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GUSTO I 90-93

2.9. 2.8. 2.8. 2.7. 2.7. 2.7. Median Time (hrs) Between Symptom Onset and Treatment. InTIME II 97-99. ASSENT II 97-98. GUSTO III 95-97. GUSTO V 99-01. GUSTO I 90-93. ASSENT 3 00-01. Gibson CM, Circulation 2001;104:2632-2634.

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GUSTO I 90-93

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  1. 2.9 2.8 2.8 2.7 2.7 2.7 Median Time (hrs) Between Symptom Onset and Treatment InTIME II 97-99 ASSENT II 97-98 GUSTO III 95-97 GUSTO V 99-01 GUSTO I 90-93 ASSENT 3 00-01 Gibson CM, Circulation 2001;104:2632-2634

  2. National Registry of Myocardial Infarction,1990-2006 Trends in symptom onset-to-door time among STEMI patients, stratified by sex Gibson CM, ACC 2008

  3. The AngelMed Guardian System • AnImplantable Device (IMD) - Implantable cardiac event recorder with ST-segment measurement and alarm. Records electrogram and will issue an alarm for acute ST shift changes • An External Device (EXD)that provides an additional (audio) alarm and telemetry up to 6 feet between the implant and the EXD. The EXD has an alert silence button, labeled LEDs to indicate the type of alarm and printed patient instructions. • A Programmerto program the IMD and retrieve and process the data captured by the IMD.

  4. Patient B9 Acute ST Elevation Event September 2007 Emergency Alarm at 12:20 pm 9/17/07 Arrival at hospital ~1 hour later 2nd Em. Alarm

  5. Patient B9 – ST Elevation 1st Emergency Alarm Start of Arterial Occlusion Patient arrives at the hospital

  6. Patient B9 – ST Elevation Emergency Alarms Patient put on Heparin and Clopidogrel 1st Em. Alarm 2nd Em. Alarm (in hospital)

  7. Ruptured Plaque Site in Pt. B9 Circumflex March 1, 2007 Sept 18, 2007

  8. Relationship Between Duration of Symptoms of Acute MI Before Reperfusion Therapy, Mortality Reduction, and Extent of Myocardial Salvage Gersh, B. J. et al. JAMA 2005;293:979-986.

  9. Normal Large Capillary Lumen Time is Muscle: Delays in Symptom to Door Time are Associated with Poorer Flow in the Muscle Independent of Flow in Artery 16% rise in risk of a closed muscle for every hour of delay in STEMI (p=0.0005) Gibson, JACC 2004 Normal non-infarcted wall without edema “Blistered” / Swollen Endothelium / wall of the capillary Infarcted wall with edema (white areas) Clinical Picture: Open Artery Closed Muscle Blistering of Capillaries & Endothelium Interstitial Edema EHJ (2004) 25, 794–803 Gibson CM 2008

  10. Symptom Onset-Balloon Time and Mortality in Primary PCI for STEMI 6 RCTs of Primary PCI by Zwolle Group 1994 – 2001N = 1791 12 10 8 6 4 2 0 P < 0.0001 One-year mortality, % RR = 1.08 for each 30 min delay(P = 0.04) 0 60 120 180 240 300 360 Symptom – balloon inflation (min) The relative risk of 1-year mortality increases by 7.5% for each 30-minute delay DeLuca, Suryapranata, Circ 109:1223, 2004

  11. National Registry of Myocardial Infarction, 1990-2006 Trend in door-to-needle time among reperfusion-eligible STEMI patients receiving fibrinolytic therapy Gibson CM, ACC 2008

  12. National Registry of Myocardial Infarction, 1994-2006 Trend in in-hospital mortality among reperfusion-eligible STEMI patients treated with fibrinolytic therapy Gibson CM, ACC 2008

  13. National Registry of Myocardial Infarction, 1994-2006 Trends in door-to-balloon time among reperfusion-eligible STEMI patients treated with primary PCI, stratified by transfer status Gibson CM, ACC 2008

  14. National Registry of Myocardial Infarction, 1994-2006 Trends in in-hospital mortality among reperfusion-eligible STEMI patients treated with primary PCI, stratified by transfer status Gibson CM, ACC 2008

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