Consensus guidelines for interventional cardiology services delivery during covid-19 pandemic in Australia and new Zealand.

The global coronavirus disease (COVID-19) pandemic poses an unprecedented stress on healthcare systems internationally. These Health system-wide demands call for efficient utilisation of resources at this time in a fair, consistent, ethical and efficient manner would improve our ability to treat patients. Excellent co-operation between hospital units (especially intensive care unit [ICU], emergency department [ED] and cardiology) is critical in ensuring optimal patient outcomes. The purpose of this document is to provide practical guidelines for the effective use of interventional cardiology services in Australia and New Zealand. The document will be updated regularly as new evidence and knowledge is gained with time. Goals Considerations.

Radiation dose difference between state of the art myocardial perfusion scintigraphy and computed tomography coronary angiography in patients undergoing evaluation for suspected coronary artery disease.

Minimisation of radiation exposure with cardiac imaging reduces the potential of secondary side effects. Radiation exposure from myocardial perfusion scintigraphy and computed tomography coronary angiography (CTCA) was compared. Overall doses were low with both modalities. Doses were lower in the CTCA group, but by only a small difference of 1.1 mSv. Radiation exposure should not be the primary consideration when choosing between these two modalities.

Small vessel disease and intracoronary plaque composition: a single centre cross-sectional observational study.

Cardiac events are commonly triggered by rupture of intracoronary plaque. Many studies have suggested that retinal small vessel abnormalities predict cardiac events. The present study examined retinal microvascular abnormalities associated with intracoronary plaque. This was a single centre cross-sectional observational study of consecutive subjects who underwent coronary angiography and intracoronary optical coherence tomography (OCT) of occlusive coronary artery disease. Subjects' retinal images were deidentified and graded for microvascular retinopathy (Wong and Mitchell classification), and vessel calibre using a semiautomated method based on Knudtson's modification of the Parr Hubbard formula. Control subjects had no significant plaque on angiography. Analysis used the Fisher's exact test or student t-test. Thirty-two subjects with intracoronary plaque including 22 males (79%) had a mean age of 62.6 ± 9.4 years. Twenty-four (86%) had hypertension, 10 (36%) had diabetes, and 21 (75%) were current or former smokers. Their average mean arterial pressure was 90.5 ± 5.8 mm Hg, and mean eGFR was 74 ± 15/min/1.73 m2. On angiography, 23 (82%) had a left anterior descending artery (LAD) stenosis, their mean diseased vessel score was 1.86 ± 1.21, and mean total stent number was 1.04 ± 1.00. Plaque type was mainly (>50%) fibrous (n = 7), lipid (n = 7), calcific (n = 10), or mixed (n = 4). Control subjects had a lower mean diastolic BP (p = 0.01), were less likely to have an LAD stenosis (p < 0.001), a lower mean diseased vessel score (p < 0.001) and fewer stents (p = 0.02). Subjects with plaque were more likely to have a moderate microvascular retinopathy than those with none (p = 0.004). Moderate retinopathy was more common with lipid (p = 0.05) or calcific (p = 0.003) plaque. Individuals with calcific plaque had a larger arteriole calibre (158.4 ± 15.2 µm) than those with no plaque (143.8 ± 10.6 µm, p = 0.02), but calibre was not related to diabetes or smoking. Calibre did not correlate with plaque length, thickness or arc angle. Thus, subjects with intracoronary artery plaque are more likely to have a moderate microvascular retinopathy. Those with calcific plaque have larger retinal arterioles which is consistent with our previous finding of larger vessel calibre in triple coronary artery disease. Retinal microvascular imaging warrants further evaluation in identifying severe coronary artery disease.

Results of primary percutaneous coronary intervention in a consecutive group of patients with acute ST elevation myocardial infarction at a tertiary Australian centre.

BACKGROUND: Multicentre randomized controlled trials (RCT) of primary percutaneous coronary intervention (PCI) for ST elevation myocardial infarction (STEMI) have consistently shown lower mortality compared with fibrinolysis, if carried out in a timely manner. Although primary PCI is now standard of care in many centres, it remains unknown whether results from RCT of selected patients are generalizable to a 'real-world' Australian setting. The primary goal of this study was to evaluate whether a strategy of routine invasive management for patients with STEMI can achieve 30-day and 12-month mortality rates comparable with multicentre RCT. Secondary goals were to determine 30-day mortality rates in prespecified high-risk subgroups, and symptom-onset- and door-to-balloon-inflation times. METHODS: A retrospective observational study of 189 consecutive patients treated with primary PCI for STEMI in a single Australian centre performing PCI for acute STEMI. RESULTS: All-cause mortality was 6.9% at 30 days, and 10.4% at 12 months. Mortality in patients presenting without cardiogenic shock was low (2.4% at 30 days; 5.0% at 12 months), whereas 12-month mortality in patients with shock was higher, particularly in the elderly (29.4% for patients <75 years; 85.7% for patients > or =75 years, P = 0.01). Symptom-onset-to-balloon-inflation time was < or =4 h in 56% of patients (median 231 min); however, a door-to-balloon time of <90 min was achieved in only 20% (median 133 min). CONCLUSION: Mortality and symptom-onset-to-balloon-inflation times reported in RCT of primary PCI for STEMI are generalizable to 'real-world' Australian practice; however, further efforts to reduce door-to-balloon times are required.