O. Farouque

Survival of Elderly Patients Undergoing Percutaneous Coronary Intervention for Acute Myocardial Infarction Complicated by Cardiogenic Shock

OBJECTIVESnWe sought to assess clinical outcomes of elderly patients (age >or=75 years) undergoing percutaneous coronary intervention (PCI) for acute myocardial infarction (MI) complicated by cardiogenic shock (CS) in a contemporary multicenter PCI registry.nnnBACKGROUNDnAlthough benefits of early PCI have been shown in younger groups, few studies have reported on clinical outcomes in elderly shock patients using current PCI techniques.nnnMETHODSnWe analyzed baseline characteristics and procedural and clinical outcomes in 143 consecutive patients presenting with MI and CS who underwent PCI from the Melbourne Interventional Group registry between 2004 and 2007.nnnRESULTSnOf the 143 patients, 31.5% (n = 45) were elderly and 68.5% were younger (age <75 years). Elderly patients were more likely to be female (46.7% vs. 22.4%, p < 0.01) and have hypertension (77.8% vs. 46.4%, p < 0.01), previous MI (31.1% vs. 15.5%, p = 0.03), renal failure (24.4% vs. 11.3%, p < 0.05) and multivessel coronary artery disease (93.1% vs. 68.3%, p < 0.01). Stent (86.7% vs. 94.8%, p = 0.09), glycoprotein IIb/IIIa inhibitor (68.9% vs. 65.3%, p = 0.67), and intra-aortic balloon pump (57.8% vs. 58.2%, p = 0.97) use were similar in both groups. In-hospital, 30-day, and 1-year mortality in the elderly group versus the younger group were 42.2% vs. 33.7% (p = 0.32), 43.2% vs. 36.1% (p = 0.42), and 52.6% vs. 46.8% (p = 0.56), respectively.nnnCONCLUSIONSnIn this study, the 1-year survival of elderly patients with acute MI complicated by CS undergoing PCI was comparable to younger patients. These data suggest that in elderly patients presenting with CS, benefit is possible with selective use of early revascularization and merits further investigation.

Outcomes after percutaneous coronary intervention of ostial lesions in the era of drug-eluting stents.

Ostial lesions are a difficult subset associated with suboptimal outcomes after percutaneous coronary intervention (PCI). The aim of this study was to analyze outcomes of ostial lesions in contemporary Australian interventional practice.

The relationship between the proportion of admitted high risk ACS patients and hospital delivery of evidence based care

AIMSnVariations in the delivery of evidence based care to high risk patients with Acute Coronary Syndromes (ACS) exist between hospitals. We hypothesised that the relative proportion of admitted high risk patients contributes to variation in care and outcomes.nnnMETHODSnReceipt of evidence based therapies (EBT) according to patient risk was documented in the Australian Co-operative National Registry of Acute Coronary Care, Guideline Adherence and Clinical Events (CONCORDANCE). Hospitals were stratified into quartiles (Q) by fraction of high risk patients according to: GRACE Risk Score (GRS), chronic kidney disease (CKD), age, Killip class, and myocardial infarction (MI). For each category, EBT and mortality were compared between hospital groups.nnnRESULTSnThis study included 8390 ACS patients from 39 hospitals. Patients with GRS>130, CKD, and >80years, were less likely to receive EBT at high proportion hospitals (p<0.0001 for all). After adjustment, proportion of patients with CKD negatively predicted coronary angiography (CA) (Q4 vs Q1: OR 0.21, 95%CI 0.10-0.45). Adjusted 6month mortality was greater in CKD and trended greater in >80years in hospitals treating the highest proportions of these patients (Q4 vs Q1 OR 3.80, 95%CI 1.85-7.83, and OR 3.10, 95%CI 0.99-9.70 respectively).nnnCONCLUSIONnElderly ACS patients and those with CKD are less likely to receive EBT at hospitals seeing high proportions of these patients. Failure to provide EBT to these high risk populations may contribute to avoidable mortality in these institutions.

The impact on long term health outcomes for STEMI patients during a period of process change to reduce door to balloon time

Background: Guidelines for the management of ST-segment elevation myocardial infarction (STEMI) recommend a ‘door to balloon time’ (DTBT) within 90 minutes. It is unclear whether strategies to reduce DTBT translate to improved longer-term health outcomes for STEMI patients. Aims: This study sought to determine whether implemented strategies to improve timely management of STEMI reduced DTBT and impacted upon health outcomes such as length of stay, unplanned readmission and 12-month mortality. Predictors of timely management for STEMI were also examined. Methods: A five-year review was undertaken on primary percutaneous coronary intervention for STEMI in one tertiary hospital. Comparisons were made between process change groups and DTBT. Logistic regression identified predictors of timely management. Results: 470 STEMI patients underwent immediate primary percutaneous coronary intervention. Process change improved the median DTBT (109 min vs. 72 min, p<0.001) with no significant effect on length of stay (p=0.83), unplanned cardiac readmissions (p=0.68) or 12-month mortality (9.0% vs. 8.6%, p=0.64). Those receiving timely treatment (i.e. DTBT< 90 min) were younger (p<0.05), male (p<0.03), presented via ambulance (p<0.004), during business hours (p<0.0001) and had a lower Thrombolysis In Myocardial Infarction score (p<0.006). Timely treatment was associated with lower 12-month mortality (3.7% vs. 15.7%, p<0.0001) and increased uptake of inpatient cardiac rehabilitation (p<0.005), with length of stay and unplanned readmission similar between groups (p=NS). Conclusions: Process changes improved DTBT but had no effect on length of stay, readmission rate or 12-month mortality. Yet, timely management was critical to 12-month outcomes. Further studies are required to explore the barriers to timely treatment.

