Total Ischemic Time Research Articles

Commercial Airlines as a Viable, Safe and Cost Effective Way for Transporting the Donor Hearts across the Country: Single Center Experience

Purpose Worldwide private chartered jets are used to transport the donor heart. The main limitations in using private jets are costs incurred and safety. Commercial airlines can be a cost saving and safer alternative. We at our center transported the donor heart from other cities using both commercial and private jets. The purpose of this study is to evaluate the feasibility, cost effectiveness and safety of transporting the donor heart by commercial airlines; we have also compared the outcomes between both the groups. Methods Single center retrospective analytical study; study period March 2014 to September 2018. Cases in which the donor heart was airlifted from another city are included. Depending upon the modality used they are divided into two study groups, Group A- Commercial airline, Group B- Private jet. The following data is collected and compared, distance of the donor city from our center, cold ischemic time spent on organ transport, overall ischemic timings, events during the transport (delay, cancellations, safety issues, organ wastage), cost incurred and recipient outcomes. Results A total of 116 donor hearts have been transported by air during this study period, 74 by commercial airlines and 42 by private jet. The distance range is comparable between the groups: Group A (350 to 1350 kilometers) Group B (140 to 1540 kilometers). The ischemic time by the time the heart reached the recipient hospital for both the groups is as follows, Group A (135 to 285 minutes) Group B (90 to 302 minutes). The mean total ischemic time is 235 minutes for Group A and 242 minutes for Group B. The cost for the organ transport is as follows; Group A (US $ 120 to 3400: median - 1375) Group B (US $ 6850 to 27350: median - 13655). There were no unexpected delays, cancellations, safety issues during the transport by both the commercial airlines and private jet. No donor organ had to be discarded because of the issues due to the transport (commercial airlines or private jet). None of the patients in either of the groups had graft dysfunction requiring mechanical circulatory support. Conclusion Transporting the heart by commercial airlines is feasible and safe. The cost incurred in the transport by commercial airlines is around 10% in comparison with private jet. Well planned organ transport by commercial airlines is a reasonable alternative under appropriate circumstances.

In Vivo Resuscitation, Perfusion and Transplantation of a Porcine Cardiac Allograft Donated after Cardiac Death

Purpose The lack of hearts available for transplant remains a major concern. Recent strategies including ex-vivo technology and DCD organs have been utilized to expand donor pool. Methods Each experiment was utilizing a donor and a recipient animal. The recipient was put on HLM and a 10 ml hemoshield graft was anastomosed end to side to recipient ascending aorta. Hearts were harvested from donor animals simulating DCD conditions. The distal end of PTFE graft was anastomosed to donor heart aorta end to side (Figure 2). In animals with acceptable donor heart function, the recipient aorta was clamped and heart was retrieved, next donor heart was anastomosed to recipient while being perfused with blood using the graft. In cases the donor heart did not achieve 4 chamber activity, it was separated from the hemoshield graft, which was further used as outflow graft for LVAD (HVAD heartware) implantation. Results pigs (n=8) were treated: 2 animals received LVAD implantation (G1) and 6 animals underwent successful cardiac transplantation (G2). Mean MAP G1 (70mmHG) GII (63.2mmHG) was during the whole procedure. Mean Warm Ischemia Time G1 (10 min) GII (9 min). Mean Cold Ischemia Time G1 (16 min) G2 (18 min). Mean Total Ischemia Time G1 (32 min) G2 (27 min). Mean Resuscitation Time G1 (77 min) G2 (8 min). Mean Transplant Time G1 (NA) G2 (176 min). Random lactate measurements ins some animals showed lactate consumption comparing arterial blood to the coronary sinus blood. Animals could be weaned to 1-1.5 liters of flow or less. Animals were sacrified at the end of the procedure. Conclusion We showed the feasibility of DCD heart transplantation. LVAD implantation allows for bridging of the patient in case DCD heart quality was not good. The recipient would have been a LVAD to heart transplantation bridge candidate anyhow. Based on this series of experiments, adaption of this protocol appears clinical feasible, and could significantly expand the donor pool.

