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Factors found to predict intrahospital mortality for patients with RV infarction were: renalimpairment defined as creatinine levels >130umol/l (OR: 8.22; 95% CI [1.33-50.9]; p:0.023), 3 vessel disease (OR: 7.09; 95% CI [1.738-28.93]; p: 0.006) and the association ofsigns of left ventricular failure with KILLIP >1 (OR: 4.09; 95% CI [1.58-10.58]; p:0.004).

Conclusion: RV infarction complicates inferior MIs mainly in elderly and in patients with ahistory of coronary artery disease. In this setting, prognosis is dramatically affected par-ticulary in patients with renal impairment, 3 vessel disease and KILLIP> 1.Disclosure of Interest: None Declared

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Coronary artery disease in The Young In India – A gender based comparison

Harikrishnan Sivadasanpillai*1, Jaganmohan Tharakan1, N. Jayakumari2, Reema George2,Jeemon Panniyammakal3, Manas Chacko1, Krishna Sankar1, Vivek Narayanan1, Suresh Babu1,C. P. Vineeth11Cardiology, 2Biochemistry, Sree Chitra Tirunal Institute for Medical Sciences and Technology,Trivandrum, India, Trivandrum, 3Center for Chronic Disease Control, New Delhi, India

Introduction: Coronary artery disease(CAD) affects Indians at a younger age. There ispaucity of data on young patients with CAD from India.Objectives: To compare the risk factor profile and mode of presentation of young females(less than 55 years) versus males in the same age group.Methods: Retrospective analysis of the data of consecutive patients admitted to SCTIMST,a tertiary care center in South India from 2001-2010 (10 years). The data regarding CADrisk factors and mode of presentation were analyzed.Results: During the 10 year period, 18537 patients presented to the hospital with CAD.Out of them 4933 (26.6%) were below 55 years. Out of the 4933 patients, 4333 were males(87.8%) and 600 were females (12.2%).Females were slightly older compared to males. Hypertension and diabetes mellitus were

GENDER

Female Male

AGE GROUP <35 8 (1.33%) 131 (3.02%)

36-45 140 (23.33%) 1240 (28.62%)

46-55 452 (75.33%) 2962 (68.36%)

PRESENTATION Non-ACS 271 (45.18%) 945 (21.85%)

ACS 329 (54.82%) 3387 (78.15)

Variables Men (n[4333) Women (n[600) P value

Age (mean, SD) 47.62 (5.88) 49.03 (5.27) <0.001

Family history (n, %) 1297 (29.93) 223 (37.35) <0.001

Hypertension (n, %) 1848 (46.25) 389 (64.83) <0.001

Diabetes (n, %) 1530 (35.31) 317 (52.83) <0.001

Dyslipidemia (n, %) 2191 (50.57) 286 (47.67) 0.183

Tobacco use (n, %) 2839 (65.52) 8 (1.3) <0.001

significantly more prevalent among females. Smoking was negligible among females(1.3%), but 65% of the males gave a history of smoking. A positive family history ofpremature coronary artery disease was significantly more among females(30 vs 37%). Thelipid profile (all in mg/dl, SD in parentheses) was significantly different, males Vs females.Total cholesterol (TC), LDL cholesterol (LDLC) and HDL cholesterol (HDLC) weresignificantly higher (p<0.001) among females [ TC - 188.40 (53.41 Vs 172.37 (49.19),LDL - 121.53 (50.24) Vs 106.06 (43.18), HDLC – 39.09 (10.38) Vs 34.51 (8.86) ].Triglyceride levels were higher among males 158.34 (72.83) Vs 137.29 (67.90). Malespresented more commonly with ACS (78%) while almost half of females (45%) had a non-ACS mode of presentation.(p<0.001).Conclusion: This data shows that females have higher prevalence of risk factors whichpredisposes them to the development of CAD in this younger age. Smoking is a veryimportant risk factor among males. Programs for early detection and control of risk factorswill do a great extent in preventing the development of CAD in the young population inKerala, India.Disclosure of Interest: None Declared

GHEART Vol 9/1S/2014 j March, 2014 j POSTER/2014 WCC Posters

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Systems of Repurfusion for STEMI in Hunter New England NSW

Lindsay Savage*1, Trent Williams1, Peter Fletcher1, Paul Stewart2, Dawn McIvor1,Helen Orvad11Cardiology Stream, Hunter New England Health, Newcastle, 2New South Wales AmbulanceService, Ambulance, Sydney, Australia

