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Reduced sedation in patients undergoing coronary angiography of total ambulatory management
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32% were hypertensive, 3% diabetic and 90% had a first degree relative with CAD. Mean peak off treatment total cholesterol was 9.7mmol/L, mean on treatment total cholesterol was 5.3 mmol/L. 57.6% of cases had a coronary calcium score of >0 and 21% had at least one epicardial artery stenosis of greater than 50%. Increased coronary calcium score was associated with increasing age (OR 1.12 95% CI 1.03-1.24 p = 0.0025), peak untreated cholesterol (OR 3.71 95% CI 1.72-11.74 p <0.0001) and peak LDL cholesterol (OR 2.38 95% CI 1.28-5.57 p = 0.0021). Conclusions: A significant proportion of those with genetically proven FH have evidence of subclinical CAD. Increasing age, off treatment peak total and LDL-C were predictors of subclinical CAD. CTCA probably adds little information not detectable on CAC. http://dx.doi.org/10.1016/j.hlc.2014.04.208 P40 Reduced sedation in patients undergoing coronary angiography of total ambulatory management S. MadenHolt-Titley *, T. Gudex, M. McAleer, S. Savage, J. White, P. Ruygrok Auckland District Health Board, Auckland Corresponding author.
*
Background: Midazolam and fentanyl are routinely used for coronary angiography via a radial approach to reduce patient anxiety, pain and arterial spasm. This has implications for ambulation, time to discharge and work-flow efficiency. There is little evidence to support the routine use of “up-front” intravenous sedation and analgesia compared to “as required” and using local anaesthesia alone. Methods: Fifty patients undergoing coronary angiography were consented to participate in a total ambulatory care pathway, consisting of management in medically approved reclining chairs and “walk-in walk-out” of catheterisation laboratory. Intravenous sedation was administered only if required. Results: Of the 50 patients enrolled (mean age 64 years, 72% male) 7 received midazolam and fentanyl during the procedure and 2 received fentanyl only (4 patients before and 5 after percutaneous puncture). The median dose of fentanyl used was 50 mg (range 25-100) and midazolam 0.5mg (range 0.5-1.0). All 50 patients walked into the procedure room with 10 requiring assistance to return to the day-stay ward; 5 in a wheelchair due to use of sedation and 5 on a bed - 3 due to crossover from radial to femoral approach and use of sedation, 1 due to a vasovagal episode and 1 requiring in-patient surgery. Of the 41 non-sedated patients 37 (90%) were discharged the same day compared to 8/9 (89%) of the sedated patients. Ten patients proceeded to percutaneous intervention, 4 of whom received IV sedation. Conclusion: Coronary angiography and intervention can be successfully performed without the routine use of “upfront” intravenous sedation. http://dx.doi.org/10.1016/j.hlc.2014.04.209
Abstracts
P41 Audit of the burden of rheumatic heart disease in the Wellington region M. Margetts 1*, A. Aitken 2, N. Wilson 3 1
University of Otago, School of Medicine, Dunedin Cardiology Department, Capital and Coast DHB, Wellington 3 Paedatric Cardiology Department, Starship Hospital, Auckland * Corresponding author. 2
Background: Acute rheumatic fever (ARF), with the potential sequelae of rheumatic heart disease (RHD), has a well defined incidence in New Zealand. However the effects of these diseases on the health of young adults is less well described. In this study we examined patients aged between 15 and 25 with a previous presentation with either ARF or RHD. Methods: We identified all cases of ARF or RHD who presented in the Wellington Region,where the patient was born between 1/1/88 and 31/12/97. Demographic data and clinical outcomes were examined. Results: We identified 99 individuals, 67 of whom had RHD and 32 with ARF without carditis. 60% of patients were male, and 65% were Pacific Islanders, 26% Maori, 9% other ethnic groups. 85% of patients came from the lowest socioeconomic quintile. 67% of the cohort had aortic regurgitation (AR), 60% had mitral regurgitation (MR), and 19% had an additional value abnormality. At the worst point 25 patients had severe MR and 15 patients severe AR. Valve surgery had been performed in 14 patients. There were 9 pregnancies within the cohort, and 8 women attended high risk antenatal clinics. There were no documented cardiovascular complications or significant bleeding events associated with any of the pregnancies. Conclusions: The majority of young adults within the region with ARF or RHD were Pacific Islander or Maori in ethnicity, from lower socioeconomic backgrounds. Severe valve disease was common, and 14 of 67 patients with RHD had required surgery. There were a small number of pregnancies in the cohort, but these had not been associated with adverse outcomes. http://dx.doi.org/10.1016/j.hlc.2014.04.210 P42 Transcatheter aortic valve implantation in patients with percutaneous coronary intervention to the left main coronary artery A. Maurice 1,2*, S. Chan 1,2, D. Murdoch 1, A. Clarke 1, D. Walters 1,2 1
Heart and Lung Institute, The Prince Charles Hospital Brisbane, Australia 2 University of Queensland, Brisbane, Australia * Corresponding author. Background: Transcatheter Aortic Valve Implantation (TAVI) is increasingly utilised in patients with severe aortic valve stenosis who are deemed unacceptably high risk for
32% were hypertensive, 3% diabetic and 90% had a first degree relative with CAD. Mean peak off treatment total cholesterol was 9.7mmol/L, mean on treatment total cholesterol was 5.3 mmol/L. 57.6% of cases had a coronary calcium score of >0 and 21% had at least one epicardial artery stenosis of greater than 50%. Increased coronary calcium score was associated with increasing age (OR 1.12 95% CI 1.03-1.24 p = 0.0025), peak untreated cholesterol (OR 3.71 95% CI 1.72-11.74 p <0.0001) and peak LDL cholesterol (OR 2.38 95% CI 1.28-5.57 p = 0.0021). Conclusions: A significant proportion of those with genetically proven FH have evidence of subclinical CAD. Increasing age, off treatment peak total and LDL-C were predictors of subclinical CAD. CTCA probably adds little information not detectable on CAC. http://dx.doi.org/10.1016/j.hlc.2014.04.208 P40 Reduced sedation in patients undergoing coronary angiography of total ambulatory management S. MadenHolt-Titley *, T. Gudex, M. McAleer, S. Savage, J. White, P. Ruygrok Auckland District Health Board, Auckland Corresponding author.
