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An introduction to the journal is presented in which the editor discusses various reports published within the issue including one on a randomized trial designed to test the efficacy of humanized monoclonal antibody component5 (C5) complement inhibitor pexelizumab, one on interventions for Segment Elevation Myocardial Infarction (STEMI) system building, and one on a survey of hospitals participating in the Mission: Lifeline program.

Background: Most studies demonstrating the benefit of perioperative glycemic control in patients undergoing CABG have primarily focused on inpatient glucose management protocols only. Our study evaluated outcomes before and after implementation of an innovative, comprehensive cardiovascular diabetes program in patients with diabetes undergoing CABG. Methods: In March 2015, Sentara Heart Hospital and Eastern Virginia Medical School implemented a Multidisciplinary Cardiovascular Diabetes Program. The inpatient aspect focuses on patient education and optimizing glycemic control with the use of Glucommander, an electronic glucose management system. Representatives from endocrinology, cardiology and cardiothoracic surgery meet monthly to review outcomes and develop policy. Patients return for a visit with the surgical and endocrine teams 1-2 weeks after discharge, followed by cardiac rehabilitation. Our retrospective study was designed to compare clinical outcomes for the period of 2 years pre- and 2 years post-implementation of the program. Data from 1013 patients (444 pre; 569 post) were extracted from the Society of Thoracic Surgeons CABG database and the EPIC electronic health record. Results: After implementation of the program, the frequency of blood glucose values <70 mg/dl was reduced by 42% (from 1.52% to 0.89%; p < 0.001) and the length of stay (LOS) decreased from 12.4 days to 11.2 days (p = 0.026). Multiple regression analyses showed the post-implementation period was associated with shorter LOS and reduced hospital charges. Poor glycemic control, infections and cardiovascular complications had a negative effect on LOS, readmissions and hospital charges. Conclusion: The implementation of a comprehensive, multidisciplinary program for patients with diabetes undergoing CABG resulted in significantly less hypoglycemia, shorter LOS and reduced hospital charges. Disclosure: E.S. Siraj: Advisory Panel; Self; Sanofi. Consultant; Self; Boehringer Ingelheim Pharmaceuticals, Inc. A. Nelson: None. J.E. Brush: None. J. Ullal: None. R. Lamichhane: None. B.E. Sheehan: None. Funding: EVMS-Sentara Healthcare Analytics and Delivery Science Institute [ABSTRACT FROM AUTHOR]

Background: Recent reductions in average door-to-balloon (D2B) times have not been associated with decreases in mortality at the population level. We investigated this seemingly paradoxical finding by assessing components of this association at the individual and population levels simultaneously. We postulated that the changing population of patients undergoing primary percutaneous coronary intervention (pPCI) contributed to secular trends toward an increasing mortality risk, despite consistently decreased mortality in individual patients with shorter D2B times.Methods: This was a retrospective study of ST-elevation myocardial infarction (STEMI) patients who underwent pPCI between Jan 1, 2005, and Dec 31, 2011, in the National Cardiovascular Data Registry (NCDR) CathPCI Registry. We looked for catheterisation laboratory visits associated with STEMI. We excluded patients not undergoing pPCI, transfer patients for pPCI, patients with D2B times less than 15 min or more than 3 h, and patients at hospitals that did not consistently report data across the study period. We assessed in-hospital mortality in the entire cohort and 6-month mortality in elderly patients aged 65 years or older matched to data from the Centers for Medicare and Medicaid Services. We built multilevel models to assess the relation between D2B time and in-hospital and 6-month mortality, including both individual and population-level components of this association after adjusting for patient and procedural factors.Findings: 423 hospitals reported data on 150,116 procedures with a 55% increase in the number of patients undergoing pPCI at these facilities over time, as well as many changes in patient and procedural factors. Annual D2B times decreased significantly from a median of 86 min (IQR 65-109) in 2005 to 63 min (IQR 47-80) in 2011 (p<0·0001) with a concurrent rise in risk-adjusted in-hospital mortality (from 4·7% to 5·3%; p=0·06) and risk-adjusted 6-month mortality (from 12·9% to 14·4%; p=0·001). In multilevel models, shorter patient-specific D2B times were consistently associated at the individual level with lower in-hospital mortality (adjusted OR for each 10 min decrease 0·92; 95% CI 0·91-0·93; p<0·0001) and 6-month mortality (adjusted OR for each 10 min decrease, 0·94; 95% CI 0·93-0·95; p<0·0001). By contrast, risk-adjusted in-hospital and 6-month mortality at the population level, independent of patient-specific D2B times, rose in the growing and changing population of patients undergoing pPCI during the study period.Interpretation: Shorter patient-specific D2B times were consistently associated with lower mortality over time, whereas secular trends suggest increased mortality risk in the growing and changing pPCI population. The absence of association of annual D2B time and changes in mortality at the population level should not be interpreted as an indication of its individual-level relation in patients with STEMI undergoing primary PCI.Funding: National Heart, Lung, and Blood Institute. [ABSTRACT FROM AUTHOR]