Impact of call-to-balloon time on 30-day mortality in contemporary practice.

OBJECTIVE: Studies reporting an association between treatment delay and outcome for patients with ST segment elevation myocardial infarction (STEMI) have generally not included patients treated by a primary percutaneous coronary intervention (PPCI) service that systematically delivers reperfusion therapy to all eligible patients. We set out to determine the association of call-to-balloon (CTB) time with 30-day mortality after PPCI in a contemporary series of patients treated within a national reperfusion service. METHODS: We analysed data on 16 907 consecutive patients with STEMI treated by PPCI in England and Wales in 2011 with CTB time of ≤6 hours. RESULTS: The median CTB and door-to-balloon times were 111 and 41 min, respectively, with 80.9% of patients treated within 150 min of the call for help. An out-of-hours call time (58.2% of patients) was associated with a 10 min increase in CTB time, whereas inter-hospital transfer for PPCI (18.5% of patients) was associated with a 49 min increase in CTB time. CTB time was independently associated with 30-day mortality (p180-240 min compared with ≤90 min. The relationship between CTB time and 30-day mortality was influenced by patient risk profile with a greater absolute impact of increasing CTB time on mortality in high-risk patients. CONCLUSION: CTB time is a useful metric to assess the overall performance of a PPCI service. Delays to reperfusion remain important even in the era of organised national PPCI services with rapid treatment times and efforts should continue to minimise treatment delays

Investigation of P2X7 dependent mechanisms of interleukin-1 β release from human endothelial cells and its relation to atherosclerosis

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Clinical utility of magnetocardiography in cardiology for the detection of myocardial ischemia.

Magnetic field maps from (A) subjects without ischemia, showing a bipolar field map throughout the cardiac cycle, and (B) patients with acute coronary syndrome in whom a distorted, fragmented or multipolar field map characterizes active myocardial ischemia. Maps were recorded with a 15-channel magnetometry device and display the magnetic field distribution at the point of maximum rate of change between the Q and R peaks (QR) and between the R and S peaks (RS). The dipoles observed in subjects without ischemia are generally aligned in the same direction and have only a single positive (red) and single negative (blue) pole. The images from ischemic patients are generally more complex. A wider spread of angles and pole to pole distance, and the presence of more than two peaks are features that generally indicate ischemia