Impact of paramedic education on door-to-balloon times and appropriate use of the primary PCI pathway in ST-elevation myocardial infarction.

Objective: Evidence supports improved outcomes and reduced mortality with rapid reperfusion through primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). UK national audit data (Myocardial Ischaemia National Audit Project [MINAP]) demonstrates minor improvements in door-to-balloon times (DTB) of <90 min but increasing call-to-balloon times (CTB). We evaluate the effect of a regional Cardiologist delivered paramedic education programme (PEP) on DTB times and appropriate use of the PPCI pathway.

Outcome of left main stem percutaneous coronary intervention in a UK nonsurgical center: A 5-year clinical experience.

Objectives: To evaluate the outcome of unprotected left main stem (LMS) percutaneous coronary intervention (PCI) in a large UK nonsurgical center.

Background: PCI on unprotected LMS is increasingly regarded as a viable alternative to coronary artery bypass grafting (CABG) with comparable outcome and safety profile in select groups. The safety and efficacy of unprotected LMS PCI without on-site surgical back up has not been reported.

Hostility and physiological responses to laboratory stress in acute coronary syndrome patients.

Objective: Evidence suggests that emotional stress can trigger acute coronary syndromes in patients with advanced coronary artery disease (CAD), although the mechanisms involved remain unclear. Hostility is associated with heightened reactivity to stress in healthy individuals, and with an elevated risk of adverse cardiac events in CAD patients. This study set out to test whether hostile individuals with advanced CAD were also more stress responsive.

Practical support predicts medication adherence and attendance at cardiac rehabilitation following acute coronary syndrome.

Objective: Poor social support is associated with recurrent cardiac events following acute coronary syndrome (ACS). Interventions have largely targeted emotional support, but practical support may be particularly important in encouraging recovery behaviors. We assessed whether practical and emotional support differentially predicted medication adherence and rehabilitation attendance following ACS.

Causal beliefs, cardiac denial and pre-hospital delays following the onset of acute coronary syndromes.

Reducing pre-hospital delay is crucial in reducing mortality from acute coronary syndrome (ACS). Patient's causal beliefs and coping styles may affect symptom appraisal and help-seeking behavior. We examined whether patient's beliefs about the causes of their ACS and denial of impact were associated with pre-hospital delay.

Type-D personality and cortisol in survivors of acute coronary syndrome.

Objective: To test the hypothesis that Type-D personality is associated with elevated cortisol levels in patients 4 months after an acute coronary syndrome (ACS).

Methods: Salivary cortisol profiles were measured at home in 70 coronary heart disease patients (Mean age = 60.90 years, SD = 10.

Pre-hospital delay in patients with acute coronary syndrome: factors associated with patient decision time and home-to-hospital delay.

Background: Pre-hospital delays in patients experiencing acute coronary syndromes (ACS) remain unacceptably long.

Aims: To examine simultaneously a wide range of clinical, sociodemographic and situational factors associated with total pre-hospital delay and its two components.

Methods: Pre-hospital delay data were collected from 228 patients with ACS using patient's medical notes and semi-structured interviews.

Social networks and partner stress as predictors of adherence to medication, rehabilitation attendance, and quality of life following acute coronary syndrome.

Objective: This study examined whether social network size and partner stress predicted medication adherence, cardiac rehabilitation attendance, and quality of life 12 months following hospitalization for an acute coronary syndrome (ACS).

Design: ACS patients (N = 193, M age = 60.6 years, SD = 11.

Cortisol awakening response is elevated in acute coronary syndrome patients with type-D personality.

Objective: Type-D or "distressed" personality and depression following admission for acute coronary syndrome (ACS) have been associated with poor clinical outcome. The biological pathways underpinning this relationship may include disruption of the hypothalamic-pituitary-adrenocortical (HPA) axis. We therefore assessed cortisol output in patients who had recently suffered from ACS.

Acute depressed mood as a trigger of acute coronary syndromes.

Background: Some cases of acute coronary syndrome (ACS) may be triggered by emotional states such as anger, but it is not known if acute depressed mood can act as a trigger.

Methods: 295 men and women with a verified ACS were studied. Depressed mood in the two hours before ACS symptom onset was compared with the same period 24 hours earlier (pair-matched analysis), and with usual levels of depressed mood, using case-crossover methods.

Pathophysiological processes underlying emotional triggering of acute cardiac events.

Acute negative emotional states may act as triggers of acute coronary syndrome (ACS), but the biological mechanisms involved are not known. Heightened platelet activation and hemodynamic shear stress provoked by acute stress may contribute. Here we investigated whether patients whose ACS had been preceded by acute anger, stress, or depression would show heightened hemodynamic and platelet activation in response to psychophysiological stress testing.

Frequency of distress and fear of dying during acute coronary syndromes and consequences for adaptation.

Experiencing an acute coronary syndrome (ACS) may provoke a range of negative emotional responses, including acute distress and fear of dying. The frequency of these emotional states has rarely been assessed. This study examined the presence and severity of the fear of dying and acute distress in 184 patients with ACS and analyzed its correlates and consequences.

Behavioral and emotional triggers of acute coronary syndromes: a systematic review and critique.

Objective: The objective of this study was to review the evidence that behavioral and emotional factors are triggers of acute coronary syndromes.

Method: Systematic review of the published literature from 1970 to 2004 of trigger events, defined as stimuli or activities occurring within 24 hours of the onset of acute coronary syndromes.

Results: There is consistent evidence that physical exertion (particularly by people who are not normally active), emotional stress, anger, and extreme excitement can trigger acute myocardial infarction and sudden cardiac death in susceptible individuals.

Mild acute inflammatory stimulation induces transient negative mood.

Objective: This study aims to assess the mood changes induced by mild acute inflammatory stimulation (typhoid vaccination).

Methods: Using a double blind study design, 26 healthy volunteers underwent baseline assessments of mood, financial strain and work stress and were randomised to injection of Salmonella typhi vaccine or placebo injection. Mood, symptoms and body temperature was assessed by a modified version of the Profile of Mood States at 1, 2, 3, 4, 6 and 8 h post injection.

Exaggerated platelet and hemodynamic reactivity to mental stress in men with coronary artery disease.

Objective: This study compared the effects of acute mental stress on cardiovascular and subjective responses and platelet activation in male patients with established coronary artery disease (CAD) and age-matched controls.

Methods: We assessed 17 male CAD patients aged 44 to 59 years and 22 healthy male controls. Blood pressure, heart rate, and hemodynamics were assessed before, during, and up to 2 hours after administration of color/word and mirror tracing tasks.

Psychosocial factors in the development of coronary artery disease.

The fact that traditional risk factors only account for approximately two thirds of cases of coronary artery disease (CAD) has stimulated increasing interest in the relationship between CAD and psychosocial factors. Five areas--chronic stress, socioeconomic status (SES), personality, depression, and social support--have been most thoroughly examined. There is evidence to support a causal relationship between chronic stress, SES, depression, and social support and development of CAD.

New insights into the mechanisms of temporal variation in the incidence of acute coronary syndromes.

Over the last few years, patterns have emerged regarding the daily (circadian), weekly (circaseptan), and yearly (circannual) variation in the incidence of acute coronary syndromes (ACS). Peaks of incidence occur in the morning, on Mondays, and in winter. There is a difference in the pattern of incidence in different subgroups such as diabetics and smokers, which, along with the incidence alteration seen with aspirin and beta blockers, gives us some potential understanding of underlying mechanisms.