TIME TO THINK BEYOND DOOR TO BALLOON TIME: SIGNIFICANCE OF TOTAL ISCHEMIC TIME IN PATIENTS WITH ST ELEVATION MYOCARDIAL INFARCTION

Door to balloon (DTB) time is a well established determinant of in-hospital outcome and long-term morbidity and mortality in the ST Elevation Myocardial Infarction (STEMI), however, significance of total ischemic time (TIT) is debatable. Therefore, aim of this study was to evaluate the association

Impact of distance between donor and recipient hospitals on cadaveric kidney transplantation outcomes.

The impact of distance between donor and recipient hospitals on outcomes in cadaveric kidney transplantations is unknown. We investigated the association between inter-hospital distance and outcomes in cadaveric kidney transplantations in Japan. We retrospectively analyzed 363 cadaveric kidney transplantations between 2002 and 2017 in Japan. Inter-hospital distance, graft transport time, total ischemic time (TIT), and graft survival were compared between our hospital and national transplantation cohort in Japan. Estimated glomerular filtration rate (eGFR) 1month and 1year after transplantation was compared between cadaveric and living-donor kidney transplantations in our hospitals. Additionally, inter-hospital distances among the seven geographical regions in Japan were assessed. There were 12 and 351 cadaveric kidney transplantations at our hospital and in Japan, respectively. Mean inter-hospital distance at our hospital (217 ± 121km) was significantly longer than that of the national cohort (53 ± 80km; P < 0.001). Mean TIT and graft survival for our hospital and national cohort were 539 ± 200min and 91% and 491 ± 193min and 81%, respectively. Mean eGFRs 1 year after cadaveric and living-donor transplantations at our hospitals were comparable (47 ± 16 vs. 47 ± 15mL/min/1.73m2). The comparison among seven regions in Japan indicated a regional difference in inter-hospital distance with an association between area (km2) and inter-hospital distance (km). Despite the longer inter-hospital distance at our hospital, TIT and transplant outcomes were acceptable in our cases. In addition, geographical inequity in graft allocation in Japan was suggested.

Very late presentation in ST elevation myocardial infarction: Predictors and long-term mortality

BackgroundDespite improvements in ST elevation myocardial infarction (STEMI) care, total ischemic time remains long in patients who present late. Our goal was to identify predictors of very late presentation (≥12 h) of STEMI and determine long-term mortality. MethodsWe retrospectively examined consecutive patients admitted with STEMI to our institution using the ACTION Registry™. Time of symptom onset to first medical contact (FMC) was calculated and categorized as <12 h or ≥12 h. Predictors of very late presentation were determined. ResultsCompared to patients who presented <12 h (n = 365), those who presented ≥12 h (n = 49) after symptom onset were more likely women, diabetics, and those with prior coronary revascularization. In addition, patients who presented ≥12 h had worse ventricular function, were less likely to report chest pain, and were less likely to be transported by ambulance and to undergo coronary angiography. Late presenters had higher rates of heart failure, longer hospitalizations, and were less likely to be discharged home. Diabetes, female sex, and absence of chest pain were strong predictors of late presentation. Long-term survival was significantly lower in late presenters (73% vs. 93%, p = 0.007). ConclusionsFemale sex, diabetes, and absence of chest pain are strong predictors of presentation delay, and long-term mortality is significantly increased in those presenting very late.

Impact of Time Delay on Short Term Outcome of Primary Percutaneous Coronary Intervention (PCI) in Bangladeshi Population

