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Background Recent UK epidemiological data suggests that while incidence and mortality of myocardial infarction (MI) is in decline, mortality associated with out of hospital cardiac arrest (OOHCA) in the setting of MI is still a significant problem now constituting 70% of its total fatality. Small studies have shown survival benefit with primary percutaneous coronary intervention (pPCI) in OOHCA in the setting of ST elevation myocardial infarction (STEMI). There is little contemporary outcome data in this population. We sought to identify predictors of survival in STEMI complicated by OOHCA in a large, contemporary cohort in the era of pPCI. Methods Between January 2008 and October 2011, 1836 consecutive STEMI admissions to a high volume pPCI centre were retrospectively analysed. 132 patients were identified as having OOHCA. Clinical and procedural data was collected from the UK Myocardial Ischaemia National Audit Project (MINAP) database and patient notes. Endpoints were all cause mortality to 4 years (mean: 559 days, median: 380 days) and neurological recovery at discharge (Cerebral Performance Score/CPS 1). Mortality data was collected using the Office of National Statistics mortality database. Results 132 out of 1836 consecutive STEMI patients were identified with OOHCA (7.2%). The mean age of patients was 59.4±14years, 78.8% were male and 55% were directly conveyed to the pPCI centre; the remaining were transferred from district hospitals. Survival to discharge was 76.5% (101/132 patients). 86 patients had full neurological recovery (65% of the whole cohort). Long term follow-up revealed only one further death making the overall survival rate 75.8%. Survivors had significantly higher incidence of witnessed arrest (p Conclusions To our knowledge, this is the first reported series of STEMI complicated by OOHCA of this size in UK contemporary practice. This data shows a 76% survival rate, 65% rate of full neurological recovery and supports the emergent transfer of this patient group to a cardiac centre for pPCI.

Background Cardiac magnetic resonance (CMR) myocardial feature tracking (FT) is emerging as a sensitive and reproducible method for measuring myocardial strain parameters without the need to acquire additional images. Up until now adult CMRFT studies have primarily focussed on the reproducibility of the software,with very few studies addressing disease states beyond ischaemic cardiomyopathy. The aim of this pilot study was to assess the feasibility of cine-images derived quantitative CMR FT strain parameters to differentiate between normal individuals and patients with Left ventricular non-compaction (LVNC). Methods Patients were identified retrospectively from an established clinical CMR database. 8 LVNC patients with negative invasive angiography or stress CMR myocardial perfusion imaging were compared to 21 normal controls. LVNC was defined according to the Petersen criteria,with an end-diastolic ratio of non-compacted to compacted layer (NC/C) >2.3. LV morphological and functional parameters were performed off-line on a dedicated workstation. CMR 4chamber(4CH) and mid-ventricular short axis(SAX) cineimages were analysed in systole(S) and diastole(D) using dedicated FT software(Diogenes MRI,TomTec Imaging Systems,Munich Germany).

Background Both mechanical thrombectomy and glycoprotein (GP) IIb/IIIa antagonists have been shown to improve clinical outcomes following primary PCI for ST segment elevation myocardial infarction. There is limited data describing the use of these technologies in the setting of stent thrombosis. We aimed to assess the combined approach of mechanical thrombectomy with adjunctive glycoprotein (GP) IIb/IIIa antagonists in patients presenting with acute stent thrombosis. Methods This was an observational cohort study of 3040 patients who underwent PPCI from 2003 to 2011. The primary outcome was major adverse cardiac events (all cause mortality, myocardial infarction, target vessel revascularisation and stroke). Follow-up was for a median of 3.0 years (IQR 1.2–4.6 years). Patients were split into 3 groups; those who underwent PCI using mechanical thrombectomy and GP IIb/IIIa inhibitors, those receiving either GPIIb/IIIa inhibitor or mechanical thrombectomy and those receiving neither. Results 201 patients (6.6%) of all STEMI patients presented with stent thrombosis (ST). Overall, GPIIb/IIIa inhibitors were used in 176 (87.6%) patients. Mechanical thrombectomy was used in 94 (46.7%) patients. 88 (44%) patients received both GPIIb/IIA inhibitors and thrombectomy, 92 (46%) received either GPIIb/IIIa inhibitor or thrombectomy and 21 (10%) received neither therapy. Baseline characteristics of these 3 groups are shown in Abstract 035 table 1. Patients receiving both therapies tended to have more successful procedures and have better post-procedural left ventricular function. Kaplan–Meier estimates of long-term major adverse cardiac events showed the lowest rates of events for those patients receiving both therapies, followed by those receiving a single therapy, with the highest rates of MACE in those receiving neither therapy (p Conclusion Prognosis after stent thrombosis is poor with high long-term event rates. Using a combined approach of mechanical thrombectomy with adjunctive GP IIb/IIIa blockade lead to effective primary PCI with improved long-term outcomes.

