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Methods: The ACACIA database (PM L 0051) a registryof consecutive ACS patients was used to undertake acase–control (1:4 ratio) comparison. Cases were definedas patients with STEMI or high-risk ACS experiencingdeath or myocardial infarction (MI), while eligible con-trols were these patients remaining free of these eventsup to 6 months, matched for GRACE score, diagnosis anddiabetes. Hospitals were classified as having no cath-lab(none), angiography only (Angio), intervention (PCI) andonsite cardiac surgery (CTS). Using conditional logisticregression, the relationship between distance travelled(km) to emergency services and the invasive services wasexplored.Results: Within the registry, 278 cases and 1,112 controlswere identified. Cases were older (73.6 years vs. 65.9 years,p = 0.01), had more renal impairment (eGFR < 60 ml/min:54.6% vs. 28.5%, p < 0.01) and were less likely to undergoinvasive management (48.6% vs. 65.6%, p < 0.01). Afteradjusting for receipt of invasive management, distanceto emergency services was not associated with increaseddeath or MI (OR per km: 1.0, p = 0.30). Presentation to hos-pital with invasive services was associated with increasedevents (Angio OR: 2.2, 95% CI: 1.1–4.4, p = 0.02, PCI OR:1.9, 95% CI: 1.11–3.2, p = 0.03, CTS OR: 2.5 95% CI: 1.5–4.1,p < 0.01).Conclusions: Distance to emergency services does notnegatively impact events among Australian ACS patients.

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were less likely to undergo coronary angiography or PCIduring the admission. There were no differences in timefrom onset of symptoms to presentation, ECG, or receiptof fibrinolysis, times to angiography or revascularization.By 6 months, mortality, myocardial infarction and strokewas not different between metropolitan and rural patients(RR: 1.15, 95% C.I. 0.90–1.46). No difference in mortalitywas observed.Conclusion: Despite a higher risk profile and lower rates ofinvasive management and guideline therapies, event freesurvival for patients presenting to rural centers in Aus-tralia remain comparable to those in metropolitan areas.

doi:10.1016/j.hlc.2007.06.307

303Opposing Trends in Serum Cholesterol and Obesity inPerth, Western Australia, 1980–1999

Michael Hobbs 1, Matthew Knuiman 1, Hanh Ngo 1, Kon-rad Jamrozik 1,2, Tom Briffa 1,∗

1 University of Western Australia, WA, Australia; 2 Universityof Queensland, Qld, Australia

Background: Given the adverse associations between obe-sity and classical risk factors for coronary heart disease(CHD), there are concerns its increasing prevalence willundermine the declining incidence of CHD. Thus, under-soMsm(dmaRmsaIbpgpaapciaCmdtfi

oi:10.1016/j.hlc.2007.06.306

02ogistics of ACS Management in Rural Versus Metropoli-

an Hospitals

. Brieger 1,∗, Amerena 2, S. Coverdale 3, J. Rankin 4, C.stley 5, D. Chew 5

Concord Hospital, Australia; 2 Geelong Hospital, Australia;Nambour Hospital, Australia; 4 Royal Perth Hospital, Aus-

ralia; 5 Flinders University/Flinders Medical Centre, Australia

ackground: While the majority of the population livesn urban centers, approximately 15% live in rural settings

ith less timely access to tertiary medical care. Strategieso improve services are dependent on understanding theurrent level of care for patients living in rural environ-ents.ethods: This analysis used data from the ACACIA reg-

stry (PM L 0051). Hospitals were deemed rural if theyesided outside the major cities. Differences in the histori-al and presenting characteristics were identified. Receiptf evidence-based therapies and death or myocardial

nfarction by 6 months between populations was com-ared.esults: Patients from rural centers comprised 22.7%

727/3260) of the population. Rural patients, more likely toe females (38.9% versus 34.1%, p = 0.022), have reducedenal function (GFR < 60 ml/min: 32.8% versus 26.1%,< 0.001) and have a history of coronary disease (54.1%ersus 47.9%, p = 0.004). Rural patients were less likely toresent with STEMI (16.4% versus 24.0%, p < 0.001). They

tanding the temporal relationships between obesity andther risk factors is warranted.ethods: We analysed data from five independent cross-

ectional population surveys of risk factors involvingetropolitan West Australian men (n = 2767) and women

n = 2833) aged 35–64 years from 1980–1999, using stan-ardised protocols. Trends in plasma cholesterol, bodyass index (BMI) and waist-hip ratio (WHR) were

ssessed.esults: There were striking annual increases in BMI foren 0.075 kg/m2 and women 0.083 kg/m2 (both p < 0.0001);

imilarly WHR increased, both approximating to 0.8%nnual rise in the prevalence of overweight and obesity.n contrast, mean cholesterol declined annually in meny 0.024 mmol/L and in women by 0.030 mmol/L (both< 0.0001) and this persisted after adjustment for demo-raphics, BMI, physical activity and smoking. Similarly,revalence of high cholesterol (≥6.5 mmol/L) declined onverage by 0.6% (OR = 0.970, 95% CI 0.954–0.985, p = 0.0002)year in men and 0.9% (OR = 0.955, 95% CI 0.938–0.971,< 0.0001) in women. The decline in cholesterol was asso-iated with a general downward shift in distribution andncreasing awareness and treatment of high cholesterolmong older adults.onclusion: Despite rapid increases in obesity in adults,ean plasma cholesterol levels have declined, possibly

ue to both dietary changes and greater awareness andreatment of high cholesterol in some individuals. Thisnding fails to confirm a positive association between

