acute myocardial infarction (AMI) is mandatory for accurate diagnosis and prompt therapeutic measures, mainly reperfusion. It has been shown that recording additional ECG leads may improve the diagnostic accuracy and therefore, the prognosis of selected cases. The aim of the study was to assess the usefulness of the 15-lead ECG (12 classic plus 3 posterior leads) in the management of chest pain patients, especially when 12-lead ECG is not diagnostic of AMI. Methods: 186 consecutive patients (127 men, 59 women, mean age 69.7±13.8 years) were admitted with an acute coronary syndrome. The initial ECG recorded the 12 classic leads, and subsequently, the 3 additional posterior leads. Demographic and clinical data, including ECG alterations and selected treatment strategy, were also studied. The cumulative impact of the 15-lead ECG on the diagnosis and management of AMI were, overall, evaluated. Results: The 12-lead ECG was diagnostic of ST-elevation AMI (STEMI) in 158 patients (Group A - 84.5%) who were promptly reperfused. On the other hand, the interpretation of the posterior leads was required in 28 patients (Group B - 15.1%) to establish the STEMI diagnosis warranting reperfusion therapy. Multivariable analysis illustrated that the 15-lead ECG was the only factor associated with achieving the STEMI diagnosis in non-conclusive 12-lead ECG cases (OR=2.43 - p=0.04). Conclusion: The use of the 15-lead ECG contributes to a faster and more accurate diagnosis of STEMI, particularly in the Emergency Department, facilitating the prompt reperfusion therapy. Acute Coronary Syndromes: Biomarkers P655 https://esc365.escardio.org/Presentation/216422/abstract Correlating novel biomarkers sST2 and IL-33 with levels of circulating dendritic cells in patients with acute myocardial infarction R Rezar,1 M Lichtenauer,1 B Wernly,1 V Paar,1 R Pistulli,2 C Jung,3 UC Hoppe,1 M Sponder,4 C Schulze5 and D Kretzschmar5 1Paracelsus Private Medical University, Salzburg, Austria 2University Hospital, Muenster, Germany 3University Hospital Duesseldorf, Düsseldorf, Germany 4Medical University of Vienna AKH, Vienna, Austria 5University Hospital Jena, Jena, Germany Background: Ischemic heart disease, including acute myocardial infarction as a dramatic event, is stated to be the greatest single cause of mortality. Novel biomarkers like the soluble suppression of tumorigenicity 2 (sST2) and interleukin-33 (IL-33) were shown to play a role in hypertrophy and remodeling of cardiomyocytes in multiple previous studies. Also, their role as inflammatory factors and the interaction with immune cells, such as dendritic cells has been the subject of recent research. Purpose: This study aims to show a correlation of novel cardiovascular biomarkers sST2 and IL-33 with numbers of dendritic cells (DCs) in peripheral blood in patients suffering from myocardial infarction, to take another step towards a detailed understanding of their interaction and clinical significance. Methods: Sixty-one patients were enrolled in the STEMI-group, fifty-seven in the NSTEMI-group. After excluding coronary artery disease via angiography, a number of seventy-six individuals were included in the control group. Serum blood levels of sST2 and IL-33 were analyzed with ELISA-kits to correlate them with standard laboratory tests as well as numbers of dendritic cells in peripheral blood obtained by FACS analysis. Standard statistical methods were used for data analysis. Results: Regarding analyzed biomarkers, significantly higher levels of sST2 were shown in patients with acute myocardial infarction (p<0.0001), whereas IL-33 clearly was observed in lower levels in patients with an acute coronary event (p=0.0028 for NSTEMI, p=0.0058 for STEMI). Looking at dendritic cells, a negative correlation between total DC numbers in peripheral blood and sST2 was observed (r=−0.2723), focusing only at DC-subpopulations the negative relationship was significant for myeloid DCs (p<0.0001) as well as plasmacytoid DCs (p<0.0001). In contrast a positive correlation of blood leucocyte count and sST2 was shown (p<0.0001). No significant relationship for IL-33 and DCs was observed, no matter if focusing on total DC-count (p=0.4852), or only myeloid DC subpopulation (p=0.4852) and plasmacytoid dendritic cells (p=0.3208). Open in new tabDownload slide Correl. sST2/IL-33 % DC/Leucocytes/CRP. Conclusions: A significant positive correlation of sST2 along with low IL-33 levels, as well as a strong negative correlation with circulating dendritic cell counts, irrespective of their subtype, in patients with acute myocardial infarction was observed. The finding of a reciprocal relationship between DC-counts and sST2 suggests a possible common pathway in a systemic inflammatory state in acute coronary events. A detailed understanding of the interaction between dendritic cells and the sST2-/IL-33 pathway may be shown in future research. Acute Coronary Syndromes: Biomarkers P659 https://esc365.escardio.org/Presentation/216463/abstract NSTEMI course depending on GRACE scale risk and ST2 plasma level IA Mezhiievska,1 VI Maslovskyi1 and VP Ivanov1 1National Pirogov Memorial Medical University, Internal medicine #3, Vinnitsa, Ukraine Aim: to determine the relationship of ST2 level with GRACE risk and NSTEMI course. Open in new tabDownload slide Table 1. Course of NSTEMI . Patient number . Mean ± Standard error . Median (25  75 Percentile) . Anterior wall 79 53,5±5,4 37,9 (29,6; 58,9) Posterior wall 11 38,1±5,0 29,4 (23,2; 47,9) Mann-Whitney U test: p=0,03 Non-complicated course 68 42,8±5,5 31,9 (25,2; 46,4) Complicated course 22 49,2±8,0 40,7 (32,9; 61,5) Mann-Whitney U test: p=0,03 Acute arrhythmia 15 62,7±15,1 47,1 (31,2; 87,5) Absent 75 47,8±4,5 35,6 (25,7; 55,3) Mann-Whitney U test: p=0,004 Acute conducting disorders 3 72,3±28,3 43,7 (38,2; 57,9) Absent 87 49,0±4,5 35,2 (25,7; 55,3) Mann-Whitney U test: p=0,13 Acute heart failure (Killip III) 4 57,0±7,4 56,3 (35,4; 103,9) Absent 86 40,7±5,0 35,2 (25,9; 56,1) Course of NSTEMI . Patient number . Mean ± Standard error . Median (25  75 Percentile) . Anterior wall 79 53,5±5,4 37,9 (29,6; 58,9) Posterior wall 11 38,1±5,0 29,4 (23,2; 47,9) Mann-Whitney U test: p=0,03 Non-complicated course 68 42,8±5,5 31,9 (25,2; 46,4) Complicated course 22 49,2±8,0 40,7 (32,9; 61,5) Mann-Whitney U test: p=0,03 Acute arrhythmia 15 62,7±15,1 47,1 (31,2; 87,5) Absent 75 47,8±4,5 35,6 (25,7; 55,3) Mann-Whitney U test: p=0,004 Acute conducting disorders 3 72,3±28,3 43,7 (38,2; 57,9) Absent 87 49,0±4,5 35,2 (25,7; 55,3) Mann-Whitney U test: p=0,13 Acute heart failure (Killip III) 4 57,0±7,4 56,3 (35,4; 103,9) Absent 86 40,7±5,0 35,2 (25,9; 56,1) Open in new tab Table 1. Course of NSTEMI . Patient number . Mean ± Standard error . Median (25  75 Percentile) . Anterior wall 79 53,5±5,4 37,9 (29,6; 58,9) Posterior wall 11 38,1±5,0 29,4 (23,2; 47,9) Mann-Whitney U test: p=0,03 Non-complicated course 68 42,8±5,5 31,9 (25,2; 46,4) Complicated course 22 49,2±8,0 40,7 (32,9; 61,5) Mann-Whitney U test: p=0,03 Acute arrhythmia 15 62,7±15,1 47,1 (31,2; 87,5) Absent 75 47,8±4,5 35,6 (25,7; 55,3) Mann-Whitney U test: p=0,004 Acute conducting disorders 3 72,3±28,3 43,7 (38,2; 57,9) Absent 87 49,0±4,5 35,2 (25,7; 55,3) Mann-Whitney U test: p=0,13 Acute heart failure (Killip III) 4 57,0±7,4 56,3 (35,4; 103,9) Absent 86 40,7±5,0 35,2 (25,9; 56,1) Course of NSTEMI . Patient number . Mean ± Standard error . Median (25  75 Percentile) . Anterior wall 79 53,5±5,4 37,9 (29,6; 58,9) Posterior wall 11 38,1±5,0 29,4 (23,2; 47,9) Mann-Whitney U test: p=0,03 Non-complicated course 68 42,8±5,5 31,9 (25,2; 46,4) Complicated course 22 49,2±8,0 40,7 (32,9; 61,5) Mann-Whitney U test: p=0,03 Acute arrhythmia 15 62,7±15,1 47,1 (31,2; 87,5) Absent 75 47,8±4,5 35,6 (25,7; 55,3) Mann-Whitney U test: p=0,004 Acute conducting disorders 3 72,3±28,3 43,7 (38,2; 57,9) Absent 87 49,0±4,5 35,2 (25,7; 55,3) Mann-Whitney U test: p=0,13 Acute heart failure (Killip III) 4 57,0±7,4 56,3 (35,4; 103,9) Absent 86 40,7±5,0 35,2 (25,9; 56,1) Open in new tab Methods: We studied 90 patients with NSTEMI aged of 35 to 79 years (mean 60.7 ± 0.8, median - 61, interquartile range 54 and 69). Plasma ST2 level was determined and analyzed in the NSTEMI group of patients, the gradations of the stimulating growth factor level (ST2) and the correlation with GRACE risk and NSTEMI course nature were highlighted. All of research corresponding to the principles of the Declaration of Helsinki of the World Medical Association. Results: The patient distribution according to GRACE risk revealed the following factors - high risk (140 points or more) was determined in 36 patients, while 54 patients had low and medium levels (less than 140 points), (p = 0.01), (Fig. 1). The ST2 level was higher in the group of patients with complicated NSTEMI course, in particular, acute arrhythmia and conduction disorders and acute heart failure. In addition, the ST2 level was established with the localization of NSTEMI. Thus, higher levels of ST2 were observed in lesions of the anterior wall of the left ventricle compared to the posterior wall of the left ventricle (Tab. 1). Conclusion: The relatively high level of ST2 was noted in the high risk group by GRACE. Determination of ST2 plasma level allows to predict NSTEMI course and complications likelihood in the early period, as well as the relationship of ST2 level with the localization of NSTEMI. Acute Coronary Syndromes: Biomarkers P665 https://esc365.escardio.org/Presentation/216485/abstract Role of macrophage-produced bone morphogenetic proteins in patients with acute primary STEMI: from experiment to clinic.The reported study was funded by RFBR, project number 19-315-60005\19 M Kercheva,1 A Gusakova,2 A Gombozhapova1 and V Ryabov2 1Siberian State Medical University, Tomsk, Russian Federation 2Cardiology Research Institute, Tomsk National Research Medical Center, Russian Academy of Sciences, Tomsk, Russian Federation The experimental data already showed that bone morphogenetic proteins (BMP)-2 and -4 expressed by type 2 macrophages in the zone of myocardial infarction (MI) are capable of changing gene expression, affecting the processes of differentiation and repair of heart tissue. However, there is insufficient clinical evidence to support these results. Purpose: to assess the early and late dynamic of serum levels of BMP-1 and - 4 and its associations with markers of inflammation, hemodynamic stress, degradation of extracellular matrix in patients with acute primary anterior myocardial infarction with ST segment elevation (STEMI). Methods: 31 pts with STEMI (mean age 58 yr), who underwent percutaneous coronary intervention (PCI) during the first 24 h of the onset of MI, were enrolled in this study. Reperfusion time was 4.8±3.3 h. Blood samples were assessed at days 1 (T1), 3 (T2), 7 (T3), and 14 (T4), and six months after STEMI (T5). The serum levels of BMP-2 and - 4 were determined by the immunoassay. Also, we assessed the associations of BMP-2 and -4 with serum levels of markers of inflammation – high-sensitivity C-reactive protein (CRP) and interleukin-1b (IL-1b); with markers of degradation of extracellular matrix - matrix metalloproteinases (MMP)-2, -3, -9; with markers of hemodynamics stress - soluble isoform of suppression of tumorigenicity 2 (sST2) and N-terminal pro-brain natriuretic peptide (NT-proBNP). Results: Serum levels of BMP-2 was increased in a third of patients at the admission, but its level decreased from T1 to T5: from 40 (12; 101) to 20 (0.7; 127) ng/ml. Only 1 pts had increased level of BMP-2 to T5. The level of BMP-2 decreased during the whole period of hospitalization: from T2 - 39 (7; 192), from T3 - 42 (5; 158), from T4 - 37 (17; 107) to Т5 (p=0.001). Serum level of BMP-4 decreased from T4 to T5 by 37%: from 464 (161; 776) to 436 (135; 2069) pg/ml (p=0.02). However it was not dynamics during the early period of MI: 336 (120; 794) at Т1, 335 (134; 157) at Т2, 422 (253; 621) at Т3. Serum level of BMP-4 was in a normal range during the whole investigated period. Serum level of ВМР-2 at T1 was associated with reperfusion time (r=−0.7, p<0.05). Serum level of BMP-2 was associated with hCRP and MMP-9, also with a level of white blood cells at T3 (r=0.5, p<0.05). Serum levels of BMP-4 was associated with hCRP and MMP-9 at T2, but it was negative correlation (r=−0.6, p<0.05), also it correlated with the level of sST2 at T1 (r=−0.5, p<0.05). Conclusion: Serum levels of BMP-2 and BMP-4 decreased to the 6 months period of MI, but dynamics was the different. BMP-2 decreased from the first day of MI, but BMP-4 - from 14th day of MI. The level of BMP-2 was increased at third of patients at the first day and had correlation with reperfusion time and with a level of hCRP, MMP-9 at the 7th day of MI. Serum levels of BMP-4 also was associated with hCRP, MMP-9, sST2 at the first 3 days after MI, but this correlation was a negative. Acute Coronary Syndromes – Treatment P666 https://esc365.escardio.org/Presentation/216718/abstract Intra-hospital LDL-c determination usefulness to predict the probability of achieving objective LDL-c after discharge in patients with acute coronary syndrome treated with high intensity statinsThis study did not receive any specific grant from funding agencies in the public, commercial or not-for-profit-sectors. FM Munoz Franco,1 AM Castillo Navarro,1 PJ Flores Blanco,1 BG Leithold,1 G Elvira Ruiz,1 AI Rodriguez Serrano,1 M Gomez Molina,1 AI Lova Navarro,1 F Cambronero Sanchez,1 CS Caro Martinez,1 DA Pascual Figal,1 JA Noguera Velasco1 and S Manzano Fernandez1 1UNIVERSITY HOSPITAL CLINIC VIRGEN DE LA ARRIXACA, Murcia, Spain Introduction: Intensive lipid lowering therapy is important in patients with acute coronary syndrome (ACS). The new guidelines for the management of dyslipidaemias recommend a low-density lipoprotein cholesterol (LDL-c) level < 55 mg/dL for very high risk patients. Purpose: The aim of this study was to analyze the association between intra-hospital low-density lipoprotein cholesterol (IHLDL) levels and the probability to reach target values of LDL-c < 55 mg/dL during the first year after hospital discharge in patients with ACS under high intensity statin treatment. Methods: Retrospective, observational study of 828 consecutive discharged patients after ACS under treatment with high intensity statins in our center. The primary end point was reaching LDL-c level < 55 mg/dL in the first analytical determination after discharge. Patients with LDL-c determination during the first 30 days or beyond 365 days after the initial event as well as those without LDL-c levels were excluded. Treatment with high intensity statins was