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ÖKG-Jahrestagung – Abstracts

J KARDIOL 2008; 15 (5–6)

181

Long-term Outcome after Drug-eluting Stent Implan-

tation in Patients With or Without Diabetes mellitus

103

I. Tentzeris, R. Jarai, S. Farhan, E. Samaha, G. Christ*, J. Wojta*, M. Nürnberg,

M. Schillinger, A. Geppert, G. Unger, K. Huber

Med. Dept., Cardiology and Emergency Medicine, Wilhelminenhospital, Vienna;

*Department of Cardiology, University of Vienna

Background Diabetes mellitus is associated with an increased

risk of death and clinical in-stent restenosis after percutaneous coro-

nary interventions. Aim of our study was to evaluate the impact of

diabetes mellitus on all-cause mortality and clinical in-stent-

restenosis (ISR) in patients undergoing drug-eluting stent (DES)

implantation in a routine “real world” clinical setting.

Methods 457 consecutive patients, who underwent PCI and DES

implantation, were included in this prospective registry from Janu-

ary 2003 until December 2006. Patients were divided retrospec-

tively into two groups, diabetics and non-diabetics. All-cause mor-

tality, ISR and the combined endpoint death and ISR was evaluated

during a mean follow-up period of 24.56 ± 12.49 months (range 6–

52 months).

Results Gender, hyperlipidemia, as well as history of MI, PCI,

CABG, cancer, smoking, PAOD, heart failure, previous cerebral

insult, and presence of acute coronary syndrome (ACS) during in-

tervention were not different between groups. Significant differ-

ences were found for age (diabetics: 64.53 ± 12.64 vs non-diabetics:

61.34 ± 12.53; p < 0,001), and arterial hypertension (82.2 % vs

72 %; p = 0.028), respectively.

5.9 % of patients with diabetes and 5.6 % without diabetes died dur-

ing the follow-up (p = 0.9). No differences in mortality could be

demonstrated between DES and BMS treated patients with or with-

out diabetes mellitus.

ISR was observed in 6 patients with diabetes and 27 without diabe-

tes (5.1 % vs. 8 %; p = 0.3)

Using the combined endpoint (all-cause death and ISR), 11 % of

patients with diabetes and 13.6 % without diabetes (p = 0.4) had an

event during the follow-up.

Conclusions Our results obtained in a “real world” clinical set-

ting demonstrate that diabetes mellitus does not affect the long-term

clinical outcome (all-cause mortality and ISR) after DES implanta-

tion.

G148A – A Non Conservative Polymorphism of the

Glycoprotein 130 is Associated with Coronary Artery

Disease 108

K. Thaler

, A. Wonnert

, P. Hohensinner

, S. Boresch

, K. Katsaros

, C. Kaun

K. Huber

, J. Wojta

, G. Maurer

, T. W. Weiss

Department of Internal Medicine II, Medical University of Vienna;

Department of

Computational Biological Chemistry;

Med. Dept., Cardiology and Emergency

Medicine, Wilhelminenhospital, Vienna

Purpose The cytokines of the interleukin-6 (IL-6) family have

been proven to play a pivotal role in inflammation, regulating the

development and progression of atherosclerosis. They are charac-

terized by their functional redundancy and pleiotropy, sharing a

common signal transducing receptor subunit: glycoprotein 130

(gp130). The importance of individual variation in inflammatory

response for atherosclerotic risk is becoming an increasingly inter-

esting and exciting new frontier in cardiovascular research. Such

variation is partially triggered by single nucleotide polymorphisms

(SNPs). Therefore we investigated whether a non conservative SNP

(G148A) of the gp130 gene affects the functional properties of the

gp130 receptor and its possible association with coronary artery dis-

ease.

Methods 522 patients, scheduled for elective coronary angio-

graphy were enrolled in this study. Absence (n = 53) or presence

(n = 469) of coronary artery disease was assessed by coronary

angiography. DNA was extracted from whole blood and gp130

polymorphism was detected by restriction fragment length analysis.

We calculated structure refinement and solvent accessible surface

of the gp130 using an in silico model.

Results CAD was confirmed in 394 out of 445 (89 %) carriers of

the common G148G allele, in 70 out of 72 (97 %) carriers of the hete-

rozygous (G148A) and 5 out of 5 (100 %) homozygous (A148A)

carriers of the Arg allele. For hetero- and homozygous carriers of

the Arg allele, univariate logistic regression revealed an odds ratio

of 4.85 (95 %-CI: 1.15–20.37; p = 0.03) for coronary artery disease.

