Table 2. Outcomes (# exclude 3 pre-hospital thrombolysis cases)

Thrombolysis PCI p value

Symptom onset to STEMI diagnosis times 39 � 15 32 � 15 NS

Symptom onset to thrombolysis / device times 75 � 22 202 � 73 0.001 *

Diagnostic ECG to thrombolysis / device times 37 � 16 164 � 69 0.001 *

DTD/DTN times # 32 � 13 95 � 49 0.014 *

Mean Peak CK 2039 � 2367 2298 � 2407 NS

Median Peak CK 904 965 NS

EF 49 � 12 45 � 16 NS

POST

ERABST

RACTS

percutaneous coronary intervention (PCI), as thrombolysis can be administered within fewminutes of STEMI diagnosis. Metropolitan hospitals are equipped with more staff, access tophysician/cardiology and sufficient resources for further treatment compared to ruralcentres. It is unclear how these expertise and choices may impact on either expediting ordelaying decision making in revascularization strategies.Objectives: Compare efficiency of thrombolysis in rural versus greater Brisbane metro-politan areas in those patients with acute STEMI.Methods: Acute STEMI patients who were directly or eventually referred to a tertiary centrein Brisbane (Princess Alexandra Hospital) over a 4 months period were identified. Theonset to needle time (OTN), first diagnostic ECG to needle times and Door to needle (DTN)times were estimated in patients presenting with acute STEMI within 6 hours. Maximumcreatine kinase (CK) rise used as the assessment of the extent of myocardial infarction.Results: A total of 195 (average age 61yrs, 78% male) acute STEMI patients were pro-spectively reviewed over the past 4 months. The Table 1 and 2 below shows the results indetail.

Table 2. Outcomes

Metropolitan Rural p value

Symptom onset to thrombolysis 110�64 169�82 NS

Diagnostic ECG to thrombolysis 35�21 37�29 NS

DTN times 34�16 47�29 0.013

Mean Peak CK 1294�1363 2427�2320 NS

Median Peak CK 813 1990 NS

EF 47�12 50�13 NS

% Failed thrombolysis 11 21

Table 1. Basic Characteristics

Metropolitan Rural p value

n 19 14

% female 11 36 NS

Age (mean � SD) 56�12 62�11 NS

Conclusion: The greater Brisbane metropolitan hospital patients had significantly lowerdoor to needle time and a propensity towards better early outcomes as shown by a trendtowards lower peak CK. When considering rural centres results, higher peak CK could alsobe reflective of delay or lack of rescue PCI access. These results have implications for ruralhospital practice in management of acute STEMI.Disclosure of Interest: None Declared

PT137

Evaluation of thrombolysis versus primary percutaneous coronary intervention (PCI)outcomes for patients with early presentation (within 60 minutes) of acute STelevation myocardial infarction (STEMI)

Mathivathana Indrajith1,2, Stuart Butterley1,2, Danielle Harrop1, Lisa Gillinder1,2, Shi Yi Goo1,2,Josh Tsai1, Stephen Rashford3, Paul Garrahy1, Arnold C. Ng1,2, William Y. Wang*1,21Cardiology, Princess Alexandra Hospital, 2School of Medicine, University of Queensland,3Director, Queensland Ambulance Service, Brisbane, Australia

Introduction: Early reperfusion is essential in the determination of outcomes of STEMI.Australia Registry data demonstrates that timely provision of PCI in STEMI patients isdifficult to achieve, with median hospital door to angioplasty device/balloon (DTD) times of102 minutes and only 36.5% of cases achieving DTD times of <90 minutes. Thrombolysisis still used where there is no ready access to PCI centres. However, given the ability torapidly deliver thrombolysis out of tertiary centres, it may be of greater value in very earlySTEMIs.Objectives: Comparison of thrombolysis with primary PCI in patients presenting withacute STEMI within 60 minutes of onset of symptoms to first medical contact (FMC).Methods: Acute STEMI patients who were directly or eventually referred to a tertiary centrein Brisbane (Princess Alexandra Hospital) over a 4 months period were identified. TheDTD/ Door to needle (DTN times) and FMC to device/thrombolysis times were assessedwith maximum CK rise used as the assessment of the extent of myocardial infarction.Results: A total of 195 (average age 61yrs, 78% male) with STEMI were identified. Out ofthese 14 (21% female) PCI patients and 15 (0%) thrombolysis (including 3 pre-hospitalthrombolysis) patients had FMC within 60 minutes. No intra-hospital mortality in bothgroups. The Table 1 and 2 below shows the results in detail.