considered: atorvastatin 80 mg, rosuvastatin 20 mg and 40 mg. Results: We enrolled 828 patients (65 ± 13 years; 75% men). The IHLDL levels and after discharge were 97 ± 38 mg/dl and 69 ± 28 mg/dL. During the follow-up, 32% of patients reached LDL-c < 55 mg/dL. The discriminative ability of IHLDL levels to predict the achievement of LDL-c target values after discharge was modest (area under the ROC curve = 0,67; 95% confidence interval 0,64 – 0,71). Patients with higher IHLDL levels were more likely to fail in reaching LDL-c < 55 mg/dL. Thus, IHLDL levels > 70 mg/dL, > 100 mg/dL and > 130 mg/dL presented a positive predictive values for non-achievement LDL-c target values of 75, 80 and 85 %, respectively. Conclusions: In this clinical context, high IHLDL levels are associated with a lower probability of reaching LDL-c objectives during the first year of follow-up. IHLDL levels can be useful for early detection of patients with a high probability of failure in which the intensification of hygienic dietary modifications and the association of other lipid lowering agents could be beneficial. Table 1. IHLDL . Sensitivity . Specificity . PPV . NPV . > 55 mg/dL 92 (90-94) 24 (19-29) 72 (69-75) 59 (49-68) > 70 mg/dL 82 (79-85) 41 (35-47) 75 (71-78) 52 (45-59) > 75 mg/dL 79 (75-82) 48 (42-54) 76 (73-80) 52 (45-58) > 100 mg/dL 49 (44-53) 74 (68-79) 80 (75-84) 41 (36-45) > 130 mg/dL 22 (19-26) 92 (88-95) 85 (79-91) 36 (32-39) IHLDL . Sensitivity . Specificity . PPV . NPV . > 55 mg/dL 92 (90-94) 24 (19-29) 72 (69-75) 59 (49-68) > 70 mg/dL 82 (79-85) 41 (35-47) 75 (71-78) 52 (45-59) > 75 mg/dL 79 (75-82) 48 (42-54) 76 (73-80) 52 (45-58) > 100 mg/dL 49 (44-53) 74 (68-79) 80 (75-84) 41 (36-45) > 130 mg/dL 22 (19-26) 92 (88-95) 85 (79-91) 36 (32-39) IHLDL: intra-hospital low-density lipoprotein cholesterol (IHLDL). PPV: positive predictive value. NPV: negative predictive value. Open in new tab Table 1. IHLDL . Sensitivity . Specificity . PPV . NPV . > 55 mg/dL 92 (90-94) 24 (19-29) 72 (69-75) 59 (49-68) > 70 mg/dL 82 (79-85) 41 (35-47) 75 (71-78) 52 (45-59) > 75 mg/dL 79 (75-82) 48 (42-54) 76 (73-80) 52 (45-58) > 100 mg/dL 49 (44-53) 74 (68-79) 80 (75-84) 41 (36-45) > 130 mg/dL 22 (19-26) 92 (88-95) 85 (79-91) 36 (32-39) IHLDL . Sensitivity . Specificity . PPV . NPV . > 55 mg/dL 92 (90-94) 24 (19-29) 72 (69-75) 59 (49-68) > 70 mg/dL 82 (79-85) 41 (35-47) 75 (71-78) 52 (45-59) > 75 mg/dL 79 (75-82) 48 (42-54) 76 (73-80) 52 (45-58) > 100 mg/dL 49 (44-53) 74 (68-79) 80 (75-84) 41 (36-45) > 130 mg/dL 22 (19-26) 92 (88-95) 85 (79-91) 36 (32-39) IHLDL: intra-hospital low-density lipoprotein cholesterol (IHLDL). PPV: positive predictive value. NPV: negative predictive value. Open in new tab Acute Coronary Syndromes: Lifestyle Modification P667 https://esc365.escardio.org/Presentation/216705/abstract Cardiac rehabilitation following acute myocardial infarction and its impact on health-related quality of lifeNational Institute for Health Research (NIHR/CS/009/004), British Heart foundation (PG/19/54/34511) B Hurdus,1 T Munyombwe1 and CP Gale1 1University of Leeds, Leeds, United Kingdom of Great Britain & Northern Ireland Background: Cardiac rehabilitation has been shown to improve health-related quality of life (HRQoL) following acute myocardial infarction (AMI). However much of this evidence was developed prior to modern drug and reperfusion therapies meaning the true impact needs further study. Purpose: To assess the association of cardiac rehabilitation and health-related quality of life HRQoL following AMI. Methods: EMMACE-3, a UK nationwide longitudinal cohort study collected data from 4570 patients admitted to 48 National Health Service hospitals in England between 1st November 2011 and 17th September 2013 with an AMI. HRQoL was estimated using EuroQol EQ-5D-3L at hospitalisation, 30 days, 6 months and 12 months following discharge. The association of cardiac rehabilitation and HRQoL was quantified using multi-level regression. Results: Patients who attended cardiac rehabilitation had higher HRQoL scores than those who did not at all follow-up points; 30 days (mean [SD] EQ-VAS: 71.0 [16.8] vs. 68.6 [19.8]), 6 months (EQ-VAS: 76.0 [16.4] vs. 70.2 [19.0]) and 12 months (EQ-VAS: 76.9 [16.8] vs. 70.4 [20.4]). Patients who attended cardiac rehabilitation and exercised ≥150 minutes per week had yet higher HRQoL scores compared with those who did neither; 30 days (mean [SD] EQ-VAS: 79.3 [14.6] vs. 67.7 [20.0]), 6 months (EQ-VAS: 82.2 [13.9] vs. 68.9 [19.1]), 12 months (EQ-VAS: 84.1 [12.1] vs. 69.2 [20.6]). Multi-level regression modelling demonstrated cardiac rehabilitation was significantly associated with improved HRQoL (2.34 [95% CI, 0.92 to 3.77]). Conclusions: Patients who received cardiac rehabilitation had higher HRQoL, which was even higher for those who also exercised ≥150 minutes per week at all follow-up points. Therefore, cardiac rehabilitation and exercise may be important in recovery post-AMI despite advances in drug and reperfusion therapies. Acute Coronary Syndromes: Pharmacotherapy P668 https://esc365.escardio.org/Presentation/221099/abstract Pharmaco-invasive strategy in patients with STEMI according to a randomized clinical trial FRIDOM1 with a 1-year mortality estimate.SupraGen E Gerasimets1 1Peoples Friendship University of Russia (PFUR), Moscow, Russian Federation Pharmaco-invasive strategy in patients with STEMI according to a randomized clinical trial FRIDOM1 with a 1-year mortality estimate. Aim: Assess the effect of pharmaco-invasive strategy using the new Russian genetic engineering drug non-immunogenic staphylokinase in comparison with the drug tenecteplase on mortality and long-term results for 1 year. Materials and methods: The study included 382 patients aged 18 years and older, with no age limit, who were admitted to emergency departments of cardiology in 11 clinical centers diagnosed with ST-elevated myocardial infarction (STEMI) with subsequent assessment of the 1-year mortality rate of patients. Results: One-year patient status was determined in 186 out of 191 (97.4%) in the non-immunogenic staphylokinase group and in 185 out of 191 (96.9%) patients in the tenecteplase group. One-year death from all causes was 11 (5.9%) patients in the non-immunogenic staphylokinase group and 12 (6.5%) in the tenecteplase group (p = 0.83; OR 0.91; 95% CI 0.42– 1.98.). One-year mortality from CVD in the non-immunogenic staphylokinase group is 5.4%, in the tenecteplase group — 6.5% (p = 0.67; OR 0.83; 95% CI 0.37-1.83). The one-year survival rate was 94.1% in the non-immunogenic staphylokinase and 93.5% tenecteplase groups. A repeated myocardial infarction for 1 year was 13 (7%) in the non-immunogenic staphylokinase group and 15 (8.1%) in the tenecteplase group. Repeated revascularization within one year was 7 (3.7%) in the non-immunogenic staphylokinase group and 6 (3.2%) in the tenecteplase group. Table 1. Results of one-year clinical outcomes. Name of indicator . Non-immunogenic staphylokinase (n=191) n (%) . Tenecteplase (n=191) n (%) . One-year patient status 186 (97.4) 185 (96.9) One-year death from all causes 11 (5.9) 12 (6.5) One-year mortality from CVD 10 (5.4) 12 (6.5) One-year survival rate 175 (94.1) 173 (93.5) Repeated myocardial infarction for 1 year 13 (7) 15 (8.1) Repeated revascularization within 1 year 7 (3.7) 6 (3.2) Name of indicator . Non-immunogenic staphylokinase (n=191) n (%) . Tenecteplase (n=191) n (%) . One-year patient status 186 (97.4) 185 (96.9) One-year death from all causes 11 (5.9) 12 (6.5) One-year mortality from CVD 10 (5.4) 12 (6.5) One-year survival rate 175 (94.1) 173 (93.5) Repeated myocardial infarction for 1 year 13 (7) 15 (8.1) Repeated revascularization within 1 year 7 (3.7) 6 (3.2) Comparative results in the non-immunogenic staphylokinase group and in the tenecteplase group. Open in new tab Table 1. Results of one-year clinical outcomes. Name of indicator . Non-immunogenic staphylokinase (n=191) n (%) . Tenecteplase (n=191) n (%) . One-year patient status 186 (97.4) 185 (96.9) One-year death from all causes 11 (5.9) 12 (6.5) One-year mortality from CVD 10 (5.4) 12 (6.5) One-year survival rate 175 (94.1) 173 (93.5) Repeated myocardial infarction for 1 year 13 (7) 15 (8.1) Repeated revascularization within 1 year 7 (3.7) 6 (3.2) Name of indicator . Non-immunogenic staphylokinase (n=191) n (%) . Tenecteplase (n=191) n (%) . One-year patient status 186 (97.4) 185 (96.9) One-year death from all causes 11 (5.9) 12 (6.5) One-year mortality from CVD 10 (5.4) 12 (6.5) One-year survival rate 175 (94.1) 173 (93.5) Repeated myocardial infarction for 1 year 13 (7) 15 (8.1) Repeated revascularization within 1 year 7 (3.7) 6 (3.2) Comparative results in the non-immunogenic staphylokinase group and in the tenecteplase group. Open in new tab Conclusion: In a 1-year all-cause mortality, the pharmaco-invasive strategy demonstrated high efficacy and safety, including high survival and low CVD mortality in patients with STEMI. TRIAL REGISTRATION: ClinicalTrials.gov NCT02301910 P669 https://esc365.escardio.org/Presentation/221294/abstract The long-term results of pharmaco-invasive reperfusion strategy in STEMI depending on the choice of thrombolytic agent AV Khripun,1 AA Kastanayan,2 AI Chesnikova,2 MV Malevannyi1 and Y Kulikovskikh1 1Regional Vascular Center, Rostov Regional Clinical Hospital, Rostov-on-Don, Russian Federation 2State Medical University of Rostov-on-Don, Rostov-on-Don, Russian Federation Background: Today pharmaco-invasive reperfusion strategy for STEMI is recognized as a valuable alternative when primary PCI cannot be timely performed. There is only limited information about results of the use of different thrombolytic agents during pharmaco-invasive reperfusion in STEMI. The comparison of the efficacy of fibrin-specific and non–fibrin-specific agents is of particular interest. Purpose: To compare long-term results of pharmaco-invasive reperfusion strategy in STEMI using different thrombolytic agents. Methods: A prospective analysis of treatment of 240 STEMI patients that underwent pharmaco-invasive reperfusion at a single center from January 1, 2013 to December 31, 2016 was performed. All patients were divided into 4 groups according to the applied thrombolytic agents (alteplase tenecteplase, recombinant staphylokinase, streptokinase), and also into 2 groups depending on their fibrin specificity. The results of echocardiography, 24-hour ECG monitoring, the six-minute walk test and NT-proBNP levels along with the rate of major adverse cardiac and cerebrovascular events (MACCE), defined as composite of death, myocardial infarction, stroke and repeat revascularization, were compared at 12 months of follow-up. Results: The difference among groups in the incidence of MACCE was insignificant (p=0.558) with a trend to a lower death rate after discharge in the group of fibrin-specific agents (p = 0.090). At 1 year of follow-up the use of fibrin-specific agents compared with non–fibrin-specific agent (streptokinase) was associated with a significantly higher left ventricular ejection fraction (49.8 ± 7.4% vs. 47.4 ± 6.8 %, p = 0.048), lower values of the left ventricular wall motion scoring index (1.19 [1.06; 1.38] vs 1.25 [1.175; 1.5], p = 0.029), left ventricular end diastolic volume (139, 1 ± 28.6 ml vs 148.7 ± 23.9 ml, p = 0.027) and left atrium diameter (39.0 ± 4.6 mm vs 41.1 ± 3.1 mm, p = 0.007). Fibrin-specific agents also demonstrated significantly lower frequency of supraventricular tachycardia (4.5% vs 13.3%, p = 0.049) and premature ventricular contractions (54.5% versus 76.7%, p = 0.022) with more favorable heart rate variability indices according to the 24-hour ECG monitoring. The patients treated with fibrin-specific agents had significantly lower levels of NT-proBNP (148 [120; 208.5] pg/ml vs 241 [189; 287] pg/ml, p = 0.000). The use of fibrin-specific agents was associated with a greater walk distance according to the results of the six-minute walk test (p = 0.000). There were found no significant differences among fibrin-specific agents during the study period. Conclusions: Pharmaco-invasive reperfusion strategy in STEMI based on the use of fibrin-specific agents compared with streptokinase demonstrated more favorable long-term results with no significant difference among fibrin-specific agents. P670 https://esc365.escardio.org/Presentation/216417/abstract Comparison of antiplatelet therapy scenarios in ST segment elevation myocardial infarction in real clinical practice L Malinova,1 N Furman,1 P Dolotovskaya,1 N Puchinyan2 and P Denisova1 1Saratov State Medical University, Saratov, Russian Federation 2Saratov State Medical University, Research institute of cardiology, Saratov, Russian Federation The purpose of the study was to characterize the scenarios of antiplatelet therapy (APT) in STEMI patients, met in real clinical practice, referring to platelet function, and to assess their efficacy and safety. Methods: We analyzed APT in 587 male STEMI patients (59.9±12.1 y.o.) according to APT history, timing, type of antiplatelet drug, or their combination at first medical contact (FMC), and in ICU, antiplatelet switching and 6 months adherence (Fig.1). Platelet aggregation and secretion, and functional subpopulations were assessed at admittance and on the 7th day; results were recalculated per cell. D dimer, thrombopoietin and platelet derived microparticles (PDMP) were measured at admission, on the second and on the 7th day since STEMI manifestation. The primary endpoint included cases of cardiovascular deaths, readmissions and major bleedings. Minimal follow-up period was 24 months. Results: There were 34 original ATP scenarios with n>10. The most frequent were 1) no history of APT – acetylsalicylic acid (ASA) as monotherapy, 30-60 min since STEMI manifestation – double APT (DAPT, ASA + P2Y12 inhibitor)– no switching – good 6 month’s adherence – 19.9%; 2) no history of APT –DAPT, 30-60 min since STEMI manifestation – DAPT escalation in ICU – no further switching – good 6 month’s adherence – 14.9%; 3) no history of APT – monotherapy with P2Y12 inhibitor, 30-60 min since STEMI manifestation – DAPT – no switching – good 6 month’s adherence – 10.9%. Platelet function varied depending on APT scenario: monotherapy with P2Y12 inhibitor at FMC resulted in highly variable suppression of platelet aggregation: 5.71 (0.0; 64.81) mOhm/cell, which significantly depended on the “STEMI manifestation - treatment” time (T1, R = 0.768, p<0.05). ASA monotherapy (at FMC) leaded to less significant suppression of platelet aggregation: 24.04 (10.59; 39.48) mOhm/cell with no noticeable effect of the T1 (p>0.05). On the 7th day of