Fatal neutropenia and thrombocytopenia associated with ticlopidine after stenting.

We report 3 cases of fatal neutropenia and thrombocytopenia associated with ticlopidine after coronary stenting. Patients should be counseled about the early signs of infection and bleeding and to have regularly scheduled complete blood counts.

The foundation and launch of the Melbourne Interventional Group: a collaborative interventional cardiology project.

The Melbourne Interventional Group (MIG) is a voluntary collaborative venture of interventional cardiologists practicing at 12 major public and private hospitals in Victoria, designed to record data pertaining to percutaneous coronary interventions (PCI) and perform long-term follow-up. The potential advantages of collaboration involve large-scale analysis of current interventional strategies (e.g. drug-eluting stents, evaluation of new technologies and cost-effective analysis), provide a basis for multi-centred clinical trials and allow comparison of clinical outcomes with cardiac surgery. The established registry documents demographic, clinical and procedural characteristics of consecutive patients undergoing PCI and permits analysis of those characteristics at 30 days and 12 months. The registry is co-ordinated by the Centre of Clinical Research Excellence (CCRE), a research body within the Department of Epidemiology and Preventive Medicine (Monash University, Melbourne). The eventual goal of MIG is to provide a contemporary appraisal of Australian interventional cardiology practice, with opportunities to improve in-hospital and long-term outcomes of patients with coronary artery disease.

Alfred Hospital Coronary Care Unit: an acute myocardial infarction quality assurance study.

A six-month prospective study was performed to assess the efficacy of delivering thrombolytic therapy to patients with acute myocardial infarction and admitted to the coronary care unit. Patient characteristics, time from chest pain onset to presentation to emergency department, from presentation to thrombolytic therapy, transfer from emergency department to coronary care unit major interventions and outcome were assessed. One hundred and twenty patients were admitted with acute myocardial infarction, mean age 66 years (26-91), 69% were males. Of these, 50% received thrombolytic therapy. The mean time from chest pain onset to emergency department was 192 +/- 164 minutes, transfer from emergency department to coronary care unit was 195 +/- 150 minutes. The mean time from presentation to emergency department to receiving thrombolytics was 63 +/- 12 minutes. Streptokinase was the choice of thrombolytic in 97%. Thrombolytic therapy was administered in emergency department in 80% of cases. Thirty-eight (63%) patients received thrombolytic therapy within 60 minutes of presentation. Compared to the non-thrombolytic group, the thrombolytic group were younger, 63 vs 69 years, P < 0.01, presented earlier to hospital (192 vs 394 minutes, P < 0.0005), were transferred to coronary care unit sooner (195 vs 472 minutes, P < 0.001), and had more coronary angiograms (29 vs 23, P < 0.02) and PTCA performed 10 vs 3, P < 0.04. There were no significant differences in length of coronary care unit stay, length of hospital stay, patients receiving CABG or death.

Percutaneous transluminal coronary angioplasty and stenting for cocaine-induced acute myocardial infarction: a case report and review.

Cocaine-induced myocardial infarction has been well reported. Likewise, there are numerous reports of patients with cocaine-induced myocardial infarction being treated conservatively with nitroglycerin, verapamil, and thrombolytics. However, based on a Medline search from 1977 to 1998 (with the keywords cocaine and angioplasty), there have been no reports in English of cocaine-induced myocardial infarction being treated with catheter-based intervention. We report such a case, as well as review what is known about the pathophysiology of cocaine-induced coronary arteriopathy and myocardial infarction.