James Crowley

Multiple source surveillance incidence and aetiology of out-of-hospital sudden cardiac death in a rural population in the West of Ireland

AIMS There is a paucity of published data on prospectively identified rates of out-of-hospital sudden cardiac death (SCD). We sought to determine the incidence, survival and aetiology of out-of-hospital SCD in the West of Ireland for the year 2005. METHODS AND RESULTS Data from emergency room resuscitation records were collected throughout the year from all hospitals in the West of Ireland and recorded according to pre-specified criteria. Hospital records of survivors were analysed. Simultaneously, autopsy reports from all pathology laboratories in the region were systematically reviewed and cases of SCD identified. Cardiac arrest associated with non-cardiac pathology was excluded. The population base was 414,277. There were 212 recorded cases of out-of-hospital SCD; 160 (75.5%) were male and the mean age was 63.3 years. The incidence rate was 51.2/100,000/year. The most common aetiology was coronary artery disease (161 cases; 75.9%). The majority of cases occurred in the home (152, 71.7%). Thirteen (6.1%) patients survived to admission of whom eight (3.8%) were alive at discharge. All survivors had ventricular fibrillation as the presenting rhythm. CONCLUSION The burden of SCD in the West of Ireland is considerable. The vast majority of cases occur in the home. Survival rates in this rural population cohort remain low.

Gene-eluting Stents: Adenovirus-mediated Delivery of eNOS to the Blood Vessel Wall Accelerates Re-endothelialization and Inhibits Restenosis

Drug-eluting stents for coronary artery disease results in inhibition of smooth muscle cell (SMC) and endothelial cells which may increase the risk of stent thrombosis. In this study, we attempted to enhance re-endothelialization of deployed stents while simultaneously inhibiting intimal hyperplasia by overexpression of endothelial nitric oxide synthase (eNOS) delivery in the vasculature using an adenovirus gene-eluting stent. Re-endothelialization was significantly greater in vessels obtained from normocholesterolemic animals at day 14 (85.34% +/- 7.38 versus 62.66% +/- 10.49; P < 0.05) and day 28 (91.1% +/- 10 versus 63.1% +/- 22; P < 0.05) and hypercholesterolemic animals (96.97% +/- 3.2 versus 28.33% +/- 38.76; P < 0.05) at day 28 with AdeNOS-eluting stents. At day 28, there was a significant increase in the lumen size [AdeNOS 2.73 mm(2) +/- 1.18, AdbetaGal 0.98 mm(2) +/- 0.98, phosphorylcholine (PC) 1.87 mm(2) +/- 1.18; P < 0.05], and a significant reduction in neointimal formation (AdeNOS 2.32 mm(2) +/- 1.13, AdbetaGal 3.73 mm(2) +/- 0.95, PC 3.2 mm(2) +/- 0.94; P < 0.05), and percent restenosis (AdeNOS 45.23 +/- 20.81, AdbetaGal 79.6 +/- 20.31, PC 70.16 +/- 22.2; P < 0.05) in AdeNOS-stented vessels in comparison with controls from hypercholesterolemic animals, assessed by morphometry and quantitative coronary angiography (AdeNOS 15.95% +/- 7.63, AdbetaGal 56.9% +/- 38.6, PC 58 +/- 34.6; P < 0.05). Stent-based delivery of AdeNOS results in enhanced endothelial regeneration and reduction in neointimal formation as compared with controls. This seems to be a promising treatment strategy for preventing in-stent restenosis (ISR) while simultaneously reducing the risk of stent thrombosis.

Translating guidelines to practice: findings from a multidisciplinary preventive cardiology programme in the west of Ireland.

Aims The aim of this observational, descriptive study is to evaluate the impact of an intensive, evidence-based preventive cardiology programme on medical and lifestyle risk factors in patients at high risk of developing cardiovascular disease (CVD). Methods Increased CVD risk patients and their family members/partners were invited to attend a 16-week programme consisting of a professional multidisciplinary lifestyle intervention, with appropriate risk factor and therapeutic management in a community setting. Smoking, dietary habits, physical activity levels, waist circumference and body mass index, and medical risk factors were measured at initial assessment, at end of programme, and at 1-year follow up. Results Adherence to the programme was high, with 375 (87.2%) participants and 181 (84.6%) partners having completed the programme, with 1-year data being obtained from 235 (93.6%) patients and 107 (90.7%) partners. There were statistically significant improvements in both lifestyle (body mass index, waist circumference, physical activity, Mediterranean diet score, fish, fruit, and vegetable consumption, smoking cessation rates), psychosocial (anxiety and depression scales and quality of life indices), and medical risk factors (blood pressure, lipid and glycaemic targets) between baseline and end of programme, with these improvements being sustained at 1-year follow up. Conclusions These findings demonstrate how a holistic model of CVD prevention can improve cardiovascular risk factors by achieving healthier lifestyles and optimal medical management.

Persistent fainting after implantation of a "curative" pacemaker

A 64-year-old man had a dizzy spell lasting several minutes, followed by syncope. A loop recorder showed a sinus-node arrest lasting 25 seconds. A dual-chamber pacemaker was implanted. Despite normal pacemaker function, he had numerous confusional episodes during the subsequent days.