Background: Now-a-days primary percutaneous coronary intervention (pPCI) is being increasingly done in our country as the treatment of acute ST elevation myocardial infarction (STEMI). Time until treatment is paramount in the management of STEMI. But the time delay to pPCI how much influencing the outcome in our setting is mostly unknown.So we evaluated the influence of total ischemic time on myocardial reperfusion and short term clinical outcome in patients with STEMI treated with primary PCI.&#x0D; Materials and methods: This prospective observational study was conducted from August 2016 to March 2017in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka. Forty-eight (48) acute STEMI patients were selected by purposive sampling based on inclusion and exclusion criteria dividing into two groups as early treatment group (group-A) in whom pain to pPCI time was &lt;6 hours and late treatment group (group-B) in whom pain to pPCI time was 6-12 hours. Angiographic (TIMI flow grade 3 &amp; MBG 3) &amp; short term clinical outcome (MACE, heart failure, major bleeding, minor bleeding, cardiogenic shock, significant arrhythmia, instent thrombosis) were observed and compared between these two groups.&#x0D; Results: The relationship between total ischemic time and 30-day mortality &amp; morbidity were assessed and compared with early and late pPCI group. The overall 30-day mortality rate was 4.2%, heart failure was 6.2%, cardiogenic shock was 4.2%, major bleeding was 2.1% and minor bleeding was 14.6%. Mortality and morbidity were higher in longer ischemic time group than shorter ischemic time group. In multivariate regression analysis, the factors independently influencing the adverse short term outcome were advance age (OR 1.51, 95% CI 1.105 to 4.101, p=0.03), hypertension (OR 2.44, 95% CI 1.102 to 4.281, p=0.02), diabetes mellitus (OR 2.51, 95% CI 1.200 to 4.987, p=0.02), anterior MI (OR 1.38, 95% CI 1.001 to 2.872, p=0.03), multivessel disease (OR 2.35, 95% CI 1.010 to 5.371, p=0.02), pain to door time (OR 1.66, CI 1.099 to 2.2.722, p=0.04), and total ischemic time (OR 2.67, 95% CI 1.122 to 5.784, p=0.02). Even after correction for predictive baseline and procedural variables of the univariate analysis, longer total ischemic time was the most significant independent predictor (OR 2.67, p=0.02) of short term adverse outcome of primary PCI. The current status of time delay in our country revealed symptom onset to door time was 5.6±2.4 hours, door to balloon time was 1.9±1.1 hours and total ischemic time was 7.3±2.6 hours.&#x0D; Conclusion: According to this study finding, there is prognostic implication of time delay in patients with STEMI undergoing primary PCI. Therefore, all efforts should be made to shorten total ischemic time, including reduction in patient related delays, to improve clinical outcome of STEMI patients.&#x0D; University Heart Journal Vol. 14, No. 2, Jul 2018; 77-82

Metabolomic fingerprint of coronary blood in STEMI patients depends on the ischemic time and inflammatory state

In this study we investigated whether the metabolomic analysis could identify a specific fingerprint of coronary blood collected during primary PCI in STEMI patients. Fifteen samples was subjected to metabolomic analysis. Subsequently, the study population was divided into two groups according to the peripheral blood neutrophil-to-lymphocyte ratio (NLR), a marker of the systemic inflammatory response. Regression analysis was then applied separately to the two NLR groups. A partial least square (PLS) regression identified the most significant involved metabolites and the PLS-class analysis revealed a significant correlation between the metabolic profile and the total ischemic time only in patients with an NLR > 5.77.

Excellent long-term outcome with lungs obtained from uncontrolled donation after circulatory death.

We aimed to propose a simple and effective preservation method in lungs procured for transplantation from uncontrolled donation after circulatory death (uDCD) associated with excellent long-term results. Outcome measures for lung recipients were survival and primary graft dysfunction (PGD) grade 3. Survival was estimated using the Kaplan-Meier method. A total of 9 lung uDCDs were evaluated and 8 lung transplants were performed. Mean no-flow time was 9.8minutes (standard deviation [SD] 8.6). Mean time from cardiac arrest to topical cooling was 96.8minutes (SD 16.8). Preservation time was 159minutes (SD 31). Ex vivo lung perfusion was used to assess lung function prior to transplantation in 2 cases. Mean recipient age was 60.8years (SD 3.1), and mean total ischemic time was 678minutes (SD 132). PGD grade 3 was observed in 2 cases (25%). The 1-month, 1-year, and 5-year survival rates were 100%, 87.5%, and 87.5%, respectively. Mean follow-up was 52months. The logistic complexity of procuring lungs from uDCDs for transplantation requires the development of new strategies designed to facilitate this type of donation. A program based on strict selection criteria, using a simple and effective preservation technique, may recover lung grafts with excellent long-term posttransplant outcomes.