This association remained significant after correction for age, sex,

body mass index, diabetes, smoking, family history, hypertension,

triglycerides, and total cholesterol levels in a multivariate logistic

regression model. Using an in silico model, we could show that the

G148A polymorphism induces a change in the solvent accessible

surface of the gp130 receptor.

Conclusion The role of the immune system in atherosclerosis is

as complicated as the disease itself, and the majority of the complex

immunological influences and interactions remain to be fully eluci-

dated. Exactly this complexity, however, offers an explanation for

the subtle, yet significant alteration in individual susceptibility to

CAD caused by a protein alteration secondary to this SNP. The

G148A polymorphism of gp130 correlates significantly with CAD.

We speculate that this effect may derive from an alteration in the

extracellular binding region of the receptor, resulting in a change in

the affinity of the receptor for its ligands.

Hohe Akzeptanz und Zunahme des Sicherheitsge-

fühls für den Patienten durch die Telemedizinische

Nachkontrolle und Monitoring von ICDs 078

K. Thudt

, P. Lercher

, S. Linder

, P.Vock

, B. Rotman

, B. Pieske

, H. Mayr

3. Medizinische Abteilung, Landesklinikum St. Pölten;

Abteilung der Kardiologie,

Interne Medizin, Universitätsklinik Graz;

Medtronic Österreich GmbH

Hintergrund Aufgrund der zunehmenden Umsetzung der Richt-

linien und Erweiterung der Indikationsstellung von implantierbaren

Defibrillatoren (ICD), die in einer steigenden Anzahl an behandel-

ten Patienten resultieren, werden neue Methoden für das Manage-

ment von ICD-Patientennachsorgen notwendig. Die Verwendung

der Telemedizin könnte eine Methode sein, um diese steigende An-

zahl an Patienten besser bewältigen zu können. Ziel dieser prospek-

tiven Studie war es, Patientenakzeptanz, das Gefühl der Sicherheit

für den Patienten, Durchführbarkeit und den möglichen Nutzen des

neuen Medtronic CareLink-Systems zur Routinenachsorge von

ICDs zu erheben.

Methoden Patienten mit einem Medtronic ICD wurden konseku-

tiv während einer Routinenachsorge in 2 Zentren eingeschlossen.

Anstelle alle 3 Monate zu einer konventionellen Nachsorge zu kom-

men, fragten die Patienten ihren ICD mit einem speziellen Monitor

zu Hause ab und sendeten die Daten über eine Standardtelefon-

leitung an einen Daten-Server. Ärzte kontrollierten die Daten im

Folgenden auf einer sicheren Webseite. Die übermittelten Daten

entsprechen den Daten, die ein Arzt bei der Abfrage während einer

konventionellen Nachsorge erhält (z. B. programmierte Parameter,

Systemintegritätsdaten und Episodendaten mit EGMs) inklusive

eines 10 Sekunden-EKGs. Die Datensammlung erfolgt während der

konventionellen Nachsorge bei Einschluss und nach einem Jahr so-

wie bei jeder telemedizinischen Fernnachsorge. Durchführbarkeit

und Patientenakzeptanz sowie das Gefühl der Sicherheit werden mit

Hilfe von Fragebögen bei der 3-Monats- und Einjahresnachsorge

erfasst.

Ergebnisse 149 Patienten (Durchschnittsalter 67 ± 12 Jahre,

21 % davon Frauen,) wurden konsekutiv eingeschlossen (33 Ein-

kammer-ICDs, 86 Zweikammer-ICDs, 30 CRT-D, 54 Implantate

davon mit automatischem kabellosem Übertragungsmodus und der

Möglichkeit von automatischen Ereignismeldungen). Während

eines durchschnittlichen Nachsorgezeitraumes von 163 ± 77 Tage

wurden 202 Übertragungen gesendet. Davon wurden 23 außerplan-

mäßige Fernnachsorgen aufgrund von Symptomen oder ICD-

Schocka/jointfilesconvert/272007/bgaben durchgeführt. Während des Nachsorgezeitraumes

gab es keine falschen oder inkorrekten Übertragungen.

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