Results: NSE levels significantly increased after coronary angiography and inter- vention compared to baseline levels (22.0327.70, 10.083.15 consecutively). Baseline characteristics were similar between groups (Table-1). Left ventricular ejection fraction in the SNI+ group was significantly lower than SNI- group (43.7112.51%, 50.849.34%, p¼0.002). Maximal CK-MB, Troponin-I, Syntax Score (SS), of SNI+ group were significantly higher than SNI- group (103.8399.22, 51.9278.33, p¼0.006; 50.0466.18, 19.1830.50, p¼0.002; 103.8399.22, 51.9278.33, p¼0.006 and 50.0466.18, 19.1830.50, p¼0.002 successively). SS and performing PCI were the independent predictors of SNI (p¼0.009, OR¼1.06, 95%CI¼1.014-1.107, p¼0.036, OR¼4.262, 95%CI¼1.097-16.56). Conclusions: PCI and coronary artery lesion complexity may increase the risk of SNI in patients with acute coronary syndrome. OP-012 Treatment of Coronary No-Reflow With Intracoronary Vasodilators Added to Intravenous Tirofiban _ Ibrahim Faruk Aktürk 1 , Ahmet Arif Yalçın 1 , Çetin Sarıkamıs ¸ 1 , Nihan Turhan Ça glar 2 , _ Ismail Bıyık 1 , Mehmet Ertürk 1 , Ömer Çelik 1 , Fatih Uzun 1 , _ Ilker Murat Ça glar 3 , Ender Öner 1 1 Department of Cardiology _ Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, _ Istanbul, 2 Department of Cardiology _ Istanbul Training and Research Hospital, _ Istanbul, 3 Department of Cardiology Bakırköy Sadi Konuk Training and Research Hospital, _ Istanbul Objective: We prospectively assessed the management and short term prognosis of no-reflow phenomenon in a tertiary referral hospital. Methods: We included 46 patients with ST-segment elevation acute myocardial infarction (STEMI) and occurrence of no-reflow phenomenon after primary percuta- neous coronary intervention. They were all received intravenous tirofiban and then randomized into one of the 3 groups: intracoronary adenosine (n¼16), intracoronary verapamil (n¼15) or serum physiologic as placebo (n¼15). Intracoronary drugs were administered after stent implantation. Thrombolysis In Myocardial Infarction (TIMI) frame counts were used to assess coronary flow. Results: Groups were similar in terms of age, sex, STEMI localisation, diabetes, hypertension, mean reperfusion time. Hemotologic and biochemical blood param- eters and procedural properties were also similar between groups (stent size and length, diameter and number of balloon(s) and stent(s) used). Verapamil plus tir- ofiban therapy had significant effect in restoring impaired coronary blood flow, decreasing TIMI frame count from 7344 to 5248 (p¼0.024). However, adeno- sine and serum physiologic administration were not found to be so effective in decreasing TIMI frame count (from 8135 to 7146, p¼ 0.084; from 7432 to 7137, p¼0.612; respectively). In-hospital and 6-month survival rates were similar among groups. Conclusion: Tirofiban plus verapamil restored the impaired coronary blood flow more effectively than tirofiban plus adenosine and tirofiban only. Although both verapamil and adenosine have multiple effects on coronary circulation and even on platelet aggregation, verapamil as a calcium channel blocker, not only relieves microvascular spasm but also reduces calcium influx into ischemic cells, relieves cellular edema and restores calcium homeostasis. It may be hypothesized that these additional features put verapamil ahead of other drugs and may explain the better results we obtained with verapamil in comparison to adenosine. OP-013 A Simple Index to Predict Adverse Clinical Outcome Associated with Acute Myocardial Infarction in Primary PCI Era Mustafa TarıkA gaç 1 , Suret A gaç 4 , Levent Korkmaz 1 , Turhan Turan 2 , Hüseyin Bektas ¸ 1 , Ali Rıza Akyüz 2 , Mustafa Çetin 1 , Hakan Erkan 1 , Bülent Vatan 3 , S ¸ükrü Çelik 1 1 Ahi Evren Cardiovascular and Thoracic Surgery Training and Research Hospital, Department of Cardiology, Trabzon, 2 Akcaabat Hackali Baba State Hospital, Department of Cardiology, Trabzon, 3 Sakarya University Medical Faculty Hospital, Department of Cardiology, Sakarya, 4 Karadeniz Technical University Medical Faculty Hospital, Department of Biochemisty, Trabzon Background: The major determinant of final infarct size for a