Patients with Definite or Probable Stent Thrombosis No Stent Thrombosis P value vents Under 30 Days: n74 n2923 Confirmed Discontinuation of Thienopyridine 2/65 (3.08%) 54/2794 (1.93%) 0.37 Confirmed Discontinuation of Aspirin 3/65 (4.62%) 59/2789 (2.12%) 0.17 Confirmed Discontinuation of Thienopyridine or Aspirin 5/65 (7.69%) 106/2795 (3.79%) 0.11 Confirmed Discontinuation on Both Aspirin and Thienopyridine 0/60 (0%) 7/2696 (0.26%) 1 Events From 30 Days to 6 months: n15 n2908 Confirmed Discontinuation of Thienopyridine 5/13 (38.5%) 204/2704 (7.54%) 0.002 Confirmed Discontinuation of Aspirin 5/13 (38.5%) 65/2701 (2.41%) 0.0001 Confirmed Discontinuation of Thienopyridine or Aspirin 7/13 (53.8%) 250/2704 (9.25%) 0.0001 Confirmed Discontinuation on Both Aspirin and Thienopyridine 3/9 (33.3%) 19/2473 (0.77%) 0.0001 Events From 6 to 12 months: n13 n2895 Confirmed Discontinuation of Thienopyridine 6/12 (50.0%) 767/2661 (28.8%) 0.18 Confirmed Discontinuation of Aspirin 0/11 (0%) 75/2660 (2.82%) 1 Confirmed Discontinuation of Thienopyridine or Aspirin 6/12 (50.0%) 803/2662 (30.2%) 0.20 Confirmed Discontinuation on Both Aspirin and Thienopyridine 0/6 (0%) 39/1898 (2.05%) 1 Events Beyond 1 year: n45 n2850 Confirmed Discontinuation of Thienopyridine 11/36 (30.6%) 1662/2599 (63.9%) 0.0001 Confirmed Discontinuation of Aspirin 5/37 (13.5%) 89/2594 (3.43%) 0.009 Confirmed Discontinuation of Thienopyridine or Aspirin 14/37 (37.8%) 1697/2599 (65.3%) 0.0008 Confirmed Discontinuation on Both Aspirin and Thienopyridine 2/25 (8.00%) 54/956 (5.65%) 0.65 Conclusions: In the HORIZONS-AMI trial of patents with STEMI undergoing stent implantation, the relationship between ST and non-usage of DAPT was complex and varied overtime. It was strong during the 1-6 month timeframe, but not between 6 and 12 months. Hereafter, very late ST was associated with non-usage of aspirin but not of a thienopyridine. TCT-490 Coronary Artery Disease and Tako-tsubo Cardiomyopathy: a Possible Association Guido Parodi 1 , Rodolfo Citro 2 , Benedetta Bellandi 1 , Eduardo Bossone 2 , Stefano Del Pace 1 , Marco Marrani 1 , Fausto Rigo 3 , Francesco Bovenzi 4 , Renato Valenti 1 , David Antoniucci 1 1 Careggi Hospital, Florence, Italy, 2 San Giovanni di Dio e Ruggi d’Aragona, Salerno, Salerno, 3 Ospedale dell’Angelo, Mestre, Mestre, 4 Ospedale campo di Marte, Lucca, Lucca Background: In the medical literature several cases of Tako-tsubo cardiomyopathy (TTC) with critical coronary artery disease (CAD) has been reported, and in the clinical practice several typical TTC cases shown significant stenosis of coronary arteries that cannot be related to the dysfunctional myocardium. The aim of this study is to evaluate the prevalence, clinical characteristics and outcome of patients with TTC and critical CAD in a large multicentre database. Methods: In the 26 participating centers, 450 patients admitted with the diagnosis of TTC (modified Mayo Criteria) underwent coronary angiography within 48 hours of hospital admission and were progressively included in the Tako-tsubo Italian Network (TIN) Registry. Results: Overall, 43 (9.6%) patients had at least 1 critical coronary stenosis ( 50%) not supplying the dysfunctional myocardium, or a previous myocardial revascularization (percutaneous or surgical), while 407 (90.4%) had not critical stenosis or truly normal coronary arteries. TTC patients with critical CAD were more likely to have advanced age, diabetes, familiar history of CAD, acute functional mitral regurgitation and a delayed left ventricular function recovery as compared with those without. At 6-month follow-up, the