[Interventional treatment of acute myocardial infarct]. / Interventionelle Behandlung des akuten Myokardinfarkts.

BACKGROUND: Randomised trials have shown that primary percutaneous angioplasty (PTCA) may offer advantages over thrombolysis in treating acute myocardial infarction (vessel patency is achieved more often, mortality and reinfarction rate are lower, cerebrovascular accidents are less frequent). Data from several foreign registries have been less clear. Up to now no registry data have been available for Switzerland. Data from registries are very important in planning optimal treatment under "real world" conditions. METHOD: All patients receiving acute PTCA during the first 24 hours of acute myocardial infarction were prospectively included in a registry at a single centre. We assessed times until revascularisation, as well as clinical, angiographic and outcome data. RESULTS: 503 patients (age 59 +/- 12 years, 15% women) were included from 1. 1. 1995 to 30.6.2000. Primary PTCA was performed in 334 patients, and rescue PTCA in 169. Diabetes mellitus was present in 36% of the total. Multivessel disease was present in 61%, anterior infarction in 36%, and 16% were in cardiogenic shock before intervention. The pre-hospital delay was 2:12 h (median). In-hospital decision delay (hospital admission until contact to cardiologist) in patients with primary PTCA was 31 minutes (median). The time from vessel puncture to recanalisation was 19 minutes (median). 273 patients were transferred for coronary angiography and intervention by other hospitals (218 by ground ambulance, 55 per helicopter transfer). The total transfer time (calculated from time of decision to arrival in the catheterization laboratory) was 57 minutes (median). PTCA was successful angiographically in 97% and TIMI 3 flow was obtained in 93% of all patients. Hospital mortality was low in view of the high proportion of patients in cardiogenic shock prior to PTCA (mortality in shock patients was 33%). Mortality in patients without pre-existing cardiogenic shock was 2%. CONCLUSION: Patients with acute myocardial infarction, especially high-risk patients, can be treated successfully by acute PTCA around the clock in Switzerland, in accordance with the strict international recommendations for time delays. The treatment results are similar to those in randomised trials. Transfer of patients from referral hospital is safe, with acceptable delays. Optimisation of the decision process and transport logistics may further improve outcome by reducing the total ischaemia time.

Radiation exposure of patients who undergo CT of the trunk.

PURPOSE: To determine the radiation dose delivered to organs during standard computed tomographic (CT) examination of the trunk. MATERIALS AND METHODS: In vivo locations and sizes of specific body organs were determined from CT images of patients who underwent examinations. The corresponding CT investigations were then simulated on an anthropomorphic phantom. The resulting doses were measured at 70 different sites inside the phantom by using thermoluminescent dosimeters. On the basis of measurements of free-in-air air kerma at the rotation axis of the CT gantry, conversion factors were calculated so that measurements could be used with different models of CT equipment. RESULTS: Starting from the dose values recorded, the mean organ doses were determined for 21 organs. The skin received 22-36 mGy; the lungs, less than 1-18 mGy; the kidneys, 7-24 mGy; and the ovaries, less than 1-19 mGy, depending on the type of CT examination performed. CONCLUSION: These values are high compared with other x-ray examinations and should be minimized as much as possible. The number of tomographic sections obtained should be kept as low as possible according to diagnostic need.