Introduction: The importance of reducing time to reperfusion in the treatment of STEMI iswell known. The greatest benefits are gained when treatment is achieved closest tosymptom onset and first medical contact. An integrated system of clinicians using tech-nology to support point of care STEMI diagnosis is utilised within Ambulance, remote ruralhealth facilities and tertiary hospitals to maximise the potential benefit to the patient withSTEMI. Hunter New England (HNE) Local Health District in NSW covers 130,000 squarekilometres or an area comparable to England.Objectives: The objective for reperfusion services in HNE is to provide early accurateidentification and treatment of STEMI. Remote rural sites and teaching hospitals needto offer treatment that does not disadvantage the community through isolation ordistance while relationships within health are used to best advantage to achieve thatobjective.Methods: HNE provides three distinct but integrated solutions to the treatment ofSTEMI. Access to primary angioplasty is provided for patients where pre-hospital orinter-hospital STEMI identification and transport to the CCL is within 60 minutes fromfirst medical contact. Patients who cannot achieve that benchmark are assessed andwhere appropriate provided lysis by paramedics, nurses or doctors as soon as possible.Identification of STEMI is supported in all hospitals (n¼36) and ambulance by theutilisation of the Glasgow algorithm and the ability to electronically send ECG forexpert review.Results: HNE has 14,500 patients’ present with cardiac symptoms to its facilities. Uti-lisation of the Glasgow algorithm in the management of STEMI has been implemented withvarying success. Local epidemiological data has shown a trend in failure to appropriatelytreat STEMI. Current instances of inadequate treatment of STEMI have been linked to thenon - use of the algorithm and transmission of the ECG to gain expert support.Pre–Hospital Thrombolysis and Nurse Administered Thrombolysis have both achieved

timely reperfusion in a rural environment.Conclusion: An integrated system of reperfusion management utilising appropriate clini-cian skills supported by a point of care electronic ECG interpretation and transmissionsystem is possible over a large geographical area. Resistance to change in the managementof STEMI poses occasional implementation difficulty.Disclosure of Interest: None Declared

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The value of electrocardiographic changes in predicting culprit coronary artery inpatients with Acute Myocardial Infarction and Combined ST-segment Elevation inAnterior and Inferior Leads

Mir Milad Pourmousavi Khoshknab*1, samad ghafari21Medical student, Member of scientific Association of medical university, Tabriz branch, IslamicAzad University, Tabriz, Iran, Member of scientific Association of medical university, Tabrizbranch, Islamic Azad University, Tabriz, Iran, 2Madani heart hospital of Tabriz, Iran, Tabrizmedical university, Tabriz, Iran, Islamic Republic Of

Introduction: Simultaneous elevation of ST-segment in precordial and inferior leads ofpatients with acute myocardial infarction is a rare finding. Acute occlusion of leftanterior descending (LAD) coronary artery often results in ST-segment Elevation inV1-V6 leads and depression in inferior leads. Also occlusion of the right coronaryartery (RCA) is a rare cause of combined ST-segment elevation in anterior and inferiorleads.Objectives: The clinical and Angiographic importance of combined ST-segment elevationin anterior and inferior leads is not yet established, so the aim of this study is determine thevalue of this pattern.Methods: In a cross-sectional–analysis study on 3650 patients, 60 out of 3650 patientswith acute myocardial infarction (1.6%) had combined ST-segment elevation in anteriorand inferior leads. These patients were studied during a period of 6 years at the Madaniheart hospital of Tabriz, Iran. Angiographic and electrocardiographic findings of patientswere gathered for comparison. Vessel diameter stenosis � 50% was considered Significant.Results: Based on angiographic findings of study population, in 34 (57%) patients LADartery was the Culprit vessel and in most of them [30 cases (88%)] it had a wrap aroundappearance. In the remaining 26 (43%) patients RCA was responsible for the infarction. Inthe LAD Group, 31 patients had patent RCA which was completely normal or had a lesionwith diameter stenosis of<50%. In the RCA Group, 22 patients had patent LAD and only 4patients showed significant stenosis of LAD. The two groups were matched for age, sex,medical history and risk factors for atherosclerosis, electrocardiographic pattern and me-chanical complications of acute myocardial infarction, the mean left ventricular ejectionfraction, rate of thrombolytic therapy, and six-month mortality rates were similar. The ST-segment elevation in leads V2 � V3 had a sensitivity of 77.2% and specificity of 78.4% inpredicting the LAD as culprit vessel. Also ST elevation in lead III � II had a sensitivity of54.4% and specificity of 72.6% in predicting the role of RCA as culprit vessel.Conclusion: Most cases of acute myocardial infarction with simultaneous ST-segmentelevation in the anterior and inferior leads are the result of a single coronary artery blockageand electrocardiographic findings can be helpful in determining the involved coronaryartery.Disclosure of Interest: None Declared

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