POSTER

ABSTRACTS

April 24–27, 2012

control, P�0.01, respectively). (3) Higher mechanical strain inhibitsSTI-571 activity in VSMCs (5% strain vs. static control, P�0.05; 15%strain vs. static control, P�0.01).

Conclusion: Our data show that higher mechanical strain activated-Akt/PKB is required for VSMC migration and probably functionthrough its effects on actin rearrangement.

AS-261Low versus High Acetylcholine Dose Response in Patients withVasospastic Angina. Sung Il Im, Seung-Woon Rha, Amro Elnagar,Byoung Geol Choi, SunWon Kim, Jin Oh Na, Seong Woo Han,Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim,Hong Seog Seo, Chang Gyu Park, Dong Joo Oh. CardiovascularCenter, Korea University Guro Hospital, Seoul, Korea (Republic of).

Background: Intracoronary injection of acetylcholine (Ach) has beenshown to induce coronary spasm in patients with variant angina. Clin-ical significance and angiographic characteristics of patients (pts) with(�) provocation results to low Ach dose are not clarified yet ascompared with pts respond to high Ach dose.

Methods: A total 3034 consecutive pts underwent coronary angiog-raphy Ach provocation tests from January 2004 to August 2010 wereenrolled for this study. Ach was injected in incremental doses of 20, 50,100� into the left coronary artery. Significant coronary artery spasm(CAS) was defined as focal or diffuse severe transient luminal narrow-ing (�70%) with/without chest pain or ST-T change on ECG. A total1445 pts (47.6%) showed positive provocation tests. We compared theclinical and angiographic characteristics of patients responded to lowdose (20�) to those to high dose (50�).

Results: The baseline clinical and procedural characteristics are wellbalanced between the two groups. There was no difference in theincidence of myocardial bridges in both groups. Low Ach dose spasmgroup showed more frequent ischemic ECG changes and atrioventric-ular (AV) block on ECG during the Ach provocation test. Further, thepts with Low Ach dose group was associated with higher incidence ofbaseline spasm, severe vasospasm, multi-vessels involvements, and atrend toward more diffuse spasms (�30mm) than those with the Highdose group (Table).

Conclusion: The pts significantly respond to low Ach dose wereassociated with more diffuse, severe and multivessel spasm than ptsrespond to high dose, suggesting more intensive medical therapy withclose clinical follow up will be required for these patients.

AS-262Efficacy and Safety of Adjuvant Proximal Balloon InflationComprising Stent Proximal Edge for Full Expansion of the Stentby Stent Balloon. Byoung Geol Choi, Seung-Woon Rha,Se Yeon Choi, Amro Elnagar, Sung Il Im, SunWon Kim, Jin Oh Na,Seong Woo Han, Cheol Ung Choi, Hong Euy Lim, Jin Won Kim,Eung Ju Kim, Hong Seog Seo, Chang Gyu Park, Dong Joo Oh.Cardiovascular Center, Korea University Guro Hospital, Seoul,

Korea (Republic of).

The American Journal of Cardiology� APRIL 24–27, 2012 AN

Background: Another shorter & bigger non-compliant balloon is beingused for optimal expansion of the stent, particularly the proximalportion of the stent when the proximal and distal reference vesseldiameters are significantly different. The safety and efficacy of adju-vant proximal balloon inflation (PBI) comprising proximal edge of thestent using stent balloon with higher inflation pressure are largelyunknown. This strategy was intended to reduce procedural time, con-trast amount and cost when we do the adjuvant ballooning for optimalstent expansion.

Methods: This study consisted of 2164 consecutive patients (pts)underwent percutaneous coronary intervention (PCI) with drug-elutingstents (DESs) from January 2004 to April 2010. A total 211 pts (259lesions) have performed PBI using same stent balloon. Six-monthangiographic and twelve-month clinical outcomes were compared be-tween the PBI group and non-PBI group.

