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S184 Abstracts Heart, Lung and Circulation2008;17S:S1–S209

of ≤90 min. The goal of this audit was to evaluate sourcesof delay for STEMI patients at Austin Health and to imple-ment processes to improve the DBT.Method: An analysis was performed on 138 consecutiveSTEMI patients that presented to the Emergency Depart-ment (ED) at Austin Health over a 13-month period.Demographic and time specific data was collected andrecorded. Inter-hospital and inter-departmental STEMIcases were excluded.Results: Age was 63 ± 12 years with 23% female. The DBTwas 116 ± 53.64 min (mean ± S.D.). A DBT of ≤90 min wasachieved in 33% and ≤60 min in 10%. The primary sourcesof delay were time taken from ECG to contacting Cardiol-ogy (mean 23 min), and the time taken for transfer to thecatheterisation laboratory (mean 12 min).Conclusion: These data indicate that improvements arerequired to facilitate rapid access to the catheterisationlaboratory for STEMI patients. A working party has beenestablished to design and implement a process that willreduce delays and streamline the pathway. An audit pro-cess will continue throughout this time to capture changesin DBT.

doi:10.1016/j.hlc.2008.05.436

436Do Patients Transferred for Primary Angioplasty from aPeripheral Hospital Get Similar Benefits as their Local

Patients transferred for primary angioplasty from aperipheral hospital had similar in hospital and mediumterm prognosis compared to local patients. The trendtowards higher stent thrombosis rate in transferredpatients requires further evaluation.

doi:10.1016/j.hlc.2008.05.437

437Predictors and Outcome of Stent Thrombosis in “Real-World” Patients in Australia

Ahmad Farshid ∗, Charles T. Itty, David Coles, Ian Jeffery,Darryl McGill, Simon O’Connor, Ren Tan

The Canberra Hospital, Canberra, ACT, Australia

Stent thrombosis rates have been found to be higherin clinical practice compared with trial data. There arenot many reports about stent thrombosis in real-worldpatients in Australia. We studied retrospectively theincidence, determinants and clinical outcomes of stentthrombosis in patients who underwent PCI at The Can-berra Hospital from January 2004 to December 2007.We treated 2413 patients (3181 lesions) (mean age 61.7years; 72% males) during the study period. Stent throm-bosis developed in 36 patients (incidence rate 1.49%): 24early (0–30 days), 11 late (31–360 days) and 1 very late (>360days). Stent thrombosis was similar in diabetic and non-

Counterparts?

Charles T. Itty ∗, Ahmad Farshid, David Coles, Ian Jeffery,Darryl McGill, Simon O’Connor, Ren Tan

The Canberra Hospital, Canberra, ACT, Australia

Rapid transfer of patients with acute STEMI for primaryangioplasty provides better prognosis than on site throm-bolysis. However it is not clear whether these patients getsimilar benefits as their local counterparts. We report aretrospective analysis of primary angioplasty performedat The Canberra Hospital from January 2004 to December2007 comparing outcomes in local vs. transferred patients.We treated 522 patients during the study period, 208patients were transferred from other hospitals while314 presented directly to us. Transferred patients wereyounger (mean age 63.3 years vs. 65.4 years, p = 0.03), andmore likely to be smokers (37% vs. 26%, p = 0.009).The door to balloon time was significantly shorter in thelocal group (median 81 vs. 134 min; p = <0.001). The mediantransfer time was 95 min.Procedural success rates (96.6% in local vs. 97.3% in trans-ferred patients; p = ns) and in hospital mortality rates(2.87% in local vs. 4.6% in transferred; p = ns) were similarin both groups.At 6 months follow up there were no significant differencesin mortality (6.7% in local vs. 6.7% in transferred group;p = ns), repeat revascularization (3.7% vs. 5.8%; p = ns),clinical restenosis (5.0% vs. 5.4%; p = ns) and overall MACE(14.1% vs. 17%; p = ns) between the two groups. There wasa trend towards higher stent thrombosis in transferredpatients (2.3% in local vs. 4.9% in transfers, p = 0.11).

diabetic patients. There was a trend towards more stentthrombosis in smokers than non-smokers (36% vs. 24%p = 0.053).Stent thrombosis was significantly higher in those whounderwent primary PCI (3.3% vs. 1.0%, p = 0.0006), inlesions with initial TIMI 0 flow (3.17% vs. 1.45%, p = 0.0111)and in those who had elevated Troponin levels (1.9% vs.0.85%, p = 0.043) and peak CK levels >1000 units (5.6% vs.1%, p = 0.0002).There was a non-significant trend towards increased stentthrombosis with use of multiple stents. Stent thrombosisrates were similar between drug eluting and bare metalstents (2.2% vs. 1.6%, p = ns). Mortality rate was signifi-cantly higher in patients with stent thrombosis (16.7% vs.3.2%, p = 0.0012) at 6 months follow up.The incidence of stent thrombosis in the present study wassimilar to other reported real-world data. Significant riskfactors for stent thrombosis were primary PTCA, initialTIMI 0 flow, elevated troponin level and peak CK level>1000 units.

doi:10.1016/j.hlc.2008.05.438

438Referral Demand for Amplatzer PFO Closure Dramati-cally Increases!

