M. Pincus

Diagnostic performance and cost of CT angiography versus stress ECG — A randomized prospective study of suspected acute coronary syndrome chest pain in the emergency department (CT-COMPARE) ☆ ☆☆

BACKGROUND Coronary CT angiography (CCTA) has high sensitivity, with 3 recent randomized trials favorably comparing CCTA to standard-of-care. Comparison to exercise stress ECG (ExECG), the most available and least expensive standard-of-care worldwide, has not been systematically tested. METHODS CT-COMPARE was a randomized, single-center trial of low-intermediate risk chest pain subjects undergoing CCTA or ExECG after the first negative troponin. From March 2010 to April 2011, 562 patients randomized to either dual-source CCTA (n=322) or ExECG (n=240). Primary endpoints were diagnostic performance for ACS, and hospital cost at 30 days. Secondary endpoints were time-to-discharge, admission rates, and downstream resource utilization. RESULTS ACS occurred in 24 (4%) patients. ExECG had 213 negative studies and 27 (26%) positive studies for ACS with sensitivity of 83% [95% CI: 36, 99.6%], specificity of 91% [CI: 86, 94%], and ROC AUC of 0.87 [CI: 0.70, 1]. CCTA (>50% stenosis considered positive) had 288 negative studies and 18/35 (51%) positive studies with a sensitivity of 100% [CI: 81.5, 100], specificity of 94% [CI: 91.2, 96.7%], and ROC of 0.97 [CI: 0.92, 1.0; p=0.2]. Despite CCTA having higher odds of downstream testing (OR 2.0), 30 day per-patient cost was significantly lower for CCTA (

SUNSCREEN USE ON QUEENSLAND BEACHES

2193 vs

Takotsubo cardiomyopathy: an Australian single centre experience with medium term follow up.

2704, p<0.001). Length of stay for CCTA was significantly reduced (13.5h [95% CI: 11.2-15.7], ExECG 19.7h [95% CI: 17.4-22.1], p<0.0005), which drove the reduction in cost. No patient had post-discharge cardiovascular events at 30 days. CONCLUSIONS CCTA had improved diagnostic performance compared to ExECG, combined with 35% relative reduction in length-of-stay, and 20% reduction in hospital costs. These data lend further evidence that CCTA is useful as a first line assessment in emergency department chest pain.

Pre-Hospital Ambulance Notification and Initiation of Treatment of ST Elevation Myocardial Infarction is Associated with Significant Reduction in Door-to-Balloon Time for Primary PCI

The prevalence of use of sunscreens was assessed in an environment of high ultraviolet (UV) exposure by surveying U7 males and 126 females on two Queensland beaches. Using a questionnaire, information was obtained about their application of sunscreen on the day of participation in the study, thus eliminating recall error. It was found that 71% of the female and 68% of the male beach‐goers sampled had applied sunscreen, 47% of which had the maximum Sun Protection Factor (15 +) rating. There was no significant association found between usage and either skin colour or socio‐economic status. Although 88% used a waterproof formulation, only 61% reapplied the sunscreen directly after swimming. Sunscreen was not applied to all exposed body parts, with over half of the subjects neglecting ears and lower limbs. Reported major reasons for use were to avoid skin cancer (44%), and to avoid sunburn (43%). The results of this study can assist in evaluating the effectiveness of present sun‐protection campaigns in the short term.

Anomalous origin of the left internal mammary artery from the aortic arch

Background:  Takotsubo cardiomyopathy (TC) is increasingly recognised in patients presenting with features of acute coronary syndrome. We present a single centre experience of TC with medium term follow up.

Diagnostic Accuracy of Ct Angiography Versus Stress Ecg: a Large Randomized Prospective Study of Suspected Acute Coronary Syndrome Chest Pain in the Emergency Department - "ctcompare"

BACKGROUND Mortality in ST elevation myocardial infarction (STEMI) is strongly predicted by the time from first medical contact to reperfusion. The aim of this study was to examine the impact of pre-hospital diagnosis by paramedics in the field on the door-to-balloon (DTB) times of patients with ST elevation myocardial infarction undergoing primary percutaneous intervention. METHODS Paramedics in the field identified patients with ST elevation myocardial infarction on a 12-lead electrocardiograph, activated the cardiac catheter laboratory team from the field and initiated therapy with anticoagulants and antiplatelet agents in the pre-hospital setting. This cohort of patients was compared to a similar group of patients without pre-hospital diagnosis and notification. The primary outcome measure was DTB times. A secondary end point was mortality at 30 days and mortality at six months. RESULTS A total of 281 patients, mean age of 61.1±12.9 years underwent primary percutaneous intervention with pre-hospital notification occurring in 63 cases. DTB times were lower in those with pre notification than in those without pre-hospital notification (40.4 vs. 75.6 minutes, p<0.001). This represented a 47.6% shorter DTB time. A non-statistically significant mortality reduction at one month and six months was observed in the pre-hospital notification group (1.6 versus 4.3%, p= 0.307 and 1.6 versus 6.4%, p= 0.203, respectively). CONCLUSION Pre-hospital intervention at our centre had a powerful effect in reducing the time to reperfusion in patients with STEMI undergoing primary percutaneous intervention.

Coronary CT angiography for patients with stable chest pain in the Emergency Department; an appraisal of current and emerging evidence

A 67-year-old diabetic man with a pacemaker for symptomatic bradycardia underwent cardiac catheterization for unstable angina, 19 years after coronary artery bypass graft surgery. There were bilateral pedicled internal mammary grafts—from the left internal mammary artery (LIMA) to the left

Assessment of Indeterminant Coronary Artery Stenosis: A comparison of CT Coronary Angiography with Intravascular Ultrasound

Coronary CT Angiography (CTCA) has high sensitivity to exclude coronary artery disease (CAD), but recent large trials compared mainly to SPECT. Whether CTCA has advantages over exercise treadmill ECG (ExECG) is unclear. Randomized, prospective, single-center study in a large academic Australian

Chronic Total Occlusions: A Single Centre Experience at the Prince Charles Hospital

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