*
Background: Midazolam and fentanyl are routinely used for coronary angiography via a radial approach to reduce patient anxiety, pain and arterial spasm. This has implications for ambulation, time to discharge and work-flow efficiency. There is little evidence to support the routine use of “up-front” intravenous sedation and analgesia compared to “as required” and using local anaesthesia alone. Methods: Fifty patients undergoing coronary angiography were consented to participate in a total ambulatory care pathway, consisting of management in medically approved reclining chairs and “walk-in walk-out” of catheterisation laboratory. Intravenous sedation was administered only if required. Results: Of the 50 patients enrolled (mean age 64 years, 72% male) 7 received midazolam and fentanyl during the procedure and 2 received fentanyl only (4 patients before and 5 after percutaneous puncture). The median dose of fentanyl used was 50 mg (range 25-100) and midazolam 0.5mg (range 0.5-1.0). All 50 patients walked into the procedure room with 10 requiring assistance to return to the day-stay ward; 5 in a wheelchair due to use of sedation and 5 on a bed - 3 due to crossover from radial to femoral approach and use of sedation, 1 due to a vasovagal episode and 1 requiring in-patient surgery. Of the 41 non-sedated patients 37 (90%) were discharged the same day compared to 8/9 (89%) of the sedated patients. Ten patients proceeded to percutaneous intervention, 4 of whom received IV sedation. Conclusion: Coronary angiography and intervention can be successfully performed without the routine use of “upfront” intravenous sedation. http://dx.doi.org/10.1016/j.hlc.2014.04.209
Abstracts
P41 Audit of the burden of rheumatic heart disease in the Wellington region M. Margetts 1*, A. Aitken 2, N. Wilson 3 1
University of Otago, School of Medicine, Dunedin Cardiology Department, Capital and Coast DHB, Wellington 3 Paedatric Cardiology Department, Starship Hospital, Auckland * Corresponding author. 2
Background: Acute rheumatic fever (ARF), with the potential sequelae of rheumatic heart disease (RHD), has a well defined incidence in New Zealand. However the effects of these diseases on the health of young adults is less well described. In this study we examined patients aged between 15 and 25 with a previous presentation with either ARF or RHD. Methods: We identified all cases of ARF or RHD who presented in the Wellington Region,where the patient was born between 1/1/88 and 31/12/97. Demographic data and clinical outcomes were examined. Results: We identified 99 individuals, 67 of whom had RHD and 32 with ARF without carditis. 60% of patients were male, and 65% were Pacific Islanders, 26% Maori, 9% other ethnic groups. 85% of patients came from the lowest socioeconomic quintile. 67% of the cohort had aortic regurgitation (AR), 60% had mitral regurgitation (MR), and 19% had an additional value abnormality. At the worst point 25 patients had severe MR and 15 patients severe AR. Valve surgery had been performed in 14 patients. There were 9 pregnancies within the cohort, and 8 women attended high risk antenatal clinics. There were no documented cardiovascular complications or significant bleeding events associated with any of the pregnancies. Conclusions: The majority of young adults within the region with ARF or RHD were Pacific Islander or Maori in ethnicity, from lower socioeconomic backgrounds. Severe valve disease was common, and 14 of 67 patients with RHD had required surgery. There were a small number of pregnancies in the cohort, but these had not been associated with adverse outcomes. http://dx.doi.org/10.1016/j.hlc.2014.04.210 P42 Transcatheter aortic valve implantation in patients with percutaneous coronary intervention to the left main coronary artery A. Maurice 1,2*, S. Chan 1,2, D. Murdoch 1, A. Clarke 1, D. Walters 1,2 1
Heart and Lung Institute, The Prince Charles Hospital Brisbane, Australia 2 University of Queensland, Brisbane, Australia * Corresponding author. Background: Transcatheter Aortic Valve Implantation (TAVI) is increasingly utilised in patients with severe aortic valve stenosis who are deemed unacceptably high risk for