incidence of death, TTC recurrence and rehospitalization rates were similar between patients with critical CAD and patients with normal coronary arteries (Table). At multivariable Cox analysis, independent predictors of death were Charlson comorbidity index while the presence of CAD did not significantly influence mid-term outcome. Variable TTC Patients (n450) p value Critical CAD Not critical CAD n43 (9.6%) n407 (90.4%) Chest pain 1 (2%) 14 (4%) 0.693 Dyspnoea 4 (10%) 14 (4%) 0.067 TTC recurrence 0 (0%) 1 (0.3%) 0.739 Rehospitalization 5 (12%) 23 (6%) 0.152 Cardiac causes 3 (7%) 11 (3%) 0.146 Non cardiac causes 2 (5%) 12 (3%) 0.584 Death 2 (5%) 11 (3%) 0.504 Cardiac causes 1 (2%) 5 (1%) 0.579 Non cardiac causes 1 (2%) 6 (2%) 0.698 Conclusions: The presence of significant CAD is a possible finding in a not trivial proportion of patients with TTC. Thus, when the the stenotic artery does not supply the dysfunctional myocardium, the presence of angiographically significant CAD should not be considered an exclusion criteria for TTC. TCT-491 Incidence And Predictors Of 30 Days Mortality In Elderly Patients With ST- Segment Elevation Acute Myocardial Infarction Undergoing Primary Angioplasty Antonio Alejandro Castro 1 , Vı ´ctor Alfonso Dı ´az 1 , Franklin Pantaleon 1 , Iva ´n Toma ´s Bla ´zquez 1 , Guillermo Ferna ´ndez 1 , Alberto Sa ´ez 1 , José Antonio Alonso 1 , Josue Bustillos 1 , Jorge Sepúlveda 1 , Andrés Romo 1 1 Hospital Meixoeiro, Complejo Hospitalario Universitario de Vigo, Vigo, Pontevedra Background: Primary percutaneous coronary intervention (PPCI) is currently the treatment of choice for patients presenting with ST-segment elevation acute myocardial infarction (STEMI). The purpose of the present study is to determine the incidence and predictors of 30 days mortality in elderly patients with STEMI treated with PPCI. Methods: Prospective observational study. Consecutive patients older than 75 years with STEMI undergoing PPCI in our Hospital were enrolled between January 2006 to December 2009. Prior PPCI, patients received loading dose of 300 mg Clopidogrel and 325-500 mg of Aspirin. Unfractionated Heparin was administered according to current guidelines. Abxicimab was administered at physician’s discretion. Statistical analysis was performedwith SPSS v.18. Results: Among 1,619 STEMI patients admitted for PPCI, 369(22.8%) were older than 75 years. Mean age was 80.1  3.9 years, 196(53.1%) male patients, 90 (24.4%) diabetes mellitus, 51 (13.8%) prior myocardial infarction, 11 (3%) prior congestive heart failure, 30 (8.3%) in Killip class III-IV, 315  238 minutes mean time of symptoms onset to PPCI. 30 days all-cause mortality occurred in 58 (16.4%) patients and cardiac mortality in 53 (15.1%). Univariate analysis determined age older than 81.3 years, non loading dose of Aspirin and Clopidogrel prior PPCI, Killip class 3-4 presentation, final TIMI grade flow less than 3 and prior congestive heart failure as predictors of 30 days mortality. A multivariate logistic regression analysis was performed, identifying as independent predictors of 30 days mortality Killip class 3-4 and final TIMI grade flow less than 3. Conclusions: Among patients older than 75 years with STEMI undergoing PPCI in our center, 30 days all-cause mortality was 16.4%, mainly due to cardiac causes(15.1%). Only Killip class 3-4 and final TIMI grade flow less than 3 were identified as independent predictors of 30 days mortality. TUESDAY, OCTOBER 23, 8:00 AM–10:00 AM www.jacc.tctabstracts2012.com B142 JACC Vol 60/17/Suppl B | October 22–26, 2012 | TCT Abstracts/POSTER/STEMI/NSTEMI POSTERS