Introduction: Faster door to balloon (DTB) times are associated with improved survival in ST elevation myocardial infarction (STEMI). Key strategies in reducing DTB time are shortening the door to activation (DTA) time of the cardiac catheterisation laboratory (CCL) and earlier patient transfer to the CCL. Traditionally, the treating cardiologist performs CCL activation and patients are routinely transferred once the CCL staff call for the patient. We implemented a change in practice in February 2009 to ED activation of "Code STEMI" thereby decreasing activation and door to balloon times. We wanted to ensure the early good results were being reproduced. Aim: To study activation rates, the presence of false positives, and maintenance in DTB times, 12 months on from a very successful "Code STEMI" implementation. Methods: DTB and DTA times were prospectively recorded in all patients undergoing primary PCI between October 2009 and December 2010. This 14-month follow on data was reviewed and compared to the data from the original experience from February 2009 to October 2009. Results: The DTB and DTA times continue to improve (DTB: 77 minutes 2009 vs 69 minutes 2010). There have been transient increases in false positive CCL activations noted that have required ongoing emergency/cardiovascular medicine communication. Conclusion: Ongoing review and monitoring of ED activated STEMIs are required to ensure activation criteria are being adhered to, and to maintain door to balloon times and adherence to the activation protocol.

Background: Faster door to balloon (DTB) times are associated with improved survival in ST elevation myocardial infarction. Key strategies in reducing DTB time are shortening the door to activation (DTA) time of the cardiac catheterisation laboratory (CCL) and earlier patient transfer to the CCL. Traditionally, the treating cardiologist performs CCL activation and patients are routinely transferred once the CCL staff calls for the patient.

Background: Faster door to balloon times are associated with lower mortality in STEMI and this has been achieved by pre hospital (ambulance mediated) activation of the cardiac catheterisation laboratory (CCL). Lower mortality should also be achievable by reducing pain to door (PTD) time and increasing the proportion of patients contacting ambulance services to enable earlier CCL activation.

Background: Reducing the time from acute vessel occlusion to reperfusion in ST elevation myocardial infarction (STEMI) is associated with improved survival. Recent interest has focused on techniques to reduce door to balloon (DTB) times however the period from pain onset to hospital arrival, called the pain to door time (PTD) is also crucial.

Background: Emergency physician (ED) activation of the cardiac catheterisation laboratory (CCL) is proven to reduce door to balloon (DTB) time in STEMI. Shorter DTB times are associated with reduced mortality. The main barrier to implementing ED CCL activation is concern of inappropriate activation of the CCL.

Background: Currently there is no, or limited, evidence-based practice for the care of patients post cardiac procedures requiring sheath removal. In mid 2006, the Coronary Care Unit (CCU) decided to evaluate the clinical nursing practice of sheath removal within Australia and New Zealand.

Aim: The project aims to reduce ALOS for patients undergoing elective cardiac procedures, including angioplasty, pacemaker device implants and electrophysiology studies.

Background: In patients with stable CAD, elevated biomarkers of inflammation including high sensitivity C-Reactive Protein [hs-CRP] level ≥2.0 mg/L predict vascular events. Since long-term low-dose colchicine is known to be a safe, effective means of dampening inflammation, we conducted an open-label pilot study to determine the effect of colchicine 0.5 mg/d or 0.5 mgbd in patients with stable CAD in whom the hs-CRP was ≥2.0 mg/L despite taking both aspirin and high dose statin.

Objective: Micro-computed tomography (microCT) imaging has the potential to allow the three-dimensional (3D) visualization of cartilage morphology. However, cartilage intensity on a microCT image is weak because cartilage does not strongly attenuate X-rays. This work was designed to demonstrate that exposure of cartilage to charged gadolinium compounds modifies the intensity to allow an improved visualization of cartilage morphology and the determination of proteoglycan content.Design: Trypsin was used to deplete proteoglycan in bovine nasal cartilage disks. Disks were then exposed to Gd3+, gadopentetate (Gd-DTPA(2-)), or gadoteridol (Gd-HP-DO3A), and imaged with microCT. The intensities of the disks were measured from the images and compared to the actual proteoglycan content determined with a dimethylmethylene blue assay.Results: Treatment of naive disks with 200 mM Gd3+ for 24 h at room temperature produced a 2.8-fold increase in intensity on microCT images. Similar treatment with 200 mM Gd-DTPA2- produced a 1.4-fold increase. After 2 h of trypsin treatment at room temperature, the intensities of cartilage disks exposed to 200 mM Gd3+ decreased by 12%. Conversely, the intensities of trypsin-treated disks exposed to 200 mM Gd-DPTA(2-) increased by 15%. Trypsin treatment caused a 4% increase in the intensities of disks exposed to neutral Gd-HP-DO3A. The correlation between proteoglycan content and the microCT intensity of cartilage treated with Gd3+ was very good (r(2) = 0.81).Conclusions: Gadolinium and microCT allow an improved 3D visualization of cartilage and quantification of its proteoglycan content. (c) 2005 OsteoArthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

The contribution of increased use of same-admission percutaneous coronary interventional procedures to recent improvements in hospital survival of patients with acute myocardial infarction (AMI) remains unclear. Patients with International Classification of Diseases codes for AMI (code 410), who were admitted to the emergency coronary care unit and underwent an initial episode of treatment, were studied over the 9-year period 1990 to 1998 (n = 2,628). Three triennia between 1990 and 1998 were compared. Trends in risk, the use of procedures, and hospital outcomes were analyzed. Hospital mortality was 33% lower (p <0.02) in the third triennium (5.8%) than in the earlier 2 triennia (8.7%), equivalent to an absolute reduction of 29 hospital deaths/1,000 patients treated. The lower hospital mortality was not due to: (1) shorter hospital stays (reduction in mortality was primarily in the first 3 hospital days), (2) treatment of lower risk subjects (a risk score based on age, gender, and presence of diabetes increased between the first and third triennia), or (3) use of in-hospital interventional procedures (although the use of percutaneous coronary intervention more than doubled in the third triennium, most procedures were performed in patients with a 1% risk of hospital death). We conclude from this study that there has been a substantial improvement over a 9-year period in early case fatality after AMI, but that this cannot be attributed to the increased use of in-hospital coronary interventions, which were largely performed on low-risk patients.