Annual Trends in Total Ischemic Time and One-Year Fatalities: The Paradox of STEMI Network Performance Assessment.

This study is aimed at assessing trends and relations between total ischemic time, the major quality measure of systemic delay, and case-fatality at the population or patient level in response to growing cardiovascular risk and a constant need to shorten the time to treatment in ST-segment elevation myocardial infarction (STEMI). Data from a prospective nationwide registry of STEMI patients admitted between 2006 and 2013 who were treated with primary percutaneous coronary intervention (PCI) were analyzed. Total ischemic time was calculated as the time from the onset of symptoms to primary PCI and was determined as individual and annual. The primary end-point was one-year, all-cause case-fatality. Among the total 70,093 analyzed patients, temporal trends showed significant decrease in total ischemic time (268 vs. 230 minutes, p < 0.001), a worsening of the risk profile and an increase in one-year case-fatality (7.1% vs. 10.8%, p < 0.001). In the multivariate analysis, longer individual total ischemic time was a risk factor for higher mortality (HR 1.024, 95%CI 1.015–1.034, p < 0.001) and remained significant after adjustment for the year of admission. An inverse relation was observed for the median annual time (HR 0.992, 95%CI 0.989–0.994, p < 0.001). Thus, the observed increasing annual trends in case-fatality cannot directly measure the quality of STEMI network performance.

Successful primary percutaneous coronary intervention determines the very long-term prognosis in ST-segment elevation myocardial infarction even in survivors of the acute phase. The ANIN Myocardial Infarction Registry.

IntroductionSuccessful primary percutaneous coronary intervention (pPCI) saves lives in the acute phase of ST-elevation myocardial infarction (STEMI) and improves the mid-term prognosis. Whether that benefit remains significant in very long-term follow-up and is associated with total ischaemic time (TIT), especially in survivors of the acute phase of STEMI, is unknown.AimWe sought to investigate the impact of initial and final thrombolysis in myocardial infarction (TIMI) flow on long-term survival in a homogeneous, unselected group of patients with STEMI undergoing pPCI at a high-volume centre.Material and methodsAll consecutive STEMI patients treated with pPCI in our tertiary centre were enrolled in the ANIN Myocardial Infarction Registry.ResultsAmong 1064 patients 871 (82%) had an occluded infarct artery (IRA) at baseline, while pPCI was successful in 885 (83%) patients. At 9 years all-cause and cardiovascular (CV) mortality were 28% (294 patients) and 19% (196 patients), respectively. Failure of pPCI was an independent predictor of long-term all-cause and CV mortality (OR = 1.5, 95% CI: 1.1–2.0, p = 0.03 and OR = 1.8, 95% CI: 1.3–2.7, p = 0.001, respectively). In survivors of the acute phase, occluded IRA at baseline was an independent predictor of all-cause mortality (OR = 1.5, 95% CI: 1.0–2.3, p = 0.04), while pPCI failure predicted CV mortality (OR = 1.8, 95% CI: 1.2–2.8, p = 0.005). Mortality rate increased with TIT even in patients with pPCI success.ConclusionsAngiographic results of pPCI determine the very long-term survival of STEMI patients, even in survivors of the acute phase of STEMI. Shortening of TIT is crucial.