Clinical Characteristics of Patients With Stable Coronary Artery Disease Undergoing Angiography by Trans-Femoral Versus Trans-Radial Approach

Tues1 Joseph OBrien Acute pericarditis a rare complication of Plasmodium falciparum malaria. Tues2 Joseph OBrien Gender specific findings among patients admitted to the Emergency Department (ED) with Atrial Fibrillation (AF). Tues3 Joseph OBrien Multiple stroke prophylaxis treatment gaps identified in the management of atrial fibrillation. Tues4 Joseph OBrien Heart rate and blood pressure as predictors of hospital length of stay in patients presenting to the Emergency Department with atrial fibrillation. Tues5 Joseph OBrien The role of appropriate advanced care directives in patients with pulmonary hypertension Tues6 Hnin Oo Prevalence of elevated lipoprotein(a) in coronary artery disease patients Tues7 Mohammad Omair Postoperative Atrial Fibrillation and Cardiac Complications after Liver Transplantation Tues8 Alexandra Murphy Case Study: Unique presentation of coronary artery fistula with infective endocarditis in the setting of a previous penetrating chest injury Tues9 Alexandra Murphy Clinical Outcomes of Patients with Established Coronary Artery Disease Presenting with Acute Coronary Syndromes Tues10 Alexandra Murphy Clinical Characteristics of Patients with Stable Coronary Artery Disease Undergoing Angiography by Trans-femoral versus Trans-radial Approach Tues11 Hamid Salehi Dobutamine Stress Echocardiography Compared With Coronary CT Angiography In Screening For Coronary Artery Disease in End Stage Liver Disease Patients Being Assessed for Liver Transplantation Tues12 Hamid Salehi The Role Of Dobutamine Stress Echo In Predicting Outcomes In Subjects Being Assessed For Liver Transplantation Tues13 Jay Ramchand This abstract is not included at the request of the author Tues14 Jay Ramchand This abstract is not included at the request of the author Clinical Haematology Tues15 Clare English Development and implementation of an algorithm to manage mucositis pain in patients post autologous and allogeneic stem cell transplant Tues16 Joseph Rigano Evaluation of the automated HemosIL® AcuStar HIT IgG chemiluminescent immunoassay for the diagnosis of HIT Tues17 Joseph Rigano Validation of the Lamson pneumatic tube system for the transportation of blood components from Blood Bank to Intensive Care and Ambulatory Care Tues18 Joseph Rigano P-selectin as a marker of cardiovascular risk in normal controls and myeloproliferative neoplasm. Critical care and Emergency Medicine Tues19 David Taylor Determination of the best early warning scores to predict important outcomes among emergency department patients Tues20 David Taylor Patient perceptions of participation in emergency medicine research projects Tues21 David Taylor Temporal trends in the publication of emergency medicine original research Tues22 David Taylor Utility of calcium, magnesium and phosphate testing in the emergency department

Primary Angiosarcoma: A Rare Cause of Right Ventricular Outflow Tract Obstruction

Primary cardiac neoplasms are extremely rare, with an incidence at autopsy of 0.0001% to 0.03%. Most (75%) primary cardiac tumors are benign. The majority of malignant cardiac tumors are sarcomas, of which 30% are angiosarcomas. Other subtypes include rhabdomyosarcoma, malignant fibrous histiocytoma, and fibrosarcoma. Despite being the most common malignant cardiac tumor, cardiac angiosarcoma is often overlooked because of its rarity and nonspecific presentation. As a result of its aggressive nature and late diagnosis, the prognosis remains poor. We describe a case of tumor in the right ventricular outflow tract (RVOT) and main pulmonary artery (MPA) that eluded preoperative diagnosis despite multimodality imaging.

Pretreatment with Dual Antiplatelet Therapy in Patients with Non-ST-Segment Elevation Acute Coronary Syndromes undergoing Percutaneous Coronary Intervention

Although dual antiplatelet therapy is the standard of care in non‐ST‐segment elevation acute coronary syndromes (NSTEACS), it remains unclear when a second antiplatelet agent should be initiated. We sought to assess the safety and efficacy of pre‐treatment with clopidogrel in patients with NSTEACS undergoing percutaneous coronary intervention (PCI).