observation, hyperactive subpopulation was minimal in patients with monotonous DAPT and early DAPT escalation: 7.58 (6.67; 32.26) mOhm/cell and 8.81 (8.33; 11.27) mOhm/cell. The highest levels of PDMP on the 7th day were in patients without history of APT, who received P2Y12 inhibitor at FMC following DAPT at ICU, and those with DAPT escalation: 54.33 (20.50; 141.23) ng/mL and 93.80 (82.65; 124.25) ng/mL. There were no significant differences in cardiovascular mortality and readmissions between those APT scenarios, which included long lasted DAPT, but event free time was maximal in patients without APT history and an early escalation of DAPT initiated within 30-60 min (p=0.002). Open in new tabDownload slide Conclusion: Antiplatelet therapy in STEMI patients may be tailored according to the APT history and time delays. As to our data in STEMI patients never treated with antiplatelet drugs before, an early escalation of DAPT initiated within 30-60 min, seems to be the most beneficial scenario referring to the event free period. P672 https://esc365.escardio.org/Presentation/216466/abstract Outcomes of pharmacoinvasive strategy compared with primary angioplasty in a large metropolitan area D Araiza Garaygordobil,1 R Gopar-Nieto,1 C Jackson-Pedroza,1 A Gallardo,1 CA Dattoli-Garcia,1 A Villalobos-Flores,1 A Loaisiga-Saenz,1 LV Torres-Araujo,1 L Baeza-Herrera,1 M Martinez-Ramos Mendez,1 R Pohls-Vazquez,1 G Raymundo-Martinez,1 A Cabello-Lopez,2 P Martinez-Amezcua3 and A Arias-Mendoza1 1National Institute of Cardiology Ignacio Chavez, Mexico City, Mexico 2UMAE Centro Medico Nacional Siglo XXI IMSS, Mexico City, Mexico 3Johns Hopkins University of Baltimore, Baltimore, United States of America Background: Timely reperfusion in ST-Elevation myocardial infarction (STEMI) is associated with improved outcomes. While percutaneous coronary intervention (PCI) is considered the gold-standard of treatment, access to PCI may be limited in low-to-middle income countries. Pharmacoinvasive strategy (PS) is a feasible alternative that has shown similar outcomes in randomized clinical trials, but real-world data is scarce. Purpose: To compare efficacy (in-hospital mortality) and safety (major bleeding) in STEMI patients treated with pharmacoinvasive strategy (PS) vs PCI in a large metropolitan hospital network. Methods: Cohort study including 503 patients with STEMI treated with either PCI (n=255) or PS (n=248) from April 2018 until October 2019, presenting to any medical center (n = 60) part of a STEMI network within a large metropolitan area (median transfer distance = 25.2km). Sociodemographic data, clinical history, and interventional variables were recorder. A Kaplan-Meier model was constructed to compare in-hospital mortality. Results: 503 patients were recruited, with a mean age of 58.3±11.1 years and an overall mortality of 5.4% (n=27). Patients had a median total ischemia time for PS of 320 min vs 315 min for PCI (p=0.16). We found no differences regarding in-hospital mortality among PS compared to PCI (4 vs 6.7%, p=0.19), arrhythmias (20.7 vs 28%, p=0.06), cardiogenic shock (6.2 vs 11.1%, p=0.06), stroke (0% vs 0.4, p=0.32) and major bleeding (3.92 vs 5.7%, p=0.36). Conclusion: PS shows similar efficacy and safety when compared with PCI in patients with STEMI from a large metropolitan hospital network. Open in new tabDownload slide In-hospital mortality in PS and PCI. P673 https://esc365.escardio.org/Presentation/216425/abstract Dual antiplatelet therapy-related haematuria after acute coronary syndromes- etiology, management and outcomes in our casuistry EC Buzdugan,1 L Stoicescu,1 A Grosu1 and D Radulescu1 1University of Medicine and Pharmacy, Cluj Napoca, Romania Background: Current management of acute coronary syndromes (ACS) includes dual antiplatelet therapy (DAPT), which can more effectively reduce cardiovascular recurent events. With development of new and more potent antiplatelet agents the risk of bleeding can outweigh benefits of therapy. Among the most frequent encountered side-effects, genitourinar haemorrage may alter the optimal course of therapy in ACS, with unfavorable potential outcomes. Mantaining a balance between safety and efficacy of DAPT remains a major challenge. Purpose: To elaborate standardised therapeutic protocols in DAPT-related urinary bleeding we have analysed etiology, management and outcomes in our casuistry. Methods: We searched in our hospital data base patients with macroscopic haematuria and coronary disease diagnostics. All medical file were retrospectively analyzed for causes of haematuria, coronary diseases types, DAPT medication, management and medical outcome at discharge. Results: In a 5 months period, a total of 5438 patients were admitted in our hospital, including 141 having concomitant macroscopic haematuria and a form of coronary heart disease. A total of 15 cases were using DAPT, 14 for ACS and 1 for recent carotid stenting. Most of the ACS patients were males (12:2), with a median age of 70.5 y/o (57-80). 12 cases had been previously revascularizate, 4 for ST-elevation myocardial infarction (STEMI) and 8 for unstable angina or non-STEMI, one of the cases having haematuria at less than 3 weeks after DES placement for STEMI. Due to patients preferences, 2 cases had been treated conservatively for coronary disease. Haematuria was related to cancer in 8 cases (tumors were localised in bladder-6 cases and prostate-2 cases), 6 cases having benign sources, equaly divided between urolithiasis, urinary tract infections and large prostatic adenoma. Due to severe haematuria and clot retention, 9 patients were treated with irigation with haemostatic agents and fluids after insertion of a three-way Foley catheter. Surgery was required in 6 cases of bladder tumors, blood transfusion being needed in 5 cases. Cardiologic assessment was perform routinely perioperative. For all patiens aspirin was mantained, and the second antiplateled agent (clopidogrel in 2 cases, and ticagrelor for the rest) was temporarly withdrawn. In case of surgery needed, a low molecular weight heparin was used whenever possible before, and routinely after proceedures. No reccurent event or invasive procedures were neccesary for coronary disease, and no fatal events were recorded during hospitalisation. Conclusion: There is a thin line between safety and efficacy of DAPT use in ACS when bleeding occurs. In our cases, maintaining aspirin and temporarily withdrawing the second antiplatelet agent has proven to be safe, regardless of whether the bleeding has been treated medically or surgically. A team-based decision can result in positive outcomes in complex cases. Acute Coronary Syndromes: Treatment, Revascularization P674 https://esc365.escardio.org/Presentation/216696/abstract A novel district hospital rapid access ambulatory cardiology clinic - a prospectively collected audit M Zaman1 1James Paget University Hospital, Great Yarmouth, United Kingdom of Great Britain & Northern Ireland Background: Many patients with new symptoms that may be attributable to cardiovascular disease are now presenting first to newly-formed Ambulatory Units at acute hospitals. Prompt and accurate diagnosis is often accrued in these units, assisted by open access to cardiac tests such as echocardiography and ambulatory cardiac monitoring, but onwards referral to specialists often entails referral onto long out-patient clinic waiting lists, given such patients do not usually require immediate hospital admission. Purpose: A novel rapid-access, rapid-fire consultant-led cardiology clinic placed within the Ambulatory Unit aimed at reducing waiting times for a specialist-directed opinion on further management within the sub-acute cardiac care pathway. Methods: Prospectively collected audit of the first six months, 17 January – 18 July 2019; 19 clinics, with 85 patients in total appointed. Results: The waiting time was an average of 11 days (range 1-30), compared with a 13 week waiting time in standard out-patients. There was a mean of 4 patients per clinic (range 1-7). Atrial fibrillation constituted the majority referral diagnosis (45 patients), 14 had heart failure and 10 had atrial flutter; the rest were an assortment of diagnoses and symptoms. The vast majority of referrals were appropriate, with only 13 of the 79 (6 did not attend) that attended having their diagnosis altered. 36 (46%) had their management changed in some way in the clinic. Two patients were urgently admitted (for cardioversion the next day). All patients were seen on time and within the rapid-fire fifteen-minute clinic slots, and administration minimised using template clinic letters allowing for rapid typing, with no dictation length longer than two minutes. Of the 85 referrals, 26 were discharged and 17 required a cardioversion (patients that would otherwise have waited for 13 weeks awaiting for an cardiology opinion to decide the need for this). Conclusion(s): A single-handed, consultant-delivered ambulatory heart clinic was associated with a large reduction in waiting time for an out-patient specialist cardiology opinion. The vast majority of referrals were appropriate. A large proportion had their management altered in some way despite having only recently been seen by the acute physicians in the Ambulatory Unit. The clinic ran to time, and administration was kept to a minimum. The experience presented here should inform further development of rapid access cardiac clinics, run by senior cardiologists, to allow early directed specialist management of newly-diagnosed cardiac conditions that would otherwise wait months for a standard out-patient clinic. P675 https://esc365.escardio.org/Presentation/216742/abstract The risk factors for development of the no-reflow phenomenon in real clinic practiceNo E Konstantinova,1 M Muksinova,2 M Gilyarov,3 E Kuzmina,1 A Udovichenko,3 E Gasparyan3 and AV Svet3 1Pirogov Russian National Research Medical University, Moscow, Russian Federation 2FSBO National Medical research center of cardiology of the Ministry of healthcare, Moscow, Russian Federation 3City Clinical Hospital No 1 of N.I.Pirogov, Moscow, Russian Federation Background: No-reflow phenomenon remains a serious complication of primary percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) Purpose: To research features of the “no / slow-reflow” phenomenon in patients with STEMI in real clinical practice Methods: In the retrospective single-center trial were included 238 patients with STEMI, who were taken by ambulance or made their own way to City Clinical Hospital №1 (CCH №1) in Moscow and were hospitalized during the period between the 1st January 2017 and the 31st of December 2017. The presence of the no-reflow phenomenon was determined by the absence of antegrade blood flow (TIMI 0) in the distal channel with angiography proven patency of this vessel, and slow-reflow - with partial delivery of contrast distal to occlusion (TIMI I-II). Patients were analyzed demographic, anamnestic, clinical and instrumental was also compared. Results: The no / slow-reflow phenomenon was diagnosed in 39 patients with STEMI (group I), which amounted to 16% and in 199 patients was not diagnosed (group II). The average age between the group with “no / slow-reflow” phenomenon and without did not statistically differ and amounted to 65.7 ± 10.3 years in the group I and 63 ± 11.4 years in the group II. In group I, women accounted for 28% (11 patients), in the group II - 32% (64 patients). Comorbid pathology was observed in groups I and II, no significant difference was found between groups of pathologies such as: arterial hypertension in 35 patients (90%) in the group I and 178 (90%) in the group II, diabetes mellitus in 11 patients (28%) in the group I and 49 (24%) in the group II, chronic kidney disease at stage 3 and above in 15 patients (38%) in the group I and 68 (34%) in the group II. In groups I and II, patients suffered history of myocardial infarction (MI) occurred in 26% and 15% of cases (p <0.05), history of stroke in 18% and 10% (p <0.05), congestive liver failure in 36% and 24% (p <0.01), Killip IV in 10% and 5% (p <0.01), atrial fibrillation (AF) in 23% and 16% (p <0.05). In I the group, the hospital death rate was 20% (8 patients), in the group II - 4% (9 patients) (p <0.01). According to the coronarography, the anterior descending artery and right coronary artery in group I were infarct dependent in 56% and 30% of cases, respectively, while in the group II - in 41% and 36%. Conclusion: The “no / slow-reflow” in patients with STEMI and primary PCI in the coronary arteries is associated with a high risk of death in the near term. It is advisable to stratify patients at risk for the development of the “no-reflow” phenomenon - with repeated myocardial infarction, AF, stroke in history, as well as damage to the anterior descending artery. P676 https://esc365.escardio.org/Presentation/216405/abstract Angioplasty with stenting in acute coronary syndromes with very low contrast volume (<30ml) using cordis 6f diagnostic catheters and improved clinical outcomes MC Arokiaraj1 1Pondicherry Institute of Medical Sciences, Pondicherry, India Background: To safely perform angioplasties in acute coronary syndromes with very low contrast volume using Cordis diagnostic catheters and thereby improve the cardiovascular and renal outcomes. Methods: In 1028 patients (1331 lesions/ 1495 stents) with acute coronary syndromes, angioplasty was performed with cordis 6F diagnostic catheters. Primary angioplasty was performed in 312 cases. In 76% of cases, Iodixanol was used. All contrast injections were given by hand. A regular follow-up of the patients was performed at 30 days. All the procedures were performed through femoral route . Tirofiban was used in 99% cases with adjusted dosages based on the creatinine values. The mean contrast volume used per patient was 27 ml (±6 ml) including the angiogram prior to angioplasty. Sixty patients had creatinine more than 2mg/dl before the angioplasty procedures. Left main angioplasty was performed in 26 patients. Forty-five patients had a cardiogenic shock at presentation. 