Bifurcation and Left Main Stenting Thursday, April 28, 2011 2:00 PM  6:00 PM (Abstract nos. AS-027, AS-077– AS-079, AS-177–AS-183) AS-027 Please see page 132A for AS-027. AS-077 The Impact of Creatine Kinase-MB Elevation on 4 Years Clinical Outcomes after Percutaneous Coronary Intervention for Left Main Coronary Artery Disease. Jong-Young Lee, Jun-Hyuk Oh, Chang Hoon Lee, Gyung-Min Park, Ki Won Hwang, Jung-Min Ahn, Hae Geun Song, Won-Jang Kim, Duk-Woo Park, Soo-Jin Kang, Seung-Whan Lee, Young-Hak Kim, Cheol Whan Lee, Seong-Wook Park, Seung-Jung Park. Asan Medical Center, Seoul, Korea (Republic of). Background: To evaluate the long-term prognostic value of creatine kinase MB fraction (CK-MB) release after percutaneous coronary in- tervention (PCI) for left main coronary artery (LMCA) disease. The impact of CK-MB elevation on 4 years clinical outcomes after PCI for patients with LMCA disease remains unclear. Methods: From March 2003 and June 2008, a total of 467 consec- utive patients underwent elective PCI for LMCA stenosis, CK-MB levels were obtained at least two times within 48 hours after procedure. Primary outcome was defined as the composite of all-cause death, myocardial infarction (MI), target lesion revascularization (TLR) dur- ing follow-up. Patients were divided into two groups according to peak CK-MB levels after procedure: CK-MB within normal range; CK-MB elevation 1 upper limit of normal (ULN). Results: CK-MB elevation above normal range was detected in 120 (25.7%) of the patients. At a median follow-up of 1455 days (inter- quartile range 1077 to 1979 days), the cumulative incidences of the primary outcome were similar between the two groups (19.0% vs. 18.7% respectively, Log rank P=0.69; hazard ratio [HR], 0.76 [95% CI, 0.44 –1.30]; P=0.30). On multivariate analysis, diabetes (HR, 1.64 [95% CI, 1.01–2.65]; P=0.044), renal failure (HR, 3.25 [95% CI, 1.74-6.06]; P0.001) and total length of stent deployed, mm, (HR, 1.01 [95% CI, 1.01–1.02]; P=0.001) were identified as independent predictors of primary outcome. Conclusion: CK-MB elevation after successful PCI for LMCA disease was not associated with major adverse clinical outcomes at 4 years. AS-078 Compression of the Ostia of the Side-branch Coronary Arteries by Different Types of Main-branch Plaques. JiLin Chen, LiJian Gao, Bo Xu, Jun Chen, Chaowei Mu, Yuejin Yang, Shubin Qiao, Runlin Gao. Cardiovascular Institute & Fuwai Hospital, Beijing, China. Background: To explore the best route and treatment strategy for bifurcation lesions in coronary heart disease. Methods: A total of 135 patients who received a single drug- eluting stent (DES) treatment with type II bifurcation lesions ac- cording to the Chen’s classification were selected. The degree of compression of the side-branch ostium was analyzed after a DES was placed into the main-branch and the compression of different types of main-branch plaques on the side-branch ostium was com- pared. Results: Among all patients, the degrees of stenosis of the main- branches in the different subtypes prior to the placement of the main- branch stent were 85.48%  5.54 (IIa), 85.45%  7.52 (IIb), 84.64%  7.73 (IIc), and 84.58%  7.20 (IId), respectively. The significantly increased stenosis of the side-branches caused by compression of the side-branch ostium by the main-branch plaques after the placement of the main-branch stent were 48.74%  20.50 (IIa), 36.36%  18.71 (IIb), 40.55%  19.63 (IIc ), and 24.00%  11.56 (IId), respectively, acute occlusion occurred in 2 cases (1.5%) (II a) after the main-branch stenting. Conclusion: Our results suggest that a single DES treatment or provisional stenting can be adopted for types Id and IIa-e bifucation lesion. If stenosis  70% in ostium of side-branch, the strategy men- tioned above suite for type I of bifurcation lesion also. Two-stent strategy should be selected in subtypes Ia, Ib, and Ic, if stenosis 70% in ostium of side-branch and the diameter of side-branch  2.5mm. AS-079 Predictors For Crossover From Radial To Femoral Approach In Patients Undergoing Percutaneous Coronary Intervention For Unprotected Left Main Disease. Young Jin Youn, Junghan Yoon, Jun-Won Lee, Joong Kyung Sung, Woo Taek Kim, Sung-Gyun Ahn, Seung-Hwan Lee. Wonju Christian Hospital, Wonju, Korea (Republic of). Background: The use of transradial coronary angiography and inter- vention (TRI) is increasing for its lower rates of major vascular access related complications and the potential for early mobilization. How- ever, TRI is limited in patients with complex lesions such as left main (LM) disease. Therefore, we evaluated the predictors for predictors for crossover from radial to femoral approach in patients undergoing per- cutaneous coronary intervention (PCI) for unprotected LM disease. Methods: Among 3,674 patients underwent drug-eluting stent im- plantation at our institute (TRI: 89.4%), 95 patients underwent coro- nary angiography with transradial approach and successfully treated unprotected left main disease with either transradial intervention or transfemoral intervention (TFI) were evaluated. Demographic, angio- graphic and procedural data was collected retrospectively. Syntax score was calculated using web site. Results: Twenty seven patients needed of crossover from radial to femoral approach. Sex, age, past history and medication were compa- rable between two groups. Acute coronary syndrome and indication of coronary intervention was similar. Although the disease extent was similar, the Syntax score was higher in TFI group (20.0  7.9 vs. 16.4  8.6, p  0.01). TFI group was need for guiding catheter larger than 6-Fr. (5 (7.4%) vs. 15 (55.5%), p  0.01). Two-stent strategy was more frequently used in TFI group (6 (8.8%) vs. 10 (37.0%), p  0.01). Clinical outcome including any death, myocardial infarction and target vessel revascularization was comparable for median 619 days. Multi- variate analysis using age, sex, disease extent, guiding catheter size, stent strategy, Syntax score and diagnosis, guiding catheter more than 6-Fr. (Odd ratio (OR), 14.50; 95% confidence interval (CI), 3.34 - 62.93; p  0.01) and Syntax score (OR, 1.08; 95% CI, 1.00-1.17; p = 0.04) were independent predictor for crossover from radial to femoral approach. 56A The American Journal of Cardiology APRIL 27–29, 2011 ANGIOPLASTY SUMMIT ABSTRACTS/Poster P O S T E R A B S T R A C T S Wednesday, April 27 - Friday April 29, 2011 (Poster Abstract Zone)