disparities of outcomes between pacific island and european patients undergoing coronary artery...

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4412 P73 4413 Diagnosis of myocardial infarction after aortic valve 4414 replacement with high-sensitivity troponins 4415 T. Wang 1* , R. Stewart 1,2 , T. Ramanathan 1 , D. Choi 1 , 4416 G. Gamble 2 , P. Ruygrok 1,2 , H. White 1,2 4417 1 Green Lane Cardiovascular Service, Auckland City 4418 Hospital 4419 2 Department of Medicine, University of Auckland 4420 * Corresponding author. 4421 Background: The Universal Definition for type 5 myocar- 4422 dial infarction (MI) applies to coronary artery bypass grafting 4423 (CABG), while perioperative MIs for other cardiac surgeries 4424 are rarely studied and not specifically defined. We assessed 4425 whether high-sensitivity troponin (hs-TnT), with or without 4426 concurrent ischaemic changes on electrocardiogram or echo- 4427 cardiogram, predicted mortality and morbidity after aortic 4428 valve replacement (AVR). 4429 Methods: Isolated AVR performed during July 2010- 4430 December 2012 were identified (n = 219), and hs-TnT rou- 4431 tinely measured 12-24 hours post-operatively were collected. 4432 We pre-specified 140ng/L (10 times 99th percentile upper 4433 reference limit (URL)), 500ng/L (10 times coefficient of vari- 4434 ation of 10% for 4th generation troponin T applied to hs-TnT) 4435 and the optimal hs-TnT cutpoints from receiver-operative 4436 characteristics curves as thresholds for analyses. 4437 Results: There were 216 (98.6%) of patients with hs- 4438 TnT>140ng/L and 31.1% (68) >500ng/L. The optimal cut- 4439 points to detect operative mortality for isolated troponin rise 4440 was 619ng/L (18.7% = 41/219), and for dual criteria was hs- 4441 TnT>448ng/Land ECG and/or echocardiographic changes 4442 (4.6% = 10/219). The latter was the only criteria to indepen- 4443 dently predict operative mortality odds ratio (OR) 10.6, 95% 4444 confidence interval (95%CI) 1.09-103, P = 0.041 and mortality 4445 during follow-up hazards ratio 5.54, 95%CI 1.35-22.8, 4446 P = 0.018. Independent predictors for this criteria include 4447 angina class, congestive heart failure, hypertension and pul- 4448 monary hypertension. Hs-TnT>619ng/L was the best predic- 4449 tor of composite morbidity OR 2.86, 95%CI 1.18-6.91, P = 0.020. 4450 Conclusions: A cut-point around 32 times 99 th percentile 4451 URL for hs-TnT together with ECG and/or echocardio- 4452 graphic criteria is the best predictor for mortality after 4453 AVR. Our findings suggest different thresholds to CABG 4454 for defining MI after AVR. http://dx.doi.org/10.1016/j.hlc.2014.04.118 4455 P74 4456 Disparities of outcomes between Pacific Island and 4457 European patients undergoing coronary artery bypass 4458 grafting 4459 T. Wang 1* , R. Stewart 1,2 , T. Ramanathan 1 , G. Gamble 2 , 4460 H. White 1,2 4461 1 Green Lane Cardiovascular Service, Auckland City 4462 Hospital 4463 2 Department of Medicine, University of Auckland 4464 * Corresponding author. 4465 Background: Ischaemic heart disease remains the single 4466 most common cause of mortality in New Zealand. Significant 4467 disparities exist in terms of cardiovascular risk factors, events 4468 and access to interventions across various ethnic groups. We 4469 compared the characteristics and outcomes of coronary 4470 artery bypass grafting (CABG) between Pacific and European 4471 patients. 4472 Methods: Isolated CABG cases at Auckland City Hospital 4473 during July 2010-June 2012 were retrospectively analysed, 4474 comparing patients of Pacific Island origin to Europeans. 4475 Results: Of 818 CABG patients, 120 (14.7%) were Pacific and 4476 444 (54.3%) were Europeans. Mean follow-up was 1.8+/-0.6 4477 years. Pacific patients were younger (59.9 vs 67.9 years, 4478 p < 0.001), had higher NZ deprivation index (8.2 vs 5.5, 4479 p < 0.001), body mass index (31.6 vs 28.8, p < 0.001), preva- 4480 lence of congestive heart failure (10.8% vs 2.3%, p < 0.001), 4481 diabetes (55.0% vs 24.1%, p < 0.001), dialysis (10.0% vs 0.9%, 4482 p < 0.001), reduced eGFR (66 vs 79 mL/min, p < 0.001) and 4483 additive EuroSCORE I (4.2 vs 4.8, p = 0.028) and longer car- 4484 diopulmonary bypass time (95 vs 89 minutes, p = 0.015). 4485 Despite these findings, Pacific patients were independently 4486 associated with greater 30-day mortality odds ratio 10.6 (95% 4487 confidence interval 1.02-111) p = 0.048 and a trend towards 4488 higher medium-term mortality hazards ratio 2.71 (95% confi- 4489 dence interval 0.86-8.49) p = 0.088. They also had higher raw 4490 rates of composite morbidity (22.5% vs 14.2%, p = 0.035) and 4491 returning to theatre (10.0% vs 3.6%, p = 0.008). 4492 Conclusion: Pacific patients had a significantly higher 4493 prevalence of cardiovascular risk factors but even upon 4494 adjusting for these they were independently associated with 4495 higher mortality after CABG. http://dx.doi.org/10.1016/j.hlc.2014.04.119 4496 P75 4497 Elevation of aspartate aminotransferase predicts 4498 mortality after coronary artery bypass grafting 4499 T. Wang 1* , R. Stewart 1,2 , T. Ramanathan 1 , G. Gamble 2 , 4500 H. White 1,2 4501 1 Green Lane Cardiovascular Service, Auckland City 4502 Hospital 4503 2 Department of Medicine, University of Auckland 4504 * Corresponding author. 4505 Background: Cardiac troponins are the recommended bio- 4506 markers for diagnosing myocardial infarction (MI). Since 4507 troponins have become widely available, the roles of other 4508 less specific biomarkers have been seldom studied. Aspartate 4509 aminotransferase (AST) not only correlates with MI, but also 4510 with liver injury due to ischaemia or congestion. We assessed 4511 whether post-operative AST levels were associated with 4512 adverse outcomes after contemporary coronary artery 4513 bypass grafting (CABG). 4514 Methods: Patients undergoing isolated CABG during July 4515 2010-June 2012 at Auckland City Hospital were included if 4516 they had a post-operative AST measurement within 48 hours 4517 (n = 805), and their prognostic utility for adverse outcomes 4518 assessed by receiver-operative characteristics and multivari- 4519 ate analyses. 4520 Results: Median post-operative AST levels was 37U/L 4521 (lower quartile 30, upper quartile 48). C-statistics and 95% 4522 confidence interval for AST at predicting 30-day mortality 4523 was 0.762 (0.609-0.915), with the optimal cutpoint of 70U/L HLC 1586 147 Abstracts e43

