TCTAP A-011 Early Invasive Versus Conservative Treatment Strategies in Octogenarians with Acute Coronary Syndrome: One-year Clinical Outcome, a Single Centre Experience Vipin Mughilassery Thomachan, 1 Abdullah M.A. Shehab, 2 Ahmed Siddiqui, 1 Ali Shamsi, 1 Gohar Jamil 1 1 Al Ain Hospital, United Arab Emirates; 2 UAE University, United Arab Emirates BACKGROUND Acute coronary syndrome (ACS) is a frequent cause of hospitalization in the octogenarians. This group of patients is scarcely represented in clinical trials comparing management strategies in ACS. They are less likely to receive treatment according to the stan- dard guidelines due to various reasons. This retrospective data anal- ysis study was aimed to evaluate whether octogenarians would beneﬁt from an Early Invasive Strategy (EIS) compared to Conserva- tive Treatment Strategy (CTS). METHODS Retrospective analysis of Electronic Medical Records (Cerner) of octogenarians admitted to our hospital between the year 2014 and 2017 with a primary diagnosis of ACS. Both EIS and CTS groups were treated according to the institutional protocol and fol- lowed for a minimum period of one year for further events. The pri- mary endpoint of the study was all-cause mortality at six and twelve months and cardiac mortality at twelve months. The rate of re-hos- pitalization during these periods was also compared. RESULTS Total 164 octogenarians admitted with ACS during this period were selected for the study. Of these, 60 patients (36.6%) had undergone Percutaneous Coronary Intervention (PCI) and 104 pa- tients (63.4%) were treated conservatively. Mean age was 86.1  5.7 years in the conservative group (female 50%) and 85.5  4.6 years in the early invasive group (female 53.3%). NSTEMI was the most com- mon form of ACS presentation in both groups (89.4% in CTS; 73.3% in EIS). The Conservative treatment group had higher in-hospital mortality compared to invasive group (17.3% vs. 8.3%; p ¼ 0.1108). Six months all-cause mortality was signiﬁcantly higher in the conservative group (26.9% vs. 11.7%; p ¼ 0.0024). Similarly, one-year all-cause mortality was signiﬁcantly higher in the conservative group than in invasive strategy (41.4% vs. 16.7%; p ¼ 0.0012). Cardiac mortality at one year was also high in the conservative group (28.8% vs. 10%; p ¼ 0.0052), which was statistically signiﬁcant. Average number of rehospitalizations per patient in the following year due to the cardiac cause was signiﬁcantly high in the conserva- tive group (1.8/year vs. 0.5/year; p < 0.0001). Non-cardiac rehospi- talization was also high in conservative group (1.7/year vs. 0.7/year; p ¼ 0.0017). Past history of coronary revascularization (31.7% in CTS vs. 15% in EIS; p ¼ 0.0186) and CKD (46.2% in CTS vs. 35% in EIS; p ¼ 0.0013) were higher in conservative group, which were statisti- cally signiﬁcant. Other baseline variables were similar and comparable between CTS and EIS groups (DM 43.3% vs. 51.7%, p ¼ 0.3003; HTN 70.2% vs. 83.3%, p ¼ 0.0629; CVD 53.8% vs. 55%, p ¼ 0.8822; low LVEF 37.5% vs. 25%, p ¼ 0.1019; AF 21.2% vs. 10%, p ¼ 0.0674). Acute Kidney Injury (AKI) was more in the invasive group (26.7% vs. 16.3%, p ¼ 0.1105), possibly related to contrast-induced nephropathy. EIS showed more bleeding complications (11.7% vs. 8.7%; p ¼ 0.5314) and Anemia (15% vs. 13.5%; p ¼ 0.7907) compared to CTS, but were not statistically signiﬁcant. Subgroup analysis of EIS showed statistically signiﬁcant one-year mortality difference between Trans-Radial PCI and Trans-Femoral PCI (9.3% vs. 35.3%; p ¼ 0.0157). CONCLUSION This retrospective data analysis study shows that early invasive strategy, though underutilized in octogenarians with ACS, is technically feasible with successful coronary revascularization in the majority of patients and appears superior to conservative strategy in terms of MACE by one year. Compared with the conservative strategy, early invasive treatment in octogenarians with ACS was associated with low in-hospital mortality, six and twelve-month all-cause mor- tality and twelve-month cardiac mortality. EIS was also associated with low rehospitalization rate following discharge. Early Invasive Strategy is a reasonably safe treatment option for ACS in octogenar- ians and trans-radial PCI appears to be a safer and superior option than trans-femoral. TCTAP A-012 Effect of Fibrinogen on Percutaneous Coronary Intervention in Chinese Patients: A Large Single-center Study Ping Jiang, 1 Bo Xu, 1 Jinqing Yuan 1 1 Fuwai Hospital, China BACKGROUND This large cohort study aimed to investigate the as- sociation between ﬁbrinogen levels and 2-year all-cause mortality, and its predictive value in addition to a basic model including tradi- tional risk factors in Chinese patients receiving the contemporary percutaneous coronary intervention (PCI). METHODS A total of 6293 patients undergoing PCI were enrolled with measurement of baseline ﬁbrinogen levels. Patients were divided into 3 groups according to tertiles of baseline ﬁbrinogen levels (low ﬁbrinogen group,  2.98 g/L; medium ﬁbrinogen group, > 2.98 g/L and  3.58 g/L; high ﬁbrinogen group, > 3.58 g/L). RESULTS Patients in the high ﬁbrinogen group were older and had a higher prevalence of traditional risk factors, such as hypertension, diabetes, previous MI, previous PCI, previous cardiovascular disease, worse left ventricular ejection fraction (LVEF), and worse creatinine clearance (CCr) compared with the other 2 groups (all p < 0.05). The 2- year all-cause mortality rate was 1.2%. Kaplan–Meier analyses showed that the 2-year all-cause mortality rates were signiﬁcantly higher in the high ﬁbrinogen group than in the other 2 groups (log-rank, p ¼ 0.022). After adjustment for potential confounders, ﬁbrinogen remained to be signiﬁcantly associated with all-cause mortality (HR 1.339, 95% CI: 1.109–1.763, p ¼ 0.005). The inclusion of ﬁbrinogen modestly improved the predictive value of the basic model. The area under curve was increased from 0.762 to 0.774 for the basic model plus ﬁbrinogen (integrated discrimination improvement ¼ 0.002, z ¼ 0.088, p ¼ 0.93). JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 73, NO. 15, SUPPL S, 2019 S7