Analysis of pre-hospital delay time of patients with myocardial infarction

The authors examined the pre-hospital delay of patients with ST-elevation myocardial infarction receiving percutaneous coronary revascularization. In the Hungarian Myocardial Infarction Registry (HUMIR), between January 1, 2014 and March 31, 2016, 7146 patients were found who had all necessary time intervals available. In the database of the National Ambulance Service (OMSZ), 3288 patients were found who had the necessary time intervals. The following time intervals were investigated: the time from the beginning of the complaint to the rescue service notification (patient delay time = PDT), the time of the rescue service to arrive at the scene (R1), the on-site care time (R2) and the time from the scene until arriving to the centre (R3). The case of care at the centre, we investigated the time from the onset of symptoms until the balloon inflation (SBI). If the first hospital had no cardiac catheterization laboratory, we measured the transfer time to the cath centre. The methodological details related to the operation of the HUMIR had been described in our earlier communication. Rescue times (R1, R2, R3) were investigated on the basis of the paper-based records of the National Emergency Service. The patients were divided into two groups based on the fact that the first admission hospital is a centre with a heart catheter facility (C) or a non-invasive hospital (H). 2621 patients (79.7%) were admitted to a hospital with cath lab (C) and 667 patients with secondary transport. Patients with primary transport to C were younger, but for other data, the two groups did not differ. The median of PDT for patients in group C was 114, and 121 minutes for patients in group H. There was no significant difference between R1 and R2 time between the two groups. R3 time in group C was longer than for H patients. In the case of secondary transport, the median time was 98 minutes until the centre. The median time from the beginning of the complaint to the balloon inflation (total ischemic time) was 260 minutes in group C and 356 minutes in group H. Based on the analysis of the total ischemic time and the pre-hospital delay, it is clear that the care of myocardial infarction patients can be further improved by reducing the patient's decision time and increasing the proportion of primary transport. Rescue times (R1, R2, R3) met the expectations, however, further analysis of the M2 time should be considered. Orv Hetil. 2019; 160(1): 20-25.

The Current Status of Percutaneous Coronary Intervention in Korea: Based on Year 2014 & 2016 Cohort of Korean Percutaneous Coronary Intervention (K-PCI) Registry.

Background and objectivesIn this second report from Korean percutaneous coronary intervention (K-PCI) registry, we sought to describe the updated information of PCI practices and Korean practice pattern of PCI (KP3).MethodsIn addition to K-PCI registry of 2014, new cohort of 2016 from 92 participating centers was appended. Demographic and procedural information, as well as in-hospital outcomes, of PCI was collected using a web-based reporting system. KP3 class C was defined as any strategy with less evidence from randomized trials and more aggressive for PCI than medical therapy or bypass-surgery.ResultsIn 2016, total 48,823 PCI procedures were performed at 92 participating centers. Mean age of the patients was 65.7±11.6 years, and 71.7% were males. Overall patient characteristics and PCI practices in 2016 were similar to those in 2014. The biggest change was the decrease in the in-hospital occurrence of myocardial infarction (MI;1.6%→0.7%, p<0.001). Many associations between PCI volumes and demographic/procedural characteristics observed in 2014 have disappeared. The median of door-to-balloon time was 62 minutes, and 83.3% of ST-elevation MI patients received primary PCI within 90 minutes, while the median of total ischemic time was 168 minutes and patients who had total ischemic time within 120 and 180 minutes were 29.1% and 54.1%, respectively. The proportion of KP3 class C cases in non-acute coronary syndrome patients decreased from 13.5% in 2014 to 12.1% in 2016 (p<0.001).ConclusionsIn this second report from K-PCI registry, we described the current practices of PCI and changes from 2014 to 2016 in Korea.

Efficacy of on-pump versus off-pump coronary artery bypass grafting in early-stage renal impairment without dialysis therapy