78% of the cases had diabetes. IVUS was used in only two patients. A variety of coronary stents from various companies were used. Buddy wires were used in 32 cases. Manual removal of the femoral sheaths was performed. Ticagrelor was used in 30 cases, and in other cases clopidogrel was used. Results: Mild reversible nephropathy (CIN) was observed in five patients. Two patients had creatinine more than 5mg/dl at presentation, and they were started on hemodialysis after the procedures. Three patients were already on dialysis, and dialysis was continued thereafter. Switch-over of angioplasty to the radial route was performed in four cases due to associated aortic/iliac obstructive lesions. Sixteen mortality in total was observed in this series; 11 of these patients had cardiogenic shock (3 late presenters), and two patients expired after discharge due to possible acute stent thrombosis, two patients had associated septic shock at presentation, and one patient had severe acute respiratory distress syndrome. Groin hematoma was seen in three cases requiring one unit of blood transfusion. Proximal mild edge dissection in the deployed stent was seen in 2 cases. Wire breakages was not seen. Acute stent thrombosis in-hospital was seen in 3 cases, which were managed with balloon dilatations and stent. Conclusions: Angioplasty and stenting could be performed safely in patients with acute coronary syndromes using Cordis diagnostic catheters using a very low volume of contrast with improved cardiovascular and renal outcomes. P677 https://esc365.escardio.org/Presentation/221101/abstract Repeated coronary catheterization after distal transradial intervention for patients with acute myocardial infarction T Yamada,1 Y Mizuguchi,1 N Taniguchi,1 S Nakajima,1 T Hata1 and A Takahashi1 1Sakurakai Takahashi Hospital, Kobe, Japan Background: The distal transradial approach (dTRA) is a novel vascular approach for coronary catheterisation which is alternative to the conventional transradial approach. This technique is expected to decrease the incidence of haemorrhagic complications and radial artery occlusion. This study investigated the impact of the dTRA for the patients with ST-elevation myocardial infarction (STEMI) who requires repeated coronary angiography or intervention. Methods: Consecutive 73 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) between April 2018 and July 2019 were investigated. Distal radial artery (dRA) was used as the primary approach whenever feasible in this study period. Patients’ background, procedural characteristics, and the success rate of repeated coronary catheterization via the distal radial artery were analysed. Results: Among the 73 STEMI patients, 65 patients (89.0%) underwent successful primary PCI via the dRA. In these patients, 27 patients (41.5%) required repeated coronary catheterization. The patients included 24 men (88.9%), and the mean age was 73.0 ± 10.6 years. A 6-French sheath (conventional or slender) was used in the primary procedure. Repeated coronary catheterization was performed via dRA on the same side in 26 patients (96.3%), and the other patient performed staged PCI via dRA on the other side because an arterial line was placed in the radial artery on the same side. Accordingly, Radial artery occlusion were not observed in this series. Conclusions: The dTRA is feasible for primary PCI in selected patients with STEMI, and the application of the dTRA may reduce the incidence of radial artery occlusion. P678 https://esc365.escardio.org/Presentation/216736/abstract Results of percutaneous coronary intervention with second-generation drug coated balloons in diabetic patients at a long-term follow-up. I Sanchez Perez,1 J Abellan-Huerta,1 MT Lopez-Lluva,1 P Perez-Diaz,1 M Negreira-Caamano,1 R Frias-Garcia,1 A Moron-Alguacil,1 J Martinez-Rio,1 VM Munoz-Garcia1 and F Lozano1 1Hospital General de Ciudad Real, Interventional Cardiology, Ciudad Real, Spain Introduction: Drug coated balloons (DCB) constitute one of the therapeutic tools used in percutaneous coronary interventions (PCI) of both stent restenosis and “De Novo” coronary lesions, mainly in bifurcations and small vessels. Diabetic patients represent an unfavorable subgroup because of their higher restenosis and adverse events rates. Nowadays, the results of PCI with DCB at a long-term follow up are unclear in this subset of patients. Purpose: To evaluate the efficacy and safety of PCI with second-generation drug coated balloons (DCB) in diabetics at a long term follow-up. Methods: We prospectively included 219 lesions in 188 diabetic patients (68.5± 11.7 years, 63.7% male) treated with DCB between March 2009 and September 2018. We evaluated the presence of major cardiac events (MACE) after a clinical follow up (median 33 months): death, nonfatal myocardial infarction, target lesion revascularization (TLR) and thrombosis. Results: 48.6% of patients had stable coronary artery disease, and 51.4% acute coronary syndromes (43.1% non-STEMI and 8.3% STEMI). 86.3% of patients had hypertension and 67.3% had dyslipidemia. 17.1% of lesions were bifurcations. Target lesion diameter was ≤2.5 mm in 47.8% of the cases. Coated drug was paclitaxel in the 92.5% of lesions, and sirolimus in the remaining 7.5%. 39.9% were “De Novo” lesions and 60.1% were restenotic lesions [40.4% restenosis of bare metal stent (BMS) and 19.7% of drug-eluting stent (DES)]. 82.7% of lesions were treated with DCB, 6.2% with DCB and BMS and 11.1% with DCB and DES. Angiographic success rate was 98.4%. There were no significant differences regarding baseline characteristics of these three groups neither in the MACE rate after follow-up (p=0.6). Death rate was 9.2% (5.4% cardiovascular death, 7.4% non-cardiovascular death), nonfatal MI rate was 5.4% and TLR rate was 6.4% during follow-up. No cases of thrombosis were observed, immediately after the procedure nor during follow up. 16.9% of patients had an angiographic follow-up. We observed a higher rate of TLR (14.3% vs 7.7%; p=0.04) as well as a higher need for additional stent during follow-up in bifurcation lesions PCI in bifurcation lesions (20% vs 5.5%; p=0.02). Conclusions: PCI of “De Novo” coronary lesions and in-stent restenosis (both BMS and DES) In diabetic patients, with second-generation drug eluting balloons provide very favorable outcomes at a long term follow-up. Bifurcated lesions were associated with a higher need of additional stent during PCI and higher rate of TLR at follow-up. P679 https://esc365.escardio.org/Presentation/216719/abstract Long-term outcomes comparison of percutaneous coronary intervention with two differents paclitaxel eluting balloon catheters. I Sanchez Perez,1 J Abellan-Huerta,1 MT Lopez-Lluva,1 P Perez-Diaz,1 M Negreira-Caamano,1 R Frias-Garcia,1 J Martinez-Rio,1 A Moron-Alguacil,1 VM Munoz-Garcia1 and F Lozano1 1Hospital General de Ciudad Real, Interventional Cardiology, Ciudad Real, Spain Introduction: Drug coated balloons (DCB) currently constitute one of the therapeutic tools used in percutaneous coronary interventions(PCI). The widely used Sequent Please® and In-Pact Falcon® are paclitaxel DCB that differ in several features such as the drug carrier. Their results at a long-term follow up have never been compared. Purpose: We aimed to compare the efficacy and safety of second-generation DCB Sequent Please® and In-Pact Falcon® at a long term follow-up. Methods:We prospectively included 378 lesions in 311 patients (67.2± 12.3 years, 75.3% male) treated with Sequent Please® (242 lesions; 65.8 %) and In-Pact Falcon® (126 lesions; 34.2%) DCB between March 2009 and December 2018. We evaluated and compared the presence of major cardiac events (MACE) after a clinical follow up (median 35 months): death, nonfatal myocardial infarction (MI), target lesion revascularization (TLR) and thrombosis. Results: 45.3% of patients had stable coronary artery disease, and 54.7% acute coronary syndromes (46.6% non-STEMI and 8.1% STEMI). 51.5% were diabetic patients, 81.8% had hypertension and 60.2% had dyslipidemia. 22% of lesions were bifurcations, 42.6% diffuse and 56.3% type B2/C lesions. Target lesion diameter was ≤ 2.5 mm in 53.8% of cases and mean length treated lesion was 20.6± 11mm. Of the 368 lesions, 45.1% were “De Novoc lesions and 54.9% were restenotic lesions [38.9% restenosis of bare metal stent (BMS) and 16% of drug-eluting stent (DES)]. 85% of lesions were treated with DCB, 6.8% with DCB and BMS and 8.2% with DCB and DES. Death rate was 7.7% (2.5% cardiovascular death, 5.2% non-cardiovascular death), nonfatal MI rate was 3.3% and TLR rate was 4.4% during follow-up. No cases of thrombosis were observed, immediately after the procedure nor during follow up. Basal characteristic showed no statistical differences when comparing both type of DCB. The rate of MACE were similar between groups at the end of follow-up, as follow: cardiovascular death (Sequent 2.5% vs Falcon 2.4%; p=0.9), non cardiovascular death (Sequent 5.4% vs Falcon 4.8%; p=0.8), nonfatal MI (Sequent 2.5% vs Falcon 4.8%; p=0.2), TLR (Sequent 4.6% vs Falcon 4%; p=0.8). Angiographic follow-up was 16.7%. Conclusions: Percutaneous coronary intervention of “De Novo” and in-stent restenosis coronary lesions with Sequent Please® and In-Pact Falcon® paclitaxel drug eluting balloons provide very favorable and comparable outcomes at a long-term follow-up. P681 https://esc365.escardio.org/Presentation/216726/abstract Percutaneous coronary intervention with second-generation drug coated balloons in elderly patients: results at long-term follow-up. I Sanchez-Perez,1 J Abellan-Huerta,1 MT Lopez-Lluva,1 P Perez-Diaz,1 M Negreira-Caamano,1 R Frias-Garcia,1 A Moron-Alguacil,1 J Martinez-Rio,1 VM Munoz-Garcia1 and F Lozano1 1Hospital General de Ciudad Real, Ciudad Real, Spain Introduction: Drug coated balloons (DCB) constitute one of the therapeutic tools used in percutaneous coronary interventions(PCI) of both stent restenosis and "De Novo" coronary lesions, mainly in bifurcations and small vessels. Elderly patients represent an unfavorable and worse prognosis subgroup, in which this technique could be of great value. Nevertheless, the results of PCI with DCB at a long-term follow up are unclear in this subset of patients. Purpose: To evaluate the efficacy and safety of PCI with second-generation drug coated balloons (DCB) in patients older than 75 years at a long term follow-up. Methods: We prospectively included 152 lesions in 121 patients (80.9 ± 4.1 years, 61.2% male) treated with DCB between March 2009 and March 2018. We evaluated the presence of major cardiac events (MACE) after a clinical follow up (median 36 months): death, nonfatal myocardial infarction, target lesion revascularization (TLR) and thrombosis. Results: 43.4% of patients had stable coronary artery disease, and 56.6% acute coronary syndromes (49.6% non-STEMI and 7% STEMI). 87.7% of patients had hypertension, 60% had diabetes, 58.5% dyslipidemia and 19.2% were active smokers. 20.8% of lesions were bifurcations. Target lesion diameter was ≤2.5 mm in 50.8% of cases. The coated drug was paclitaxel in 90.7% of lesions, and sirolimus in the remaining 9.3%. Of the 130 lesions, 48% were "De Novo" lesions and 52% were restenosis [33.9% restenosis of bare metal stent (BMS) and 18.1% of drug-eluting stent (DES)]. 84.2% of lesions were treated with DCB, 6.5% with DCB and BMS and 9.3% with DCB and DES. Angiographic success rate was 99%. There were no significant differences regarding baseline characteristics of these three groups neither in the MACE rate after follow-up (p=0.2). Death rate was 16.2% (3.9% cardiovascular death, 12.3% non-cardiovascular death), nonfatal MI rate was 2.3% and TLR rate was 1.5% during follow-up. No cases of thrombosis were observed, immediately after the procedure nor during follow up. Angiographic follow-up was 15.6%. Conclusions: PCI of "De Novo" coronary lesions and in-stent restenosis (both BMS and DES) with second-generation DCB in the elderly patients provides very favorable outcomes at a long term follow-up, constituting an alternative treatment to PCI with stent implantation in this subgroup of high risk patients. P683 https://esc365.escardio.org/Presentation/216737/abstract Results of urgent percutaneous coronary intervention to non-protected left main coronary artery FM Munoz Franco,1 D Fernandez Vazquez,1 AI Rodriguez Serrano,1 M Gomez Molina,1 J Garcia De Lara,1 JA Hurtado Martinez,1 R Valdesuso,1 JR Gimeno Blanes,1 E Pinar Bermudez1 and J Lacunza Ruiz1 1Hospital Clínico Univeristario Virgen de la Arrixaca, Servicio de Cardiología, Murcia, Spain Purpose: Coronary by-pass surgery is the "gold standard" treatment for significant left main coronary artery (LMCA) disease. However, percutaneous coronary intervention (PCI) is probably the only therapeutic option in patients with acute coronary syndrome (ACS) affecting the LMCA. The aim of the study was to evaluate the results of PCI in patients with ACS affecting LMCA in our center. Methods: retrospective analysis of consecutive patients with urgent PCI to LMCA between January 2015 and December 2017. We evaluated in-hospital mortality, and mortality and non-fatal myocardial infarction (MI) at one year follow-up. Results: 36 patients were evaluated (58.3% male; age 68,1 ± 14,7 years). Baseline characteristics: 25% with diabetes, 67% hypertension, 33% smokers, 44% with left ventricular ejection fraction under 40%. 21 patients (58%) were in Killip class III-IV. The indication for urgent PCI was STEMI in 24 (66%) patients, non-STEMI 6 (17%) patients and cardiogenic shock in 6 (17%) patients. Mean Syntax score was 24.6± 8.4. Provisional stenting was the chosen technique in 86% of patients, with only 5 patients treated with complex techniques (crush or V stenting). In 6 procedures IVUS was used to guide the procedure. Sixteen patients (44%) had died at the end of follow-up: 9 (25%) died during hospitalization and 7 (19%) during follow-up. All deaths were of cardiovascular origin except one septic shock. Mortality among patients with cardiogenic shock or pulmonary edema at presentation (KK III-IV) was 68%, while mortality among stable patients was 13% (p=0.001). 