Ciara Cahill

Randomized study comparing incidence of radial artery occlusion post-percutaneous coronary intervention between two conventional compression devices using a novel air-inflation technique

AIM To compare post-percutaneous coronary intervention (PCI) radial artery occlusion (RAO) incidence between two conventional radial artery compression devices using a novel air-inflation technique. METHODS One hundred consecutive patients post-PCI were randomized 1:1 to Safeguard or TR band compression devices. Post-radial sheath removal, each compression device was inflated with additional 2 mL of air above index bleeding point during air-filled device application and gradually down-titrated accordingly. RAO was defined as absence of Doppler flow signal performed at 24 h and at 6 wk post-PCI. Patients with missing data were excluded. Statistical significance was defined as P < 0.05. RESULTS All patients had 6F radial sheath inserted. No significant differences were observed between Safeguard Radial (n = 42) vs TR band (n = 42) in terms of age (63 ± 11 years vs 67 ± 11 years), clinical presentation (electives, n = 18 vs n = 16; acute coronary syndrome, n = 24 vs n = 26) and total procedural heparin (7778 ± 2704 IU vs 7825 ± 2450 IU). RAO incidence was not significantly different between groups at 24 h (2% vs 0%, P = 0.32) and 6 wk (0%, both). CONCLUSION Safeguard Radial and TR band did not demonstrate significant between-group differences in short-term RAO incidence. Lack of evidence of RAO in all post-PCI patients at 6 wk follow-up, regardless of radial compression device indicate advantage of using the novel and pragmatic air-inflation technique. Further work is required to more accurately confirm these findings.

Circadian and seasonal variations in patients with acute STEMI: A retrospective, single PPCI center study

ABSTRACT This was a retrospective observational analysis of all (n = 876) ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PPCI) at University Hospital Limerick (UHL) from 2012 to 2016 to determine whether chronological patterns existed in incidence and mortality at our center. Data were obtained from the electronic Cardiology STEMI database in UHL. Statistical analysis was performed using the Independent Samples t Test, ANOVA and Pearson’s Chi-Squared test. The rate of STEMI from 0800 and 2259 hours (46.9/hr) was greater than 2300 to 0759 hours (19.1/hr) (p < 0.001). No association was found between 30-day mortality and weekend/weekdays presentation (p = 0.81) or off/in hour presentation (p = 0.86). No seasonal variation was found in STEMI incidence at our center using international (p = 0.29) or Celtic (p = 0.82) seasonal calendars. 30-Day mortality is equivalent whether STEMI patients treated with PPCI present during “normal working hours” or during the “out of hours”/weekend period at our center. The majority of STEMIs occur during the hours 0800 to 2259, but no further chronological relationship was observed in incidence.

Significance of High-Sensitivity Troponin T After Elective External Direct Current Cardioversion for Atrial Fibrillation or Atrial Flutter

External transthoracic direct current (DC) cardioversion is a commonly used method of terminating cardiac arrhythmias. Previous research has shown that DC cardioversion resulted in myocardial injury as evidenced by increased levels of cardiac troponin, even though only minimally. Many of these studies were based on the outdated monophasic defibrillators and older, less sensitive troponin assays. This study aimed to assess the effect of external transthoracic DC cardioversion on myocardial injury as measured by the change in the new high-sensitivity cardiac troponin T (hs-cTnT) using the more modern biphasic defibrillators. Patients who were admitted for elective DC cardioversion for atrial fibrillation or atrial flutter were recruited. Hs-cTnT levels were taken before cardioversion and at 6 hours after cardioversion. A total of 120 cardioversions were performed. Median (twenty-fifth to seventy-fifth interquartile range) cumulative energy was 161 J (155 to 532 J). A total of 49 (41%) patients received a cumulative energy of 300 J or higher. The median hs-cTnT level before cardioversion was 7 ng/L (4 to 11 ng/L) and that after cardioversion was 7 ng/L (4 to 10 ng/L). A Wilcoxon signed-rank test showed no significant difference between pre- and post-cardioversion hs-cTnT levels (Z = -0.940, p = 0.347). In conclusion, external DC cardioversion did not result in myocardial injury within the first 6 hours as measured by high-sensitivity troponin T. Patients who are cardioverted and are found to have a significant increase in cardiac troponin after cardioversion should be assessed for causes of myocardial injury and not assumed to have myocardial injury due to the cardioversion itself.