Results: The baseline clinical and procedural characteristics werewell balanced between the two groups, except that the left circumflexlesions were more common in the PBI group. There was no differencein procedural success rate and in hospital complications between thetwo groups, except that the incidence of peri-procedural myocardialinfarction (MI, 5.8% vs. 10.4%, P�0.001) was higher in the PBI group.At 6-month, the follow up minimal luminal diameter (MLD) wassmaller in the PBI group. However, this angiographic benefit was nottranslated into the clinical benefit up to 12 months. (Table).

Conclusion: PBI was associated with higher incidence of peri-procedural MI but other safety profiles, procedural success, in-hospitalcomplications, mid-term angiographic and clinical outcomes were sim-ilar with those of non-PBI group. PBI can be a cost-effective strategywhen the proximal and distal reference vessel diameters are signifi-cantly different at the time of stent implantation.

AS-263Serum Adipocyte-Specific Fatty Acid-Binding Protein is aPredictable Marker of Coronary Artery Disease and DiabetesMellitus. A-Ra Cho1, Seung-Woon Rha2, Sang-Ho Park1,Hyeok-Gyu Lee1, Se-Whan Lee1, Won-Yong Shin1, Seung-Jin Lee1,Dong-Kyu Jin1, Amro Elnagar2, Byoung Geol Choi2, Sung Il Im2,SunWon Kim2, Jin Oh Na2, Seong Woo Han2, Cheol Ung Choi2,Hong Euy Lim2, Jin Won Kim2, Eung Ju Kim2, Hong Seog Seo2,Chang Gyu Park2, Dong Joo Oh2. 1Soonchunhyang UniversityCheonan Hospital, Cheonan, Korea (Republic of); 2CardiovascularCenter, Korea University Guro Hospital, Seoul, Korea (Republic of).

Background: Introduction : Adipocyte-specific fatty acid-binding pro-tein (A-FABP), abundantly expressed in adipocytes and macrophages,plays a central role in the development of atherosclerosis and diabetes

mellitus in experimental animals.

GIOPLASTY SUMMIT ABSTRACTS/Poster 129S

POSTER

ABSTRACTS

April 24–27, 2012

Hypothesis: We assessed the hypothesis that A-FABP is also playsa central role in the development of atherosclerotic cardiovasculardisease and diabetes mellitus in humans.

Methods: In a total of 175 Korean adult, in whom coronary angiogramwere performed, anthropometrical and biochemical parameters were mea-sured. Serum A-FABP levels were measured using ELISA. The presenceof metabolic syndrome was diagnosed according to American Heart As-sociation/National Heart, Lung and Blood Institute (AHA/NHBL).

Results: Among the subjects, 136 subjects (77.2%) had coronaryartery disease (CAD) and 61 subjects (34.9%) had diabetes mellitus.Serum A-FABP level in CAD patients is showned significantly higherthan in non-CAD patients (46.75 � 17.79 ng/mL vs. 26.75 � 9.48ng/mL, p � 0.001). Serum A-FABP level in diabetes mellitus andmetabolic syndrome patients is also showed significantly higher than innon-diabetic and non-metabolic syndrome patients. In addition, serumA-FABP level in CAD patients is showed significantly higher than innon-CAD patients after adjustment for sex, age, diabetes mellitus andmetabolic syndrome (p � 0.035). And serum A-FABP level in diabeticpatients is also showed significantly higher than in non-diabetic patientsafter adjustment for sex, age, CAD and metabolic syndrome (p � 0.001).

Conclusion: In conclusions, serum A-FABP might be a predictablemarker of coronary artery disease and diabetes mellitus in Koreanadults.

AS-264Angiographic Characteristics according to Acetylcholine DoseResponsible for Significant Coronary Artery Spasm.Woong Gil Choi1, Seung-Woon Rha2, Soo Hyun Kim1,Amro Elnagar2, Byoung Geol Choi2, Sung Il Im2, SunWon Kim2,Jin Oh Na2, Seong Woo Han2, Cheol Ung Choi2, Hong Euy Lim2,Jin Won Kim2, Eung Ju Kim2, Hong Seog Seo2, Chang Gyu Park2,Dong Joo Oh2. 1Kunkuk University Chungju Hospital, Chungju,Korea (Republic of); 2Cardiovascular Center, Korea UniversityGuro Hospital, Seoul, Korea (Republic of).

