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Objectives: We investigated the predictors of mortality in patients with Acute CoronarySyndrome from a large sample of hospital admissions.Methods: Anonymous information on patients with Acute Coronary Syndrome, co-mor-bidities and procedures attending large multi-ethnic general hospitals in Manchester,United Kingdom in the period 2000-2013 was obtained from the local health authoritycomputerised hospital activity analysis register using ICD-10 and OPCS coding systems.Statistical analysis was performed using SPSS version 20.Results: Out of 1221216 patients admitted, there were 25322 (2.1%) patients with AcuteCoronary Syndrome; mean age 66.6 years� 14.4 (S.D); Male (64.2%), Female (35.8%). Themain co-morbidities were Hypertension (11397;45.0%), Previous Myocardial Infarction(9184;36.3%), Hyperlipidaemia (6271;24.8%), Type 2 Diabetes Mellitus (4759;18.8%),Heart Failure (4670;18.4%), Chronic Kidney Disease (1612;6.4%). A multi-nominal logisticregression model accounting for variations in age, sex and ethnic group showed thatHypertension (RR0.8;C.I0.7-0.9), Previous Myocardial Infarction RR1.2;C.I1.1-1.3),Hyperlipidaemia (RR0.5;C.I0.4-0.6), Type 2 Diabetes Mellitus (RR1.5;C.I1.3-1.6), HeartFailure (RR2.9;C.I2.6-3.2) and Chronic Kidney Disease (RR2.3;C.I1.9-2.7) as significantpredictors of mortality (p <0.05).Conclusion: We have shown that Previous Myocardial Infarction, Type 2 Diabetes Mellitus,Heart Failure and Chronic Kidney Disease are significant predictors of mortality in patientswith Acute Coronary Syndrome from a large hospital based sample in the UK. A diagnosis ofHypertension and Hyperlipidaemia seem to confer improved mortality possibly reflectingmortality benefit of drugs such as beta blockers and ACE-inhibitors. Our improved under-standing of these predictors will guide clinicians to focus on these high risk groups to improveclinical practice and outcomes in patients with Acute Coronary Syndrome.Disclosure of Interest: None Declared

PM137

Toll like receptor 2 (TLR-2) but not TLR-4 and TLR-9 is significantly increased inplatelets from patients with acute coronary syndrome

Ingo Ahrens*1, Madlin Albrecht1, Daniel Duerschmied1, Christian Colberg1, Andreas Zirlik1,Karlheinz Peter2, Christoph Bode11Cardiology and Angiology I, University Heart Center Freiburg, Freiburg, Germany,2Atherothrombosis and Vascular Biology, Baker IDI Heart and Diabetes Institute, Melbourne,Australia

Introduction: Platelets contribute to innate immunity, the pathogenesis of atherosclerosisand ACS. Several functionally active immune receptors of the toll-like receptor (TLR) familyincluding TLR-2, which has been linked to the development of atherosclerosis, areexpressed in platelets. Furthermore, platelets are capable of de novo protein synthesis viaplatelet specific mRNA. We hypothesized that platelet TLRs are involved in the patho-genesis of atherosclerosis and ACS.Objectives: We hypothesized that platelet TLRs are involved in the pathogenesis ofatherosclerosis and ACS.Methods: We established a method to generate highly purified platelets for the quantitativeassessment of platelet mRNA. Platelets were sampled frompatients with NSTEMI, STEMI andpatients without coronary artery disease (CAD) after coronary angiography. Analysis of hu-man TLR-2, TLR-4, and TLR-9 mRNA expression was done by plasmid-based quantitativereal-time PCR with beta-actin as house-keeping gene. Soluble TLR-2 was assessed by ELISA.Results: Patient’s mean age was 59.4 +/- 2.9 years. Mean platelet count was 236 +/- 21.25K/ml (NSTEMI, n¼14), 251 +/- 76 K/ml (STEMI, n¼24) and 227 +/- 12.06 K/ml for non-CAD patients (n¼13). Mean CK and CK-MB levels for patients with NSTEMI were 321.8+/- 108.9 U/l and 76.33 +/- 28.02 U/l respectively. Platelet TLR-4 and -9 mRNA levels didnot differ in patients with ACS (NSTEMI or STEMI) versus non-CAD patients. TLR-2mRNA was significantly elevated in NSTEMI patients (12.10 e-005 +/- 2.391e-005 copiesin relation to platelet beta-actin) versus non-CAD controls (4.738e-005 +/- 7.128e-006copies in relation to platelet beta-actin, p¼0.012). In STEMI patients TLR-2 was not-significantly increased (p¼0.061 for non-CAD versus STEMI). There was no difference inplasma soluble TLR-2 (NSTEMI: 0.38 +/- 0.17 ng/ml, non-CAD: 0.52 +/- 0.21 ng/ml,p¼0.679).Conclusion: Platelet TLR-2 mRNA was highly up-regulated in patients with NSTEMIcompared to non-CAD patients. This was not accompanied by increased serum solubleTLR-2. Elevated TLR-2 mRNA in platelets indicates a crucial role of platelet mediatedinnate immunity in the pathogenesis of ACS. Further exploration of platelet TLR-2 functionin atherosclerosis is warranted and may lead to platelet targeted anti-inflammatory thera-pies as a novel therapeutic approach in the preventive treatment of ACS.Disclosure of Interest: None Declared

PM138

A systematic review investigating whether gender differences in risk stratificationprofile explain lower rates of angiography among women compared to men withnon-ST elevation acute coronary syndrome