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Page 1: Disparities of outcomes between Pacific Island and European patients undergoing coronary artery bypass grafting

4412 P73

4413 Diagnosis of myocardial infarction after aortic valve4414 replacement with high-sensitivity troponins

4415 T. Wang 1*, R. Stewart 1,2, T. Ramanathan 1, D. Choi 1,4416 G. Gamble 2, P. Ruygrok 1,2, H. White 1,2

4417 1Green Lane Cardiovascular Service, Auckland City4418 Hospital4419 2Department of Medicine, University of Auckland4420 *Corresponding author.

4421 Background: The Universal Definition for type 5 myocar-4422 dial infarction (MI) applies to coronary artery bypass grafting4423 (CABG), while perioperative MIs for other cardiac surgeries4424 are rarely studied and not specifically defined. We assessed4425 whether high-sensitivity troponin (hs-TnT), with or without4426 concurrent ischaemic changes on electrocardiogram or echo-4427 cardiogram, predicted mortality and morbidity after aortic4428 valve replacement (AVR).4429 Methods: Isolated AVR performed during July 2010-4430 December 2012 were identified (n = 219), and hs-TnT rou-4431 tinely measured 12-24 hours post-operatively were collected.4432 We pre-specified 140ng/L (10 times 99th percentile upper4433 reference limit (URL)), 500ng/L (10 times coefficient of vari-4434 ation of 10% for 4th generation troponin T applied to hs-TnT)4435 and the optimal hs-TnT cutpoints from receiver-operative4436 characteristics curves as thresholds for analyses.4437 Results: There were 216 (98.6%) of patients with hs-4438 TnT>140ng/L and 31.1% (68) >500ng/L. The optimal cut-4439 points to detect operative mortality for isolated troponin rise4440 was 619ng/L (18.7% = 41/219), and for dual criteria was hs-4441 TnT>448ng/Land ECG and/or echocardiographic changes4442 (4.6% = 10/219). The latter was the only criteria to indepen-4443 dently predict operative mortality odds ratio (OR) 10.6, 95%4444 confidence interval (95%CI) 1.09-103, P = 0.041 and mortality4445 during follow-up hazards ratio 5.54, 95%CI 1.35-22.8,4446 P = 0.018. Independent predictors for this criteria include4447 angina class, congestive heart failure, hypertension and pul-4448 monary hypertension. Hs-TnT>619ng/L was the best predic-4449 tor of compositemorbidityOR2.86, 95%CI 1.18-6.91, P = 0.020.4450 Conclusions: A cut-point around 32 times 99th percentile4451 URL for hs-TnT together with ECG and/or echocardio-4452 graphic criteria is the best predictor for mortality after4453 AVR. Our findings suggest different thresholds to CABG4454 for defining MI after AVR.

