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Rapid identification of acute myocardial infarction (MI) is important for the early initiation of evidence-based therapy. In the European Society of Cardiology (ESC) 0/1h-algorithm (also called early-rule-out algorithm) high-sentivity cardiac troponin is measured at admission and one hour later. By using assay-specific cut-off levels patients are triaged to three different groups; "rule-out", "observation" or "rule-in" of acute MI. The ESC 0/1h-algorithm has high diagnostic accuracy and safety to rule out MI. This review summaries the current knowledge and practical use of the new early-rule-out algorithm.

This review provides a summary of treatment of cardiac arrest with mechanical cardiopulmonary resuscitation (CPR). CPR provides chest compressions according to guidelines in the treatment of out-of-hospital cardiac arrest. This is useful in situations where CPR cannot be safely delivered (e.g. during transportation and prolonged CPR). Randomized controlled trials have not shown improved patient outcomes after treatment with mechanical CPR compared to manual CPR. Mechanical CPR can, like manual CPR, cause injuries, and some may be life-threatening. Mechanical CPR is therefore recommended as an adjunct to manual CPR in special circumstances but not used routinely.

Patients with ST-elevation myocardial infarction (STEMI) are treated with primary percutaneous coronary intervention (pPCI) or fibrinolysis. pPCI is superior to fibrinolysis when initiated timely. However, geography and weather sometimes become obstacles for transporting the patient to a PCI centre. In this case story teamwork between hospital instances and the military enabled transport to a PCI centre for a PCI intervention even though the weather conditions were unfavourable.

Thoracic aortic dissection is a life-threatening emergency that must be met and surmounted immediately to increase survival. In this case, telemedicine involving ECG and GSM-based communication between the patient in the ambulance and the centre doctor was used to obtain remote pre-hospital suspicion of aorta dissection. Thus, the ambulance was re-routed directly to a specialized unit where the diagnosis was confirmed and immediate and successful surgical treatment was performed. Telemedicine allowing direct communication between the patient and the doctor is recommended.

Mortality in untreated pulmonary embolism is high and short-term outcome depends on a timely diagnosis. In this case telemedicine involving 12-lead ECG and GSM-based communication between the patient in the ambulance and the telemedical staff resulted in remote pre-hospital suspicion of acute pulmonary embolism. The ambulance was referred directly to the nearest department of cardiology where acute CT and echocardiography confirmed the diagnosis. Acute trombolysis was successful. Telemedicine may be beneficial in other medical emergencies than acute myocardial infarction.

Introduction: Several studies, including the DANAMI-2 trial, have shown that primary percutanous intervention (PCI) results in better survival, fewer reinfarctions and fewer cerebrovascular incidents than thrombolysis in the treatment of acute ST-elevation myocardial infarction (STEMI). The aim of this study was to follow the implementation of primary PCI as a routine treatment for patients with STEMI and to compare the results with those of DANAMI-2., Materials and Methods: We performed a prospective analysis of 212 patients admitted to our department from 1 April 2002 to 31 December 2002 with STEMI. Acute coronary angiography and, if indicated, primary PCI were performed., Results: At 30 days, the mortality rate was 6.6%, the reinfarction rate 1.4% and the rate of disabling stroke 1.4%. Combined endpoints were present in 8% of the patients. The results are in agreement with those from the DANAMI-2 trial., Discussion: Primary PCI can be performed in daily clinical practice in accordance with the DANAMI-2 protocol. The results are in agreement with data from newly published meta-analyses.

Introduction: The aim of this study was to estimate the extension of oral anticoagulant therapy (OAT) in Denmark between 1997 and 1999., Material and Methods: 1) Data from persons who were registered at the Danish Medicines Agency with at least one prescription of a vitamin K-antagonist, and 2) persons registered in the Laboratory Information System, Aarhus County Hospital, Denmark, with three or more consecutive INR tests, with no more than four months between each test, and with at least one INR test > 1.9 were examined., Results: The prevalence of OAT increased from 663 patients per 100,000 inhabitants in 1997 to 784 patients in 1999 (method 1). The prevalence increased significantly from 1997 to 1998 and from 1998 to 1999 and had a mean increase of 73.1 patients per 100,000 inhabitants (95% CI: 61.3-84.8) and a mean increase of 52.8 patients per 100,000 inhabitants (95% CI: 44.3-61.2), respectively. The prevalence of OAT was highest within the Country of Copenhagen and lowest within the County of Ringkobing. The difference between these two counties in 1997 was 0.0024 (p < 0.0001; 95% CI: 0.0017-0.0031). Within the admission area of Aarhus County Hospital (method 2), the prevalence increased from 518 patients per 100,000 inhabitants in 1997 to 630 patients in 1999. There was no statistical difference in the prevalence identified by the two methods., Discussion: The study shows: 1) a significant increase in the prevalence throughout the study period, 2) a significant variation between the counties. A precise estimate of prevalence is identified by method 1. A more detailed survey is, however, provided by method 2. We recommend further investigations on the identified regional variation.