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S122 Abstracts Heart, Lung and Circulation2007;16:S1–S201

trends in obesity and plasma cholesterol in the generalpopulation.

doi:10.1016/j.hlc.2007.06.308

304Explaining Recent Trends in Coronary Heart DiseasesHospitalisations in New Zealand: 1993–2005

W. Chan, C. Wright, M. Tobias, S. Mann ∗, R. Jackson

University of Auckland, Auckland, New Zealand

Background: It has been suggested that recent increases inhospitalisations for coronary heart disease (CHD), partic-ularly acute myocardial infarction (AMI), in New Zealandmay signal a new epidemic of CHD. This study investi-gated alternative explanations for these trends, includingchanging demographics, hospital transfers, readmissionsand changes in diagnostic criteria for AMI.Methods: New Zealand public hospitalisation recordsfrom 1993 to 2005 held by the New Zealand Health Infor-mation Services were examined. CHD hospitalisationswere identified from hospital discharge ICD codes.Results: Between 1993 and 2005, there were 324663 hos-pital admissions for CHD with numbers peaking in 2000.Approximately 35% (n = 113345) were coded as AMI. Inter-hospital transfers increased by 117% from 1993 (n = 1319)to 2005 (n = 2862) and by 2005 60% of CHD admissions were

those with ST elevation myocardial infarction (STEMI)patients following successful thrombolysis.Methods: Consecutive patients (n = 60) with STEMI suc-cessfully treated with thrombolysis underwent coronaryangiography. Quantitative coronary angiography wasused to assess the severity of disease in the infarct-relatedartery (IRA) as well as in non infarct-related arteries (non-IRAs). An extent score (percentage of the coronary arterysurface involved by atheroma) was calculated.Results: The mean age of patients was 59 ± 12 years (range36–87 years) and 77% were male. Thirty-five (58%), 13(22%), and 12 (20%) had one, two and three vessel coro-nary artery disease, respectively. The infarct-related lesion(VP) involved rupture at a high-grade stenosis (≥60%) in65% of cases. Mean luminal diameter stenosis of the VPwas higher than that for the most severe lesion in thenon-IRAs (non-VP)(62 ± 22% versus 45 ± 27%; P < 0.001).Plaque ulceration was highly associated with VP (40%in VP versus 2% in non-VP; P < 0.001) but calcificationdid not (23% in VP versus 18% in non-VP; P = 0.5). Meanextent score was not significantly different between IRA(19.8 ± 5%) and non-IRA (22 ± 10%); P = 0.10.Conclusion: In STEMI, the VP often involves a high-gradeangiographic stenosis. Angiographic plaque ulceration isa highly specific sign for VP and may assist in VP detection.

doi:10.1016/j.hlc.2007.06.310

readmissions. Between 1999 and 2005, hospitalisation forAMI increased by almost 50% from 7294 to 10738 whileangina admissions fell by one-third from 15821 to 10201.Conclusion: This study has demonstrated that afteradjusting for inter-hospital transfers and excluding read-missions, New Zealand age standardised hospitalisationrates for first CHD events have been declining since 2000.Recent apparent increases in admissions for AMI areprimarily due to increases in readmissions, changes indiagnostic criteria and increases in inter-hospital trans-fers. These findings suggest that the incidence of non-fatalCHD is declining in parallel with the well-documenteddecline in fatal CHD.

doi:10.1016/j.hlc.2007.06.309

305Angiographic Characterisation of Vulnerable Plaques inST Elevation Myocardial Infarction Treated with Throm-bolysis

C. Chawantanpipat ∗, T. Gattorna, M.K.C. Ng

Royal Prince Alfred Hospital, Missenden Rd, Sydney, NewSouth Wales, Australia

Background: Detection of coronary artery lesions whichare at risk of rupture (i.e. vulnerable plaques (VP)) remainselusive. Previous angiographic studies of VPs have beenlimited by heterogeneity in acute coronary syndromedefinitions. We therefore sought to angiographically char-acterise VPs and extent of atherosclerosis in a patientpopulation unequivocally manifesting plaque rupture:

306The ACACIA Registry—Frequency of In-Hospital Com-plications and Their Association with 6-Month MortalityAfter Acute Coronary Syndromes (ACS)

John Amerena 1,2,3,4,5,∗, David Brieger 1,2,3,4,5,Steve Coverdale 1,2,3,4,5, Jamie Rankin 1,2,3,4,5,Luan T. Huynh 1,2,3,4,5, Carolyn M. Astley 1,2,3,4,5,Derek P. Chew 1,2,3,4,5

1 Geelong Hospital, Australia; 2 Concord Hospital, Australia;3 Nambour Hospital, Australia; 4 Royal Perth Hospital, Aus-tralia; 5 Flinders University/Flinders Medical Centre, Australia

Background: Complications after ACS are not uncommonand are associated with worse outcomes. We sought toidentify the frequency of complications and their asso-ciation with 6-month mortality in a cohort of Australianpatients with ACS.Methods: The ACACIA registry, (PM L 0051) is a prospec-tive, nation-wide multi-centre registry of 3402 consecutivepatients with high/intermediate risk ACS. Data includesdemographic factors, clinical risk stratification, in-hospitalmanagement and clinical events at 6 and 12 months. Forthis analysis the frequency of in-hospital complicationsis reported and their association with 6-month mortalityevaluated by logistic regressionResults: 15.7% (495/3262) of patients with assessable datahad a new in-hospital event – this was associated with a5.3-fold odds ratio for 6-month mortality and accountedfor 26% of the mortality seen. The frequency, odds ratio(ORD6m) and attributable risk (AR%) of events are listedbelow: bold: p < 0.05