Assay interference as a cause of false positive troponin T elevation in emergency department patients.

Background: Troponin assays are used in the diagnosis of myocardial injury and may show elevated results for a variety of reasons. However it is increasingly recognised that cardiac troponin elevation may in some cases be due to assay interference. This is of significant importance as a misdiagnosis of myocardial injury may lead to unnecessary and potentially harmful investigation and treatment for patients.

Transformation of Heart Attack Care: A Primary Percutaneous Coronary Intervention Service for Northern Ireland.

Primary percutaneous coronary intervention (primary PCI) is the preferred immediate treatment for patients with acute ST elevation myocardial infarction. It is however, considerably more labour-intensive than the previous standard of care and requires an immediate response from consultant-led teams to deliver best outcomes. We describe the introduction of a comprehensive primary PCI service for Northern Ireland and suggest that the process by which it was designed, piloted, commissioned and benchmarked can serve as a prototype for other high-risk, time-sensitive clinical emergency services.

Fifty Years of Ventricular Tachycardia in a Single Patient.

We report a patient who first presented during childhood in the early 1960's with several episodes of ventricular tachycardia (VT) and we describe her management which reflected the best medical knowledge at the time. She then presented more than 50 years later, again with VT, at which time a definitive diagnosis of the underlying cause was made. Her case illustrates the evolution in the understanding and management of VT over the past 50 years.

Analysis of weekend effect on 30-day mortality among patients with acute myocardial infarction.

Objectives: Several publications have demonstrated increased 30-day mortality in patients admitted on Saturdays or Sundays compared with weekdays. We sought to determine whether this was true for two different cohorts of patients admitted with acute myocardial infarction (MI).

Methods And Results: Thirty-day mortality data were obtained for 3757 patients who had been admitted to the Belfast Health and Social Care Trust with acute MI between 2009 and 2015.

A prospective intravascular ultrasound investigation of the necessity for and efficacy of postdilation beyond nominal diameter of 3 current generation DES platforms for the percutaneous treatment of the left main coronary artery.

Objectives: To define the size of the left mainstem coronary artery (LMS) in the Northern Irish population and investigate the clinical feasibility, safety, and efficacy of post dilation beyond nominal diameter of current generation Drug eluting stent (DES) when treating the LMS.

Background: There is no prospective data examining the need, feasibility, and safety of over-expansion of current generation DES beyond nominal diameter.

Methods: Patients with flow-limiting coronary atheroma requiring IVUS assessment of the LMS were recruited.

'I am still a bit unsure how much of a heart attack it really was!' Patients presenting with non ST elevation myocardial infarction lack understanding about their illness and have less motivation for secondary prevention.

Background: There are considerable differences in the type of treatments offered to patients presenting with acute myocardial infarction (AMI), in terms of the speed and urgency with which they are admitted, treated and discharged from hospital. The impact of these different treatment experiences on patients' illness perception and motivation for behavioural changes is unknown.

Aim: The aim of this study was to explore and compare patients' illness perception and motivation for behavioural change following myocardial infarction (MI) treated by different methods.

Comparison of radiation dose and the effect of operator experience in femoral and radial arterial access for coronary procedures.

Radial access coronary procedures are associated with fewer access site complications compared to femoral access. There is controversy regarding greater radiation exposure to patient and operator using radial access. We aimed to compare radiation dose during coronary procedures for the 2 access routes and assess the effect of operator experience with radial access on radiation dose.

A classic diagnosis with a new 'spin'.

We describe a case of pericardial constriction following viral pericarditis and illustrate the use of cardiac magnetic resonance imaging in the diagnostic process. The advantages of cardiac magnetic resonance in the investigation of pericardial disease are briefly explained.

Prospective survey of serial troponin T requesting in an acute teaching hospital.

Background: Requests for troponin T, a biomarker for myocardial infarction, may be sent in a variety of clinical situations. In most cases, a single sample 12 hours or more after symptom onset should be sufficient for diagnosis. We chose to investigate how troponin T testing is used in our hospital with emphasis on those who had serial rather than single troponin measurements during their hospital stay.

Progressively increasing operative risk among patients referred for coronary artery bypass surgery.