11% of patients had a non-fatal MI during follow-up. No major bleeding were reported during follow-up. Conclusion: patients with ACS affecting LMCA treated with PCI have very high in-hospital mortality rate, mainly due to cardiogenic shock. Cardiovascular event rate among Killip I-II patients was relatively low, similar to previous published series. P684 https://esc365.escardio.org/Presentation/216510/abstract Will my patient with acute coronary syndrome end up in surgery? R Menezes Fernandes,1 HA Costa,1 TF Mota,1 JS Bispo,1 D Bento,1 N Marques,1 J Mimoso1 and I Jesus1 1Faro Hospital, Cardiology, Faro, Portugal Introduction: In acute coronary syndrome (ACS), about 10% of patients are eligible for coronary artery bypass grafting (CABG). Being able to early identify these patients would hasten surgical referral, which has shown to be associated with lower in-hospital mortality. Moreover, it would be possible to adjust antiplatelet therapy earlier. Purpose: To identify a predictive score of CABG in patients with ACS. Methods: We performed a retrospective, descriptive and correlational study encompassing patients admitted with ACS in a Cardiology service from 1st October 2010 to 1st October 2018. Demographic factors, risk factors, antecedents and clinical characteristics were analyzed. The correlation between the categorical variables was performed by the Chi-square test, while the T-Student test was applied to the continuous variables, with a significance level of 95%. Independent predictors of CABG were identified through a binary logistic regression analysis, considering p=0,05. Then, a discriminatory function was applied using the Wilks lambda test to determine the discriminant score of the analyzed groups. Statistical analysis was conducted using SPSS 24.0. Results: During this period, 4458 patients were admitted with ACS and 313 (7,0%) had indication for CABG. This subgroup had a mean age of 66 ± 11 years and 78,3% were males. Regarding the diagnosis at admission, 87,2% presented with ACS without ST-segment elevation (NSTEACS) and 12,8% with ST-segment elevation acute myocardial infarction (STEMI). NSTEACS (p<0,001), presence of ST-depression (p<0,001), creatinine <1,5mg/dL (p=0,007), BNP>100 pg/ml (p=0,007), history of angina pectoris (p=0,001) and absence of history of percutaneous coronary intervention (PCI) (p=0,002) were independent predictors of CABG. A predictive score of CABG in patients with ACS was determined with the formula: -2,120+1,075x(NSTEACS) + 0,648x(angina pectoris) + 1,133x(ST-depression) + 0,433x(BNP>100) – 0,926X(history of ICP) – 0,893x(creatinine>1,5). In this equation, variables should be substituted by 1 or 0, depending on whether the condition is present or not. A cutoff of 0,5 was obtained with 74% sensitivity and 67% specificity. Conclusion: In this population of patients admitted with ACS, 7% were referred for CABG. We determined a predictive score of CABG including NSTEACS, ST-depression, BNP>100 pg/ml, creatinine <1.5mg/dL, history of angina pectoris and no history of PCI, with a good discriminative power. By considering clinical variables, this score can be used at an early stage of the patient’s admission, but requires validation to allow its application in clinical practice. P685 https://esc365.escardio.org/Presentation/221616/abstract Outcomes in nonagenarians with myocardial infarction JCEM Echarte Morales,1 JBR Borrego,1 CGF Galan,1 ETS Tundidor-Sanz,1 PMS Menendez,1 JMS Maillo,1 AMC Martin,1 SCG Del Castillo,1 CMC Minguito,1 CGM Gonzalez Maniega,1 RBG Bergel Garcia,1 ESM Sanchez1 and FFV Fernandez-Vazquez1 1Hospital of Leon, Leon, Spain Background: Acute coronary syndromes (ACS) in the elderly population are becoming more frequent. Treatment of nonagenarian patients is a difficult task due to an increased incidence of adverse events and high comorbidity. They are not adequately represented in clinical trials. Purpose: The aim of this study is to evaluate the clinical presentation, risk factors, co-morbidities, and outcomes depending of treatment strategy. Methods: We included retrospectively all nonagenarians presenting with ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation myocardial infarction (NSTEMI) admitted to our department between 2000-2018. We collected demographic, clinical, and procedural data. All-cause mortality was assessed in-hospital, at 6 months and 1-year follow-up. Results: A total of 140 patients (mean age 92 years) were included. 71 (50.71%) were male. 49.29% of patients suffered from NSTEMI (n = 69) while 50.71% STEMI (n = 71). In-hospital mortality was 16.43%, increased up to 24.2% at 6 months and 50.71% at 1-year follow-up. The average survival time was 385 ± 667 days. Percutaneous revascularization intervention (PCI) was higher in the STEMI group compared to NSTEMI (38.03% vs. 11.59%, p 0.0003), although this group had a higher in-hospital mortality (25.35% vs. 7.25%, p 0.004). At follow-up, mortality at one year was lower in revascularized patients versus those who did not revascularize (28.57% vs. 57.14%, p 0.0034). Patients in whom only medical treatment was chosen were older (92 ± 0.22 vs. 91 ± 0.32, p 0.01). Table 1. . NSTEMI . STEMI . p . Female 42,03% 56,33% 0.09 Diabetes 27.54% 23.94% 0.62 Hypertension 65.22% 76.06% 0.16 Chronic kidney disease 37.68% 49.30% 0.17 Disability or dependence for activities of daily living 40.6% 33.8% 0.41 In-hospital mortality 7.25% 25.35% 0.004 PCI 11.59% 38.03% 0.0003 Left ventricular ejection fraction post ACS 47.93% 42.59% 0.01 Mortality 52.17% 47.89% 0.61 . NSTEMI . STEMI . p . Female 42,03% 56,33% 0.09 Diabetes 27.54% 23.94% 0.62 Hypertension 65.22% 76.06% 0.16 Chronic kidney disease 37.68% 49.30% 0.17 Disability or dependence for activities of daily living 40.6% 33.8% 0.41 In-hospital mortality 7.25% 25.35% 0.004 PCI 11.59% 38.03% 0.0003 Left ventricular ejection fraction post ACS 47.93% 42.59% 0.01 Mortality 52.17% 47.89% 0.61 Open in new tab Table 1. . NSTEMI . STEMI . p . Female 42,03% 56,33% 0.09 Diabetes 27.54% 23.94% 0.62 Hypertension 65.22% 76.06% 0.16 Chronic kidney disease 37.68% 49.30% 0.17 Disability or dependence for activities of daily living 40.6% 33.8% 0.41 In-hospital mortality 7.25% 25.35% 0.004 PCI 11.59% 38.03% 0.0003 Left ventricular ejection fraction post ACS 47.93% 42.59% 0.01 Mortality 52.17% 47.89% 0.61 . NSTEMI . STEMI . p . Female 42,03% 56,33% 0.09 Diabetes 27.54% 23.94% 0.62 Hypertension 65.22% 76.06% 0.16 Chronic kidney disease 37.68% 49.30% 0.17 Disability or dependence for activities of daily living 40.6% 33.8% 0.41 In-hospital mortality 7.25% 25.35% 0.004 PCI 11.59% 38.03% 0.0003 Left ventricular ejection fraction post ACS 47.93% 42.59% 0.01 Mortality 52.17% 47.89% 0.61 Open in new tab Open in new tabDownload slide Conclusions: Nonagenarians patients suffering from an acute coronary syndrome have a high mortality up to 1-year follow up. Medical treatment is more often chosen in patients with NSTEMI. An invasive treatment strategy associates with better survival in these patients. P688 https://esc365.escardio.org/Presentation/221285/abstract Coronary angiography after cardiorrespiratory arrest: what’s the best timing? NPD Cunha,1 P Carrilho-Ferreira,1 J Rigueira,1 R Aguiar-Ricardo,1 R Santos,1 A Nunes-Ferreira,1 T Rodrigues,1 S Pereira,1 P Morais,1 P Antonio,1 F J Pinto1 and P Canas Da Silva1 1Santa Maria University Hospital/CHULN, CAML, CCUL, Lisbon School of Medicine, Universidade de Lisboa, Cardiology Department, Lisbon, Portugal Introduction: Despite the advances in emergency medicine, the prognosis after cardiorrespiratory arrest (CRA) is still poor. Data available in the literature concerning the indication and timing for coronary angiogram (CA) in these patients are limited and incomplete. Objective: We aimed to identify the best timing for CA in patients after cardiopulmonary resuscitation. Methods: Retrospective single centre study of patients consecutively submitted to coronary angiography after CRA between January 2015 and July 2018. Demographic, clinical, electrocardiographic and angiographic data were analyzed. Imagiological (echocardiographic and coronary computer tomography angiographic) data, procedure characteristics and patient outcomes were also analyzed. The results were obtained using student’s t-test, chi-square test (X2) and Receiver Operator Curve (ROC) analysis. Results: 121 patients were included (mean age 63.2±13 years; 76% men), of which 39.7% had previous history of coronary heart disease, 61.2% of hypertension and 40.5% of dyslipidemia. Most of the CRAs occurred out-of-hospital (58.4%) and in defibrillable rhythm (69.4%). Acute myocardial infarction was the most frequent cause (58.4%), of which the majority were type 1 (59.5%) and in the presence of ST elevation (36.4%). The mean time in arrest was 16±17 minutes. We could not assess the time between CRA and CA in 30 cases. Among the remainder, CA was performed after 1.3±3 days after the event, on average. The time between CRA and CA was not associated with mortality, neither when introduced as a continuous variable nor as a categorical variable, using the median time (3 hours) or at 24 hours as cut-offs. We found no statistically significant difference in mortality between the group submitted to CA on the first 24 hours after CRA and those submitted later (n=70 and n=21 respectively, p>0.01) . We also could not identify an optimal cut-off timing to perform CA after CRA in order to predict mortality (AUC=0.45, p=NS). Conclusion: We found no association between mortality and the time between CRA and CA and we could not establish an optimal cut-off time to perform CA. Our study thus reinforces the importance of an individual approach in the current setting and highlights the urgency for studies that include a higher number of cases, in order to optimise the medical care provided to these patients. Acute Coronary Syndromes – Prevention P690 https://esc365.escardio.org/Presentation/217582/abstract Acute Coronary Syndromes in young patientsnone H Santos,1 M Santos,1 H Miranda,1 I Almeida,1 L Almeida,1 C Sousa,1 S Almeida,1 C Sa,1 J Chin,1 L Santos1 and J Tavares1 1Hospital N.S. Rosario, Cardiology, Barreiro, Portugal Background: Acute coronary syndromes (ACS) are frequent in adult patients, yet its prevalence is lower in young patients. The analysis of clinical predictors of coronary events in young patients can help to establish a better prevention strategy. Objective: Evaluate the clinical predictors of ACS in young patients. Methods: Multicenter retrospective study, based on the Portuguese Registry of ACS between 1/10/2010-8/01/2019. Patients were divided in two groups: A – age inferior to 35 years old, and B - age between 35 and 45 years old. Were excluded patients without a previous cardiovascular history or clinical data on the admission, and with angina diagnostic. Logistic regression was performed to assess predictors of ACS in young patients. Results: 1266 patients were included, 115 in group A (9.1%) and 1151 in group B (90.9%). Both groups were similar regarding gender, body mass index, first medical contact, diabetes, smoking status, familiar history of cardiovascular disease, previous ACS, symptoms, Killip classification and admission blood samples. Group A had lower prevalence of arterial hypertension (14 vs 34.7%, p<0.001) and dyslipidemia (25.9 vs 47.5%, p<0.001), presented more ST-segment elevation myocardial infarction (STEMI) at admission (68.7 vs 57.1%, p=0.016) with a culprit lesion on the left anterior descending artery (67 vs 44.9%, p<0.001). On the other hand, Group B had more non-STEMI (42.9 vs 31.3%, p=0.016), more multivessel coronary disease (34.3 vs 16.3%, p<0.001), and a culprit lesion in STEMI patients was the right coronary artery (29 vs 18.1%, p=0.024). Blood work reveals higher values of low-density lipoprotein (53.5 vs 23.9%, p<0.001) and triglycerides (29.9 vs 49.7%, p<0.001) on the group B. Curiously, the group A had more prevalence of midrange left ventricular ejection fraction (LVEF), with both groups with similar preserved LVEF. Logistic regression revealed arterial hypertension (odds ratio (OR) 2.61, p=0.002, confidence interval (CI) 1.44-4.73) and dyslipidemia (OR 2.27, p=0.001, CI 1.39-3.71) as predictors of ACS in young patients. Conclusions: Arterial hypertension and dyslipidemia were clinical predictors of ACS in young patients. P691 https://esc365.escardio.org/Presentation/216424/abstract Decline of mortality associated to acute coronary syndromes: what can we still improve? I Almeida,1 H Santos,1 H Miranda,1 M Santos,1 J Chin,1 C Sousa,1 S Almeida1 and J Tavares1 1Hospital N.S. Rosario, Barreiro, Portugal Introduction: Mortality associated to acute coronary syndromes (ACS) has decreased on the last years due to better risk control at population level and more efficient interventions on coronary revascularization, leading to an improvement on patient prognosis. Purpose: Evaluation of mortality rate and its contributing factors in patients with ACS. Material and methods: Retrospective analysis of patient data admitted with ACS included in a multicentric registry between 2012-2017. Results: 10156 patients were admitted with ACS. 3% died during hospitalization (p <0.001), of which 59.3% was of male gender and average age (78±11 years vs 65±13, p<0.001). The most prevalent comorbidities were arterial hypertension (72.1%), dyslipidaemia (50.2%) and diabetes (37.2%). 12.7% were current smoker (vs 28.9%, p<0.001). The majority of patients who died arrived at the hospital by an ambulance without a doctor or their own transport (72.4% on total, p<0.001), only 13% used the emergency medical system. In what concerns to the place of hospital admission: 48.3% were admitted at emergency department and 35.3% at cardiac intensive care units. 46.3% (p 0.088) were admitted in hospitals without hemodynamic department. The evaluated average times were: symptoms beginning - first medical contact (FMC) 573 vs 322 minutes; FMC – admission 200 vs 226 minutes; and symptoms beginning – admission 669 vs 433 minutes, p<0.001. The dominant symptom at admission was chest pain in 69% (91.6% at rest) and dyspnoea in 15.7%, p<0.001. 57.3% had the diagnosis of ST elevation myocardial infarction, in 63.4% of anterior location (p <0.001). 