The implantable defibrillator and return to operation of vehicles study

AIMS We sought to characterise driving habits of contemporary implantable cardioverter defibrillator (ICD) patients. METHODS AND RESULTS We performed a multicentre prospective observational study of consecutive ICD recipients. Non-commercial drivers with a valid licence were eligible. Patient and ICD data were recorded. All patients completed an anonymous questionnaire regarding their driving habits. Among 275 patients, 25 (9.1%) stopped driving permanently after ICD implantation. During a mean follow-up of 26.5 ± 4.5 months, 25.3% of patients received an ICD shock (52.5% appropriate). The median time to first shock was 7.0 (2.5, 17.5) months and was not significantly different between primary and secondary ICD patients. However, shocks (36.5 vs. 21.3%, P = 0.027) and recurrent shock episodes (17.5 vs. 6.2%, P = 0.011) were more common in secondary ICD patients. Physician-recommended driving restrictions were not recalled by 37.9% and not followed by 23.0% of patients. Overall, the mean duration of driving abstinence was 2.2 ± 2.9 and 3.6 ± 5.3 months for primary and secondary patients, respectively. Notably, 36.5% of secondary patients drove within 1 month. Eight patients (3.3%) received a shock while driving, five of which resulted in road traffic accidents. The annual risk of a shock while driving was 1.5%. CONCLUSIONS Patient driving behaviour following ICD implantation is variable, with over one-third not remembering and almost one-quarter not adhering to physician-directed driving restrictions. Over one-third of secondary ICD patients drive within 1 month despite physician recommendations. Further studies are required to establish the optimal duration of driving restriction in ICD recipients.

A multicenter randomized trial comparing the effectiveness and safety of a novel vascular closure device to manual compression in anticoagulated patients undergoing percutaneous transfemoral procedures: The Celt ACD trial

This study compared the performance of Celt ACD®, a novel stainless steel based vascular closure device versus manual compression (MC) for femoral arteriotomy site hemostasis in patients undergoing percutaneous coronary procedures.

Clinical outcomes in unselected patients treated with the PROMUS Element platinum-chromium, everolimus-eluting stent: Final five-year results from the PE PROVE Study

The goal of this analysis was to evaluate the final 5‐year safety and effectiveness of the PROMUS Element platinum‐chromium everolimus‐eluting stent in unselected patients treated in routine clinical practice.

FAMP10 Is there a Need for a Primary Pci Programme in the West of Ireland

(DM), hypertension, hypercholesterolemia, body mass index (BMI), and smoking. Results: Patients have reported higher PCS and MCS vs. baseline, respectively: 54, 60 vs. 53,28; p<0,05, and 55,10 vs 54,20; p<0,05. We have noted higher QoL results in all domains of SF-36 scale. A multivariative analysis have shown that the following variables were associated with lower PCS results at 6 month follow-up: age >65, smoking, hypertension, and BMI>30 and with lower MCS results: age>65 and BMI>30. DM and clinical manifestations of ACS did not influence the QoL results. Conclusions: Patients with ACS treated by PCI reported higher QoL results at 6 month follow-up. Predictors that influenced PCS results at 6-months follow-up were: age>65, smoking, hypertension, and BMI>30. MCS results were influenced by: age >65 and BMI>30. DM and clinical manifestations of ACS did not influence the QoL results.

874. Prolonged Adenovirus and Adeno-Associated Virus-Mediated Gene Delivery to Rabbit Iliac Arteries Using Gene-Eluting Stents: A Direct Comparison

Top of pageAbstract Introduction: Gene eluting stents are now being evaluated in animals as an alternative approach to inhibiting in stent restenosis. AAV and particularly adenovirus are commonly used for gene transfer applications. However, it is unknown whether these vectors can be eluted from a stent over a prolonged period. We tested the hypothesis that these vectors can achieve a prolonged and localized gene delivery to vessel wall using stents as delivery platform. Methods: Ad|[beta]|Gal and AAV2|[beta]|Gal at a concentration of 5 |[times]| 109 pfu and 5.3 |[times]| 109 drp respectively were used to coat BiodivYsio Hi Matrix stents. Gene transfer was assessed at five time points (3, 7, 14, 21, 28 days) using X-gal staining. After balloon injury, 3.0/11 mm stents were deployed in the external iliac arteries of NZW rabbits. 21 stents were used in the adenovirus group and 23 stents were used in the AAV group. 8 PC coated stents were used as controls. RT-PCR was used to assess distal spread of virus in multiple organs (n=6). Results: Expression of LacZ was demonstrated with both vectors at all time points. In the adenovirus group mean percentage of cells expressing transgene at 3 days was 5.15% which increased gradually to a mean expression of 9.85% at 28 days (p>0.005). Expression was localized to medial cells at 3 day, but it was predominantly seen in the neointimal cells at 28 days. In the AAV group 3 day expression was 8.45% which gradually decreased to 1.73% at 28day (p<0.005). Gene transfer was also confirmed in both groups on histological sections. No systemic dissemination of virus was seen in any group. Conclusion: Adenovirus and AAV2-coated stents can be used to deliver genes for up to 28 days. Expression was seen in the medial and in neointimal cells. These vectors can be used to target the blood vessel wall in order to reduce the incidence of in stent restenosis.