given coronary occlusion is the size of myocardium that the artery perfuses. Defining the initial area- at-risk (AAR) for infarction has major clinical implications since it permits an accurate estimate of myocardial salvage provided by reperfusion therapies. We proposed a new index 'Relative Importance Index (RII)' to predict potential infarct size in patients with anterior MI. Aim: The aim of the study is to assess the predictive role of RII for reduction in systolic function and its relation to adverse clinical outcomes. Methods: One Hundred twenty-three acute anterior MI patients with their first acute coronary syndrome incident were consecutively and prospectively enrolled to the study. Patients with a clinical history of congestive heart failure, valvular heart disease, and previous coronary revascularization were excluded. All patients under- went primary percutaneous coronary intervention (PCI) for revascularization. Angiographic exclusion criteria were 1) pre-procedural TIMI flow 2 in the infarct related artery, 2) chronic total occlusion of other arterial territory 3) any visible collateral flow to infarct related artery 4) diffuse disease at proximal segments of coronary arteries that precludes defining reference segment. Coronary diameters were measured with quantitative coronary analysis program. RII was calculated by dividing culprit segment diameter to the sum of diameters of LAD, Cx, and RCA at their proximal segments (Figure 1). Troponin I (TnI) concentration at 72 hour was chosen as a serological estimate of infarct size. We evaluated 1-month follow up rates of major clinical endpoints (MCE), which is defined as death, non fatal MI, stroke, and new congestive heart failure. Left ventricular EF (LVEF) at 1st month was chosen as an index for systolic function. Results: RII was significantly and negatively correlation LVEF (r¼-0.65, p<0.001) (Figure 2). As RII of culprit lesion increased there was tendency to end up with lower EF. Likewise, RII was significantly correlated with 72 h TnI (r¼0.48, p<0.001). Patients were dichotomized according to median value of RII (median RII¼0.30) (Table 1). Supra-median RII was associated with lower EF and higher incidence of composite MACE. The mortality (12.9% vs. 6.6%), non-fatal MI (6.5% vs. 3.3%), and new CHF (12.9% vs. 3.3%) rate in supra-median RII group trend higher but they did not reach statistical significance. An RII >0.30 had a 88% sensitivity and 60% specificity (ROC area 0.82, p<0.001, CI [0.73-0.90]) for predicting severe LV dysfunction (LVEF <30%) (Figure 3). Conclusion: A Simple index derived from coronary angiography at time of primary PCI can predict LV systolic function loss and adverse clinical outcome in patients with acute anterior myocardial infarction. Table-1 Variable SNI+ SNI- p value Age, year 62.689.33 64.0111.27 0.566 Male n(%) 26 (83.8%) 49 (73.1%) 0.243 Body Mass Index, kg/m2 28.064.03 28.014.85 0.515 Hypertension, n(%) 10 (32.3%) 25 (37.3%) 0.627 Diabetes, n(%) 10 (32.3%) 24 (35.8) 0.730 Hyperlipidemia, n(%) 9 (28.1%) 22 (32.8%) 0.782 Smoking, n(%) 11 (35.5%) 20 (29.9%9 0.752 Atrial fibrillation, n(%) 2 (6.5%) 8 (11.9%) 0.404 Mean Arterial Pressure, mmHg 100.7113.80 98.2612.14 0.374 Percutaneous Coronary Intervention, n(%) 21 (67.7%) 30 (44.8%) 0.034 SYNTAX score 28.1314.68 18.7113.23 0.002 Fluoroscopy Time, min 6.374.23 4.704.16 0.069 estimated Creatinine Clearance, ml/min 103.6530.51 99.1034.47 0.530 Glucose, mg/dl 127.7160.40 133.0767.80 0.707 LDL, mg/dl 141.3242.59 135.1947.74 0.733 Total Cholesterol, mg/dl 201.2166.84 205.8555.17 0.718 Hemoglobin, g/dl 14.421.59 13.971.70 0.210 Mean Platelet Volume, femtolitre 8.271.51 8.210.93 0.797 Red cell Distribution Width, % 13.550.91 13.361.42 0.498 CK-MB, ng/ml 103.8399.22 51.9278.33 0.006 Troponin-I, ng/ml 50.0466.18 19.1830.50 0.002 Left Atrial diameter, mm 38.294.09 38.515.85 0.853 Left Ventricular End Diastolic Diameter, mm 49.905.83 49.305.03 0.600 Left ventricular End Systolic Diameter, mm 36.105.76 33.396.00 0.037 Ejection Fraction, % 43.7112.51 50.849.34 0.002 Asendan Aorta diameter, mm 34.714.11 34.574.20 0.875 C4 JACC Vol 62/18/Suppl C j October 26–29, 2013 j TSC Abstracts/ORALS ORALS