Background Coronary artery disease is the most common of the cardiovascular diseases that can be treated with coronary artery bypass grafting (CABG) surgery, with either on-pump or off-pump technique. In this study, we aimed to compare the early results of isolated CABG, using on-pump and off-pump techniques, in patients with preoperative mild-to-moderate elevation of serum creatinine (1.6–2.5 mg/dl) level who did not require maintenance dialysis to support renal function. Patients and methods This prospective nonrandomized study included 60 patients who complained of symptoms of coronary artery disease and subsequently underwent myocardial revascularization at Cardiothoracic Surgery Department, Shebin El-Kom Teaching Hospital, Menoufia, Egypt, between June 2017 and August 2018. Results In group A (the on-pump group), the mean age was 73.40 ± 6.38 years, whereas in group B (the off-pump group), the mean age was 72.87 ± 9.62 years. The mean of total pump time was 112.40 ± 37.80 min and the mean of total ischemic time was 67.50 ± 24.18 min Regarding the operation time, the mean of on-pump CABG operation time was 234.60 ± 57.54 min, and 273.77 ± 43.07 min for the off-pump CABG operation, with statistically significant difference (P = 0.004). The mean time of ICU stay was 4.66 ± 3.36 days in the on-pump CABG and 3.70 ± 2.15 days in the off-pump CABG group, with no statistically significant difference between the two groups (P = 0.191). Conclusion Regarding postoperative renal dysfunction and need for dialysis, results were in favor of the off-pump technique. Renal function is better preserved in patients undergoing off-pump CABG than those undergoing on-pump CABG.

Predictors of Short Term Outcomes of Primary Percutaneous Coronary Intervention

Background: Acute myocardial infarction (AMI) is one of the leading causes of death and disability all over the world. Primary percutaneous coronary intervention (PCI) is the treatment of choice for patients with acute ST segment elevation myocardial infarction (STEMI). Primary PCI is being increasingly done in our country also. But the factor influencing the outcome of primary PCI in our setting are mostly unknown. The present study was conducted to investigate factors that influencing the short term outcomes of primary PCI.&#x0D; Materials and methods: This prospective observational study was conducted from September 2014 to January 2016in the Department of Cardiology, National Institute of Cardiovascular Diseases (NICVD), Dhaka. 48 patients were selected by purposive sampling. Patients with acute STEMI treated with primary PCI were included in the study based on inclusion and exclusion criteria. Effect of factors including advanced age, male sex, diabetes mellitus, hypertension, dyslipidemia, serum creatinine, left ventricular ejection fraction, anterior myocardial infarction (MI), thrombolysis in myocardial infarction (TIMI) flow, multi vessel disease, angiographic severity score (Leaman score), thrombus aspiration, door to balloon time and total ischemic time on major adverse cardiac events (MACE) i.e. death, post procedural MI, target vessel revascularization (TVR), stroke as well as, on other adverse events like heart failure, cardiogenic shock, major bleeding, significant arrhythmia and stent thrombosis were studied.&#x0D; Results: The overall incidence of MACE was 2.1%, major bleeding 2.1%, heart failure 4.2% and cardiogenic shock 2.1%. In multivariate analysis, the factors independently influencing the adverse short term outcomes (MACE and other adverse events) were diabetes mellitus (odds ratio (OR) 2.55, 95% confidence interval (CI) 1.180 to 4.124, p=0.02), anterior MI (OR 1.48, 95% CI 1.020 to 1.926, p=0.04), total ischaemic time (OR 1.49, 95% CI 1.044 to 2.444, p=0.04), multivessel coronary artery disease (OR 1.77, 95% CI 1.26 to 3.261, p=0.03) and Leaman score (OR 2.5, 95% CI 1.100-4.504, p=.03).&#x0D; Conclusion: According to our finding, diabetes mellitus, anterior myocardial infarction, total ischemic time, multivessel coronary artery disease and high Leaman score are predictors of adverse short term outcomes of primary PCI&#x0D; Bangladesh Heart Journal 2018; 33(2) : 112-120

Predictors and prognosis of no-reflow during primary percutaneous coronary intervention

The no-reflow phenomenon occurs in a considerable number of patients with ST elevation myocardial infarction (STEMI) undergoing primary reperfusion therapy. Our study aimed to identify clinical, angiographic, and procedural variables that predict this phenomenon in patients with STEMI undergoing primary percutaneous coronary intervention (PPCI), as well as determine the impact of no-reflow on in-hospital mortality. Prospective observational data from 410 patients with STEMI undergoing PPCI were obtained. In this study, diabetes mellitus, late presentation, higher Killip class at admission, anterior wall infarction, proximal site of occlusion, presence of high-grade thrombus, and left ventricular systolic dysfunction at admission were significantly associated with suboptimal coronary flow. Diabetes mellitus, a high thrombus burden, prolonged total ischemic time, and low left ventricular ejection fraction on admission were independent predictors of no-reflow. No-reflow during PPCI was associated with in-hospital mortality more than twice that for normal flow.

