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S10

Poster Presentations / Resuscitation 84S (2013) S8S98

Conclusion: The early quick management in patients with


STEMI infarctions is much better by EMS even with serious infarctions. All efforts must be made to decrease the time intervals
between the onset of symptoms and the beginning of reperfusion
therapy. More intense measures must be taken to educate the public.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.038
AP007
Helicopter interventions for the patients with
STEMI in the North-East Romania
Diana Carmen Cimpoesu 1, , Paul Nedelea 2
1 University of Medicine and Pharmacy Gr. T. Popa,
Iasi, Romania
2 Emergency County Hospital Sf. Spiridon, Iasi,
Romania

From 2010, Romanian patients diagnosed with STEMI can benet from the primary PCI through a national program, according to
the Stent for Life ESC program.
Purpose: Evaluate the importance of helicopter transport of
patients with STEMI in a region with a decit of emergency specialists and only one Interventional Cardiology Centre.
Methods: Retrospective study of the interventions by helicopter for patients with STEMI in the North-East Region of
Romania between March 15, 2011 and March 15, 2013. MY 8
helicopter/Eurocopter 135 was used, with intensive care medical
equipment, 2 pilots, 1 doctor and 1 nurse.
Results: The study includes 71 patients that needed medical
intervention and transportation to hospital via helicopter. The decisions to send the helicopter were taken on medical criteria STEMI
diagnostic, the transfer time to PCI and the availability of the terrestrial emergency crew. The average distance to the site, measured
by land, was 162 km, (34250 km). The average time of transport
by air was 39.3 14.6 min compared to 108.7 47.3 min estimated
by land (p > 0.01) with an average time since the chest pain onset
6.32 4.7 h. 66.2% were males, aged between 25 and 85 years old.
Three patients suffered cardiopulmonary arrest during transportation, 2 were pronounced dead after receiving CPR. During transfer
Aspirin and Clopidogrel was administrated in 69.01% cases, Heparin 28.16% cases, thrombolytics in 7.04% (5 patients). 4.22% of the
patients needed oro-tracheal intubation and mechanical ventilation due to cardiogenic shock. In this period, the mortality rate in
patients with STEMI decreased from 13.4% to 8.19% all over Romania and to 7.9% in our region.
Conclusion: The helicopter is a very important means of transportation for patients living in either far or inaccessible by land
areas, reducing the door-to-balloon times in patients with STEMI.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.039
AP008
Improvement of myocardinal infarction
assistance times when calling an EMS
Francesc Carmona , Josep M. Soto-Ejarque,
Gilberto Alonso, ngels Mora, Marta Trayner,
Xavier Jimnez
Sistema dEmergncies Mdiques, Catalonia, Spain
Purpose: To analyze if out-of-hospital times of assistance to
patients with acute myocardial infarction (AMI) improve when an
EMS is called instead of turned to a primary care center.

Methods: A prospective study was performed from August 2010


to December 2012. All the patients who suffered an AMI assisted by
the EMS in the out-of-hospital setting (home, public place or in a
primary care center) during the study period were included. Studied variables were: sex, age, place of rst assistance, and minutes
from: pain to rst medical contact, rst medical contact to ECG, pain
to out-of-hospital brinolysis, pain to arrival to ICP room, rst medical contact to out-of-hospital brinolysis and rst medical contact
to arrival to ICP room. Qualitative data are presented as percents;
quantitative data are presented as median and intercuartil range
and compared with MannWhitney U test.
Results: From 2194 patients suffering an AMI, 1755 (80%) were
men with a median age of 62 (IQR = 5273) years. 829 (37.8%) had
rst assistance in a primary care center and 1365 (62.2%) at home
or in a public place by the EMS. Assistance times are presented in
the table:

Pain to 1st medical contact


1st medical contact to ECG
Pain to OOH brinolysis
Pain to arrival to ICP
1st medical contact to OOH
brinolysis
1st medical contact to ICP
arrival

Primary care
median (IQR)

EMS median
(IQR)

p-value

60 (29120)
6 (412)
125 (85203.75)
180(135260)
54 (38.590.5)

45 (2480.5)
5 (29)
90(60126.25)
130 (94185)
43.5 (2769)

<0.001
<0.001
0.004
<0.001
0.022

99 (74135)

72 (5498)

