Cardiovascular Business - July/August 2008 - (Page 12)

Clinical Study Digest › By Justine Cadet - WiFi helps chest pain patients - Improving CABG survival HRS: Cell phone technology improves time-to-treatment by sending ECG from EMS Paramedics equipped with pre-hospital ECG devices that wirelessly transmit critical information to emergency rooms while en route to the hospital can reduce the time it takes to diagnose and treat patients by more than 30 percent, according to a study presented at the Heart Rhythm Society (HRS) meeting in San Francisco. The researchers from the University of California, San Francisco said the study is the first to prospectively evaluate hospital time-to-treatment and outcomes in individuals, who were randomized to receive a pre-hospital ECG versus the usual method of obtaining an ECG after hospital arrival. Results showed that pre-hospital ECG transmissions shortened the time to diagnosis, the time it took to receive the first ECG after the patient dialed 911 and the door-to-balloon time. A greater proportion of patients who received a pre-hospital ECG received PCI within 90 minutes versus those without a pre-hospital ECG (65 vs. 36 percent). Researchers observed a small but statistically significant increase in scene time from 15 minutes pre-implementation of the wireless devices to 17 minutes post-implementation. “However, this is negated by a much greater time savings of greater than 36 minutes in door-to-balloon time,” said lead author Barbara Drew, PhD. Investigators found no significant correlation between all-cause, risk-adjusted in-hospital mortality rates and the proportion of preventable deaths at the hospital level. However, the authors noted that a large proportion of preventable deaths were related to problems in the operating room (86 percent) and the intensive care unit (61 percent). Many deaths were associated with deviations in perioperative care—32 percent based on concurrence of two reviewers, and another 42 percent in cases in which one reviewer reached that opinion. Guru and colleagues concluded that all-cause risk-adjusted mortality rates are convenient measures of institutional quality of care, but were not correlated with preventable mortality in their jurisdiction. JACC: Longer clopidogrel duration lowers mortality with both BMS, DES Researchers from New York City have found a correlation between clopidogrel duration and cardiac events and death (J Am Coll Cardiol 2008;51:2220–2227). Somjot S. Brar, MD, and colleagues from Columbia University Medical Center identified 749 patients with diabetes mellitus who underwent stent implantation with either bare-metal stents (BMS) (251 patients) or and drug-eluting stents (DES) (498 patients). Researchers found that the event rate for death or MI was 3.2 percent in the group receiving clopidogrel greater than ninemonths, 9.4 percent in the six- to nine-month group and 16.5 percent in the less than six-month group. For death alone, the event rate was 0.5 percent in the group receiving clopidogrel greater than nine months, 4.3 percent in the six- to nine-month group and 10 percent in the less than six-month group. Investigators noted their results are specific to patients with diabetes. In another study, Bryan P. Yan, MBBS, and colleagues from the U.S. and Australia found similar incidence of stent thrombosis (early or late) between BMS and DES (Am J Cardiol 2008;101[12]:1716-1722). The absence of clopidogrel was an independent predictor of stent thrombosis. Additionally, patients receiving DES were at higher risk and scheduled to take clopidogrel longer. Circulation: Many in-hospital CABG-related deaths are preventable Researchers from Toronto concluded that one-third of in-hospital CABG deaths are preventable and that providers should conduct detailed adverse event audits to drive meaningful improvements in quality (Circulation 2008;117:2969–2976). Veena Guru, MD, from the Institute for Clinical Evaluative Sciences, and colleagues retrospectively analyzed 347 randomly selected in-hospital deaths after isolated CABG surgery at nine institutions in Ontario over the period of 1998 to 2003. Researchers deemed that 32 percent of deaths were preventable, despite a low risk-adjusted mortality range (1.3 to 3.1 percent) across hospitals. 12 Cardiovascular Business July/August 2008

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Cardiovascular Business - July/August 2008 Table of Contents First Word Cover Story: Planning for the Ideal Cath Lab Requires the Multidisciplinary Approach Clinical Study Digest: Cell Phone Technology Speeds Ecgs As Real-Time 3d Echo Matures, It Finds a Clinical Niche Ecg Image Management Brings Increased Productivity and Confidence Overcoming Barriers to Cath Lab Inventory Control Maximizing Reimbursement, Minimizing Penalties News & Views Calendar Reader Resources The Back Page

Cardiovascular Business - July/August 2008

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