54.5% of the patients presented in a Killip Kimball class higher than I. In 81% of the performed coronarographies there was stenosis of the anterior descendent artery, 45.8% occlusion of this artery and in 74.1% multivessel disease (p <0.001). The patients who died needed more invasive interventions namely: non-invasive mechanical ventilation in 26.3 vs 1.5%, invasive mechanical ventilation in 20.7 vs 1.6%, temporary pacemaker in 15 vs 1.5% and intra-aortic balloon in 4.7 vs 0.4% (p <0.001). A logistic regression was performed to evaluate the prognostic impact of demographic and clinical predictors of patients on endpoint death: age (≥75 years), the presence of right bundle branch block pattern, hypotension (systolic blood pressure <90mmHg), Killip Kimball class higher than I, persistent ST elevation or depression and an ejection fraction less than 50% were independent predictors of death. Conclusion: Efforts made to reduce mortality associated to acute coronary syndromes has been well succeeded, yet the authors reinforce the importance of continuing this task to increase public awareness of how to recognize common symptoms and to call the emergency services. Coronary Intervention: Primary and Acute PCI P693 https://esc365.escardio.org/Presentation/221186/abstract STEMI Reperfusion survey: Physicians’ knowledge and Hospitals readiness AHM Ahmed,1 AAA Suliman,1 MG Ahmed,2 AAA Deifa,3 MAF Nuri,4 KME Eltalib5 and AE Babiker6 1Shaab Teaching Hospital, Khartoum, Sudan 2Osman digna teaching Hospital, Cardiology, Port sudan, Sudan 3El Fasher teaching Hospital, cardiology, El Fasher, Sudan 4Merowe medical city, Cardiology, Merowe, Sudan 5Elobeid teaching Hospital, Cardiology, Elobeid, Sudan 6Royal care international hospital, cardiology, Khartoum, Sudan Introduction: Coronary artery disease (CAD) is a leading cause of death and disability-adjusted life years lost worldwide . ST-elevation myocardial infarction (STEMI) due to occlusion of epicardial coronary arteries is one of the major manifestations of CAD. Prompt diagnosis and administration of effective therapy saves lives and reduces morbidity. Objective: To study hospital electrocardiogram (ECG), thrombolysis and percutaneous angioplasty (PCI) capability as well as physicians knowledge regarding the key management points of STEMI. Open in new tabDownload slide Sudan map showing Hospitals capabilities. Methods: An online survey of emergency room physicians in hospitals in different states in Sudan on 10 questions regarding the different metrics for STEMI management according to ESC guidlines . A principal investigator provided data on volume of total and STEMI admissions and ECG,thrombolysis and PCI capability. The 10 key survey questions regarding diagnosis and reperfusion therapy in STEMI were: time of first medical contact (FMC) to ECG, ECG criteria for diagnosis of STEMI,time target of reperfusion therapy from onset of symptoms, of fibrinolytic therapy from ECG diagnosis,of repeat ECG from time of fibrinolysis administration, ECG criteria for successful thrombolysis, absolute contra-indications for fibrinolysis,time target of primary PCI from FMC, indications for referral to PCI capable center after successful and unsuccessful thrombolysis. Results: A total of 197 physicians were surveyed. The correct responses for the 10 survey questions was 48% of total answers. All hospitals were 24-hour ECG capable except one, 9 hospitals were thrombolysis capable, and 4 were PCI capable. Conclusion: Most Hospitals surveyed are 24-hr ECG capable while not all offered thrombolysis. Access to PCI remains limited in Sudan. Physicians knowledge regarding management of STEMI in Sudan remains poor. P694 https://esc365.escardio.org/Presentation/216448/abstract Left main percutaneous coronary intervention with second generation drug-eluting stents CC Oliveira,1 C Braga,1 I Campos,1 P Medeiros,1 C Pires,1 R Flores,1 F Mane,1 J Costa1 and J Marques1 1Hospital de Braga, Braga, Portugal Introduction: Improved percutaneous coronary intervention (PCI) has reduced its complications in the treatment of left main (LM) coronary disease. Aim: To characterize patients and procedures with LM PCI and to evaluate their outcomes. Methods: Single-center, retrospective study performed from January 2015 to December 2017 in patients with LM PCIwith second-generation drug-eluting stents (n=67). Results: Patients with LM PCIwere mainly male (68.7%) with median age of 70.1 years. 57.1% of patients were diabetic and 52.% had reduced ejection fraction. Previous CABG was presented in 20.9% (only patient had unprotected LM). The SYNTAX score was low (22 or less) in 56.6%, intermediate (22 to 32) in 30.2% and high (33 or higher) in 13.2%. Distal LM bifurcation PCIwas performed in 79.1% and 73% of patients had two-vessel or three-vessel disease. 13.2% of patients with distal disease were treated with a two-stent technique (1 with T-stent, 2 with TAP, and 4 with culotte technique), in which proximal optimization technique (POT) and kissing balloon were always performed. When one-stent technique was used in distal LM, POT was performed in 66.0% and kissing balloon in 25%. Pre and post dilatation were performed in 91.0 and 82.1% of all cases, respectively. Indications for PCIwere elective PCI for stable angina (n=18), stabilized NSTEMI(n=20), NSTEMI with ongoing instability (n=10), STEMI(n= 16), and non-culprit lesion treatment after primary-PCI for STEMI(n=3). 22.4% of patients were in cardiogenic shock. After our first LM PCI guided with intracoronary imaging, 38.6% of the procedures were performed with it. 14.6% of patients died during the hospitalization (1 with stent thrombosis; 9 were in cardiogenic shock). All patients had at least 1 year of follow-up. At follow-up, 13.2% of patients died. 85% of deaths were non-cardiovascular; cardiovascular deaths were due to heart failure. Non-fatal myocardial infarction occurred in 7.5% patients with 2 patients undergoing unplanned PCI (one with LM PCI). Target lesion failure occurred in 4 patients (1 had fatal stent thrombosis; 3 had stent restenosis; 2 were send to CABG and 1 was treated with PCI). One patient had a stroke during hospitalization and other during follow-up. Conclusion: LM PCI can be considered as an alternative revascularization in urgent situations when surgery cannot be considered. Though it can be a high-risk subset, the results in our population are encouraging. Coronary Intervention: Primary and Acute PCI P696 https://esc365.escardio.org/Presentation/221103/abstract Symptom to door time interval has more effect on Ejection Fraction than door to balloon time after primary PCIfinancially supported by vice chancellor for research of Hormozgan University of medical sciences H Farshidi,1 S Behrooch1 and F Farshidi1 1Hormozgan Medical Science University, Bandar Abbas, Iran (Islamic Republic of) Introduction: for several years, primary percutaneous coronary intervention (PPCI) has been considered as an effective treatment for ST elevation myocardial infarction (STEMI). Many effort have been done to reduce the time interval between patient’s admission to hospital and performing PPCI. The present study evaluated the effect of the time delay on left ventricular ejection fraction (LVEF) in patients with STEMI who candidated for PPCI. Methodology: The target population were patients been admitted in Emergency Department(ED) with acute STEMI. Eventually, 174 patients were investigated through a questionnaire and the data were analyzed via SPSS20. Findings: From 174 patients diagnosed as acute STAMI, 72% were male. The mean age of the patients was 57.2 years (±13SD). To explore the correlation of SBT and LVEF, linear chi-squared test was run. There was a linear relationship between symptom to balloon time (SBT) and LVEF which was statistically significant at p≤.05.but there was no statistically significant linear relationship between door to balloon time (DBT) and LVEF at p≤.05. Discussion: In developed countries shorter DBT were associated with better outcome. Several studies was conducted to minimize this time interval .What is been published from developing countries was focusing on delay from beginning of symptoms to asking for help. Table 1. . . . First LVEF . 20-29 . 30-34 . 35-39 . 40-44 . 45-50 . >50% . SBT ≤60 min f. 0 0 1 1 0 3 % .0 .0 20.0 20.0 .0 60.0 61-180 min f. 0 3 3 10 18 21 % .0 5.5 5.5 18.2 32.7 38.2 181-360 min f. 3 5 3 5 16 16 % 6.3 10.4 6.3 10.4 33.3 33.3 > 360 min f. 4 5 5 11 16 16 % 7.0 8.8 8.8 19.3 28.1 28.1 . . . First LVEF . 20-29 . 30-34 . 35-39 . 40-44 . 45-50 . >50% . SBT ≤60 min f. 0 0 1 1 0 3 % .0 .0 20.0 20.0 .0 60.0 61-180 min f. 0 3 3 10 18 21 % .0 5.5 5.5 18.2 32.7 38.2 181-360 min f. 3 5 3 5 16 16 % 6.3 10.4 6.3 10.4 33.3 33.3 > 360 min f. 4 5 5 11 16 16 % 7.0 8.8 8.8 19.3 28.1 28.1 Distribution of LVEF and SBT in time categories Open in new tab Table 1. . . . First LVEF . 20-29 . 30-34 . 35-39 . 40-44 . 45-50 . >50% . SBT ≤60 min f. 0 0 1 1 0 3 % .0 .0 20.0 20.0 .0 60.0 61-180 min f. 0 3 3 10 18 21 % .0 5.5 5.5 18.2 32.7 38.2 181-360 min f. 3 5 3 5 16 16 % 6.3 10.4 6.3 10.4 33.3 33.3 > 360 min f. 4 5 5 11 16 16 % 7.0 8.8 8.8 19.3 28.1 28.1 . . . First LVEF . 20-29 . 30-34 . 35-39 . 40-44 . 45-50 . >50% . SBT ≤60 min f. 0 0 1 1 0 3 % .0 .0 20.0 20.0 .0 60.0 61-180 min f. 0 3 3 10 18 21 % .0 5.5 5.5 18.2 32.7 38.2 181-360 min f. 3 5 3 5 16 16 % 6.3 10.4 6.3 10.4 33.3 33.3 > 360 min f. 4 5 5 11 16 16 % 7.0 8.8 8.8 19.3 28.1 28.1 Distribution of LVEF and SBT in time categories Open in new tab Conclusion: Time management in treatment of STEMI is the most important part of treatment strategy. In developing countries population awareness about cardiac symptoms and accessibility to PPCI capable facilities has very vital role in preserving myocardium. Coronary Intervention: Mechanical Circulatory Support P699 https://esc365.escardio.org/Presentation/221517/abstract Decreased observed versus expected mortality under cytokine adsorption in patients after eCPR A Supady,1 T Zahn,1 D Staudacher,1 T Wengenmayer,1 P Biever,1 C Benk,2 C Bode1 and D Duerschmied1 1Heart center Freiburg University, Freiburg im Breisgau, Germany 2Heart Center Freiburg University, Cardiosurgery, Freiburg, Germany Purpose: Even after the introduction of extracorporeal resuscitation (eCPR) mortality after cardiac arrest remains on a very high level. The main reason for death in this patient group is severe post-cardiac arrest syndrome (PCAS). In PCAS generalized vasodilatation and membrane leakage following and sustained by an uncontrolled cytokine release (so-called “cytokine storm”) results in severe circulatory instability which can be controlled poorly and leads to death in most cases. The aim of this study is the assessment of extracorporeal cytokine adsorption in patients after eCPR with a focus on safety, practicability and laboratory as well as clinical parameters. Methods: We included 14 patients after intra- or extra-hospital cardiac arrest and eCPR that were treated with a CytoSorb® cytokine adsorber in our monocentric, retrospective registry study. Besides survival, serum-lactate and interleukin-6 (IL-6) levels, norepinephrine support and volume supply were measured before and after CytoSorb® treatment. Results: Observed 30-day mortality in this patient group (age 56 ± 19 years) was 78.6% (11/14) and thus lower than the expected mortality according to the SAPS II-Score (96.5%; 92 ± 8.4). Mean lactate levels (9.7 ± 5.2 mmol/l) and mean IL-6 levels (1316 ± 1469 pg/ml), norepinephrine support (0.29 ± 0.27 μg/kg/min) and volume requirement (3587 ± 4009 ml/6h) decreased after treatment with CytoSorb® over 72 hours (lactate: 2.0 ± 0.8 mmol/l, p < 0.05; IL-6: 739 ± 675 pg/ml, n.s.; norpinephrine: 0.09 ± 0.09 μg/kg/min, p < 0.05; volume requirement: 10 ± 424 ml/6h, p < 0.05). Technical errors or safety relevant issues related to the adsorber treatment have not occurred. Conclusions: Cytokine adsorption in patients after extracorporeal resuscitation using a CytoSorb® cytokine adsorber is feasible and safe. Data from our registry suggest that effective reduction of circulating cytokines after eCPR may support early cardiocirculatory stabilization within 72 hours after initiation of therapy as measured by reduced levels of serum lactate and decreased demand for norepinephrine support and volume administration. Most interestingly, observed mortality in our cohort is considerably below expected mortality as predicted by SAPS II scoring. Further data, preferably from randomized controlled trials, are needed to further determine the effect of cytokine removal on clinically relevant parameters and on survival after eCPR. P702 https://esc365.escardio.org/Presentation/217589/abstract Clinical profiles, outcome and prognostic factors of patients treated with percutaneous left ventricular assist devices (Impella) for protected PCI and cardiogenic shock M Noutsias,1 M Matiakis1 and A Rigopoulos1 1University Clinic Halle (Saale), Mid-German Heart Center, Department of Internal Medicine III (KIM-III), Division of Cardiology, Halle, Germany Introduction: Percutaneous left ventricular assist devices (Impella) are used both for protected PCI (pPCI) and for patients with cardiogenic shock (CS). Aims: We investigated the clinical profiles, outcome and prognostic factors of patients under Impella support for pPCI and CS in our monocentric registry. Results: We evaluated n=25 consecutive patients (males: 72%; age: 67.4+11.2 years; range: 43-86 years), treated with Impella devices from 11/2016 to 01/2018 at our tertiary center. Impella 3.5 / CP was used in 48%, and Impella 2.5 in 52% of the patients. 88% of the patients had ischemic heart disease, and additional 3 cases had CS due to non-ischemic cardiomyopathy (dilated cardiomyopathy: n=2; non-compaction cardiomyopathy: n=1). The indications for the implantation of Impella were pPCI in 48%, and CS in 52% of the patients, respectively. All cases with pPCI were treated with an Impella 2.5, while all but one CS cases were treated with an Impella 3.5 / CP (p<0.0001). The mean duration on Impella-support was 53.8+157 hours. The rate of non-fatal complications was 9.8% (i.e. bleeding, hematoma), however, no fatal complications due to the use of the Impella occurred. Intra-hospital mortality occurred in 52% of the total patients, and was significantly higher in CS patients (84.6%) as compared with patients with pPCI (16.7%; p=0.0007). Furthermore, intra-hospital mortality was significantly associated with cardiopulmonary resuscitation (p=0.0017), with peak creatine kinase (CK; p=0.0020), peak high-sensitive Troponin T (hsTnT; p=0.0011), and with peak lactate (p=0.0002). Conclusions: Our data confirm the safety of Impella for pPCI and CS. Intra-hospital mortality in severe CS patients is still high despite Impella support. In contrast, mortality in patients with severe coronary artery disease subjected to pPCI is low. In addition to myocardial ischemia markers (CK, hsTnT), peak lactate might prove a relevant prognostic marker for adverse outcome in this setting. Author Index Abdullah K. P530 Abellan Huerta J. P422, P423 Abellan-Huerta J. P191, P194, P195, P678, P679, P681 Abras M. P120 Abu-Daoud I. P501 Achilli F. P488 Adamopoulos S. 382, 388, 389, P418 Adriaenssens T. P475 Afanasyev S.A. P452 Agnieszka Rzeszotarska A. 302 Agostinho J. P462 Agostini C. P168 Aguiar J. P112 Aguiar Rosa S. P476 Aguiar-Ricardo I. P462, P494 Aguiar-Ricardo R. P688 Aguila Gordo D. P460 Ahmed A.H.M. P693 Ahmed M.G. P693 Ahmed W. P162 Aiad N. P174, P176, P177 Ainla T. P134 Alabdallah K. P176, P177 Alanazi M. 381, P161 Aldea A. P500 Aldoma Balasch A. P649 Alegre O. 378 Alegria S. 86, P201 Alekseeva Y. P119 Aleksova A. P144 Alexandrov A. P126, P127, P509 Alfieri O. P641 Almeida I. P129, P131, P141, P411, P449, P643, P690, P691 Almeida J. P181, P514 Almeida L. P129, P690 Almeida S. P129, P131, P141, P449, P511, P527, P690, P691 Almendro Delia M. P136 Almendro-Delia M. 289 Alonso Fernandez De Gatta M. P167, P464 Alonso J.R. P500 Alonso Salinas G.L. P447, P448, P473 Alonso-Munoz G. 289 Alonso-Vazquez A. 79 