Imaging in ischaemic heart disease / Congenital heart disease - interventional and surgical issues 367 individuals who were of similar age, gender, CAD risk factors and symptom pre- sentation. Results: 13372 patients (56.2±12.8 years, 51% male) were followed for 2.0±0.9 years follow-up, with 279 (2.1%) MACE occurring. Compared to non-smokers, current and past smokers had higher prevalence of obstructive CAD (≥50%) [1- vessel disease (VD); 11.2% vs. 16.6% vs. 16.2%, p<0.001, 2VD; 4.8% vs. 7.3% vs. 7.8%, p<0.001, 3VD; 2.3% vs. 5.1% vs. 5.0%, p<0.001]. Current smokers experienced higher risk of MACE compared to non-smokers (HR 1.9, 95% CI 1.4-2.5, p<0.001), while past smokers did not (HR 1.2, 95% CI 0.9-1.6, p=0.29). Even amongst matched individuals, current smoking was associated with MACE risk (HR 2.3, 95% CI 1.2-4.4, p=0.01), while past smoking was not (HR1.0, 95% CI 0.5-2.1, p=0.98). Conclusion: While both current and past smokers possess a greater prevalence, extent and severity of CAD compared to non-smokers, current smokers experi- ence higher risk of MACE than past smokers and non-smokers. P2073 | BENCH Myocardial perfusion scintigraphy (Gated-SPECT) in patients with ischemic ST-segment only during recovery phase of the exercise testing A. Falcao 1 , W.A. Chalela 1 , R. Imada 1 , R. Irabi 1 , L.O. Azouri 1 , M. Costa 1 , R. Kalil Filho 1 , J.A.F. Ramires 1 , J.C. Meneghetti 1 , S. Borges-Neto 2 . 1 Heart Institute (InCor)–Hospital das Clínicas,Faculdade de Medicina da Universidade de São Paulo, Sao Paulo, Brazil; 2 Duke University Medical Center and The Duke Heart Center, Durham, United States of America Purpose: The ST-segment depression occurring only in the recovery phase (↓STr) is relatively rare and occurs in 1-3% of the exercise testing (ET). The diag- nostic and prognostic value is less investigated as compared with that observed during exercise. Only few studies have investigated the clinical significance of this finding. Objective: The aim of this study was evaluate the association between the ↓STr of the ET with the gated-SPECT imaging alterations. Methods: We analyzed 92 patients with ↓STr (≥ 1 mm), who underwent gated- SPECT associated with ET and Bruce protocol, mean age 60±9.9 years, 74 (80.4%) male, with previous coronary artery bypass graft in 20%, myocardial in- farction in 25%, and percutaneous coronary intervention in 35.2%. Qualitative analysis of imaging used 5-point score (0-normal; 4-no uptake) for perfusion (17 myocardial segments), and 6-point score (0-normal; 5-diskinesia) for motility. Left ventricular ejection fraction (LVEF) was assessed after ET. ↓STr, blood pressure (BP), heart rate (HR), time of tolerance to exercise (TTE), functional capacity (MET), appearance time to ↓STr (AT↓STr), and presence of arrhythmias were evaluated during ET. Results: Abnormal perfusion was observed in 58 patients (63.04%), 50% with isolated ischemia or associated with persistent defect; abnormal motility in 31 pa- tients (33.7%) and mean LVEF of 57.8±11.6%. AT↓STr 202±38 sec, magnitude of ↓STr 1.2±0.3 mm, 10.4±2.7 MET; angina in 16pts (17.6%) and ventricular arrhythmias in 58 pts (63%). There were significant differences in the associa- tion between perfusion alterations with: male p = 0.000, positive predictive value (PPV) 73%; AT↓STr p = 0.011, PPV 76.2%; increase in systolic blood pressure ≤ 30mmHg during ET p = 0.002, PPV 91.3%; and typical angina p = 0.025, PPV 87.5%. In patients with only transient defect, there were significant differences for male (p = 0.01), hypertension (p = 0.04) and marginal significance when systolic blood pressure ≤ 30mmHg (p = 0.09). The PPV of ↓STr to any perfusion, motility or LVEF alteration was 64%. Conclusion: ↓STr of the ET occurred late, and was a relevant finding due to the high incidence of documented alterations in the gated-SPECT. P2074 | BEDSIDE Atherosclerotic plaque characteristics improve diagnosis of ischemia for non-obstructive coronary artery lesions: a direct comparison to fractional flow reserve H.-B. Park 1 , R. Nakazato 1 , J. Leipsic 2 , H. Gransar 1 , M.J. Budoff 3 , J. Malpeso 3 , D.S. Berman 1 , J.K. Min 1 . 1 Cedars-Sinai Medical Center, Los Angeles, United States of America; 2 St. Paul’s Hospital, Vancouver, Canada; 3 Harbor UCLA Medical Center, Torrance, United States of America Purpose: Fractional flow reserve (FFR) at the time of invasive coronary angiog- raphy (ICA) is the gold standard for determining lesion-specific ischemia, and identifies ischemia in a significant proportion of lesions considered anatomically non-obstructive. Beyond luminal stenosis severity, coronary CT angiography (CT) enables evaluation of atherosclerotic plaque characteristics (APCs) that include positive remodeling (PR), low attenuation plaque (LAP) and spotty intra-plaque calcification (SC). The relationship of these APCs to ischemia in non-obstructive coronary lesions has not been evaluated to date. Methods: 252 patients from 17 centers in 5 countries were prospectively en- rolled. Patients underwent CT and ICA, with clinically indicated FFR performed for 407 coronary lesions. CTs were evaluated by an independent core laboratory in blinded fashion, with ≥50% and <50% stenosis considered obstructive and non-obstructive, respectively. Presence of APCs within coronary lesions by CT was defined as: (1) PR, maximal lesion diameter/reference diameter ≥1.10; (2) LAP, any