Introduction Chronic total occlusion (CTO) remains a challenging lesion subset. Despite advances in equipment and expertise, many CTO patients may not be offered PCI as physicians perceive procedural success may be lower, and the anatomy is stable. The aim of this study was to investigate the impact of procedural success on mortality following CTO-PCI in a large cohort of patients in the drug eluting stent era. Methods 6122 consecutive patients underwent elective PCI at a single centre (October 2003–May 2010), 836 (13.7%) for CTO. Demographic and procedural data were collected at the time of intervention (Abstract 35 table 1). In-hospital MACE (myocardial infarction, urgent revascularisation, stroke or death) was documented at discharge. All cause mortality data was obtained from the Office of National Statistics via the BCIS/CCAD national audit out to 4 years (mean 2.9±1.6) and stratified according to successful or unsuccessful CTO recanalisation. Results 572 (68.4%) CTO procedures were successful. Coronary stents were implanted in 96.9% (mean 2.3±0.1 stents per patient, 70% drug eluting). Prior revascularisation was more frequent among patients with unsuccessful CTO-PCI than successful; prior CABG 16.5% unsuccessful vs 7.4% successful, (p Conclusion A successful angiographic outcome following CTO-PCI is associated with a survival advantage out to 4 years following intervention. These data suggest that the adoption of new techniques and technologies to improve procedural success may improve prognosis.

Introduction CMR perfusion (CMRP) imaging using adenosine is increasingly used for the assessment of patients with known or suspected coronary artery disease. At a standard dose adenosine is well tolerated with a good safety profile but on occasion fails to produce a significant haemodynamic response. This may potentially lead to the misdiagnosis of significant ischaemia. We therefore examined whether using a higher dose in the these patients to induce a haemodynamic response would lead to the identification of additional perfusion defects. Methods We prospectively recruited from 1230 consecutive patients undergoing CMRP. First pass CMRP was performed on a Philips Achieva CV 1.5T MR scanner (Philips, The Netherlands), with standardised acquisition protocol with standard dose adenosine (SDA) at 140 μg/kg/min for 3 min. Three short axis slices of 10 mm thickness were acquired per cardiac cycle using a single shot prospectively gated balanced TFE sequence (TR 2.5 ms, TE 1.3 ms, Flip angle 500 and voxel size 2.8×2.8 mm 2 ) after the administration of a 0.1 mmol/kg bolus of intravenous Gadolinium. Heart rate (HR) and blood pressure (BP) were recorded at baseline and during stress. Non responders were defined as those patients with a normal CMRP scan and blunted hamodynamic response (maximum HR increase Results Fifty-one patients (4.1%) recieved HDA. HDA was well tolerated with no serious adverse events. Coronary angiographic data were available for 20 patients (39%). HDA stress resulted in a significant increase in HR and RPP in non responders (Abstract 78 Table 2). CMRP with HDA identified perfusion defects in 12 patients (24%) which were not present following stress with SDA. In 11 patients (92%) the identified perfusion defects correlated with significant stenosis (>70%) on the angiogram. Conclusion HDA achieved significant heamodynamic end-points with no significant clinical adverse events. Additional perfusion defects in the non responders with SDA were found using HDA. The perfusion defects correlated with significant coronary stenoses. The use of HDA may be important in certain patients where there is little or no haemdynamic response to SDA.

Methods A retrospective cohort of 2139 patients who had undergone both adenosine stress CMR (2008-2011) and a coronary angiographic procedure (2006 to 2011) was identified. 142 patients with a diagnosis of cardiomyopathy and 98 patients with previous CABG were excluded. 1899 patients comprised the study group with the latest date of followup being 31.8.2012. Data was extracted from each patient’s hospital health record and analysed using STATA version 8.0. This study was undertaken as part of clinical service evaluation.