http://dx.doi.org/10.1016/j.hlc.2014.04.118

4455 P74

4456 Disparities of outcomes between Pacific Island and4457 European patients undergoing coronary artery bypass4458 grafting

4459 T. Wang 1*, R. Stewart 1,2, T. Ramanathan 1, G. Gamble 2,4460 H. White 1,2

4461 1Green Lane Cardiovascular Service, Auckland City4462 Hospital4463 2Department of Medicine, University of Auckland4464 *Corresponding author.

4465 Background: Ischaemic heart disease remains the single4466 most common cause of mortality in NewZealand. Significant

4467disparities exist in terms of cardiovascular risk factors, events4468and access to interventions across various ethnic groups. We4469compared the characteristics and outcomes of coronary4470artery bypass grafting (CABG) between Pacific and European4471patients.4472Methods: Isolated CABG cases at Auckland City Hospital4473during July 2010-June 2012 were retrospectively analysed,4474comparing patients of Pacific Island origin to Europeans.4475Results:Of 818 CABGpatients, 120 (14.7%)werePacific and4476444 (54.3%) were Europeans. Mean follow-up was 1.8+/-0.64477years. Pacific patients were younger (59.9 vs 67.9 years,4478p < 0.001), had higher NZ deprivation index (8.2 vs 5.5,4479p < 0.001), body mass index (31.6 vs 28.8, p < 0.001), preva-4480lence of congestive heart failure (10.8% vs 2.3%, p < 0.001),4481diabetes (55.0% vs 24.1%, p < 0.001), dialysis (10.0% vs 0.9%,4482p < 0.001), reduced eGFR (66 vs 79 mL/min, p < 0.001) and4483additive EuroSCORE I (4.2 vs 4.8, p = 0.028) and longer car-4484diopulmonary bypass time (95 vs 89 minutes, p = 0.015).4485Despite these findings, Pacific patients were independently4486associated with greater 30-day mortality odds ratio 10.6 (95%4487confidence interval 1.02-111) p = 0.048 and a trend towards4488higher medium-term mortality hazards ratio 2.71 (95% confi-4489dence interval 0.86-8.49) p = 0.088. They also had higher raw4490rates of composite morbidity (22.5% vs 14.2%, p = 0.035) and4491returning to theatre (10.0% vs 3.6%, p = 0.008).4492Conclusion: Pacific patients had a significantly higher4493prevalence of cardiovascular risk factors but even upon4494adjusting for these they were independently associated with4495higher mortality after CABG.

http://dx.doi.org/10.1016/j.hlc.2014.04.119

4496P75

4497Elevation of aspartate aminotransferase predicts4498mortality after coronary artery bypass grafting

4499T. Wang 1*, R. Stewart 1,2, T. Ramanathan 1, G. Gamble 2,4500H. White 1,2

45011Green Lane Cardiovascular Service, Auckland City4502Hospital45032Department of Medicine, University of Auckland4504*Corresponding author.

4505Background: Cardiac troponins are the recommended bio-4506markers for diagnosing myocardial infarction (MI). Since4507troponins have become widely available, the roles of other4508less specific biomarkers have been seldom studied. Aspartate4509aminotransferase (AST) not only correlates with MI, but also4510with liver injury due to ischaemia or congestion.We assessed4511whether post-operative AST levels were associated with4512adverse outcomes after contemporary coronary artery4513bypass grafting (CABG).4514Methods: Patients undergoing isolated CABG during July45152010-June 2012 at Auckland City Hospital were included if4516they had a post-operative AST measurement within 48 hours4517(n = 805), and their prognostic utility for adverse outcomes4518assessed by receiver-operative characteristics and multivari-4519ate analyses.4520Results: Median post-operative AST levels was 37U/L4521(lower quartile 30, upper quartile 48). C-statistics and 95%4522confidence interval for AST at predicting 30-day mortality4523was 0.762 (0.609-0.915), with the optimal cutpoint of 70U/L

HLC 1586 1–47

Abstracts e43