intra-plaque voxel <30 HU; and (3) SC, nodular calcified plaque ≤3 mm. Coronary lesion-specific ischemia was defined by an FFR ≤0.8. Results: For FFR-interrogated coronary lesions, 195 of 407 (48%) were non- obstructive by CT. FFR-defined ischemia was present in 33 of 195 (17%) le- sions, with a mean FFR value of 0.75±0.07. Amongst non-obstructive lesions that caused ischemia, 24 (73%), 9 (27%) and 8 (24%) exhibited PR, LAP and SC, respectively; with at least 1 APC present in 24 (73%) of lesions. In multivari- able analyses, the presence of PR [Odds ratio (OR) 6.6, 95% confidence interval (CI) 2.4-17.9, p<0.0001)] was associated with lesion-specific ischemia while LAP (OR 1.0, 95% CI 0.3-3.2, p=0.9) and SC (OR 1.4, 95% CI 0.5-4.5, p=0.5) were not. A dose-response relationship was observed for increasing risk of ischemia for non-obstructive coronary lesions possessing 1 (OR 4.5, p=0.006), 2 (OR 11.8, p<0.001) and 3 (OR 4.0, p=0.1) APCs. Conclusion: The presence of positive arterial remodeling and increasing num- bers of APCs enhances diagnosis of non-obstructive coronary lesions that cause ischemia. P2075 | BEDSIDE Four-year outcomes of a coronary computed tomography angiography-guided strategy for chest pain evaluation in the emergency department A. Nasis, I.T. Meredith, P. Sinha, J.D. Cameron, S.K. Seneviratne. Monash Heart, Melbourne, Australia Purpose: We sought to determine the long-term safety of a novel diagnostic ap- proach that utilised coronary computed tomography angiography (CTA) to assess patients presenting to the Emergency Department (ED) with low-to-intermediate risk chest pain. Methods: We prospectively evaluated 585 consecutive patients who presented to ED between September 2008 and June 2011 with low-to-intermediate risk (TIMI 0–4) ischaemic-type chest pain who were evaluated with 320-row CTA after nor- mal electrocardiogram and negative single (284 patients) or serial troponin (301 patients) depending on time of presentation. Patients with previous significant coronary stenoses or revascularisation were excluded. Patients undergoing CTA after single troponin who had no plaque on CTA were discharged without se- rial troponin and no further investigation following discharge. Patients undergoing CTA after single troponin who had any plaque and up to mild stenoses were dis- charged after repeat troponin with no further investigation following discharge. Patients with moderate stenoses were discharged with outpatient stress echocar- diography. Patients with severe stenoses were admitted for invasive angiography. Discharged patients were contacted by telephone and medical records reviewed to determine safety outcomes. Results: Mean age was 58±11 years (58% male). 93/284 patients (33%) under- going CTA after single troponin had no plaque and were discharged after only a single troponin. 486/585 patients overall (83%) had no plaque or mild stenoses on CTA and were discharged with no further investigation, 24/585 (4%) had mod- erate stenoses on CTA and were discharged with outpatient stress echocardio- graphy and 74/585 (13%) had severe stenoses on CTA and were admitted for in- vasive angiography. At median 47.1-month follow-up (range 20-53 months), there had been five chest pain readmissions (1%, 95% confidence interval 0.4-2.3%), no revsascularisation procedures, no myocardial infarctions and no deaths (95% confidence interval 0-0.8%). Follow-up was 99% complete. Conclusion: Triaging low-to-intermediate risk patients with a CTA-guided strat- egy is safe at long-term follow-up, including patients discharged after a single negative troponin. CONGENITAL HEART DISEASE - INTERVENTIONAL AND SURGICAL ISSUES P2077 | BEDSIDE Transcatheter closure of perimembranous ventricular septal defect with a new occluder: one-year follow-up A. Tzikas 1 , D. Aguirre 2 , D. Velasco-Sanchez 3 , X. Freixa 1 , M. Alburquenque 2 , P. Khairy 1 , J.L. Bass 4 , J. Ramirez 5 , R. Ibrahim 1 , J. Miro 3 . 1 Montreal Heart Institute, Montreal, Canada; 2 Hospital de Niños Roberto del Río, Santiago, Chile; 3 Hôpital Sainte-Justine, Montreal, Canada; 4 Amplatz Children’s Hospital, Minneapolis, United States of America; 5 Corominas Hospital, Santo Domingo, Dominican Republic Purpose: Transcatheter closure of peri-membranous ventricular septal defects (pmVSDs) has been associated with a significant risk of complete heart block, leading most groups to abandon the technique. We describe the initial world ex- perience of pmVSD closure with a newly designed occluder. Methods: Patients with pmVSD underwent catheter closure using the Amplatzer ® Membranous VSD Occluder 2 (St. Jude Medical, MN, USA). Results: Nineteen patients from the 4 centers initially involved worldwide were prospectively included and followed for a 12±3 months. Patients ranged in age from 1.4 to 62 years (median 6 years) and in weight from 9.3 to 96 kg (median26 kg). The Qp/Qs ratio was (mean ± SD) 1.9±1.6. The size of the defect on left ven- tricular side was (mean ± SD) 9.9±3.5 mm (range 4.6 – 16 mm) and the orifice on right ventricularside was 8.1±2.8 mm (range 3.9 – 14 mm) by echocardiography. Mean device size was 9.4±2.4 mm (range 5 – 14 mm). An eccentric device was used in 9 patients (47%) and a concentric device in 10 (53%). A device was suc- Downloaded from https://academic.oup.com/eurheartj/article-abstract/34/suppl_1/P2073/2860823 by guest on 06 June 2020