Natalie Kelly ∗, Lisa Hourigan, Darren Walters, DarrylBurstow, Gregory Scalia

The Prince Charles Hospital, Chermside, Queensland, Australia

Background: Percutaneous Amplatzer device occlusion isnow a routine treatment for the haemodyamically signif-

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icant atrial septal defect (ASD), ventricular septal defect(VSD) and patent forman ovale (PFO). When performedin experienced and specialised centres there are excellentshort and long-term results, low complication rates andshorter hospital stays when compared to surgical inter-ventions. We report the trends observed in our institutionover an 8-year period.Methods: Data was retrospectively reviewed from the car-diac catheterization laboratory database at The PrinceCharles Hospital. Information was prospectively recordedon patient and procedural characteristics.Results: A total of 255 percutaneous device closures weresuccessfully deployed over an 8-year period (164 females,42 ± 21 years). This included 196 (76%) secundum ASD(130 females, 33 ± 22 years), 48 (18%) PFO (27 females,43 ± 14 years) and 11(4%) VSD (7 females, 51 ± 19 years)devices. PFO and VSD devices were first implanted at ourinstitution in 2003. The number of ASDs increased overthe first 5 years and remained stable from 2003. The num-ber of VSD cases remained small—3% (2003) to 7% (2007).In contrast, referrals for PFO closure for secondary strokeprevention, scuba diving and more recently, migraine con-trol continue to increase significantly (p < 0.01). Over a5-year period the PFO cases have increased from 7% (2003)to 38% (2007).Conclusion: The number of percutaneous PFO deviceclosures performed makes up a small but increasingphs

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formed at Monash Medical Centre and Royal AdelaideHospital. We report the procedural success and medium-term outcome.Method: Stenting was performed under general anaes-thetic using a percutaneous right femoral artery approachrequiring 14F sheath access. Arterial haemostasis wasachieved post catheterization by using a preclosure tech-nique with a 10F Prostar XL10 closure device. All patientshad implantation of Cheatham Platinum stents deliv-ered over a 0.035′′ Amplatz extra-stiff guidewire using aBalloon-in-Balloon implantation catheter.Results: Of the four patients (age 42 ± 17 years, all male),three had native and one had recurrent coarctation afterprevious childhood surgery. Stenting resulted in an imme-diate significant reduction in pressure gradient (50 ± 24to 2 ± 5mmHg; P = 0.02) and the coarctation site: descend-ing aorta diameter ratio increased from 0.22 ± 0.12 to0.87 ± 0.20. The only vascular complication was a minorbrachial artery dissection in 1 patient. Median patientlength of stay was 2.5 days (range: 2–6 days). During clinicalfollow-up of 19 ± 6 months, patient blood pressures haveimproved (systolic: 155 ± 17 to 128 ± 16 mmHg, (P = 0.04);diastolic: 91 ± 9 to 81 ± 10 mmHg, P = 0.02). One patientwith cardiac failure (EF 30%) had resolution of symptomsand normalisation of ejection fraction. No aneurysm for-mation, dissection or increase in flow-velocity has beendetected at the stented site with detailed imaging.Chss

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roportion of closures performed, while the number ofaemodynamically significant ASD closure remains con-tant.

oi:10.1016/j.hlc.2008.05.439

39tent Treatment for Coarctation of the Aorta in Adults:rocedural Success and Medium-term Outcome

ichael Leung 1,∗, Claudio La Posta 1, Stephen Worthley 1,atrick Disney 1, Ian Meredith 2, Geoff Lane 3

Royal Adelaide Hospital and Adelaide University, Adelaide,outh Australia, Australia; 2 Monash Medical Centre andonash University, Clayton, Victoria, Australia; 3 Royal Chil-

ren’s Hospital, Melbourne, Victoria, Australia

ntroduction: Aortic coarctation stenting has emerged asn alternative treatment to surgery. From 2005 to 2006, fouratients with aortic coarctation had stent placement per-

onclusions: In this cohort, aortic coarctation stenting hadigh procedural success and safety with short hospitaltay. The medium-term outcome appears equivalent tourgical repair.

oi:10.1016/j.hlc.2008.05.440

40Multi-centre Study of the Impact of Delayed STEMI

iagnosis in Emergency Departments on Door to Balloonimes

ernadette Hoffmann ∗, Wai Chan, Aaron Sverdlov,athryn Hines, Sharon Taylor, Margaret Arstall, Christo-her Zeitz

Lyell McEwin Hospital, Elizabeth Vale, Australia

ercutaneous coronary intervention (PCI) is the preferredtrategy for treating ST elevation myocardial infarctionSTEMI) but must be delivered in a timely fashion toe superior to fibrinolysis. Published strategies to reduceoor to balloon (DB) times have focused on processes toapidly activate the catheterization laboratory (CL) team.

e service STEMI patients at two sites (A and B). Dataver 27 months are presented.