Utilizing the prehospital ECG as a tool to bypass ER triage significantly decreases D2B times in patients with STEMI. This technology has the potential to substantially expedite reperfusion therapy in patients with STEMI.

Thebesian veins are microvascular connections from the coronary arterial supply directly into the heart chambers. While they play an important role in providing nourishment to the myocardium by maintaining adequate perfusion, they are also responsible for a physiologic right to left shunt in the body's circulation. We present a case report of this rare anatomic finding of extensive Thebesian veins causing acute coronary syndrome and Takostubo cardiomyopathy.

Percutaneous Coronary Intervention (PCI) is the primary guideline-recommended treatment strategy for patients presenting with CAD, STEMI, NSTEMI, Unstable Angina. It is known that, the use of oral P2Y12 receptor antagonists (Prasugrel and Ticagrelor) in PCI patients could lead to improved outcomes compared with clopidogrel. This study has been designed for review and analysis of clinical safety and outcomes of these agents in patients undergoing PCI.  Out of 100 patients (50 in Prasugrel group & 50 in Ticagrelor group) considered for the study, the incidence of stroke, stent thrombosis was comparable between the groups with P =0.044, P =0.041 respectively and was not comparable for MI (P=0.245). Single Death was reported. The results differed significantly for Palpitations/Arrhythmia(P=0.018), SOB(P=0.000), Dizziness(P=0.005), Creatinine levels(P=0.000), Fatigue(P=0.003), Headache(P=0.000) and did not differ significantly for Bleeding and Back pain in both the drug groups with P =1.000, P =0.438 respectively. Also, majority of the patients showed decreased platelet count in both the drug groups. Withdrawal parameters, like withdrawal due to cost(P=0.172) and withdrawal due to fear of side effects(P=1.000) when evaluated for both the drugs showed no significant difference. Outcomes associated with Prasugrel were not superior to outcomes associated with Ticagrelor when 30 days to 6 months follow up was done. The clinical safety, side effects and withdrawal parameters were comparable and the results showed no significant difference between these drug groups. Keywords: Percutaneous Coronary Intervention, Ticagrelor, Prasugrel, Dual Anti-Platelet therapy, Acute Coronary Syndrome, Coronary Artery Disease.

Background: The goal of mechanical reperfusion therapy in the setting of ST Segment Elevation Myocardial Infarction (STEMI) is to re-establish blood flow to the affected vascular bed as quickly as possible. Primary angioplasty has been shown to be superior to fibrinolysis when door-to-balloon (DTB) time is less than 60 minutes. The median DTB time in the United States is 185 minutes and only 3% of patients are currently being mechanically reperfused within the 90 minutes as recommended by American College of Cardiology guidelines. The purpose of this study is to see if an aggressive approach involving emergency medical services (EMS), emergency room (ER) personnel, and the early activation of cardiac interventional team could improve reperfusion times. We evaluated the feasibility of pre-hospital Electrocardiogram (phECG) to triage patients with STEMI directly to the cardiac catheterization laboratory (CCL) compared to the standard therapy at two primary PCI centers Methods: The EMS personnel obtained a 12-lead ECG during initial assessment in the field from patients with symptoms of myocardial infarction. The ECG was immediately transmitted to the ER physician by cellular link to a computer receiving station located in the ER. The ER physician reviewed the 12-lead ECG digital tracing. The cardiac catheterization laboratory (CCL) team was activated from the patients’ homes. Patients were transported from the field directly to the CCL by EMS bypassing ER admission. Results: From Oct 2003 to May 2007, 142 consecutive patients with STEMI who presented to Providence Hospital and Medical Centers were included in the study. The conventional treatment group (125 patients) had a mean DTB time of 123 minutes. We identified 359 phECGs transmitted to the ER, 43 of which had inadequate transmission signal. Adequate phECG transmission was detected in 88% cases. We diagnosed 17 patients with STEMI by phECG who were included for the analysis. The mean DTB time was significantly lower in patients diagnosed using phECG (46 minutes vs. 123 minutes, p<0.001). Conclusion: Utilizing the phECG as a tool to bypass ER triage significantly decreases DTB times in patients with STEMI. This technology has the potential to substantially expedite reperfusion therapy in patients with STEMI.