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1. Abstract 1.1. Objective: Recent data has suggested an increased risk for patients with raised troponin,but prognosis of older patients with non-obstructive Coronary Artery Disease (CAD) is still unknown. 1.2. Methods : A retrospective cohort analysis was performed for all in-patients with raised troponin T (January 2010 to December 2011, n=1351), 858 above the age of 65 were studied. Of these, 513 had angiography and they were stratified according to their coronary arteries anatomy into older obstructive CAD (≥ 50% stenosis) (OO- CAD, 448, 87.3%) and older non-obstructive (1.3. Results: The mean age was similar between both older groups (77.9 ± 6.95 Vs.76.9 ± 7.02, P=0.236). The one-year MACCE rate was similar in both the ONO-CAD and OO-CAD group (one-year MACCE: RR [95% CI]=1.01[0.61-1.66], P=0.95). This was driven by the acute coronary syndrome patients who had unplanned revascularization and stroke. The one-year mortality was equal in ONO-CAD and OO-CAD group with a RR [95% CI]=1.48[0.81-2.7], P=0.19. This was similar to the total patient groups mortality at one- year with a RR [95% CI]= 0.93 [0.53-1.64], P=0.8. 1.4. Conclusion: Older patients with a raised troponin and non-obstructive CAD are at equivalent MACCE & mortality risk at one year to those with obstructive CAD.

Introduction Troponin elevation is an independent risk factor for mortality, but the prognosis of patients with troponin elevation and non-obstructive coronary artery disease (CAD) is unknown. Recent data have suggested an increased risk of mortality. This study was performed to further investigate the outcomes of troponin-positive patients with obstructive and non-obstructive CAD. Methods A retrospective cohort analysis was performed of all patients with raised troponin presenting to Kettering General Hospital (January 2010 to December 2011, n = 1,351). The patients who had angiograms were stratified anatomically into obstructive CAD and non-obstructive CAD (≤50% stenosis). The obstructive CAD group (O-CAD) was sub-analyzed by management strategy: emergency re-vascularization (

Background and purpose Complex cardiac pacing with either an implantable cardiovertor defibrillator (ICD) or a biventricular pacemaker with pacing only (CRT-P) or biventricular pacemaker with implantable cardiovertor defibrillator (CRT-D) plays an important role in the management of patients with heart failure. However, device implantation is associated with rare but significant complications which may limit the number of centres offering this treatment. The aim of this study is to define procedural success and complication rates associated with implantation of complex implantable cardiac devices in a district general hospital. Methods and subjects The pacing records of all the patients who underwent complex cardiac pacing (ICD, CRT-P and CRT-D) between January 2010 and December 2011 were reviewed. Information on clinical characteristics, pacing indications, venous access, implantation data, lead stability at follow-up, and procedure-related complications were obtained. Results A total of 151 devices (60 CRT-Ds, 55 CRT-Ps and 36 ICDs), were implanted between January 2010 and December 2011 with a median follow-up of 12 months. Overall transvenous procedural success rate was 99.3%. 14 (9.3%) out of the 151 patients suffered a complication. There were no procedure-related deaths, and lead displacement (5.3%) was the most common complication. Other complications included pocket haematoma and phrenic nerve stimulation (1.3% and 3.4%, respectively). There were no cases of pneumothorax, cardiac tamponade, device-related infection, symptomatic venous thrombosis and stroke. Lead thresholds, in particular that of the left ventricular lead, remained stable during the follow-up period indicating persistent delivery of cardiac resynchronisation therapy in the group receiving CRT systems. Conclusions In the presence of necessary clinical expertise, complex cardiac devices can be implanted successfully and with a high degree of safety in the setting of a district general hospital.

