AB

ST

RA

CT

S

S164 Abstracts Heart, Lung and Circulation2008;17S:S1–S209

patient underwent Left Main bifurcation stenting as a semielective procedure. One unstable patient died during theemergency procedure.Five of these patients had multiple vessel stenting in thesame procedure. Nine patients survived the procedureand were discharged after stabilizing. There was no MACEin 30-day follow-up. Five of these patients have had pro-tocol follow-up angiograms. One showed restenosis andrequired repeat PCI. All patients were doing well at a meanfollow-up of 10 ± 4 months.Conclusions: Unprotected Left Main stenting in anemergent situation can be life saving. It can also beuseful when surgeons refuse the case for co-existingmorbidities.Reduce costs and the risk of late stent thrombosis.

doi:10.1016/j.hlc.2008.05.389

389Primary Percutaneous Coronary Interventions WithoutOn-site Cardiac Surgery: Two Years’ Observational Expe-rience and Follow-up

Akshay Mishra 1,∗, Ravinder Batra 2, Rohan Jayasinghe 2,Sharmalar Rajendran 2, Naylin Bissesor 2, John Sedgwick 1

1 The Prince Charles Hospital, Brisbane, QLD, Australia; 2 TheGold Coast Hospital, Gold Coast, QLD, Australia

390Outcomes with Targeted Use of Drug Eluting Stents inPatients with Acute ST Elevation Myocardial Infarction(STEMI)

Calvin Hsieh ∗, Harshini Sivaramakrishnan, ArunNarayan, Norman Sadick, Andrew Ong, Pramesh Kovoor

Westmead Hospital, NSW, Australia

Introduction: Given the cost differential of drug elut-ing stents (DES) compared to bare metal stents (BMS),we assessed the outcomes of selective use of DES inSTEMI patients with high risk of in-stent restenosis(ISR).Methods and results: 787 consecutive patients with acuteSTEMI over a 41-month period were recruited andprospectively followed up for a mean of 12 ± 9 months.All had a stent implanted, BMS = 433 (55%) and DES = 354(55%). Criteria for DES selection were target vessel≤2.5 mm diameter in non-diabetics, target vessel ≤3.0 mmin diabetics, target vessel lesion length >18 mm, ISR,saphenous vein graft lesions, ostial lesions, bifurcationlesion, left main coronary artery lesions, and multi-vesseldisease. The Kaplan Meier survival estimates at 24 monthswere 91% and 93% for the BMS and DES groups respec-tively (p = 0.637). Using ARC classification there were 4/433(0.9%) and 12/354 (3.4%) definite, 3/433 (0.7%) and 1/354probable, 5/433 (1.2%) and 0/354 possible, episodes of

Background: The drive to achieve rapid revascularizationin STEMI patients has led to many centres using PrimaryPCI without having the option of backup surgery. Our cen-tre is located 75 km from the nearest hospital with on-sitecardiac surgery.Objectives: We studied the safety and efficacy of perform-ing round the clock acute infarct percutaneous coronaryinterventions at a hospital without cardiac surgical facility.Methods: A total of 115 patients presented with acuteinfarct in our hospital in the period between October2005 till November 2007. Periodically newer and morerigorous protocols were implemented to reduce our door-to-balloon times.Results: The procedure was successful in 112 patientsachieving TIMI III flow in the culprit vessel. We achieveda mean Door to Balloon time of 89.6 min. The culprit ves-sel was the RCA/PDA in 50 patients, LAD/Diagonal in 54,LCX/OM/Intermediate in 11, Diagonal in 3.These patients were followed up for procedural in hospital,30 days and follow-up MACE. One patient died on thetable (he was 92 years). Two more died within 30 days oneof whom had a VSD. One patient died at 9 months froma reinfarction at home. There was reinfarction in anotherpatient due to instent restenosis. Eight patients were lost tofollow-up. The others were doing well at a mean follow-upof 6 ± 4 months.Conclusions: Acute infarct percutaneous coronary inter-ventions can be performed with safety and efficacy at ahospital without cardiac surgical capability with similarresults as a centre with surgical facilities.

doi:10.1016/j.hlc.2008.05.390

stent thrombosis in the BMS and DES groups respec-tively (p = 0.014). Of these 0/433 and 1/354 were acute, 7/433(1.6%) and 3/354 (0.8%) were subacute, 2/433 (0.5%) and8/254 (3.1%) were late, and 3/433 and 1/354 were very late(p = 0.101). The rate of clinically driven TLR for ISR was17/433 (3.0%) and 2/354 (0.6%) during the follow-up period(p = 0.002).Conclusions: Selective use of DES significantly decreasesthe rate of clinically driven TVR for ISR in STEMI patients.There was a slightly higher rate of stent thrombosis withDES compared to BMS using this protocol.

doi:10.1016/j.hlc.2008.05.391

391ST-Elevation Myocardial Infarction: Strategies to Ensurethat all Patients Receive Prompt Percutaneous CoronaryIntervention

Wai Ping Alicia Chan 1,∗, Aaron Sverdlov 1, BernadetteHoffman 2, Kathryn Hines 2, Christopher Zeitz 1

1 The Queen Elizabeth Hospital, Adelaide, SA, Australia; 2 LyellMcEwin Health Service, Adelaide, SA, Australia

Percutaneous coronary intervention (PCI) is the preferredstrategy for acute management of ST elevation myocar-dial infarction (STEMI), provided it can be delivered ina timely fashion by experienced operators. The targetdoor to balloon interval of 90 min is seldom achieved inpractice. Reported times focus on median values with asubstantial cohort of patients having delays >2 h. We re-designed our PCI management of STEMI to aim for atarget of 90% of balloon inflations within 90 min. Phase 1