Objective: Advances in surgical, anaesthetic and percutaneous interventional techniques may have led to higher risk patients being referred for coronary artery bypass graft surgery (CABG). The purpose of this study was to compare the predicted mortality risk (EuroSCORE) of a contemporary cohort of patients referred for isolated elective CABG (2002) with that of a cohort referred five years previously (1997) and to examine temporal trends in patient demographics.

Methods: Records (n=2873) of weekly cardiac surgical referral meetings were examined and the age, sex, type of operation and surgical decision for every patient referred from 1997 to 2002 inclusive were recorded.

Evaluation of high-pressure retrograde coronary venous delivery of FGF-2 protein.

Delivery of angiogenic factors to ischemic myocardium remains a practical challenge. We evaluated the efficiency and efficacy of delivery of fibroblast growth factor-2 (FGF-2) protein via high-pressure retrograde injection into the anterior interventricular vein (AIV) in a porcine model of chronic myocardial ischemia. Labeled FGF-2 protein was delivered to the myocardium of three pigs via the AIV and the left anterior descending (LAD) coronary artery in three others.

Flow-responsive remodeling after angioplasty is enhanced by high cholesterol diet. Prevention with pyrrolidine dithiocarbamate.

We examined the effects of high cholesterol diet and pyrrolidine dithiocarbamate (PDTC) on flow-dependent remodeling after angioplasty. After right common carotid balloon-injury, the right external carotid (low flow) or left common carotid artery were ligated (high flow) in rabbits fed normal diet, 1% cholesterol diet without or with the antioxidant PDTC for 7 days pre- and 7-28 days post-injury. Angiographic lumen diameter was significantly greater at 28 days in high flow than low flow normal diet animals, attributable on perfusion-fixed vessel morphometry to altered remodeling (area within the external elastic lamina: high flow 1.

Effect of a change in gender on coronary arterial size: a longitudinal intravascular ultrasound study in transplanted hearts.

Objectives: We sought to document whether a physiologic change in gender has any effect on coronary arterial size.

Background: The coronary arteries are smaller in women, even after correction for body surface area (BSA). These differences may contribute to adverse clinical outcomes after coronary artery bypass graft surgery and myocardial infarction in women.

Adjunctive platelet glycoprotein IIb/IIIa receptor inhibition with tirofiban before primary angioplasty improves angiographic outcomes: results of the TIrofiban Given in the Emergency Room before Primary Angioplasty (TIGER-PA) pilot trial.

Background: Previous work has suggested that platelet glycoprotein IIb/IIIa receptor blockade may confer benefit in the treatment of acute myocardial infarction. The TIGER-PA pilot trial was a single-center randomized study to evaluate the safety, feasibility, and utility of early tirofiban administration before planned primary angioplasty in patients presenting with acute myocardial infarction.

Methods And Results: A total of 100 patients presenting with acute myocardial infarction were randomized to either early administration of tirofiban in the emergency room or later administration in the catheterization laboratory.

Inhaled nitric oxide in combination with volume resuscitation refines a porcine model of endotoxic shock.

Background: Existing porcine models of endotoxic shock poorly represent the human situation.

Aims: To assess whether the cardiovascular profile of a porcine model could be improved by refining the protocol.

Methods: In 30 pigs, right and left heart pressures and cardiac output were measured.

Acute myocardial infarction and vascular remodeling.

We used intravascular ultrasound to show that outward remodeling predominates in lesions responsible for acute myocardial infarction, whereas negative remodeling is far more prevalent in lesions responsible for chronic stable angina. The total cholesterol:high-density lipoprotein ratio was also strongly correlated with outward remodeling.

Mild hyperhomocysteinemia is not associated with cardiac allograft coronary disease.

Background: Hyperhomocysteinemia is an independent risk factor for coronary disease and elevated plasma homocysteine levels have been documented in heart transplant recipients. The aim of this study was to test the hypothesis that homocysteine levels are associated with presence or absence of transplant coronary artery disease.

Methods: Forty-three non-smoking adults were recruited, all of whom had received a heart transplant between 2 and 7 yr previously.

Coronary artery distensibility and compensatory vessel enlargement--a novel parameter influencing vascular remodeling?

Vascular remodeling implies the concept of compensatory vessel enlargement to preserve luminal dimensions during atheromatous plaque development. However, negative remodeling, i.e.