Linda Worrall-Carter1, Samantha McEvedy2, Lisa Kuhn2, Andrew MacIsaac3,Muhammad Aziz Rahman*11St Vincent’s Centre for Nursing Research (SVCNR) and The Cardiovascular Research Centre(CvRC), Faculty of Health Sciences, 2St Vincent’s Centre for Nursing Research (SVCNR), Facultyof Health Sciences, Australian Catholic University, 3Department of Cardiology, St Vincent’sHospital, Melbourne, Australia

Introduction: Literature review suggests a gender disparity in the use of coronary angi-ography among patients with acute coronary syndrome (ACS). Guidelines recommend useof angiography for all high-risk patients with non-ST elevation ACS (NSTEACS),

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

irrespective of gender; whilst a more conservative approach is recommended for lower-riskpatients. Therefore, investigating risk stratification profiles according to gender may pro-vide an explanation for lower rates of angiography amongst women.Objectives: To test the hypothesis that women with NSTEACS are less likely than men tobe stratified into the high-risk category by reviewing studies reporting risk stratification ofNSTEACS patients by gender.Methods: PubMed, Scopus and Web of Science databases were searched using pre-determined search criteria to extract studies published in peer-reviewed scientific literatureuntil August 2013. The search revealed 248 articles, from which seven articles wereselected to increase the current understanding of the relationship between risk stratificationand gender and the influence of these factors on the provision of angiography.Results: Studies involved retrospective analyses of prospective registries from a range ofcountries. Three risk stratification methods were used: Global Registry of Acute CardiacEvents (GRACE), Thrombolysis in Myocardial Infarction (TIMI) and Physician’s RiskAssessment (PRA). Using GRACE score, two studies found that women were more likely tobe high-risk than men (one study: 38% vs. 29%, p<0.001; another study: 35% vs. 26%,p<0.001) and two studies found no statistically significant difference (56% vs. 49%,p¼0.22; 30% vs. 27%, p¼0.55). Paradoxically, high-risk patients, categorised by GRACEscores, were less likely to receive angiography than lower-risk patients (p<0.001). UsingTIMI score, there was no significant gender difference in the proportion of high-risk pa-tients in two studies (women 17% vs. men 14%, p¼0.13; both 15%, p¼0.87). Classifi-cation by PRA in two studies also found no gender difference (women 22% vs. men 23%,p¼0.75; both 40%, p¼0.87).Conclusion: Current published research does not provide conclusive evidence regardingrisk stratification profiles by gender. Further research designed to profile male and femaleNSTEACS patients using the guideline risk stratification paradigm is required to betterunderstand the relationship between gender and the paradoxical use of angiography.Disclosure of Interest: None Declared

PM139

A systematic review investigating whether the presence of severe co-morbiditiesexplains lower rates of angiography among women compared to men with non-STelevation acute coronary syndrome

Linda Worrall-Carter1, Samantha McEvedy2, Lisa Kuhn2, Andrew MacIsaac3,Muhammad Aziz Rahman*11St Vincent’s Centre for Nursing Research (SVCNR) and The Cardiovascular Research Centre(CvRC), Faculty of Health Sciences, 2St Vincent’s Centre for Nursing Research (SVCNR), Facultyof Health Sciences, Australian Catholic University, 3Department of Cardiology, St Vincent’sHospital, Melbourne, Australia

Introduction: Literature review suggests a gender disparity in the use of coronary angi-ography among patients with acute coronary syndrome (ACS). This is despite guidelinesrecommending the use of angiography for all high-risk patients with non-ST elevation ACS(NSTEACS), irrespective of gender. An exception to this guideline is made in the presenceof severe co-morbidities. Therefore, investigating co-morbidity profiles according to gendermay provide an explanation for lower rates of angiography use amongst women.Objectives: To test the hypothesis that women with NSTEACS are more likely to havesevere co-morbidities than men by reviewing studies reporting co-morbidities of NSTEACSpatients by gender.Methods: PubMed, Scopus and Web of Science databases were searched using pre-determined search criteria to extract studies published in peer-reviewed scientific literatureuntil August 2013. The search revealed 47 articles, from which five were selected to in-crease the current understanding of the relationship between co-morbidities and gender inNSTEACS patients, and the influence of these factors on the provision of angiography.Results: Studies were from the USA, Germany and Spain. All studies involved retrospectiveanalyses, usually of prospective hospital registries, although one analysed a health insur-ance database. One study reporting an average Charlson co-morbidity index by genderfound that women scored higher than men (women 2.22 �1.5 vs. men 2.07 �1.5,p<0.001). Another study using a simplified co-morbidity index did not find any significantgender difference for the highest co-morbidity group (women 23% vs. men 21%, p¼0.5).Other selected studies did not report a summary or co-morbidity index, instead considereddifferences between men and women for individual co-morbidity. Compared to men,women were consistently more likely to have diabetes and heart failure. Women were alsomore likely to be overweight and hypertensive than men. On the other hand, women wereless likely than men to have suffered previous myocardial infarction.Conclusion:We found nothing conclusive to support the hypothesis that women are morelikely to suffer severe co-morbidities or the notion that this could explain the genderdisparity in angiogram usage. Future research needs to include a more systematic approachto the definition of severe co-morbidities in NSTEACS and, in particular, how this relates togender.Disclosure of Interest: None Declared

PM140

Influence of Tirofiban Duration on Patients With Acute Myocardial InfarctionManaged By Percutaneous Coronary Intervention

Zhen-Guo Ji1,2, Zhi-Hong Liu*1, Hong-bin Liu11Cardiology, The Third Hospital of Shijiazhuang City, 2Cardiology, The First Hospital of HebeiMedical University, Shijiazhuang, Hebei, China

Introduction: Clinical randomized trials and observational studies have demonstratedthat adjunctive infusion of glycoprotein (GP) IIb/IIIa inhibitors (intravenous and

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