Heart, Lung and Circulation Abstracts S91

2008;17S:S1–S209

ABSTRACTS
rates. Medication beliefs may be a more reliable predictor 216
of adherence. Incidence of Radiocontrast-induced Nephropathy (RCIN)
During Cardiac Catheterisation in Patients With Normal
doi:10.1016/j.hlc.2008.05.215 Serum Creatinine

215 Sonia Cherian ∗ , Namal Wijesinghe, Gerard Devlin

Effectiveness of an “On-line”, Evidence-based, Referral
System for the Risk Stratification and Early Management
of Patients Presenting with Acute Coronary Syndromes to
Rural and Remote Hospitals Without On-site Angiogra-
phy
Peter J. Larsen ∗ , Margaret Dahl, Brendan Bell, Darren
Walters
The Prince Charles Hospital, Chermside, Queensland, Australia
Background: We prospectively evaluated the use of an
“on-line”, evidenced-based, referral system for patients
presenting with Acute Coronary Syndromes (ACS) to hos-
pitals without on-site angiography. The objectives were to
achieve guideline targets for the risk stratification, treat-
ment, and early transfer of patients for angiography and
revascularisation.
Methods: Prospective cohort analysis of ACS patients
referred from seven non-metropolitan hospitals between 1
December 2006 and 31 December 2007 using the “on-line”
referral system. Data was compared with the correspond-
ing 13-month period pre-implementation. The TIMI score
was used to risk stratify patients. Follow-up included
death, repeat MI and re-admission to hospital within 30
days of discharge.
Results: A total of 428 patients were referred during the
study period using the “on-line” system. The average
patient age was 64.98 years; 35.3% female; 20.1% diabetic.
The transfer diagnosis was NSTEMI/UAP (89.5%), STEMI
(10.5%; 7.3% received fibrinolysis pre-transfer). Sixty per-
centages of the NSTEMI patients had a TIMI score >3.0.
The mean time to transfer was 40.8 h cf. 88.8 h previously
(p = 0.001). At angiography over 90% had significant coro-
nary artery disease; 57% were treated with PCI; 32% were
referred for CABG and the remainder were managed med-
ically. Follow-up was complete for all patients transferred.
There were three deaths, four re-admissions for planned
PCI, 1 re-admission with pericarditis, and one recurrent
MI within 30 days of discharge.
Conclusions: The implementation of an “on-line”,
evidenced-based, referral system for patients present-
ing with ACS to hospitals without on-site angiography
significantly reduced the transfer time for invasive
angiography and subsequent revascularisation, thereby
achieving guideline targets.
doi:10.1016/j.hlc.2008.05.216
Waikato Hospital, Hamilton, New Zealand
Background: RCIN is a recognized complication after car-
diac catheterisation. Prophylaxis to minimize RCIN is only
given to patients with raised serum creatinine and/or dia-
betes mellitus. Our aim was to assess the risk of developing
RCIN after cardiac catheterisation in patients with normal
serum creatinine.
Method: All consecutive patients who had normal
serum creatinine (≤100 ␮mol/L) having cardiac catheter-
isation between 19 November 2007 and 20 January
2008 were prospectively studied. Estimated RCIN risk
was calculated using Mehran’s risk score (risk vari-
ables: cardiogenic shock, intraaortic balloon pump usage,
pulmonary oedema, age >75 years, anaemia, diabetes,
contrast volume, serum creatinine >130 ␮mol/L, and eGRF
<60 ml/min/1.73 m2 ). Patients were risk stratified into
quartiles 1 (low) to 4 (high) to assess risk of RICN and
dialysis. RCIN was defined as a 25% increase in serum
creatinine or 44.2 ␮mol/L at 3–5 days after the procedure.
Results: A total of 222 patients (mean age 62.3 ± 11.5, 68%
men, 18% diabetics) were studied. Overall RCIN was
noted in 2.3% with normal creatinine, most commonly
with high Mehran score. None underwent dialysis.
Risk groups Risk of Risk of % of patients RICN
Mehran score RICN (%) dialysis (%) in each risk incidence (%)
group
1 (score ≤5) 7.5 0.04 49 1.9
2 (score 6–10) 14 0.12 41 3.3
3 (Score 11–15 26.1 1.09 8.7 –
4 (score ≥16) 57.3 12.6 2.3 –
Conclusion: RCIN after cardiac catheterisation is not infre-
quent in patients with normal serum creatinine. Using
a risk score may be more beneficial to identify high risk
patients for prophylaxis.
doi:10.1016/j.hlc.2008.05.217
217
Creatinine Clearance (eGFR) and Radiocontrast-induced
Nephropathy (RCIN) in Patients with Normal Serum Cre-
atinine Levels
Sonia Cherian ∗ , Namal Wijesinghe, Gerard Devlin
Waikato Hospital, Hamilton, New Zealand
Background: Abnormal renal function is the main
risk factor for development of radiocontrast-induced
nephropathy (RCIN) after cardiac catheterisation pro-
cedures. Creatinine is not a reliable marker of renal
function as patients may have normal serum creati-
nine levels despite having significant renal impairment.
Our aim was to evaluate creatinine clearance (eGFR)
as a marker of risk assessment for RCIN in patients