Impact of hybrid thoracoabdominal aortic repair on visceral and spinal cord perfusion: The new and improved SPIDER-graft

ObjectivesSPIDER-graft for thoracoabdominal aortic aneurysm repair avoiding thoracotomy and extracorporeal circulation was modified, enabling reimplantation of lumbar arteries to prevent spinal cord ischemia and compared with open aortic repair (control) in a pig model. MethodsGraft implantation was performed in 7 pigs per group (75-85 kg). For SPIDER-graft (groups I and II), the infra-diaphragmatic aorta was exposed through retroperitoneal access. The right iliac branch was first temporarily anastomosed end-to-side to the distal aorta maintaining periprocedural retrograde visceral perfusion. SPIDER-graft was deployed in the descending thoracic aorta via the celiac artery ostium. The celiac, superior mesenteric, and renal arteries were successively connected to the corresponding side branches of the graft. In group II, the lumbar arteries were reimplanted into the former access branch. For control, complete thoracoabdominal exposure of the aorta was required. After crossclamping, proximal anastomosis was performed, and the celiac artery, superior mesenteric artery, renal arteries, and iliac arteries were reattached. Technical feasibility, ischemic times, blood flow, and visceral and spinal cord perfusion in the related organs were evaluated before implantation and 3 and 6 hours after implantation using transit-time flow measurement and fluorescent microspheres. ResultsTechnical success was achieved in all animals in all groups. Total aortic clamping time and selective ischemic times of related organs were significantly longer during open aortic repair compared with groups I and II (P < .0001). Fluorescent microspheres confirmed best spinal cord perfusion in group II. ConclusionsSPIDER-graft reduced ischemic time, avoided extracorporeal circulation and thoracotomy, and improved spinal cord perfusion during thoracoabdominal aortic aneurysm repair in a pig model.

Ischemic Time VS Door-To-Balloon Time as A Predictor for Mortality in ST-Elevation Myocardial Infarction

Background: Timely reperfusion is critical in ST-segment-elevation myocardial infarction (STEMI). Current guidelines for STEMI recommend early revascularization with first medical contact to coronary intervention is <120 min and door-to-balloon (D2B) time between 60-90 mins depending on presentation to a PCI or non-PCI capable hospital. However, this narrow focus does not consider the substantial duration of myocardial ischemia that exists prior to first medical contact. Several experimental studies have confirmed that infarct size and mortality are correlated with the total ischemic time (IT), that is the time from chest pain to coronary intervention.

Impact of summer season on pre-hospital time delays in women and men undergoing primary percutaneous coronary intervention

BackgroundPre-hospital delays have been associated with poor outcomes in patients with acute ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI). It is currently unknown how environmental variables affect treatment delays in these patients. Methods and resultsThe association between environmental variables, time to treatment including transportation times and adverse in-hospital events was assessed in 1828 consecutive patients with STEMI undergoing primary PCI between 2010 and 2014 in the Montreal metropolitan area. Median[Q1;Q3] total ischemia time was significantly longer during summer season (April–September) as compared to winter season (October–March, 201[140;305] min vs 187[126;266] min, p = 0.022). This difference between seasons was due to a significant increase in median decision time to seek treatment for symptoms during summer (90[46;185] min vs 78[40;156], p = 0.004). The former peaked during July and August and was most pronounced in men. Hence, outside temperature and summer season were identified as strong predictors of prolonged decision time in patients with STEMI (p < 0.001 and p = 0.002, respectively). Transportation times slightly increased during winter season and snow fall, this difference, however, was not significant (p = 0.46). A significant increase in in-hospital adverse outcomes following primary PCI was observed during summer season as compared to winter season (7.2% vs 4.8%, p = 0.032). Accordingly, multivariate logistic regression models adjusted for baseline variables identified summer season as a strong predictor of periprocedural adverse events (OR 1.83, 95% CI 1.2–3.11, p = 0.037). ConclusionContrary to our initial hypothesis, pre-hospital delays in patients with STEMI are considerably longer and associated with adverse in-hospital outcomes during summer season. Considering the consequences of global warming, it is imperative that educational efforts targeting patients' perception are implemented to counter treatment delays.

