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Time to Reperfusion with the Radial Approach in STEMI PCI
372 Time of Presentation and Door to Lab Time in ST Elevation Myocardial Infarction M. Dooris ∗ Royal Brisbane and Women’s Hospital, Australia Aim: We investigated the relationship between time of presentation and door-to-lab time (DTL) for Emergency Department (ED) patients with ST elevation myocardial infarction (STEMI) to 7 day 24 hour emergency catheterisation (EC) service. Methods: Data was extracted from a prospective database of STEMI patients undergoing EC. Patients presenting to ED without cardiac arrest were selected. Door-to-lab time was modeled as continuous (linear and quantile regression (QR)) and dichotomous variable (logistic regression (LR)). Explanatory variables used were: day of week, weekend (WE), time of day (TOD): 24 hour clock or dichotomised (in/after-hours). Results: 154 patients were identified: age 61 ± 13 years; 82% male; median time intervals (minutes): DTL 42.5, lab to balloon 29.5, door to balloon 75; mortality 2.6%. WE had a trend to longer DTL than weekday (42 vs 48, p = 0.06). This effect was significant in QR model. A parabolic function of TOD was correlated to DTL in all models. The QR model of WE and TOD is in Fig. 1.The LR model of TOD is graphically illustrated in Fig. 2 (parameters in Fig. 3).
Conclusion: WE and TOD are predictors of DTL. A parabolic function of TOD has a strong correlation across diverse models. The out of hours effect remains a challenge for improving time to mechanical reperfusion in STEMI. doi:10.1016/j.hlc.2011.05.375 373 Time to Reperfusion with the Radial Approach in STEMI PCI M. Lawrence ∗ , A. Hutchison, Y. Malaiapan, I. Meredith MonashHEART and Monash Cardiovascular Research Centre, Southern Clinical School, Monash University, Melbourne, Australia Background: In patients with STEMI rapid reperfusion is mandatory. STEMI PCI (Primary and Rescue) via the radial approach is safe, however concerns persist regarding possible increases in procedure time.
Abstracts CSANZ Abstracts 2011
S151
Methods and results: Between August 2009 to August 2010, 337 consecutive patients undergoing STEMI PCI at a single tertiary referral institution were analysed to investigate the effect of the access site used on cardiac catheter laboratory to balloon time (CCL2BT). The approach was at the discretion of the operator. None of the primary operators were solely radial angiographers. Two patients in the radial group changed to a femoral approach. The median CCL2BT of all patients using a femoral approach was 29 minutes (N = 242, IQR 22–36 minutes) compared to 31 minutes (N = 96, IQR 27–37) using a radial approach, p = 0.02. The femoral group was noted to be older (61.3 years femoral group vs 57.9 years radial group, p = 0.04) with other baseline patient characteristics and lesion complexity similar between the two groups. There was no difference in the proportion of women in either the radial or femoral access groups (14% vs 17%, NS). Conclusions: Emergency percutaneous coronary intervention performed via a radial route results in a modest increase in cardiac catheter laboratory to balloon time. Whether this 2 minutes time delay results in an appreciable difference in outcomes is the subject of ongoing studies. doi:10.1016/j.hlc.2011.05.376
374 TIMI Myocardial Perfusion Grade Predicts Myocardial Salvage Index: Insights From A Cardiac MRI Study D. Wong 1,∗ , R. Das 1 , M. Leung 2 , R. Puri 1 , K. Teo 1 , I. Meredith 2 , M. Worthley 1 , S. Worthley 1 1 Cardiovascular Research Centre, Royal Adelaide Hospital, University of Adelaide, Australia 2 Monash Cardiovascular Research Centre, Department of Medicine (MMC), Monash University, and MonashHeart, Melbourne, Australia
Introduction: Myocardial salvage is the principle mechanism by which patients with acute myocardial infarction benefit from reperfusion therapies. Recent studies have shown that myocardial salvage is an independent predictor of outcome. An “in-lab tool” to predict myocardial salvage may therefore provide important prognostic information on patient outcomes. We therefore evaluated the
ABSTRACTS
Heart, Lung and Circulation 2011;20S:S1–S155
Conclusion: WE and TOD are predictors of DTL. A parabolic function of TOD has a strong correlation across diverse models. The out of hours effect remains a challenge for improving time to mechanical reperfusion in STEMI. doi:10.1016/j.hlc.2011.05.375 373 Time to Reperfusion with the Radial Approach in STEMI PCI M. Lawrence ∗ , A. Hutchison, Y. Malaiapan, I. Meredith MonashHEART and Monash Cardiovascular Research Centre, Southern Clinical School, Monash University, Melbourne, Australia Background: In patients with STEMI rapid reperfusion is mandatory. STEMI PCI (Primary and Rescue) via the radial approach is safe, however concerns persist regarding possible increases in procedure time.
Abstracts CSANZ Abstracts 2011
S151
Methods and results: Between August 2009 to August 2010, 337 consecutive patients undergoing STEMI PCI at a single tertiary referral institution were analysed to investigate the effect of the access site used on cardiac catheter laboratory to balloon time (CCL2BT). The approach was at the discretion of the operator. None of the primary operators were solely radial angiographers. Two patients in the radial group changed to a femoral approach. The median CCL2BT of all patients using a femoral approach was 29 minutes (N = 242, IQR 22–36 minutes) compared to 31 minutes (N = 96, IQR 27–37) using a radial approach, p = 0.02. The femoral group was noted to be older (61.3 years femoral group vs 57.9 years radial group, p = 0.04) with other baseline patient characteristics and lesion complexity similar between the two groups. There was no difference in the proportion of women in either the radial or femoral access groups (14% vs 17%, NS). Conclusions: Emergency percutaneous coronary intervention performed via a radial route results in a modest increase in cardiac catheter laboratory to balloon time. Whether this 2 minutes time delay results in an appreciable difference in outcomes is the subject of ongoing studies. doi:10.1016/j.hlc.2011.05.376
374 TIMI Myocardial Perfusion Grade Predicts Myocardial Salvage Index: Insights From A Cardiac MRI Study D. Wong 1,∗ , R. Das 1 , M. Leung 2 , R. Puri 1 , K. Teo 1 , I. Meredith 2 , M. Worthley 1 , S. Worthley 1 1 Cardiovascular Research Centre, Royal Adelaide Hospital, University of Adelaide, Australia 2 Monash Cardiovascular Research Centre, Department of Medicine (MMC), Monash University, and MonashHeart, Melbourne, Australia
Introduction: Myocardial salvage is the principle mechanism by which patients with acute myocardial infarction benefit from reperfusion therapies. Recent studies have shown that myocardial salvage is an independent predictor of outcome. An “in-lab tool” to predict myocardial salvage may therefore provide important prognostic information on patient outcomes. We therefore evaluated the
ABSTRACTS
Heart, Lung and Circulation 2011;20S:S1–S155