Aims Rotational atherectomy/rotablation (RA) has been traditionally considered a high risk procedure and performed in tertiary centres with on-site surgical backup. Our aim was to analyse RA with regards to procedural success and safety in the setting of a cardiac centre without on-site cardiac surgery. Methods A retrospective analysis of all RA pts between Jan 2010 and April 2013 was undertaken. Demographic data and procedural details were collected from medical case notes, cathlab records, BCIS and radiographer’s database. Hospital, GP records and national mortality registry were used for follow-up information. F/u data was analysed at 30 days and 1 yr post procedure. Results 184 pts underwent 206 PCI’s with RA in the study period of 40 months. This represents 5% of our total 3884 PCI work load. In comparison to non-RA group, RA group was older (74 vs. 67 yr) and had higher risk profile: HTN (72 vs. 68%), DM (35 vs. 21%). Procedures were elective in 153 (74%), ACS-41 (20%) and STEMI-12 (6%). 3-vessel CAD was present in 61 (30%), LMS disease in 26 pts (14%). Intervention was performed on LMS 20 (10%), LAD 111 (54%), LCx 30 (15%) and RCA 66 (32%), with 18 (9%) pts having multivessel RA. There were 9 (4%) ostial lesions, 35 (17%) bifurcation lesions, and 2 (1%) CTOs. There was previous failed PCI in 21 (10%) pts, with ad-hoc RA in 24 (12%) and the rest having upfront RA (161, 78%). Radial access was 38% and femoral in 62% with 6 and 7F catheters used equally. A single burr was used in 175 (85%). Burr sizes were: 1.25 mm (55%), 1.5 mm (39%). IVUS use in 45 (22%); prophylactic temporary PPM in 14 (10%) and prophylactic IABP in 9 (4%). Procedural success was achieved in 198 (96%) with 5 requiring balloon only dilation. Mean total radiation time was 43.8 min, with a mean DAP of 16793 cGy with >50% reduction after first 2 yrs and mean contrast load 270 ml with a 17% reduction after 2 yrs. No procedural comp were seen in 184 (89%) cases, major comp in 6% (12: vascular comp requiring surgery/transfusion-5; tamponade-3; temporary PPM related-2 and PCI wire related in 1; contrast nephropathy-2; coronary perforation due PCI wire-1; transfusion with no source of bleeding-1), and minor comp in 6% (13: hypotension requiring IABP-3; bradycardia requiring temporary PPM-1; coronary slow/no flow-2; coronary dissection-1; other coronary comp-2; other – hypotension, bradyarrhythmia, tachyarrhythmia treated medically-4). In hospital mortality was 1%(2: both ACS) and at 1 yr 5.8%(12) with 2% cardiac mortality. MACE rate (i.e. cardiac mortality, MI, TLR and CABG) at 1 month was 1.5% and at 1 yr 8.7% driven mainly by TLR due to ISR. Event free survival at 1 yr was 178 (86%). Conclusions RA in the setting of off-site surgical backup is a safe and effective with an overall high procedural success rate. Ours is one of the largest series of RA pts in the DES era and support RA use in calcified coronary lesions. Event rate during 1 yr follow-up was mainly driven by TLR due to ISR.

A 61-year-old patient with diabetes had a bio-prosthetic aortic valve replacement 3 years before admission. He complained of lethargy, night sweats, decreased appetite and erratic blood glucose with no weight loss. He had splinter haemorrhage and a systolic ejection murmur at the aortic area. Chest and abdominal examination revealed no abnormality. The erythrocyte sedimentation rate and C reactive protein were raised. He had several sets of blood cultures and he was started on empirical vancomycin, rifampicin and gentamicin. Transthoracic echocardiography showed vegetation on the base of the anterior mitral leaflet, which was confirmed by a trans-oesophageal echocardiography. Blood culture was positive for Haemophilus aphrophilus, and he was started on ceftriaxone for 6 weeks instead of vancomycin and rifampicin and continued gentamicin for 2 weeks. Follow-up echocardiography showed no evidence of vegetations. The patient recovered completely and he was discharged home.

Although Kawasaki disease is generally self-limiting, 15-25% of children with Kawasaki disease may develop significant cardiovascular sequelae, presentation may occur acutely or late (death has been reported up to 14 years after the acute illness). The most common late complication is the persistence of coronary artery aneurysms, these may produce myocardial ischaemia and even myocardial infarction, valvular dysfunction has also been reported. However the occurrence of late abnormalities of myocardial function is controversial. We describe a 24-year-old man who presented with myocardial infarction as a result of coronary artery aneurysms caused by Kawasaki disease, he gave no recent or childhood history of prodromal illness compatible with Kawasaki disease. The diagnosis was confirmed at post mortem.