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Background Key performance indices such as door-to-balloon times have long been recognized as quality metrics in reducing time to care for patients with acute coronary syndromes (ACS). In the situation where patients do not present to a facility capable of 24/7 percutaneous coronary interventions (PCI) delays in time to therapy can exceed the recommendation of 90 min or less. This study aimed to evaluate the impact of transfers on performance indices for patients diagnosed with ST-segment elevation myocardial infarction (STEMI). Methods Over a seven month collection period, all patients presenting with symptoms suggestive of ACS and admitted for PCI were studied. Patients were divided into dichotomous groups of direct presentations or transfers from a secondary non-PCI capable hospital with key times recorded, including symptom-onset, first hospital and PCI-capable hospital arrival and balloon inflation times to evaluate time of treatment for STEMI patients. Results Of the 87 patients diagnosed with STEMI, transferred patients experienced statistically significant delays in symptom-onset to the PCI-capable hospital (PCI-H) arrival (215 vs. 95 min, P < 0.001), symptom-onset to balloon inflation (225 vs. 160 min, P = 0.009) and first hospital arrival to balloon inflation times (106 vs. 56 min, P < 0.001). Only 28% (n = 9) of transferred patients underwent balloon inflation within 90 min from first hospital arrival, while 60% (n = 19) did within 120 min, although all received balloon inflation within 90 min from arrival at the PCI-H. After controlling for confounding factors of socio-economic status, presentation date/time and diagnostic category, transferred patients experienced an average 162% longer delays from symptom-onset to PCI-H door arrival, and 98% longer delays in symptom-onset to balloon inflation; compared to patients who present directly to the PCI-H. No statistically significant differences were noted between transferred and direct patients when measured from PCI-H door-to-balloon times. Conclusions This study shows that transferred patients experience a greater overall system delay, compared to patients who present directly for PCI, significantly increasing their time to treatment and therefore infarct times. Despite the majority of transfers experiencing pre-hospital activation, their treatment hospital arrival to balloon times are no less than direct presenters after controlling for confounding factors, further compounding the overall delay to therapy.

Abdominal aortic aneurysm is a common vascular disease that affects elderly population. Open surgical repair is regarded as the gold standard technique for treatment of abdominal aortic aneurysm, however, endovascular aneurysm repair has rapidly expanded since its first introduction in 1990s. As a less invasive technique, endovascular aneurysm repair has been confirmed to be an effective alternative to open surgical repair, especially in patients with co-morbid conditions. Computed tomography (CT) angiography is currently the preferred imaging modality for both preoperative planning and post-operative follow-up. 2D CT images are complemented by a number of 3D reconstructions which enhance the diagnostic applications of CT angiography in both planning and follow-up of endovascular repair. CT has the disadvantage of high cummulative radiation dose, of particular concern in younger patients, since patients require regular imaging follow-ups after endovascular repair, thus, exposing patients to repeated radiation exposure for life. There is a trend to change from CT to ultrasound surveillance of endovascular aneurysm repair. Medical image visualizations demonstrate excellent morphological assessment of aneurysm and stent-grafts, but fail to provide hemodynamic changes caused by the complex stent-graft device that is implanted into the aorta. This article reviews the treatment options of abdominal aortic aneurysm, various image visualization tools, and follow-up procedures with use of different modalities including both imaging and computational fluid dynamics methods. Future directions to improve treatment outcomes in the follow-up of endovascular aneurysm repair are outlined.

To the Editor: Coronary arterial involvement is rare in Takayasu's arteritis. We describe successful coronary artery stenting in a 17-year-old teenager with Takayasu's arteritis and acute inferior myocardial infarction due to occlusion of the right coronary artery. The patient, a male student, 17-year-old, was admitted to our emergency room with persistent retrosternal pain accompanied by sweat 2 h. The patient had no history of hypertension or diabetes, and he neither drank alcohol nor smoked. There was no family history of coronary heart disease. On his physical examination, blood pressure of left arm was 140/70 mmHg and 100/70 mmHg for the right. Vascular murmur can be heard in the neck, supraclavicular and groin area. His initial electrocardiogram revealed II, III, avF ST-segment elevation 0.6–0.7 mV, laboratory test revealed a markedly elevated troponin I (>100 ng/ml), so we considered Takayasu's arteritis could not be excluded. We performed emergency percutaneous coronary interventional therapy. Coronary angiography revealed that the middle of the right coronary artery was totally occlusive [Figure 1a]. The proximal stenosis of left anterior descending branch was 50% and formed collateral circulation to the distal right coronary artery [Figure 1b]. Therefore, drug-eluting stent was implanted in the occlusion of right coronary artery [Figure 1c]. On the 2nd day of admission, his C-reactive protein level (20 mg/dl) and erythrocyte sedimentation rate (48.7 mm/h) were high. After 4th day of stenting, large vessel computed tomography (CT) was performed. CT angiography of the aorta showed that bilateral proximal subclavian arteries, internal carotid artery and renal artery had severe stenosis, celiac trunk had moderate stenosis. The superior mesenteric artery had severe stenosis. Figure 1 (a) Coronary angiography of right coronary artery; (b) Coronary angiography of left coronary artery; (c) Coronary stenting in right coronary artery. Takayasu's arteritis is a rare chronic nonspecific inflammatory disease, its cause was unknown and predominantly affected the aorta and its main branches, including coronary arteries and pulmonary arteries. Coronary arterial involvement is rare in Takayasu's arteritis.[1,2] Coronary angiographic and pathologic studies together have revealed coronary artery lesions in 9–11% of cases.[3] We performed emergency coronary angiography successfully and implanted a drug-eluting stent in the occlusion of right coronary artery. It is important to select the appropriate operation time for the treatment of Takayasu arteritis with early detection and treatment, hormone drugs should be taken under the supervision of doctor. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.