Publications (15) View all
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Article: Retrospective description and analysis of consecutive catheterization laboratory ST-segment elevation myocardial infarction activations with proposal, rationale, and use of a new classification scheme.
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ABSTRACT: Rapid activation of a cardiac catheterization laboratory (CCL) has reduced door-to-balloon times in ST-segment elevation myocardial infarction (STEMI), leading to lower mortality. This process is accelerated with prehospital electrocardiography and notification. False activations of the CCL occur at an unknown rate and have been poorly described. We analyzed 345 consecutive CCL activations for suspected STEMI over 18 months (March 2009-August 2010). We retrospectively reviewed the ECGs that prompted activation, as well as the clinical course and final diagnoses. Among all CCL activations, STEMI was not confirmed in 28%. On review, 301 (87.2%) had appropriate ECG criteria for activation. However, even among the ECG-appropriate patients, only 247 (82%) had a final diagnosis of STEMI. The inclusion of clinical characteristics did not improve the ability to identify patients with STEMI. Activations were modestly more accurate when made by emergency department physicians than by emergency medical service personnel, but door-to-balloon time was noticeably shorter when emergency medical service personnel requested prehospital activation. If all CCL activations are considered, the occurrence of false activations is surprisingly high. Although still the gold standard for diagnosis, these data reveal the inherent limitations of clinical evaluation and the ECG in identifying patients with STEMI. Within our retrospective review, we used a 2-tiered classification for STEMI activations based on ECG appropriateness and final clinical diagnosis to give a complete picture of false activations and assist in quality improvement.Circulation Cardiovascular Quality and Outcomes 12/2011; 5(1):62-9. · 4.91 Impact Factor -
Article: The use of radiographic contrast media during PCI: a focused review: a position statement of the Society of Cardiovascular Angiography and Interventions.
Catheterization and Cardiovascular Interventions 11/2009; 74(5):728-46. · 2.29 Impact Factor -
Article: Novel technique using the Outback LTD catheter for a common iliac artery occlusion.
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ABSTRACT: We present a case of an unusual arterial--arterial anastamosis that resulted from an unsuccessful attempt at crossing a total occlusion of the common iliac artery. Subsequently, we were able to successful recanalize the artery using a modified technique with the Outback reentry catheter.Catheterization and Cardiovascular Interventions 11/2008; 73(3):415-8. · 2.29 Impact Factor -
Article: Guidewire pacing safely and effectively treats bradyarrhythmias induced by rheolytic thrombectomy and precludes the need for transvenous pacing: the Scott & White experience.
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ABSTRACT: Rheolytic thrombectomy (RT) is useful in certain percutaneous coronary interventions but may be associated with transient bradyarrhythmias. Clinicians have devised numerous strategies to deal with these arrhythmias apart from transvenous right ventricular pacing, some of which are described in other parts of this supplement. We report the Scott & White experience utilizing guidewire pacing to quickly and safely pace the heart in the event of bradyarrhythmia. We found this method to be safe and reliable (96.2% successful) during RT and now use this technique almost exclusively in the cardiac catheterization lab to deal with transient bradyarrhythmias during RT or due to any other cause.We also report an increased incidence of bradyarrhythmia occurring during RT when it is performed in the right coronary artery, with a trend toward an increased incidence during the clinical presentation of ST-elevation myocardial infarction.The Journal of invasive cardiology 08/2008; 20(8 Suppl A):5A-8A. · 1.84 Impact Factor -
Article: Drive-through angioplasty: is it safe or necessary?
Circulation 01/2007; 114(24):2578-80. · 14.74 Impact Factor
