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Invasive cardiac care is the preferred method of treatment for patients with acute coronary syndromes (ACS) complicated by cardiogenic shock (CS). In Nova Scotia, invasive cardiac care is only available in Halifax at the Queen Elizabeth II Health Sciences Centre (QEII-HSC).All consecutive patients diagnosed with ACS and CS in 2009-2013 in Nova Scotia were included. Data were obtained from the clinical database of Cardiovascular Health Nova Scotia. The primary outcome was in-hospital mortality.A total of 418 patients with ACS and CS were admitted to the hospital. Access to invasive care was limited to 309 (73.9%) of these patients. For those who presented elsewhere in the province, 64.2% were transferred to the QEII-HSC. The mortality rate among the 309 patients with access to invasive care was significantly lower than that among the 109 patients who did not have access (41.7% vs 83.5%; P 0.0001). Unadjusted mortality was lowest among patients undergoing primary percutaneous coronary intervention (33.1%). After adjustment for clinical differences, access to cardiac catheterization remained an independent predictor of survival (odds ratio, 0.2; 95% confidence interval, 0.11-0.36). Heat map analysis revealed that access was lowest in regions furthest from Halifax.ACS complicated by CS has a high mortality rate. We demonstrate that access to health care centres offering cardiac catheterization is independently associated with survival, and public health initiatives that improve access should be considered. Patients presenting furthest from Halifax were the least likely to be transferred, suggesting that geography remains an important barrier to livesaving care.

Background Numerous studies have examined the effect of geographic place of residence on access to cardiovascular care, but few have examined their effect on outcomes after cardiac operations. This study examined the effect of geographic place of residence on in-hospital and 30-day outcomes after cardiac operations. Methods We performed a retrospective analysis of all patients undergoing nonemergency cardiac operations at a single institution between April 2004 and March 2011. Geographic place of residence was defined as the driving distance from the patient's home to the tertiary cardiac care center divided into the following categories: 0 to 50 km, 50 to 100 km, 100 to 150 km, 150 to 200 km, 200 to 250 km, and more than 250 km. Multivariable logistic regression was used to determine the independent effect of driving distance on in-hospital and 30-day outcomes. Results The final study population included 4,493 patients, of whom 3,897 (86.7%) had 30-day follow-up. After adjusting for differences among patient groups, no consistent relationship existed between distance and in-hospital outcomes. However, increased distance beyond 100 km was significantly associated with a greater risk of adverse outcomes at 30 days (0 to 50 km: referent; 50 to 100 km: odds ratio, 1.16 [95% confidence interval, 0.83 to 1.62]; 100 to 150 km: 1.32 [1.05 to 1.65], 150 to 200 km: 1.68 [1.33 to 2.11], 200 to 250 km: 1.41 [1.06 to 1.88], and >250 km: 1.30 [1.04 to 1.63]). Conclusions Patients who live at an increased distance from the tertiary cardiac care center are more likely to have worse 30-day outcomes after cardiac operations. Further study is required to determine the mechanisms underlying this relationship and how such inequalities may be minimized.

s S231 groups that was of significance. In terms of survival, there were significant differences between the 35. 345 READMISSION RATES AND DIAGNOSES FOR PROLONGED INTENSIVE UNIT CARE STAY SURVIVORS FOLLOWING CARDIAC SURGERY RA Manji, BM Hiebert, RC Arora, MC Moon, DH Freed, AH Menkis

itoneally for 14 days. Echocardiography demonstrated that Celastrol improved cardiac functional recovery with enhanced% LVEF compared to Control animals (p1⁄40.017), and prevented anterior wall thinning (P1⁄40.004) and LV enlargement (P1⁄40.019, LVESD). Celastrol reduced infarct size and fibrosis (P

status postoperatively (odds ratio 2.6 1.3 per increasing MR grade; P 0.07). CONCLUSION: After mitral valve repair for ischemic MR, persistent or recurrent MR of mild to moderate degree appears associated with functional compromise. This finding carries implications with regards to the ongoing controversy of repair versus replacement for ischemic MR, and for new percutaneous mitral therapies which may not eradicate MR.