were studied. After excluding patients with prior coronary artery bypass surgery, 925 patients were included in the analysis. Patients were classified into 3 groups according to the as-treated revascularization strategy: culprit-vessel revascularization first, contralateral angiography first, or complete angiography first. Propensity score matching was used to minimize difference in clinical characteristics between groups. Predictors of culprit-vessel first revascularization were anterior/lateral infarct location and absence of diabetes mellitus. After propensity score matching, the median vascular access-to-balloon time was 4 to 6 minutes shorter with a culprit-vessel revascularization first strategy. This reduction in time to reperfusion increased the proportion of patients treated within recommended delays. However, there was no significant difference in 30-day clinical outcomes associated with these delays reduction. Conclusions-Performing culprit-vessel primary percutaneous coronary intervention before contralateral or complete diagnostic angiography is associated with a statistically significant reduction in vascular access-to-balloon time, although the 4-to 6-minute difference is unlikely to be clinically relevant. This small but significant reduction could translate in an augmentation in the proportion of patients treated within recommended delays. (Circ Cardiovasc Interv. 2016;9:e003510.

Cardiovascular disease is the leading cause of death worldwide. This disease includes chronic total occlusion (CTO), which is a complete blockage of an artery. Unlike partial occlusions, CTOs are difficult to cross percutaneously using conventional guidewires (thin and flexible wires) because of the fibrotic and calcified nature of the blockage. The lack of data regarding the mechanical properties of CTO limits the development of new technologies in the field of percutaneous coronary intervention (PCI) and percutaneous peripheral intervention (PPI). In this study, calcified plaques retrieved from occluded arteries are analyzed in order to better understand their mechanical properties and to help propose an artificial analogue. Calcified plaques samples were collected from the superficial femoral artery wall within one hour following a lower limb amputation surgery. These samples were studied to determine their composition and mechanical properties. The same characterization procedures were performed on various potential artificial analogues. These analogues include three plaster materials and dense hydroxyapatite blocks. The results were then compared with those of the calcified plaques in order to determine the more favorable analogue. This mechanical analysis and the proposal of a potential analogue for the calcified plaques found in occluded arteries could benefit the development of new technologies and devices in the field PCI and PPI.

Background As a result of the COVID-19 pandemic first wave, reductions in STEMI invasive care ranging from 23% to 76% have been reported from various countries. Whether it had any impact on coronary angiography (CA) volume or on mechanical support device use for ST-elevation myocardial infarction (STEMI) and post-STEMI mechanical complications in Canada is unknown. Methods We administered a Canada-wide survey to all Cardiac Catheterization Laboratory Directors seeking the volume of CA for STEMI performed during 01/03/2020-31/05/2020 (pandemic period) and from two control periods (01/03/2019-31/05/2019 and 01/03/2018-31/05/2018). The number of left ventricular support devices used, as well as the number of ventricular septal defects or papillary muscle rupture cases diagnosed, were also recorded. We also assessed if the number of COVID-19 cases recorded in each province was associated with STEMI CA volume. Results Forty-one out of 42 Canadian catheterization laboratories (98%) provided data. There was a modest but statistically significant 16% reduction (Incidence Rate Ratio or IRR 0.84; 95%CI 0.80-0.87) in CA for STEMI during the first wave of the pandemic compared to control periods. IRR was not associated with provincial COVID-19 caseload. We observed a 26% reduction (IRR 0.74; 95%CI 0.61-0.89) in the use of intra-aortic balloon pump in STEMI. Use of Impella® and mechanical complications from STEMI were exceedingly rare. Conclusion We observed a modest 16% decrease in CA for STEMI during the pandemic first wave in Canada, lower than reported in other countries. Provincial COVID-19 caseload did not influence this reduction.

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Since the introduction of the plastination process by von Hagens [Anat Rec 194/2: 247-256, 1979], the cost of acetone used for the dehydration step has been considered an important factor in the cost of plastination. We have developed a three-step method that permits the reuse of acetone. The first step simply consists of storing the contaminated acetone in the freezer and separating the congealed fat by filtration. The second step is vacuum distillation of the acetone and can be conducted with the freezer and vacuum pump (found in any plastination laboratory) with just a few additions. It produces 95-97% pure acetone. The last step uses a desiccant to take away the residual water from the distilled acetone and brings the purity to 99.5%. With this method, we have reduced the amount of acetone to be purchased to a minimum and completely eliminated the cost of discarding used acetone. In addition vaporized acetone released during the impregnation step of plastination is recaptured.