Gender differences in patient and system delay for primary percutaneous coronary intervention: current trends in a Swiss ST-segment elevation myocardial infarction population.

Women with ST-segment elevation myocardial infarction (STEMI) experience greater delays for percutaneous coronary intervention-facilitated reperfusion than men. Whether women and men benefit equally from current strategies to reduce ischaemic time and whether there are gender differences in factors determining delays is unclear. Patient delay (symptom onset to first medical contact) and system delay (first medical contact to percutaneous coronary intervention-facilitated reperfusion) were compared between women ( n=967) and men ( n=3393) in a Swiss STEMI treatment network. Trends from 2000 to 2016 were analysed, with additional comparisons between three time periods (2000-2005, 2006-2011 and 2012-2016). Factors predicting delays and hospital mortality were determined by multivariate regression modelling. Female gender was independently associated with greater patient delay ( P=0.02 vs. men), accounting for a 12% greater total ischaemic time among women in 2012-2016 (median 215 vs. 192 minutes, P<0.001 vs. men). From 2000-2005 to 2012-2016, median system delay was reduced by 18 and 25 minutes in women and men, respectively ( P<0.0001 for trend, P=n.s. for gender difference). Total occlusion of the culprit artery, stent thrombosis, a Killip class of 3 or greater, and presentation during off-hours predicted delays in men, but not in women. A Killip class of 3 or greater and age, but not gender or delays, were independently associated with hospital mortality. STEMI-related ischaemic time in women remains greater than in men due to persistently greater patient delays. In contrast to men, clinical signs of ongoing chest discomfort do not predict delays in women, suggesting that female STEMI patients are less likely to attribute symptoms to a condition requiring urgent treatment.

Morphine and Ticagrelor Interaction in Primary Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction: ATLANTIC-Morphine.

Morphine adversely impacts the action of oral adenosine diphosphate (ADP)-receptor blockers in ST-segment elevation myocardial infarction (STEMI) patients, and is possibly associated with differing patient characteristics. This retrospective analysis investigated whether interaction between morphine use and pre-percutaneous coronary intervention (pre-PCI) ST-segment elevation resolution in STEMI patients in the ATLANTIC study was associated with differences in patient characteristics and management. ATLANTIC was an international, multicenter, randomized study of treatment in the acute ambulance/hospital setting where STEMI patients received ticagrelor 180mg ± morphine. Patient characteristics, cardiovascular history, risk factors, management, and outcomes were recorded. Opioids (97.6% morphine) were used in 921 out of 1862 patients (49.5%). There were no significant differences in age, sex or cardiovascular history, but more morphine-treated patients had anterior myocardial infarction and left-main disease. Time from chest pain to electrocardiogram and ticagrelor loading was shorter with morphine (both p = 0.01) but not total ischemic time. Morphine-treated patients more frequently received glycoprotein IIb/IIIa inhibitors (p = 0.002), thromboaspiration and stent implantation (both p < 0.001). No significant difference between the two groups was found regarding pre-PCI ≥ 70% ST-segment elevation resolution, death, myocardial infarction, stroke, urgent revascularization and definitive acute stent thrombosis. More morphine-treated patients had an absence of pre-PCI Thrombolysis in Myocardial Infarction (TIMI) 3 flow (85.8% vs. 79.7%; p = 0.001) and more had TIMI major bleeding (1.1% vs. 0.1%; p = 0.02). Morphine-treatment was associated with increased GP IIb/IIIa inhibitor use, less pre-PCI TIMI 3 flow, and more bleeding. Judicious morphine use is advised with non-opioid analgesics preferred for non-severe acute pain. clinicaltrials.gov identifier: NCT01347580.