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Heart, Lung and Circulation S252008;17S:S1–S34 Abstracts

due to 2 stent thromboses, 4 access site complications and1 episode of chest pain. The 30-day MACE rate was sim-ilar in both the elderly (3.25%) and control groups (3.1%,P = 1.0).

Conclusion: Same day discharge is safe and can beachieved in the majority of elderly patients following elec-tive PCI. Suitability for same day discharge should bedetermined by the occurrence of in-hospital complicationsrather than age.

doi:10.1016/j.hlc.2008.03.056

56SURGEONS AND ANAESTHETISTS REQUIREEDUCATION ABOUT THE TIMING OF ELECTIVESURGERY AND PERIOPERATIVE MANAGEMENT OFANTIPLATELET THERAPY IN PATIENTS WITH DRUGELUTING STENTS

AM Ranchord 1,∗, P Kay 2, H Tanner 1, W Harrison 2, MRatnayeke 3, J Swampillai 4, S Plunkett 1, SA Harding 1

1 Wellington Hospital, Wellington, New Zealand2 Middlemore Hospital, Auckland, New Zealand3 Auckland City Hospital, Auckland, New Zealand4 Waikato Hospital, Waikato, New Zealand

Objectives: This study assessed the knowledge of NewZealand surgeons and anaesthetists with regard to theaai

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57HAVE CHANGES IN TECHNIQUE AFFECTED THEOUTCOME OF PRIMARY PCI?

J Sathananthan ∗, Y Malaiapan, IT Meredith, M Leung, MBaldi, SA Hope

Monash Cardiovascular Research Centre, MonashHeart,Southern Health and, Monash University, Melbourne, Aus-tralia

Background: There have been several changes in proce-dural technique since the advent of primary percutaneouscoronary intervention (PCI). We aimed to determinewhether changes in technique have altered proceduraland clinical outcome of primary PCI in our institution.

Methods: Data was retrieved from the institutional PCIdatabase on patients who underwent primary PCI within24 h of presentation with an acute ST elevation myocar-dial infarction (STEMI). Data from 2 two year eras (1.January 2000–December 2001; 2. November 2004–October2006) were analysed and compared.

Results: 87 patients (mean age 62 ± 13 years, 77% male)underwent primary PCI in era 1 and 298 patients (meanage 62 ± 13 years, 76% male) in era 2. A greater proportionof patients in era 1 had an anterior MI (infarct-related-artery LAD P < 0.05). Maximum balloon inflation pressurewas higher in era 1 (14 ± 2.6 atmospheres and 12 ± 2.6atmospheres, era 1 and 2, respectively, P < 0.001) and gly-c(idf(ilas

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ppropriate timing of major elective non-cardiac surgerynd the perioperative management of antiplatelet therapyn patients with drug eluting stents (DES).

Methods: A total of 85 surgeons and 65 anaesthetistsere surveyed by telephone using vignettes in whichatients were presenting for surgery 3 or 12 months afterlacement of a DES for stable single vessel coronary arteryisease. The vignettes did not include patients havingrgent elective or neurosurgical operations.Results: Surgeons (63%) and anaesthetists (32%) fre-

uently reported that they did not have a goodnderstanding of the differences between bare metaltents and DES. Major elective surgery would be per-ormed by 37% of those interviewed 3 months followingES implantation. Of those operating at 3 months, 17%ould stop dual antiplatelet therapy and 67% would stop

ither aspirin or clopidogrel with the remaining 16% con-inuing dual antiplatelet therapy perioperatively. Thoseho deferred surgery most often did so because of con-

erns about increased bleeding whilst on dual antiplateletherapy (56%) rather than the risk of stent thrombosis34%) although a minority (10%) were concerned aboutoth. No one deferred surgery in those presenting 12onths after DES placement, however 36% of surgeons

nd 11% of anaesthetists would stop aspirin periopera-ively.

Conclusions: Surgeons and anaesthetists have knowl-dge deficiencies regarding the optimal management ofatients with DES. Education strategies are required to

mprove awareness and avoid potential adverse outcomes.

oi:10.1016/j.hlc.2008.03.057

oprotein 2b3a antagonists were used more frequently46%, 21%, P < 0.001). No patients in era 1, and 29%n era 2 received drug-eluting stents. Clopidogrel useid not differ (93%, 97%). There was no significant dif-

erence between the two eras for procedural success95%, 96%) but a trend towards improved clinical successn era 2 (81%, 89%, P = 0.05). Neither maximum bal-oon inflation pressure nor glycoprotein 2b3a antagonistdministration were associated with procedural or clinicaluccess.