<0.001

Conclusions: Call to an EMS shortens the time of assistance


when an AMI occurs compared with going to a primary care center.
Population should be encouraged to call EMS when suffering chest
pain.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.040
AP009
Hypoxia-inducible factor-1 alpha gene
polymorphisms are associated with risk of
developing acute coronary syndrome
Alberto Lopez-Reyes 1 , Jose Manuel
Rodriguez-Perez 2 , Javier Fernandez-Torres 1 ,
Nonanzit Perez-Hernandez 2 , Arturo Javier
Fuentes-Gomez 3, , Carlos Alberto
Aguilar-Gonzalez 1 , Carlos Pineda 1 , Gilberto
Vargas-Alarcn 2
1

Instituto Nacional de Rehabilitacin, Mexico,


Mexico
2 Instituto Nacional de Cardiologia Ignacion Chavez,
Mexico, Mexico
3 Hospital ABC, Mexico, Mexico

Aim: To explore the role of HIF1A and AGER gene polymorphisms in the risk of developing acute coronary syndrome
(ACS). Methods: Three single-nucleotide polymorphisms in
HIF1A (rs11549465, rs11549467, rs2057482) and two in AGER
(rs2070600, rs1800624) genes were genotyped in 869 ACS Mexican
Mestizo patients and 682 controls. Haplotypes were constructed
after linkage disequilibrium (LD) analysis. Results: ACS patients
showed increased frequency of rs11549465C allele (P = 0.016, OR
3.6) and rs2057482C allele (P = 0.018, OR 1.39) and CC genotype
(P = 0.048, OR 1.39) when compared to controls. According to the
dominant model, rs11549465 and rs2057482 polymorphisms were
associated with risk of developing ACS. Two polymorphisms of
HIF1A gene were in LD and were included in two haplotypes: H1
(CC) and H2 (CT). ACS patients showed increased frequency of H1
when compared to controls (P = 0.009). Conclusion: Results sug-

Poster Presentations / Resuscitation 84S (2013) S8S98

gest that two HIF1A gene polymorphisms are associated with risk
of developing ACS in Mexican individuals.

S11

Table 1
Hemodynamic effects of Lv therapy.
D0
Group 2
(n = 15)

HR, bpm

112 2.9

GFR, ml/min/
1.73 m2

48.2 3.4

http://dx.doi.org/10.1016/j.resuscitation.2013.08.041
AP010
Acute myocardinal infarction complications
rate after prehospital thrombolysis or transport
to PCI. A prospective study

D21

Group 1
(n = 12)

M12

114 2.9

Group 1
(n = 12)
73 5.6##

Group 2
(n = 15)
70 5.3##

Group 1
(n = 8)
74 5.8##

Group 2
(n = 7)
76 5.1##

47.4 3.3

84 7.4##

76 5.7##

78 6.0## *

66 4.4##

68 4.1## , * 78 5.7##
76 5.9##,* 84 6.2#
46 3.1## , * 41 2.1#
42 2.4#
38 2.8
2580 54.2# 2400 47.4# 2450 49.2 2300 44.3

ESV, ml

95 8.3

97 8.4

EF, %

37 1.8

36 1.7

CI, ml/min/m2

2249 44.2

2100 41.2

p < 0.05 compared to Group 2.