Altamirano-Castillo A. 332 Altinsoy M. 27 Alvarez Roy L.A.R. P458 Alvarez-Garcia J. 374 Alviar Restrepo C.L. P174, P176, P177 Alzola E. P167, P464 Ancona M. P641 Andersen A. 327, 33, 331, 37 Andrea Riba R. P444, P99 Andres J. P133 Andronescu A.M. P505, P506 Andrucovici S. P505, P506 Angelini G. 21, P110 Anibal Ibanez Mora A.I.M. P180 Antonatos D. P114, P192 Antonio P. P462, P688 Antonopoulou G. P157 Antunes N. P142, P143, P143, P143 Apostolos A. P187 Aragiannis D. P170, P525 Araiza Garaygordobil D. 19, 332, P672,79 Aramendi E. 303 Araujo A. P103 Araujo I. P642 Aravanis N. 388, 389, P646 Arboleda-Sanchez J.A. 289 Arias-Garrido J.J. 289 Arias-Mendoza A. 19, 332, 79, P672 Ariza A. 386 Ariza Sole A. P473 Ariza-Sole A. 378 Arizon Munoz J.M. P460 Armenis I. 32, 382, P646 Armonis C.H. P114, P192 Arokiaraj M.C. P676 Arroyo Monino D.F. P136, P433 Arzuffi L. 80 Assis R. P103 Astiawati T. P440, P441 Atabegashvili M. P145 Atar D. 93 Augusto J. 25 Avalli L. P488 Avram R. P506 Avram R.L. P505 Azevedo O. P457 Azevedo P. 91 Azul Freitas A. P181, P514 Azzouzi L. P198 Babaeva L.A. P503 Babic Z. P436, P485 Babiker A.E. P693 Bader R. P175 Baeza-Herrera L. 79, P672 Bakosis G. P413 Baldetti L. P641 Baldi E. 303 Ballarotto M. 77 Ballesteros Tejerizo F. 82 Balthazar T. P475 Baluta M.M. P505, P506 Bankova A. P126, P127 Baptista A. P100 Barbarash O. P513 Bardaji A. 84 Bari V. 390 Barrio Rodriguez A. P167, P464 Barrionuevo M.I. P491 Barrionuevo-Sanchez M.I. P153, P489 Barriuso Barrado I. P649 Bascunan E. P182 Bassi I. 391 Batalov R.E. 26 Bauer A. 330 Bayes-Genis A. 374, P133 Bayraktarova I. P126, P127 Becher P.M. 407 Bedogni F. 391 Behalf Of Portuguese Registry On Acs O.N. P112 Behrens S. P146 Behrooch S. P696 Beigel R. 36 Beltrami A.P. P144 Beneduce A. P641, P648 Benk C. P699 Bento D. P139, P140, P457, P684 Ben-Zekry S. 36 Bergel Garcia R.B.G. P685 Beringuilho M. 25 Bernardo I. P102 Bernardo P. P168 Bernhardt A.L.M. 407 Berns S. P513 Bertoldi L.F. P648 Besis G. P507 Biasucci L.M. 21, P110 Biever P. P699 Bispo J.S. P139, P140, P684 Bistola V. P413 Bjelica S. P435 Blanco Ponce E. P649 Blankenberg S.B. 407 Blondal M. P134 Bode C. P699 Bojic M. P189 Bonanni A. 21, P110 Bonet G. 84 Bonios M. 382, 388, P418 Borderias Villaroel T. 376, 385, P169, P466, P467, P650 Borderias Villarroel T. P477, P480 Borges S. 305, 306, P208 Borkhalenko Y. P188 Borrego J.B.R. P685 Borrego-Rodriguez J.B.R. P458 Borrellas A. P133 Bosch Gaya A. P649 Boskovic S. P189 Botelho A. P128 Bottiroli M. P190 Bousoula E. P646 Bozzano A. P488 Braga C. P102, P138, P193, P694 Brandao L. P527 Bras D. P112 Braz M. P531 Brechot N. 374 Briani M. P496 Briosa A. 86, P201, P527 Briseno-De La Cruz J.L. 19, 332 Broa A.L. P201, P527 Bro-Jeppesen J. 298, 299 Bruch L. P146 Budiyanto R. P166 Buffon A. 76 Bugajski J. P419 Buksinska-Lisik M. P492, P495 Buksinska-Lisik M.B.L. 302 Burgos Palacios V. 376, 385, P169, P466, P467, P473, P477, P480, P650 Butron-Calderon M. 289 Buzdugan E.C. P673 Cabello-Lopez A. 19, P672 Cabrera Rubio I. 376, 385, P169, P466, P467, P477, P480, P650 Cacela D. P476 Caetano A.F. P475 Calaf Vall I. P649 Calchera I. P488 Caldentey G. P529 Cale R. 86 Calero Nunez S. P153 Calero S. P491 Calero-Nunez S. P489 Calini A. P190 Calvo A. P529 Camacho A. P159, P214 Cambronero Sanchez F. P666 Camici P.G. P648 Camilli M. 76 Campanile A. P149 Campodonico J. 77, P130 Camporotondo R. 80 Campos D. P132, P414, P425 Campos I. P102, P138, P142, P143, P143, P143, P193, P218, P694 Campos L. P642 Canas Da Silva P. P494, P688 Candeias Faria D.A. 25 Caniato F. P168 Cannavaro G. P149 Canonico F. 21, P110, P117 Canteli Alvarez A. 376, 385, P169, P466, P467, P477, P480, P650 Cappelli F. P168 Capucci A. P526 Carbonell Prat B. P444 Cardoso F. P457 Carey M. G. P124 Carmona Carmona J. P136, P433 Caro Martinez C.S. P666 Carrasquer A. 84 Carreras Mora J. P482, P483 Carrilho-Ferreira P. P462, P494, P688 Carrington M. 292, P112 Casado Pena M. P99 Castelo A. P476 Castillo Navarro A.M. P666 Castrillo Bustamante C. 376, 385, P169, P466, P467, P477, P650 Castrillo Bustamante M.C. P480 Castro L.S. P424 Catorze N. P103 Catoya Villa S. 376, 385, P169, P466, P477, P480, P650 Cediel G. 84 Cedro A.V. P424 Celentano K. 77, P130 Cepas Guillen P. P444, P453 Cepas P. P500 Cesana F. P488 Cesar Del Castillo Gordillo C.D.G. P180 Chalkias A. 29, 31 Chatzi S. P646 Chatzianastasiou S. P418 Chernomordik F. 36 Chernova A. P518, P519, P520, P521, P522, P523 Chesnikova A.I. P669 Chicote B. 303 Chieffo A. P648 Chin J. P129, P131, P141, P449, P690, P691 Chipayo Gonzales D.A. P433 Chlabicz M. P173 Chliara O. P157 Chommeloux J. 374 Chronaki M. P175 Ciampi P. 21, P110 Ciccarelli M. P149 Cicek V. P412 Cinar T. P412 Cinca J. 374 Ciobanu L. P120 Claeys M. P98 Cobo Belaustegui M. 376, 385, P169, P477, P650 Coelho I. P103 Coelho M. P102 Collado E. 386 Collado Lledo E. 378 Combes A. 374 Compagnoni S. 303 Corbi M.J. P491 Corbi Pascual M. P473 Corbi-Pascual M. P489 Corbi-Pascual M.J. P153 Corrada E. P496 Cortes Cortes F.J. P136, P183 Cosentino N. 77, P130 Costa H. 91, P100, P159, P214 Costa H.A. P139, P140, P684 Costa J. P138, P142, P143, P143, P143, P193, P694 Costa M. P132, P414 Couto Pereira S. P494 Crea F. 21, 76, P110, P117 Crimi G. 80 Cristo Ropero M.J. P136 Crljenko K. P485 Crnomarkovic B. P435 Cruz Ferreira R. P476 Cruz I. P201 Cunha G. P642 Cunha N. P462, P494 Cunha N.P.D. P688 Cunha P. P531 Cvetkovic A. P451 Czapla M. P156 Czarnik T. P419 Da Conceicao Pedro Pais J.A. 292 D’aiello A. 21, P110 D’aloja E. 29, 31 D’amario D. P117 Danilevich T. P647 Darzi Ramandi E.L.H.A.M. P429 Dattoli-Garcia C. 79 Dattoli-Garcia C.A. P672 Dauksaite N. P111 Davies S. P475 Davlouros P. P187 De Bonis M. P641 De Campos D. P128 De Diego Soler O. P444 De Ferrari T. P190 De La Chica-Ruiz-Ruano R. 289 De Leon-Ruiz A. P153 De Marco F. 391 De Metrio M. 77, P130 De Sousa Bispo J. 91 De Sousa Bispo J.P. P159, P214 De Tapia Majado B. P169, P466, P467, P477, P480 De Waha-Thiele S. 387 Deifa A.A.A. P693 Del Buono M.G. 76 Del Castillo C. P182 Del Castillo S.C.G. P458, P685 Delcea C. P505, P506 Delgado A. P531 Delgado-Cruz I. 79 D’elia S. 24 Delic Brkljacic D. P485 Deligianni M. P157 Denisova P. P670 Denti P. P641 Desch S. 387 Despotopoulos S. P187 Di Mario C. P168 Diaz R. P428 Diaz S. P491 Diaz-Lancha S. P153, P489 Diego Nieto A. P167, P464 Dimic S. P435 Dimitriadis K. P114, P192 Dimitrova E. P126, P127, P509 Dionisio F.M. 80 Djuzel A. P485 Dobrzycki S. P173 Dogan S. P412 Dohi T. P445 Dolotovskaya P. P670 Doumanis G. P413 Dovhan O. P108 Doyle J. P106 Drumond A. 305, 306, P208 Dubois C. P475 Duchnowski P. P101, P172, P420 Duerschmied D. P699 Dukhin O. P113 Duplyakov D. P513 Duran Cambra A. P482, P483 Durante Lopez A. P472 Durante-Lopez A. P471, P474 Duszanska A. 409, P419 Dzhioeva O. P199, P517 Dzikowicz D. J. P124 Echarte Morales J.C.E.M. P458, P685 Eckardt L. P530 Edgar Hernandez-Leiva E.-H. P164 Eha J. P134 El Adaoui A. P198 El Gohary A. P202 El Ouaddi N. P133 Elad B. P501 Elias T. P103 Eltalib K.M.E. P693 Elvira Ruiz G. P666 Erlikh A. P513 Escudier Villa J.M. P471, P472, P474 Esposito G. 391 Esteves A. P201, P527 Esteves A.F. P524 Exposito L. P491 Exposito-Calamardo L. P153, P489 Faia G. P457 Falces C. P453 Fallavollita J. A. P124 Falsetti L. P526 Fantinato A. 390 Farag A. P207 Faria B. P457 Faria Da Mota T. 91 Farre N. P529 Farshidi F. P696 Farshidi H. P696 Felipe Hernandez-Huertas F.-H. P164 Ferlini M. 80 Fernandes A. P524 Fernandes J. P469, P484 Fernandes L. P642 Fernandes R. 91, P159, P214 Fernandez Gonzalez L. 82 Fernandez Martinez J. 386, P482, P483 Fernandez Valenzuela I. P183 Fernandez Valledor A. P444, P99 Fernandez Vazquez D. P683 Fernandez-Vazquez F.F.V. P458, P685 Ferreira A.R. P469, P484 Ferreira C. P181, P514 Ferreira J. 25, P181, P514 Ferreira L. P476 Ferreira R. P531 Ferreira V. P476 Ferrer M. P133 Fialho I. 25 Filippatos G. P413 Fina D. 390 Fisher R. P106 Flores Blanco P.J. P666 Flores D. P500 Flores R. P102, P138, P142, P143, P143, P143, P193, P218, P694 Flores Umanzor E. P444 Flouda V. P157 Fluschnik N.F. 407 Fojt A. P148 Fonseca C. P642 Forni L. 24 Forteza Gil A. P471 Fortounis K. P157 Fortuni F. 80 Fountas E. 32, 382, 388, 389, P418, P646 Fracchia R. 303 Franca L. P103 Francescut C. P144 Franchineau G. 374 Francisca Yanez Vidal F.Y.V. P180 Frederiksen K.P. 380 Freitas A. I. 306 Freitas S. 306, P208 Frias Garcia R. P422, P423, P460 Frias-Garcia R. P191, P194, P195, P678, P679, P681 Frydland M. 298, 373, 380 Fuernau G. 387 Furman N. P670 Fyntanidou V. P157 Gagno G. P144 Galan C.G.F. P458, P685 Galas A. P492, P495 Gale C.P. P667 Galiatsou E. P106 Galiuto L. 76 Gallardo A. P672 Gallardo-Grajeda A. 79 Gallego-Sanchez G. P489 Galli M. P117 Galvao Braga C. P142, P143, P143, P143 Gambaro A. P106 Garcia Bras P. P476 Garcia Bueno L.G.B. P458 Garcia De Lara J. P683 Garcia Del Rio M. P183 Garcia Gomez S. P471, P472, P474 Garcia Gonzalez N. P183, P433 Garcia Hernando V. P482, P483 Garcia Rodriguez D. P471 Garcia Rubira J.C. P136, P183, P433 Garcia-Alcantara A. 289 Garcia-Garcia C. 374, P133 Garcia-Munoz V.M. P191 Garcia-Rubira J.C. 289 Garda R. P106 Gasior M. 409, P148 Gasparyan E. P675 Gatta S. P182 Gawor M. P419 Gayan Ordas J. P649 Gazquez Toscano A. P99 Georgiev B. P126, P127, P509 Gerasimets E. P668 Gierlotka M. 409, P148, P173, P419, P644 Gil-Jaurena J.M. 82 Gil-Klimek M. P173, P644 Gilyarov M. P145, P675 Gimeno Blanes J.R. P683 Giralt T. P529 Gkouziouta A. 32, 382, 388, 389, P418 Gnecchi M. 80 Godino C. P641 Godziek J. P135 Goetschalckx K. P475 Goirigolzarri Artaza J. P471, P474 Goitein O. 36 Gombozhapova A. P665 Gomes A. P132, P414 Gomes R. P128, P524 Gomez Bueno M. P471, P472, P474 Gomez Dominguez R. P649 Gomez Gonzalez A. P136, P433 Gomez Molina M. P666, P683 Gomez Varela S. P473 Goncalves A. P531 Goncalves L. P125, P128, P132, P181, P414, P425, P514 Gonzalez A.I. P472 Gonzalez Cebrian M. P167, P464 Gonzalez Lizarbe S. 376, 385, P169, P466, P467, P477, P480, P650 Gonzalez Maniega C.G.M. P685 Gonzalez Roman A. P471 Gonzalez-Del-Hoyo M. 84 Gonzalez-Fernandez V. 378 Gonzalez-Pacheco H. 19, 332 Gopar-Nieto R. 19, 79, P672 Gorzko M. P135 Gossling A.G. 407 Gotcheva N. P126, P127, P509 Goumenakis M.A.R.K.O.S. P654 Graca Rodrigues T.E. P462 Graca Santos L. P103 Gramegna M. P648 Grammata P. P175 Grand J. 298, 299, 333 Grapsas N. P187 Grazi M. 77, P130 Grejs A. 333 Grib A. P120 Grigorov V. P126, P127, P509 Grippo R. 391 Grosu A. P673 Grupper A. 36 Gualandro D.M. P500 Guerra G. 305 Guerreiro R. 292, P112 Gusakova A. P665 Gustafsson F. 299 Gutierrez Ibanes E. 82 Gutierrez-Gonzalez F.M. 19 Haake H. P530 Habbal R. P198 Hahalis G. P187 Halvorsen S. 93 Hansen A. 37 Hansen A.K. 327, 33, 331 Hartvig-Thomsen J. 380 Hassager C. 298, 299, 333, 373, 380, 383, 384 Hata T. P677 Hayiroglu M.I. P412 Hayon S.G. P440, P441 Hayrapetyan H. P438, P439 Heinz G. 22, P154, P163 Hekimian G. 374 Hengstenberg C. 22, P154 Henriques E. 305, P208 Hernandez Martin I. P649 Hernandez Perez F.J. P471, P472, P474 Hernandez-Perez F.J. 378 Herscovici R. 36 Hidalgo Urbano R. P433 Hidalgo Urbano R.J. P136, P183 Hidalgo Velastegui M. P136 Hidalgo-Olivares V.M. P153 Hidalgo-Urbano R. 289 Hill S. P207 Hoejgaard H.F. 384 Hohensinner P.J. P163 Holmvang L. 373, 380, 383, 384 Holzknecht M. 328, 330 Honrado T. P469, P484 Hoppe U.C. P655 Hristova G. P126, P127 Hryniewiecki T. P101, P172, P420 Huang F. 374 Huber K. 22, 387, P154 Hurdus B. P667 Hurtado A. P106 Hurtado Martinez J.A. P683 Iacovidou N. 29, 31 Iliodromitis E. P413 Innerhofer L. 330 Ioannidis A. 392, P104, P213 Iotti G. 303 Irusta U. 303 Ivanov V.P. P659 Izquierdo M. P453, P500 Izquierdo Montilla L. P99 Izquierdo Ribas M. P444 J Pinto F. P494 Jackson C. 79 Jackson-Pedroza C. P672 Janssens S. P475 Jarakovic M. P435 Jaramillo V. P174 Jaramillo-Restrepo V. P176, P177 Jaroch J. 295 Javanshir E.L.N.A.Z. P429 Jensen L.O. 373, 380, 383, 384 Jesus I. 91, P139, P140, P159, P214, P684 Jimenez J. P491, P529 Jimenez-Mazuecos J. P489 Jirak P. P530 Johannessen T.R. 93 Jorens P. P98 Jorge E. P181, P514 Josiassen J. 383, 384 Jung C. P655 Junior J.R.C. P424 Jurado Roman A. P422, P423 Jurgaitiene R. P111 Kadda O. P646 Kakkavas A. P175 Kakoudaki T. P507 Kalinskaya A. P113 Kaminski K. P173, P644 Kanareykina E. P145 Kapnopoulos C. P157 Karagiannis A. P646 Karagoz U. 27 Karakus A. 27 Karalejic A. P189 Karasek A. P492, P495 Karniej P. P156 Kastanayan A.A. P669 Kaufman L. 36 Kaun C. P163 Kautzner J. 30, 300 Kawecki D. P135 Kazimierczyk R. P173, P644 Kazmierczak-Dziuk A. P492, P495 Keca S. P435 Kecman E. P451 Kelemeneva A. P518 Kercheva M. P665 Kettner J. 300 Khawaja S. P641 Kheraskov V. P513 Khripun A.V. P669 Kintis K. P114, P192 Kirkegaard H. 333 Kitsiou A. P175 Kjaergaard J. 298, 299, 373, 384 Kleinrok A. 409 Kleissner M. 300 Klug G. 328, 330 Kobalava Z.H.D. P503 Kocabas U. 27 Kogerakis N. 32, 382, 388, 389, P418 Konstantinova E. P145, P675 Koppen G. P98 Koren O. P151, P501 Korsak J. 302, P492, P495 Kostopoulou A. 32, 389 Kostova E. P126, P127, P509 Koulouris E.F.S.T.A.T.H.I. P654 Koumallos N. P525 Koumalos Nikolaos K.N. P170 Koutouzis M. P114, P192 Kovacevic M. P435 Kowalik R. P148 Kowalska O. 295 Kozma M. P101, P172, P420 Kretzschmar D. P655 Kruchinkina E. 26 Krychtiuk K.A. 22, P154, P163 Krzesinski P. 302, P492, P495 Kulikovskikh Y. P669 Kuskaeva A. P520, P521, P522, P523 Kusmierczyk M. P101, P172, P420 Kusuma M.A. P440, P441 Kuzmina E. P675 Kwasiborski P. P495 Kwasiborski P.J. 302, P492 Kyriakopoulos V. P114, P192 Labata C. P133 Lacunza Ruiz J. P683 Laimoud M. 381, P161, P162 Laitio T. 333 Laitupa F.S. P440, P441 Lamote K. P98 Laranjo M. P218 Larasati Y.D. P440, P441 Larbig R. P530 Larico M. P174, P176, P177 Larstorp A.C. 93 Lauri G. 77, P130 Lazaro M. P100 Lebreton G. 374 Lechner I. 330 Ledot S. P106, P475 Lees N. P106 Leithold B.G. P666 Lenz M. 22, P154, P163 Leonardi S. 80 Leone P. P496 Lerche-Helgestad O.K. 383, 384 Lerma-Landeros E. 19 Lettino M. P488 Lichtenauer M. P655 Lidon R.M. 378 Lima Gil S. 292 Lindholm M.G. 373 Liori S. P413 Lisiak M.H. 295 Lisowska A. P644 Liuzzo G. 21, 76, P110 Livanis E. 32, 389 Llanos C. P491 Llanos-Guerrero C. P153, P489 Llao I. 378 Loaisiga-Saenz A. 79, P672 Locci E. 29, 31 Loiveke P. P134 Lojovic N. P451 Lombardi A. P168 Lopatowska P. P173, P644 Lopes J. P128, P132, P414, P425 Lopes J.G. P125 Lopez De Sa E. P473 Lopez Domenech G. P99 Lopez I. P491 Lopez Lluva M.T. P422, P423 Lopez Serna M. P167, P464 Lopez Sobrino T. P444 Lopez-Barbeito B. P500 Lopez-Lluva M.T. P191, P194, P195, P678, P679, P681 Lopez-Neyra I. P489 Lopez-Sobrino T. P453, P99 Lorenzo Lopez B. P136, P183 Lorenzo-Lopez B. 289 Lourenco A. P457 Lourenco C. P125, P132, P414, P425 Lova Navarro A.I. P666 Lozano F. P191, P194, P195, P678, P679, P681 Lozano Gonzalez M. 376, 385, P169, P466, P467, P477, P480, P650 Lozano