Conclusions: Changes in procedural technique do notppear to have impacted either procedural or clinical out-ome of primary PCI in our institution.

oi:10.1016/j.hlc.2008.03.058

8NTRA-AORTIC BALLOON COUNTER-PULSATIONSE AT TWO TERTIARY REFERRAL CENTRES IN THEOUTH ISLAND

Siriwardena 1,∗, A Pilbrow 2, AM Richards 1, GTilkins 3

Department of Cardiology, Christchurch Public Hospital,hristchurch, New ZealandChristchurch School of Medicine, University of Otago, NewealandDepartment of Cardiology, Dunedin Public Hospital, Newealand

Background: The intra-aortic balloon pump (IABP) ishe most widely used form of circulatory assist device. Cur-ent theories regarding counter-pulsation is often based

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on results from the Benchmark Registry; heavily biasedby North American practice. Presented is a summary ofIABP use in the South Island.

Methods: Information regarding indications forcounter-pulsation, patient demographics, in-hospitaloutcomes and complications directly related to IABP wasgathered. The rates of complication in the cardiologysetting, the preoperative setting and the postoperativesetting were assessed.

Results: Results based on 300 cases analyzed to date.Dunedin Christchurch Benchmark Registry

Prophylactic use forhigh-risk PCI

<2% <2% 20%

Predominantindication

Assist wean fromcardiopulmonarybypass

Preoperativesupport for offpump high-risksurgery

Prophylactic use forhigh-risk PCI

In-hospitalmortality rate

>25% <20% >20%

Incidence ofcardiogenicshock

>85% <40% 20%

Preoperative counter-pulsation was consistently usedfor a longer duration but had the lowest major complica-tion rate (1–2%). The highest complication rates were seenin the post-operative setting despite the shortest durationof IABP use (18–26%).

The most significant predictor of morbidity may be the

analysed. 4-Year Kaplan–Meier survival analysis (mediansurvival 604 days) compared patients with and withoutthe RFP at baseline: endpoint was time to first rehospi-talisation. Cox proportional hazards model was used todetermine independence of these relationships.

Results: 602 (27%) patients were readmitted for exacer-bation of HF; 826 (38%) had RFP at baseline which wasassociated with higher readmission rates (41%) comparedwith non-RFP patients (19%) (see figure), OR 3.00 (95%CI: 2.48, 3.64). In multivariable analysis, RFP (HR 2.43, CI:2.05, 2.89), age (HR 1.03, CI: 1.02, 1.04), EF (HR 0.98, CI:0.97, 0.99) and male gender (HR 0.75, CI: 0.62, 0.90) inde-pendently predicted readmission.

Conclusions: The presence of RFP by Doppler echo, in

acceptance of an unsatisfactory position as demonstratedby the chest radiograph.

Conclusion: Vast differences exist in the way counter-pulsation is used in New Zealand compared to NorthAmerica. There is also heterogeneity in it’s use betweenthe two South Island centres likely reflecting a lack of clearguidelines.

doi:10.1016/j.hlc.2008.03.059

59DOES RESTRICTIVE MITRAL FILLING PATTERN ONDOPPLER ECHOCARDIOGRAPHY PREDICT READ-MISSION IN PATIENTS WITH HEART FAILURE?

J Somaratne 1,∗, R Doughty 1, K Poppe 1, D Prior 2, C Yu 3,G Whalley 1,

MeRGE HR Collaborators

1 The University of Auckland, Auckland, New Zealand2 St Vincent’s Health, Melbourne, Australia3 Prince of Wales Hospital, Hong Kong

Background: Restrictive filling pattern (RFP; decelera-tion time (DT) < 140 ms) is linked with worse prognosis inheart failure (HF). MeRGE, an individual patient meta-analysis testing the independence of this relationship,showed that RFP predicts mortality independent of ejec-tion fraction (EF) in HF patients. This sub-analysis investi-gates whether RFP independently identifies increased riskof readmission in patients with HF.

Methods: Data from 2202 patients with HF (male 79%;mean age 62 years, EF 29%, E:A 1.7, DT 162 ms) were

patients with HF, was independently predictive of higherrates of rehospitalisation and as such may represent anaccessible marker of subsequent events. These data fur-ther support routine echocardiographic assessment ofdiastolic function in all patients with HF.

doi:10.1016/j.hlc.2008.03.060

60IMPLEMENTING A REAL-TIME ACUTE CORONARYSYNDROME (RACS) DATABASE AND REPORTINGSYSTEM IN SOUTH AUCKLAND

JB Somaratne ∗, A To, A McLachlan, E Chan, P Funaki, AJKerr

Middlemore Hospital, Auckland, New Zealand

Background: There is scarce local data on clinical per-formance and outcomes after acute coronary syndromes(ACS). This prospective online database and reporting sys-tem aims to facilitate audit of ACS management and studyof the determinants of late outcome.

Methods: From August 2007 all patients with ACS(unstable angina (UA), NSTEMI, STEMI) admitted tothe Coronary Care Unit (CCU) were registered in thedatabase. Information was rapidly and simply entered bymedical staff using drop-down menus and checkboxesincluded: risk prediction data, laboratory results (auto-matically populated), cardiac investigations, managementand in-hospital outcomes. Real-time data reporting wasreadily available. NZ Health Information Service linkageusing encrypted NHIs will allow future outcome datacollection.