p < 0.05.
##
p < 0.01 compared to D0.
#

Xavier Jimenez-Fabrega , Francesc Carmona,


Silvia Sol, Maria Timon, Anna Puig, Xavier
Escalada
SEM Medical Emergency Department, Barcelona,
Catalonia, Spain
Purpose: To describe medical complications of patients who
suffered a myocardial infarction (AMI) and to analyze if patients
who underwent to thrombolysis had higher number of complications than those transferred to PCI.
Methods: A prospective study was performed from August 2010
to December 2012. All the patients who suffered an AMI assisted
by the EMS in the out-of-hospital setting during the study period
were included. Studied variables were: sex, age, kind of treatment,
presence and kind of complications during the out-of-hospital
assistance, Killip, and times from rst medical contact to thrombolysis (1MCC-TL) and to hospital arrival (1MCC-HA). Qualitative
data are presented as percents; quantitative data are presented as
mean and standard deviation and compared with Students t-test.
A logistical regression model was performed to adjust the effect
of thrombolysis over the presence of complications by possible
confounding factors.
Results: From 2194 patients suffering an AMI, 1755 (80%) were
men with a mean age of 58.64 years (SD = 1.3). 103 (4.8%) underwent to thrombolysis. 529 (24.1%) presented any complication but
only one patient died despite that 211 suffered ventricular brillation and 27 asystole. The mean time from 1MCC-TL was 45.23 min
(SD = 4.11). Thrombolysis increased in a 16.2% (CI95% = 6.625.8%)
the presence of any complication rate (p < 0.001), in an 11.2%
(CI95% = 4.420%) the risk of ventricular brillation and in a 5.8%
(CI95% = 2.312.4%) the risk of asystole.
After adjusting thrombolysis effect by age, Killip, time from
1MCC-HA and their rst order interactions in a logistic regression
model, thrombolysis multiplies by 3.2 the presence of any complication odds (CI95% = 1.47.4).
Conclusions: AMI thrombolysis in the out-of-hospital setting is
associated with a higher rate of complications than transfer to PCI
treatment and with a delay in hospital arrival. Time from 1MCC-TL
should be shorter than the observed in this study.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.042
AP011
Long term effects of Levosimendan therapy in
patients with cardiogenic shock
Igor Katsytadze , Ekaterina Amosova, Igor
Prudkyi, Anna Kyrylova
O.Bogomolets National Medical University, Kiev,
Ukraine
Purpose: To determine the long-term prognosis in patients
with acute myocardial infarction (AMI) complicated by cardiogenic
shock (CS) after Levosimendan (Lv) infusion.

Material and methods: 27 patients with AMI, complicated CS


were retrospectively randomized in two groups. Both groups were
similar in age, sex, comorbidities. Group 1 (12 patients) was infused
Lv on 23 days of AMI on a background infusion of middle and high
doses of dopamine. Group 2 (15 patients) received all similar necessary conservative treatment without Lv. For our study, patients of
both groups were assessed three times: at the beginning of treatment (D0), at discharge from the hospital on 21 1.4 days (D21)
and at 12 months (M12).
Results: In M12 in Group 1 glomerular ltration rate (GFR), end
systolic volume (ESV), cardiac index (CI) were signicantly higher
than in group 2 (78 6.0 vs 66 4.4 ml/min/1.73 m2 , 76 5.9 vs
84 6.2 ml, 2450 49.2 vs 2300 44.3 ml/min/m2 , all p < 0.05), 1year mortality in Group 1 was 33 1.32% (4 patients), in Group
253 2.12% (8 patients) (p < 0.001). Heart rate (HR) and ejection
fraction (EF) at M12 were similar in both groups. Other results
presented in the Table 1.
Conclusions: Levosimendan infusion in patients with AMI complicated with cardiogenic shock and systolic blood pressure more
than 90 mm Hg, on a background infusion of middle and high
doses of dopamine effectively stabilizes hemodynamics in the early
stages and throughout the year, reduces mortality compared with a
similar group of patients without the use of levosimendan. Levosimendan can be used for complex therapy of this patients category.
http://dx.doi.org/10.1016/j.resuscitation.2013.08.043
AP012
Acuter coronary syndrome during pregnancy
Nikolaos Georgios Dagkonakis , Karl Heinz Seidl,
Harald Franck
Klinikum Ingolstadt, Ingolstadt, Germany
Introduction: ACS is rare during pregnancy, its incidence is estimated at 36 per 100,000 deliveries. Case report description: We
report about a 41-year-old female patient in the third week of
pregnancy. She was admitted with recurrent chest pain CCS III during the last 34 days. In the last 2 weeks she had suffered from
a cold. She was asymptomatic at admission; vital signs were at
the norm. The ECG showed a normal sinus rhythm, without repolarization disorders. Except from an elevated Troponin I level, the
other lab values were normal. Her echocardiography study showed
a normal ejection fraction, without regional wall motion abnormalities or signs of right heart dysfunction. An aortic dissection
was excluded through trans-esophageal echocardiography. Continuous ECG-monitoring revealed no cardiac arrhythmias. As the
troponin level was falling we concluded to the diagnosis of perimyocarditis. The patient stayed pain free and was discharged with by
now negative TNI values. Two weeks later she was again admitted
with similar symptoms. Laboratory tests showed only an increased
TNI. A stress echocardiography study was performed and showed
no evidence for stenotic coronary artery disease. The pain ceased