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Background: Epidemiological information on patients with acute coronary syndromes managed in specialized cardiac centres is limited., Objective: To report the evolution of demographics, treatment and outcome of patients admitted to a tertiary coronary care unit (CCU) over a 17-year period., Methods: A prospective database of 18,719 patients admitted from April 1986 to March 2003 in a 21-bed CCU was analyzed., Results: From 1986 to 2003, the number of admissions increased from 937 to 1577 per year, while the length of stay declined from 7.5 to 3.5 days. The mean age increased from 58.4 to 63.4 years, and the proportion of men remained stable at approximately 70%. The use of coronary angiograms increased from 49.8% to 81.1% in all patients, while fibrinolysis dropped to 0.4%. In-hospital mortality decreased from 9% to 1.5%. The percentage of overall instrumentation (arterial line, central venous catheter, temporary pacemaker, Swan-Ganz catheter and intra-aortic balloon pump) decreased from 38% to 8.1%. From 1995 to 2003, the proportion of stenting during percutaneous transluminal coronary angioplasty increased dramatically from 0% to 86%. In the past five years, surgical revascularization has remained stable at approximately 20% of all admissions. The proportion of patients discharged with a noncoronary chest pain diagnosis has remained constant at approximately 4%., Interpretation: There has been a tremendous increase in efficiency, with an approximate doubling of the admissions turnover rate in a tertiary CCU. Patients with acute coronary syndromes are stratified faster and treated more invasively. Therapeutic advances are reflected by an almost linear 0.5% per year decrease in in-hospital mortality.

Coronary perforations remain a rare but life-threatening complication of percutaneous coronary intervention. In the setting of complex coronary lesions, 14 of 25 consecutive perforations related to percutaneous coronary intervention were managed with stents covered with polytetrafluoroethylene (PTFE), and 11 were managed conventionally with reversal of anticoagulation and prolonged balloon inflation. Procedural success was achieved in 71.4% (10 of 14 perforations) of the PTFE arm compared with 27.3% (3 of 11 perforations) in the standard management arm (p = 0.047). Smaller final percent diameter stenosis and postprocedural cessation of dye extravasation were achieved with PTFE-covered stents. No delayed cardiac tamponade or in-hospital mortality was reported among patients in the PTFE group.

Objective: We sought to calculate the sensitivity, specificity, negative predictive value, and positive predictive value of a limited sinus computed tomographic (CT) scan for sinus disease., Methods: We conducted a retrospective case series. Inclusion criteria included a sinus CT scan obtained between April 1999 and November 2000. From the complete sinus CT scan, the limited series were obtained by blocking from view all the other cuts and leaving the radiologist only four slices to read (midfrontal, anterior maxillary sinuses, posterior maxillary sinuses, and midsphenoidal). The complete CT scan was the "gold standard.", Results: Fifty-one patients were eligible. We observed 81.3% sensitivity, 89.5% specificity, a 73.9% negative predictive value, and a 92.9% positive predictive value for the limited CT scan for the detection of sinus disease. This sensitivity and specificity were higher than reported in the literature for plain films., Conclusion: The limited sinus CT scan is superior to plain radiographs but is not as good as the full CT scan in the evaluation of sinusitis.