Ruiz Poveda F. P422, P423 Lucci C. 21, 77, P130 Ludwig S.L. 407 Luesebrink E. P165 Lui A.Y. P174, P176, P177 Luiso D. 378 Lujan Valencia E. P477, P650 Lujan Valencia J. P467 Lujan Valencia J.E. 376, 385, P169, P466, P480 Lukina O.I. P503 Luna-Herbert A. 19 Luque M. P182 Lusona V. 24 Luyt C.E. 374 Lyhne M.D. 327, 33, 331, 37 Lymperiadis D. P170 Maestro Benedicto A. P482, P483 Maggioni E. P488 Mahamid M. P151 Maier B. P146 Maillo J.M.S. P458, P685 Maksimov V. P518 Malagon Lopez L. P473 Malakos I. P646 Malevannyi M.V. P669 Malinova L. P670 Mane F. P102, P138, P193, P218, P694 Mane G. P142, P143, P143, P143 Mano T. P476 Mantis C.H.R. P114, P192 Manzano Fernandez S. P666 Manzur-Sandoval D. 332 Marana I. 77, P130 Marandi T. P134 Maravic-Stojkovic V. P189 Marcelo Luque Gonzalez M.L.G. P180 Marenzi G. 21, 77, P130 Mariani T. P168 Marini C. P648 Marinoni B. 80 Markov V.A. P119 Marques A. 86, P201 Marques F. P218 Marques J. P102, P138, P142, P143, P143, P143, P193, P218, P694 Marques N. P139, P140, P159, P214, P457, P684 Marques Pires C. P142, P143, P218 Martin A.M.C. P458, P685 Martin C.E. P472 Martin Herrero F. P167 Martin Herrero M. P464 Martinez Del Rio J. P422, P460 Martinez Primoy I.R. P136, P183, P433 Martinez-Amezcua P. 19, P672 Martinez-Nadal G. P500 Martinez-Ramos M. 79 Martinez-Ramos Mendez M. P672 Martinez-Rio J. P191, P194, P195, P678, P679, P681 Martinho S. P181, P514 Martins A.C. 86 Maseda Uriza R. P422, P423, P460 Maslovskyi V.I. P659 Massberg S. P165 Mas-Stachurska A. P529 Matas A. P500 Mateev H. P126, P127, P509 Mateo Gomez C. P460 Matiakis M. P702 Matic D. P155 Matute Blanco L. P649 Mauro A. P488 Mayr A. 328, 330 Mazin I. 36 Mdala I. 93 Meani P. 24, P190 Medeiros P. P102, P102, P138, P142, P143, P143, P143, P193, P218, P694 Medonca M. I. P208 Melillo F. P641 Mendonca C. P511 Mendonca F. 305, P208 Mendonca M. I. 305, 306 Mendoza-Garcia S. 332 Menendez P.M.S. P458, P685 Menezes Fernandes R. P139, P140, P684 Meray I. P503 Merchan Gomez S. P167, P464 Metzler B. 328, 330 Meucci M.C. 76 Meyns B. P475 Mezhiievska I.A. P659 Mielniczuk M. P492, P495 Miguel Oyonarte Gomez M.O.G. P180 Milazzo V. 77, P130 Miliopoulos D. 32, 382, 388, 389, P418 Millan R. P529 Milner J. P181, P514 Mimoso J. 91, P139, P140, P159, P214, P684 Minguito C.M.C. P458, P685 Miranda H. P129, P131, P141, P215, P411, P449, P531, P643, P690, P691 Miranda R. P527 Miro O. P500 Mitrovic P. P451 Mizuguchi Y. P677 Mochula O.V. P119 Moeller J.E. 373, 380, 383, 384 Moeller-Helgestad O. 373, 380 Molina San Quirico M. 385, P477, P480 Moliner Abos C. P482, P483 Moltrasio M. 77, P130 Monsieurs K. P98 Montalto C. 80 Monteiro A. P531 Monteiro J. 305, 306, P208 Montemerlo E. P488 Montero Gaspar M.A. P460 Montero S. 374, P133 Montone R.A. 76, P117 Montorfano M. P641 Morais C. 25 Morais L. P476 Morais P. P462, P688 Morais R. P642 Morawiec B. P135 Moreno Reig A. P460 Morici N. 24, 391, P190 Mornar Jelavic M. P436 Moron Alguacil A. P423, P460 Moron-Alguacil A. P191, P194, P195, P678, P679, P681 Mortensen C.S. 327, 33, 331, 37 Mota D. P424 Mota T.F. P139, P140, P159, P214, P684 Motloch L. P530 Moulias A. P187 Mrdovic I. P155 Mueller C. P500 Muksinova M. P145, P675 Munoz Franco F.M. P666, P683 Munoz Garcia M. P460 Munoz-Garcia V.M. P195, P678, P679, P681 Munyombwe T. P667 Muradova L. P145 Mutlu I. 27 Muzyk P. P135 Nakajima S. P677 Naseva E. P126, P127 Natanzon S.S. 36 Nava S. 391 Navarro J. P491 Navarro-Cuartero J. P489 Nechita A.C. P505, P506 Nedic M. P485 Negreira Caamano M. P460 Negreira-Caamano M. P191, P194, P195, P678, P679, P681 Neiva J. P511 Neto M. 306 Neves S. P218 Niccoli G. 76 Nielsen N. 299 Nielsen-Kudsk J.E. 327, 33, 331, 37 Nikulin D.A. P518, P519 Nikulina S. P518, P519, P520, P521, P522, P523 Nishio R. P445 Nitti C. P526 Noguera Velasco J.A. P666 Nonnini S. P190 Noriega F.J. 378 Noto A. 29, 31 Noutsias M. P702 Novakovic A. P451 Nowalany-Kozielska E. P135 Nozaki Y. P445 Ntouvas I. P187 Nugraha A.W. P440, P441 Nunes Rigueira J. P494 Nunes-Ferreira A. P462, P688 Nuri M.A.F. P693 Ogita M. P445 Ohe L.N. P424 Ohnewein B. P530 Olavarri Miguel I. P467 Oliva F. 391, P190 Oliva F.G. 24 Olivares Martinez B. P136, P183, P433 Oliveira C. P142, P143, P143, P143, P218 Oliveira C.C. P102, P138, P193, P694 Oliveira M. P531 Oliveras T. P133 Oltrona Visconti L. 303 Oltrona-Visconti L. 80 Opolski G. P148 Orban M. P165 Oreglia J. P190 Oreglia J.A. 391 Orhan A.L. P412 Orlov D. P517 Ornelas I. 305, 306, P208 Orozco D. P182 Ortega Marcos J. P471, P472, P474 Ortiz Perez J.T. P99 Otasevic P. P189 Oz A. P412 Ozyurtlu F. 27 Paar V. P655 Padilla Lopez M. P482, P483 Padoan L. P144 Pagnesi M. P648 Palma Dos Reis P. 306 Palma Dos Reis R. 305, P208 Palo A. 303 Pamies-Besora J. P482, P483 Panagiotou C. P646 Panagiotou C.H. P418 Panic G. P435 Papadakis E. P114, P192 Papadopoulos A.N.T.O.N.I.S. P654 Papadopoulou E. P157 Papafanis T. P175 Papageorgiou A. P187 Papalois A. 29 Papanikolaou A. P187 Pappalardo F. P648 Paraskelidou M. 392 Paredes-Paucar C.P. 19, 332 Parellada Vendrell M. P99 Parissis J. P413 Parkhomenko A. P108, P108 Parra P. P182 Pascual Figal D.A. P666 Passariello M. P106 Pastor Pueyo P. P649 Patsilinakos S. P114, P192 Pavlov M. P485 Pazzanese V. P648 Pechlevanis A. 392 Pedicino D. 21, 76, P110 Pehlivanoglu S. 27 Peichl P. 30 Peiro Ibanez O.M. 84 Pejic M. P451 Pellegrino M. P496 Pepper J. P106 Pereira A. 305, 306, P208 Pereira A.R. 86, P201 Pereira H. 86, P201, P527 Pereira S. P688 Pereira S.C. P462 Pereira T. P103 Pereira V.H. P102, P218 Pereverzeva K. P212 Pereyra Acha E. P649 Perez Diaz P. P422, P423, P460 Perez Espejo P. P433 Perez-Diaz P. P191, P194, P195, P678, P679, P681 Pessoa L. P103 Petrosyan H.H. P438, P439 Petrovic M. P435 Picarra B. 292, P112 Pidone C. P117 Piemonti A. P488 Pinar Bermudez E. P683 Pintaric H. P436 Pinto F. J. P688 Pinto F.J. P462 Piqueras Flores J. P422, P423, P460 Piqueras-Flores J. P194 Pires C. P102, P138, P193, P694 Pisano E. 21, P110 Pisaryuk A.S. P503 Pistuddi V. 390 Pistulli R. P655 Pliatsika M.A.R.I.A. P654 Plonka J. P419 Poess J. 387 Pohls-Vazquez R. 79, P672 Polytarchou K. 29, 31 Ponzo M. 21, P110 Porta A. 390 Portero J.J. P491 Portero-Portaz J.J. P489 Portolan M. 80 Poulianitou A. P114, P192 Poullet-Brea A.M. 289 Prepoudis A. P500 Price S. P106, P475 Proietti M. P526 Puchinyan N. P670 Pueyo Balsells N. P649 Puga L. P128, P132, P414, P425 Quien M. P174, P176, P177 Quintern V. 84 Quiroga X. P529 Quiterio A. P100 Rabacal C. P511 Radosavljevic-Radovanovic M. P451 Radovanovic N. P451 Radulescu D. P673 Rafouli-Stergiou P. P413 Rahmi D.A. P440, P441 Ramirez C. P182, P491 Ramirez-Guijarro C. P489 Ramos R. P491 Ramos-Martinez R. P153, P489 Rangel I. 86 Ranucci M. 390 Raposeiras Rubin S. P473 Rasmussen B.S. 333 Rasputin V. P647 Rasputina L. P647 Ravera A. P149 Ravn H.B. 383, 384 Raymundo-Martinez G. 79, P672 Rayo Gutierrez M. P460 Real A. P103 Rebrova T.Y.U. P452 Rebuzzi A.G. 76 Recio Mayoral A. P136 Reichenspurner H.R. 407 Reina-Toral A. 289 Reindl M. 328, 330 Reinstadler S. 330 Reinstadler S.J. 328 Reis J. P476 Reis L. P125 Remior Perez P. P471 Repetto A. 80 Resta H. P133 Restivo A. P117 Reynier-Garza V. 19 Rezar R. P655 Ribas N. P529 Ribeiro J. P132, P414, P425 Ribeiro J. M. P128 Ribeiro S. P457 Ribichini F. P106 Riccomi F. P526 Rico-Mesa J.S. P174, P176, P177 Righetti S. P488 Rigopoulos A. P702 Rigueira J. P462, P688 Rios M. P469, P484 Rivas-Lasarte M. 374, 378, 386 Rocha A.R. 292, P112 Rocha B. P642 Roditis P.A.V.L.O.S. P654 Rodrigues M. 305, 306 Rodrigues T. P494, P688 Rodriguez De Leiras Otero S. P433 Rodriguez Estevez L. P167, P464 Rodriguez M.R.S. P458 Rodriguez Ogando A. 82 Rodriguez Serrano A.I. P666, P683 Rodriguez-Yanez J.C. 289 Rodriguez-Zanella H. 19 Roedler J. P530 Roehnisch J.U. P146 Rogovskaya Y.V. 26 Rojas S. 84 Rojo Prieto N. P99 Romeu Mirabete N. P99 Roque D. 25 Roque M. P453 Roqueta C. P529 Rosenberg A. P106 Royuela Martinez N. P466 Rozner E. P151, P501 Rubini Gimenez M. 387 Rubino M. 77, P130 Rueda F. P133 Ruggio A. P110 Ruhittel S. P163 Ruiz Falques C. P99 Ruiz Garcia M.P. P136 Ruiz Garcia P. P433 Ruiz Lera M. 376, 385, P169, P466, P467, P477, P480, P650 Ruspiono E. P440, P441 Russo G. P110 Ryabov V. P665 Ryabov V. V. P452 Ryabov V.V. 26, P119 Ryczek R. 302, P492, P495 Ryzhkova Y.U. P145 Rzeszotarska A. P492, P495 Sa C. P129, P690 Saar A. P134 Sabate Tenas M. P453 Sacco A. 24, P190 Safarova A.F. P503 Salas Bravo D. P460 Salas-Teles B. 19 Saleiro C. P128, P425 Salmeron F.M. P491 Salmeron-Martinez F.M. P153, P489 Salvatella N. P529 Salvi A. P526 Samaras A. P157 Sampaolesi M. P526 Sanchez Cena J. 376, 385, P169, P466, P467, P477, P480, P650 Sanchez E.S.M. P685 Sanchez Fernandez P.L. P167, P464 Sanchez Perez I. P191, P194, P195, P422, P423, P678, P679 Sanchez Vega J.D. P447, P448, P473 Sanchez-Carpintero A. P529 Sanchez-Perez I. P681 Sanchis Fores J. P473 Sanmartin Fernandez M. P447, P448, P473 Sanna T. 76 Sans Rosello J. P482, P483 Sans-Rosello J. 386 Santon D. P144 Santos A.R. 292 Santos H. P129, P131, P141, P215, P411, P449, P469, P484, P643, P690, P691 Santos I. P215 Santos L. P129, P690 Santos M. P129, P131, P141, P215, P449, P690, P691 Santos R. P462, P494, P511, P688 Santos W. 91, P159 Sanz E. 84 Sanz Ruiz R. 82, P473 Sarralde Aguayo A. 376, 385, P650 Sarralde Aguayo J.A. P169, P466, P467, P477, P480 Savastano S. 303 Savic L. P155 Sbarouni E. P646 Scanziani E. P488 Schmidt H. 383, 384 Schmidt M. 374 Schoeller R. P146 Schrage B.S. 407 Schuehlen H. P146 Schultz J.G. 327, 33, 331 Schultz J.S. 37 Schulze C. P655 Sdogkos E.V.A.N.G.E.L.O. P654 Sebaiti D. 86, P201 Segovia Cubero J. P471, P472, P474 Segovia J. 386 Segovia-Cubero J. 378 Seiffert M.S. 407 Seker M. P412 Semedo P. P112 Seoane Garcia T. P136, P183, P433 Separham A. P429 Serbout S. P198 Serra J. P133 Serrano Fiz Garcia S. P474 Serrano Lozano D. 376, P169, P467, P480, P650 Serrao M. 305, 306, P208 Severino A. 21, P110 Shiozawa T. P445 Shlomi S. 36 Shlomo N. 36 Shmidt E. P513 Shpektor A. P113 Shumakov A. P108, P108 Shvartz V. P517 Sierra-Lara D. 19, 332 Sigala E. P157, P170, P525 Silva D. P428 Silva Melchor L. P471, P473, P474 Silva T. P100 Silverio Antonio P. P494 Simoes Morais P. P494 Simon M.A. P491 Simon-Garcia M.A. P153 Sinagra G. P144 Sinan U.Y. 27 Sionis A. 378, 386, P482, P483 Skrifvars M. 333 Slingers G. P98 Smeding C. P148 Smilowitz N. P174, P176, P177 Smith R. P475 Soares A. 25 Sobkowicz B. P173, P644 Sobrino Baladron A. 82 Soeholm H. 298, 380 Soffici F. P488 Soler Silva M. P99 Solomonchuk A. P647 Sonoda T. P445 Soreide E. 333 Sori A. P168 Soriano F. 391, P190 Sousa A. C. 305, 306, P208 Sousa C. P129, P131, P141, P215, P411, P449, P643, P690, P691 Sousa J. P425 Sousa J. A. 305, P208 Sousa J.A. 306 Sousa J.P. P125, P132, P414 Sousa N. P218 Spartalis M. 389 Speidl W.S. 22, P154, P163 Sponder M. P655 Sramko M. 30, 300 Srdic M. P155 Staikou C.H. 29, 31 Stamate S.C. P505, P506 Stark K. P165 Staudacher D. P699 Stavrou K. P187 Stefanakis A. P157 Stenner E. P144 Stepinska J. 387 Stocchero M. 29, 31 Stockburger M. P146 Stoicescu L. P673 Stojadinovic P. 30 Storm C. 333 Stratinaki M. P646 Sulastri N.T. P166 Suliman A.A.A. P693 Sun J. 24 Sungkono R.D. P440, P441 Supady A. P699 Surev A. P120 Suwa S. P445 Suyani N.A. P440, P441 Svet A.V. P145, P675 Szendey I. P530 Szyszkowsa A. P644 Taccone F. 333 Takahashi A. P677 Takahashi D. P445 Takeuchi M. P445 Talayeva T. P108, P108 Taniguchi N. P677 Tapia Majado B. 376, 385, P650 Tavares J. P129, P131, P141, P215, P411, P449, P643, P690, P691 Teixeira R. P128, P132, P414 Temtem M. 305, 306, P208 Testa L. 391 Teterina M. P503 Theres H. P146 Thiele H. 387 Thiru S. P207 Thodi M. P413 Thomopoulos K. P114, P192 Thomsen J. 298 Thomsen J.H. 373 Tica O. P415 Tica O.T.I.L.I.A. P415 Tiller C. 328, 330 Timerman A. P424 Timoteo A. P476 Tizon H. P529 Todurov B. P188 Tohtobina A. P522 Tomas Querol C. P649 Tomashkevych A. P647 Tomasik A. P135 Toranzo Nieto I. P167, P464 Tornus M. P529 Torozyan S.A. P438, P439 Torres Sanabria M. P472 Torres-Araujo L.V. P672 Totaro R. 80 Trajkovic M. P435 Trani C. 76 Trendafilova E. P126, P127, P509 Tresoldi S. P488 Tretyak I. P108, P108 Tretyakova S. P518, P519 Triantafyllou K. P170, P525 Trimlett R. P106 Trzeciak P. 409 Tsaturyan A.A. P438, P439 Tsiafoutis I. P114, P192 Tsiambalis A. 382 Tsiampalis A. P646 Tsigkas G. P187 Tsuboi S. P445 Tundidor-Sanz E.T.S. P458, P685 Turgeman Y. P151, P501 Tycinska A. 409, P173, P419, P644 Uchmanowicz I. 295 Udovichenko A. P675 Urgun O.D. 27 Urraca C. P491 Urraca Espejel C. P433 Urraca-Espejel C. P153, P489 Ussov V.Y. P119 Ustundag S. 27 Uzhakhova H. P113 Uzun M. P412 Vaini E. 390 Valdesuso R. P683 Valente B. P531 Vallersnes O.M. 93 Valteryte G. P111 Van Meerbeeck J. P98 Vanden Eede M. P98 Vandenbriele C. P475 Vandoni P. P488 Vaquerizo B. P529 Varela-Lopez A. 289 Vargas A. P174, P176, P177 Varudo R. P524 Varvarousis D. 29, 31 Varvarouta A. P157 Vasilagkos G. P187 Vasilieva H. P113 Vazir A. P106 Vazquez Calvo S. P444, P99 Vazquez Lopez-Ibor J. P471, P472, P474 Veas N. 391 Velasco Ortiz I. P99 Veldre G. P134 Ventura Gomes R. P511, P642 Vergallo R. P117 Vergni F. 76 Viana-Tejedor A. 378, 386 Vidal Burdeus M. P482, P483 Vidal Cales P. P444 Vidal Fernandez M. P474 Viduljevic M. P155 Vieira C. P218 Vieira T. P469, P484 Vieitez Florez J.M. P447, P448, P473 Vila Cha Vaz Saleiro C. P132, P414 Vila Perales M. P482, P483 Villalobos-Flores A. 79, P672 Villar Calle P. P433 Vinci R. 21, P110 Viola G. 24, P190 Visco E. P641 Vladimirov G. P126, P127 Vladu G. P505, P506 Vogiatzis I.A. P654 Voigt J.U. P475 Vom Dahl J. P530 Von Hafe Leite P. P457 Vorobeva D.A. P452 Vorobyev A. P212 Voudris V. P418 Vyshlov E.V. P119 Wada H. P445 Wagner M. 330 Walker M. 80 Wengenmayer T. P699 Wernly B. P530, P655 Westermann D.W. 407 Wiberg S. 298, 373, 380 Wibisono A. P440, P441 Wilk K. P644 Wilson J. P475 Wojta J. 22, P154, P163 Worner Diz F. P649 Wyderka R. 295 Xanthos T. 29, 31 Yakushin S. P212 Yamada T. P677 Yasuda K. P445 Yatsu S. P445 Yepanchintseva O. P188 Yfanti F. P157 Yousef Z. P507 Zaccone V. P526 Zahn T. P699 Zaleski W. P135 Zaliaduonyte D. P111 Zaman M. P674 Zamorano Gomez J.L. P473 Zamorano J.L. P447, P448 Zaya-Ganfo B. 289 Zdebska M. P135 Zeymer U. 387 Zharinov O. P188 Zheltoukhova M. P145 Zimatoura M.E. 389 Zlatic N. P155 Zofia Zielonka M. P649 Zunzunegui Martinez J.L. 82 Zymatoura M. P646 Zymatoura M.E. 382 Zysko D. P156 © The European Society of Cardiology 2020 This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model) © The European Society of Cardiology 2020
TI - ACVC Essentials 4 You
JF - European Heart Journal. Acute Cardiovascular Care
DO - 10.1177/2048872620937980
DA - 2020-08-01
UR - https://www.deepdyve.com/lp/oxford-university-press/acvc-essentials-4-you-jvfJ3T10dX
SP - 1
EP - 196
VL - 9
IS - 2_suppl
DP - DeepDyve
ER -