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Reperfusion therapy with percutaneous coronary intervention (PCI) is the preferred method for treatment of STEMI if it can be done in a timely manner in a high volume center. The present study aimed to evaluate the correlation between total PCI volume, emergency PCI volume, elective PCI volume, mean door-to-balloon (DTB) time and in-hospital mortality of patients with STEMI treated with emergency PCI.Using Prince of Songkla university emergency PCI registry, the authors analyzed the study population of STEMI patients who underwent emergency PCI between January 2007 and December 2010. Pearson's Correlation Coefficient was used to determine the correlation.One thousand five hundred one PCI procedures including 355 emergency PCI procedures were done during the present study period. All types of PCI volume increased in each consecutive year between 2007 and 2010 while mean DTB time and in-hospital mortality continuously declined. The mean DTB time had positive correlation (r = 0.932) with in-hospital mortality. The emergency PCI volume was strongly negatively correlated with in hospital mortality (r = -0.953) and was statistically significant. There were negative correlations of elective PCI volume (r = -0.796), total PCI volume (r = -0.848), and in-hospital mortality but the correlations were not statistically significant.For emergency PCI, shorten mean DTB time in each consecutive year was associated with lower in-hospital mortality. Regarding to procedural volume, increase in each type of PCI procedure especially emergency PCI procedure was associated with a decrease in-hospital mortality.

Review the efficacy and safety of using the anatomical characteristics of the first septal branch to select the target vessel for alcohol septal ablation (ASA) in treating patients with medically refractory symptoms hypertrophic obstructive cardiomyopathy (HOCM), ASA without guided myocardial contrast echocardiography (MCE).Fifteen patients with HOCM and refractory to medical therapy were screened by echocardiography and coronary angiography between November 2007 and January 2010 in Songklanagarind university hospital. The procedure was abandoned in three patients due to vessel unsuitability. The clinical and hemodynamic data of 12 patients with HOCM before and after ASA were reviewed. The authors used the anatomical characteristics of vessel to identify the suitable septal perforator artery.ASA was done successfully in 12 patients. The averages of left ventricular outflow tract (LVOT) peak/mean pressure gradients (PPG/MPG) were 92.4 +/- 22.5/48.8 +/- 12.8 before and 21.6 +/- 11/12.8 +/- 5 mmHg immediately after ASA. The mean absolute alcohol volume was 2.5 +/- 0.64 ml. One patient had to have alcohol injection into two septal branches. Transient complete atrioventricular block occurred in two patients. All patients reported substantial symptomatic improvement.Most patients with medically refractory symptom HCOM have suitable first septal branches for ASA. ASA without MCE in those with suitable first septal branches is effective and safe.

Alcohol septal ablation (ASA) is an emerging percutaneous technique to treat patients with hypertrophic obstructive cardiomyopathy (HOCM) and refractory to medical therapy. ASA in Thailand has never been reported.The authors reviewed clinical and hemodynamic data of four patients with HOCM before and after ASA performed between November 2007 and May 2008 in Songklanagarind Hospital.ASA without myocardial contrast echocardiography was done successfully in all four patients with HOCM and refractory to medical therapy. The authors used the anatomical characteristics of vessel and pressure-guided technique to identify the optimal septal perforator artery. The averages of left ventricular outflow tract (LVOT) peak/mean pressure gradients (PPG/MPG) were 105/56 before and 32/18 mmHg immediately after ASA, consecutively. There were further falls in LVOT PPG and MPG to averages of 14 and 8.5 mmHg respectively at 6-12 week follow-up. The mean absolute alcohol volume was 2.5 +/- 0.41 ml. Transient complete atrioventricular block occurred in one patient. All patients reported substantial symptomatic improvement.The authors reported the first cases series of HOCM patients who underwent ASA in Thailand ASA without myocardial contrast echocardiography in carefully selected patient is feasible, effective, and safe.