Background CMR perfusion (CMRP) imaging using adenosine is increasingly used for the assessment of patients with known or suspected coronary artery disease. The scanning protocol requires administration of intravenous adenosine to achieve maximum hyperaemia followed by acquisition of CMR images during first pass perfusion of gadolinium. Traditionally this involves placing two intravenous lines, one in each arm, for the administration of adenosine and gadolinium. Two-way intravenous adapters allow administration of two compatible agents through a single intravenous line. We introduced this simple adapter for use during CMRP at our institution. We now report on our experience and the impact of this change to our CMRP protocol. Methods

confirmed using the Office of National Statistics database with follow-up ranging from 3 to 44 months. Results: The mean age was 60 14years and 80.3% patients were male. The incidence of previous coronary disease in the cohort was 27.8%, 32.8% patients were hypertensive, 37.7% smokers, 24.6% hypercholesterolaemic and 8.2% had known diabetes. 45% patients had a witnessed arrest and 43.4% were directly conveyed to the pPCI centre. Mean arrest-to-arrival time in the cohort was 115 24mins with a mean call-to-balloon time of 168 24mins. The rate of successful pPCI in the cohort was 85% with 21.7% having 3-vessel disease. Shock was present in 16% and severe left ventricular impairment in 25% patients. The in-hospital mortality within the cohort was 21%. Of the patients who died 14 were cardiovascular deaths, 3 being shortly after return of spontaneous circulation in the catheterisation laboratory, and 6 of all deaths were secondary to hypoxic brain injury in Intensive Care. 79% of all patients survived to discharge. Of the patients who survived 92% were discharged with no neurological deficit. At follow-up (12-44 months in 62% patients) 100% of patients who survived to discharge were still alive. Conclusions: Here we present descriptive data of a large, contemporary cohort of STEMI admissions for pPCI that are complicated by OOHCA. Here we show a 79% survival rate to discharge, a higher proportion than previously reported, with good long term prognosis after discharge.

Introduction CMR perfusion (CMRP) imaging using adenosine is increasingly used for the assessment of patients with known or suspected coronary artery disease. At a standard dose adenosine is well tolerated with a good safety profile but on occasion fails to produce a significant haemodynamic response. This may potentially lead to the misdiagnosis of significant ischaemia. We therefore examined whether using a higher dose in these patients to induce a haemodynamic response would lead to the identification of additional perfusion defects.

Background Cardiac magnetic resonance (CMR) is frequently used to assess the extent of trabeculations in cases of left ventricular non-compaction. Most routine CMR studies do not acquire full 3D isotropic cine datasets and consequently suboptimal acquisition of prescribed image views could lead to clinically important inaccuracies in calculating non-compacted to compacted myocardial ratios (NC/C). This study compares measurement of the NC/C ratio between optimal and off-axis views derived from 3D cardiac computer tomography (CT) datasets and compares these with those derived from optimal CMR datasets. Methods We studied 10 participants who underwent CMR and contrast CT imaging (retrospective gating) as part of the Evaluation of Integrated Cardiac Imaging for the Detection, Characterization and Monitoring of Ischemic Heart Disease study protocol (EVINCI study). NC/C ratios were determined for CMR and for CT images in mid and apical anterior and inferior segments based on 2 chamber views and short axis views in diastole. NC/C ratios in the same segments were compared in “off-axis” 2-chamber view and short axis views in optimal position and tilted by 30 and 45 degrees for CT. Results Comparing measurements from optimal 2-chamber views for CMR and CT, there was no difference for NC/ C ratio (CMR 1.1 ± 0.5 vs. CT 0.8 ± 0.3, p = 0.2). The NC/C ratio was higher in MRI short axis view compared with CT short axis (1.0 ± 0.4 vs. 0.6 ± 0.4, p = 0.001). The NC/C ratio was overestimated from off-axis 2 chamber CT views compared to the optimal 2 chamber view: NC/C 1.0 ± 0.4 vs. 0.8 ± 0.3, p = 0.001. There were no differences between NC/C ratio in optimally oriented short axis and angulated planes: 0.6 ± 0.4 vs. 0.6 ± 0.3 (30 degrees) vs. 0.6 ± 0.3 (45 degrees), p = 0.9.

Background The first MRI conditional pacemaker was introduced in 2008. Though, they represent the minority of all devices implanted, their use has increased. Similarly, CMR imaging in the UK has increased from just over 20,000 studies in 2008 to nearly 40,000 scans in 2010. However, there is limited data describing the frequency, safety and diagnostic quality of CMR scans in patients with MR conditional devices. Our aim was to describe device scanning in our clinical practice and identify reasons why MR conditional pacemakers were selected.