Table 1. Baseline Characteristics

Thrombolysis PCI p value

n 15 14

% female 0% 21% NS

Age (mean � SD) 58 � 10 56 � 11 NS

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

Conclusion: In patients who received medical contact within 60 minutes from onset ofsymptoms, thrombolysis and primary PCI had similar early outcomes.Disclosure of Interest: None Declared

PT138

The implementation of the myocardial infarction system of care in a large city inBrazil

Milena Marcolino*1, Luisa C. C. Brant2, de Araujo J. Guimarães3, Bruno R. Nascimento1,Luiz Ricardo A. Castro4, Paula Martins3, Lucas Lodi-Junqueira4, Antonio L. Ribeiro11Internal Medicine Department, Medical School, Universidade Federal de Minas Gerais,2Cardiology Service, Univerity Hospital, Universidade Federal de Minas Gerais, 3MunicipalHealth Department of Belo Horizonte, 4Cardiology Service, University Hospital, UniversidadeFederal de Minas Gerais, Belo Horizonte, Brazil

Introduction: Although there was a significant reduction in mortality from cardiovasculardiseases in recent decades worldwide, they still remain the leading cause of mortality inBrazil. The implementation of system of care for Acute Myocardial Infarction (AMI) isdesigned to optimize timeliness of therapy and improve patient care.Objectives: Tto evaluate the implementation of the system of care for AMI in Belo Hori-zonte, Brazil, a large urban city with 2.4 million inhabitants, and its impact on AMI hospitalmortality rate.Methods: The system of care for AMI was established in Belo Horizonte in 2010-2011 inorder to increase the access of patients of the public healthcare to treatment recommendedby current guidelines, including early reperfusion and treatment in intensive care. Therewas an increase in the number of intensive care unit beds, teams of emergency units weretrained and tele-electrocardiography was implemented in those units, to enable the earlyactivation of the catheterization laboratory. The primary endpoints of this retrospectiveobservational study were the number of hospitalizations and hospital mortality from AMIin the years 2009 (baseline) to 2011.Results: During the study period, 294 professionals were trained and 563 ECGs weretransmitted from the emergency care units to the coronary care units. There was a sig-nificant decrease in hospital mortality rate (12.3% in 2009 vs. 7.1% in 2011, p <0.001),while the number of admissions for AMI remained stable. There was an increase in theaverage cost of hospitalization (average US$ 1189.56 vs. US$ 1679.30, p <0.001),increasing the proportion of admissions which included admission in intensive care unit(32.4% in 2009 vs. 66.1% in 2011, p <0.001) and admission in high complexity hospitals(47.0% vs. 69.6%, p <0.001).The establishment of the system of care for AMI led to the reorganization of the care of

patients with suspected acute coronary syndrome in the city of Belo Horizonte, Brazil,which included training and motivation of emergency care teams, in addition to integrationbetween the services, facilitating the access to hemodynamic laboratories, intensive carebeds and high-complexity hospitals in cardiology. There was a significant reduction inhospital mortality from AMI after the establishment of this system of care.Conclusion: The implementation of the system of care for AMI in Belo Horizonte allowedeasier access to appropriate treatment and, consequently, reduction in AMI hospitalmortality rate.Disclosure of Interest: None Declared

PT140

Complete Myocardial Revascularization In The Same Session In Patients With AcuteMyocardial Infarct And Cardiac Failure

Ricardo A. Costantini*1, Cristian S. García1, Juan M. Telayna11Interventional Cardiology, Austral University Hospital, Pilar, Argentina

Introduction: In STEMI with cardiogenic shock (CS), prompt primary PCI of the infarct-related artery improves survival; however, mortality remains unacceptably high. The ma-jority of STEMI and CS has multivessel coronary disease (MVD). This is more likely toinduce widespread myocardial ischemia and progressive ventricular dysfunction, and hasbeen associated with increased mortality. However, there is little evidence to support thestrategy multivessel, which could conversely worsen outcomes by increasing the risk ofnon-IRA distal embolization, stent thrombosis, and contrast nephropathy.Objectives: To determine the results of the primary PCI with complete revascularization inSTEMI and cardiac failure with presence of MVD.Methods: From 7/2000 to 2/2013, was realized 342 procedures of primary PCI, of which89(26%), presented signs of cardiac failure to the admission. These were analyzed ac-cording to the presence of MVD (n¼54) and the PCI only of the culprit vessel (Group A¼33) vs complete revascularization coronary in the same session (Group B¼ 21).

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