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JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, VOL. 69, NO. 16, SUPPL S, 2017
OTHER (UNCLASSIFIED) (TCTAP A-100 TO TCTAP A-120) TCTAP A-100 To Reduce In-hospital Cardiac Arrest Using Innovative Early Warning Information System WangTing Hung,1 Wei-Chun Huang,1 Cheng-Hung Chiang,1 Chin-Chang Cheng,1 Wang-Chuan Juan,1 Shu-Hung Kuo,1 Kun Chang Lin,1 Po Hsiang Lin,1 Guang-Yuan Mar,1 Shue-Ren Wann,1 Yao-shen Chen,1 Chun-Peng Liu1 1 Kaohsiung Veterans General Hospital, Taiwan BACKGROUND The rate of survival to discharge is still low in patients after in-hospital cardiac arrest (IHCA), despite improvement of survival and neurological outcomes during the past decade. The early warning system is critical to detect IHCA patients. This study aimed to investigate the innovative early warning information system to reduce in-hospital cardiac arrest in a tertiary medical center. METHODS A multidisciplinary team was organized, including cardiologists, emergency physicians, intensivists, and nursing staffs. The key interventions in this project include electronic national early warning score information system, nurses and physicians computerbased reminding alarm if NEWS7 or more than highest scores among previous 3 measurements, real-time early warning screensaver and electric board, in-service education and early warning monitor team. Total 170,097 patients admitted between January 2013 and August 2016 were divided into 3 groups: pre-interventional group (Jan 2013 to April 2015; n¼707,957 patient-day), interventional group (May to June 2015; n¼52,687 patient-day) and post-interventional group (July 2015 to August 2016; n¼361,387 patient-day). RESULTS The incidence of in-hospital cardiac arrest improved from 0.38& in the pre-interventional group, to 0.32& in the interventional group and to 0.25& in the post-interventional group (p<0.05). The rate of in-hospital cardiac arrest improved from 2.53& in the pre-interventional group, to 2.15& in the interventional group and to 1.64& in the post-interventional group (p<0.05). The 48-hour survival rate in IHCA patients increased from 34.4% in the preinterventional group, to 41.2% in the interventional group and to 43.2% in post-interventional group (p<0.05). The rate of survival to discharge in IHCA patients increased from 15.6% to 29.4% and 37.1% in post-interventional group (p<0.05). CONCLUSION This study showed that innovative early warning information system could improve the incidence if IHCA, the rate of IHCA, 48-hour survival rate and discharge survival rate in IHCA patients. TCTAP A-101 Clinical Implication According to Spasm Type of Single Coronary Artery Provoked by Intracoronary Ergonovine Tests in Korean Patients Sung-Ho Her,1 Dae-Won Kim1 The Catholic University of Korea, Daejeon St. Mary’s Hospital, Korea (Republic of)
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BACKGROUND This study aimed to evaluate clinical implications of single vessel coronary spasm provoked by intracoronary ergonovine provocation test in the Korean population. METHODS A total of 1,248 patients who presented with single vessel coronary artery spasm induced by intracoronary ergonovine provocation test, excluding 1,712 with multiple and mixed coronary artery spasms among 2,960 patients in the VA-KOREA (Vasospastic Angina in Korea) registry, were classified into diffuse (n¼705) and focal (n¼543) groups. The 24-month incidences of composite primary endpoints (cardiac death, new-onset arrhythmia, and acute coronary syndrome) were determined. RESULTS Over a median follow-up of 30 months, the composite primary end point occurred more frequently in the focal type patients than in the diffuse type patients (primary endpoint: adjusted hazard ratio [aHR], 1.658; 95% confidence interval [CI] 1.272 to 2.162, p<0.001). Especially, unstable angina in ACS components played a major role in this effect (hazard ratio [HR], 2.365; 95% confidence interval [CI] 1.100 to 5.087, p¼0.028).