Background: Acetylcholine (Ach) is a useful agent assessing signifi-cant coronary artery spasm (CAS). We assume that patients (pt) show-ing positive acetylcholine (Ach) provocation test to lower Ach dosemay more vulnerable to CAS. We investigated whether there aredifferences in angiographic characteristics according to Ach dose caus-ing significant CAS during intracoronary Ach provocation test.

Methods: A total 1730 consecutive pts without significant coronaryartery disease (CAD) who underwent Ach provocation test by injectingincremental doses of 20, 50, 100 ug into the left coronary arterybetween March 2004 and April 2009 were enrolled. Significant CASwas defined as focal or diffuse severe transient luminal narrowing(�70%) with/without chest pain or ST-T change on ECG. Angio-graphic characteristics were compared between the Low dose group (20& 50 ug, n�716) and High dose group (100 ug, n�1014) among ptswith positive Ach provocation test.

Results: Baseline clinical characteristics were similar between thetwo groups except the Low dose group had more elderly (� 50 years),

diabetes mellitus and previous myocardial infarction (MI). During the

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Ach provocation test, the incidence of atrio-ventricular (AV) block,severe CAS (�70% stenosis by QCA), multi-vessel spasm and diffusespasm were more frequent in low dose group.

Conclusion: In our study, we found that pts showing significantCAS to lower Ach dose showed more chance to have severe, diffuseand mulitvessel spasm during the test. Special care with intensivemedical therapy should be considered who showed significant Achresponse to lower Ach dose as compared with those responded tohigher Ach dose.

AS-265Impact of Increased Basal Tonicity of Coronary Artery onAcetylcholine Provocation Test Result in Korean Patient withChest Pain. Sun Won Kim, Seung-Woon Rha, Amro Elnagar,Byoung Geol Choi, Sung Il Im, Jin Oh Na, Seong Woo Han,Cheol Ung Choi, Hong Euy Lim, Jin Won Kim, Eung Ju Kim,Hong Seog Seo, Chang Gyu Park, Dong Joo Oh. CardiovascularCenter, Korea University Guro Hospital, Seoul, Korea (Republic of).

Background: Vasospastic angina is suspected when coronary angiog-raphy fail to show a culprit lesion in a patient with typical chest pain.Intracoronary (IC) nitroglycerine (NTG) infusion often induce modestvasodilation in arteries without significant vasoconstriction at provo-cation test. We designated this phenomenon as ‘baseline spasm’, andinvestigated the characteristics and clinical meaning of it.

Methods: Provocation test was performed using IC infusion ofacetylcholine (Ach) with incremental dosage (20, 50, 100�g) wheninitial angiography revealed a normal coronary artery, or no severestenosis (� 70%). Vasoconstriction more than 70% compared to base-line by visual assessment was considered to be positive, and angio-graphical data were also analyzed by QCA. A total of 1764 patients(pts) from January 2004 to august 2010, without prior history ofcoronary artery disease, peripheral artery disease, congestive heartfailure, and renal insufficiency were analyzed. Pts were grouped ac-cording to existence of baseline coronary spasm which was defined asdiffuse coronary vasodilation more than 30% after IC NTG infusionwhen compared to initial angiography.

Results: There were no significant differences in baseline charac-teristics between 2 groups except alcohol consumption history. Therewas a trend toward greater use of CCB in baseline spasm group.Baseline spasm group have significantly higher incidence of positiveprovocation test result, multi-vessel involvement, and chest pain duringthe exam. By QCA analysis, pts with baseline spasm had higherincidence of significant vasoconstriction (� 70%) at lower dose of ICAch. There was a tendency toward higher incidence of myocardialbridge in baseline spasm group.

Conclusion: According to our study, baseline spasm was consideredas an important prognostic factor of positive Ach provocation test, anindicator of hyperreactivity of coronary artery to Ach, which represents

severe endothelial dysfunction.

4–27, 2012 ANGIOPLASTY SUMMIT ABSTRACTS/Poster