Incidence of symptom-driven Coronary Angiographic procedures post-drug-eluting Balloon treatment of Coronary Artery drug-eluting stent in-stent Restenosis-does it matter?

Incidence of symptom-driven Coronary Angiographic procedures post-drug-eluting Balloon treatment of Coronary Artery drugeluting stent in-stent Restenosis-does it matter? Victor Voon1*, Dikshaini Gumani1, Calvin Craig2, Ciara Cahill1, Khalid Mustafa1, Terry Hennessy1, Samer Arnous1 and Thomas Kiernan1 1Cardiology Department, University Hospital Limerick, Dooradoyle, Limerick, Ireland 2Graduate Entry Medical School, University Hospital Limerick, Limerick, Ireland

13 High sensitive troponin t levels following elective external direct current cardioversion for atrial fibrillation and atrial flutter

Introduction External transthoracic direct current (DC) cardioversion is a commonly used method of terminating arrhythmias, emergently or electively. It is known that external DC cardioversion can result in a rise in creatine kinase (CK). Previous research has shown that DC cardioversion resulted in subtle myocardial injury as evidenced by CK-MB, troponin I and troponin T increase, even though only minimally. These studies were based on the outdated monophasic defibrillators and older troponin assays. Since early 2010, the new high sensitive troponin T (Hs-trop T) assays have been used to diagnose myocardial injury and have been found to be highly sensitive and specific. This study aimed to assess the effect of external transthoracic DC cardioversion on myocardial injury as measured by the change in Hs-trop T using the more modern biphasic defibrillators in an elective setting. Methods Patients who were admitted for a day-case elective DC cardioversion for atrial fibrillation or atrial flutter were asked to participate in the study. DC cardioversion was performed using the Phillips Heartstart XL biphasic defibrillator. For cardioversions that failed at 200 Joules, the Physio-Control Lifepak 20e 360 J biphasic defibrillator was used. Hs-trop T levels were taken pre-cardioversion and at 6 h post-cardioversion (in keeping with the Third Universal Definition of Myocardial Infarction guidelines on biomarker detection of myocardial injury with necrosis). The assay used was the Roche Elecsys Troponin T hs (high sensitive) immunoassay. Quantitative analysis for haemolysis, icterus and lipaemia (which could result in interference with the Hs-trop T assay) were measured in each blood sample that was taken using the Abbott Architect c16000. Results A total of 120 cardioversions were done on 101 patients. Analysis of each of the blood sample taken showed no raised haemolytic, icteric or lipaemic indices above the recommendations for the Hs-trop T assay. Median number of shocks was 1, and the maximum number of shocks was 6. Median cumulative energy was 150 Joules (interquartile range = 387.5 Joules) with the minimum being 50 Joules and maximum being 1730 Joules. A total of 49 (40.8%) patients received a cumulative defibrillation energy of 300 Joules or higher. The highest energy delivered per shock was 360 Joules and median peak impedance levels was 80.80 Ohms (interquartile range = 19.05 Ohms). Median Hs-trop T levels pre-cardioversion was 7 ng/L (interquartile range = 7) and post-cardioversion was 7 ng/L (interquartile range = 6). A Wilcoxon signed-rank test showed no significant difference between pre-and-post cardioversion Hs-Trop T levels (Z = -0.940, p = 0.347). Conclusions External DC cardioversion did not result in myocardial injury as measured by high sensitive troponin T. The implications of this study is important as patients who are cardioverted and are found to have a significant troponin rise post-cardioversion should be assessed for causes of myocardial injury and not assumed to have myocardial injury due to the cardioversion itself.