Radiofrequency ablation using CARTOSound(®) guidance is accurate and effective in treating LVOT gradients in HOCM in this preliminary group of patients.

Objective The acute administration of high-dose erythropoietin (EPO) on reperfusing ischaemic myocardium has been reported to halve myocardial infarct (MI) size in preclinical studies, but its effect in ST elevation myocardial infarction patients undergoing primary percutaneous coronary intervention (PPCI) remains unknown. We investigated whether high-dose EPO administered as an adjunct to PPCI reduces MI size. Design Double-blinded, randomised, placebo-controlled. Setting Single tertiary cardiac centre. Patients Fifty-one ST elevation myocardial infarction patients undergoing PPCI. Interventions Patients were randomly assigned to receive either a single intravenous bolus of EPO (50 000 IU) prior to PPCI with a further bolus given 24 h later (n¼26) or placebo (n¼25). Main outcome measures MI size measured by 24 h area under the curve troponin T and cardiac magnetic resonance imaging performed on day 2 and at 4 months. Results EPO treatment failed to reduce MI size (troponin T area under the curve: 114.6678 mg/ml EPO vs 100.8668 mg/ml placebo; infarct mass by cardiac magnetic resonance: 33616 g EPO vs 25616 g placebo; both p>0.05). Unexpectedly, EPO treatment doubled the incidence of microvascular obstruction (82% EPO vs 47% placebo; p¼0.02) and significantly increased indexed left ventricular (LV) end-diastolic volumes (84610 ml/m 2 EPO vs 73613 ml/m 2 placebo; p¼0.003), indexed LV end-systolic volumes (4169 ml/m 2 EPO vs 35611 ml/m 2 placebo; p¼0.035) and indexed myocardial mass (89616 g/m 2 EPO vs 79611 g/m 2 placebo; p¼0.03). At 4 months, there were no significant differences between groups. Conclusions High-dose EPO administered as an adjunct to PPCI failed to reduce MI size. In fact, EPO treatment was associated with an increased incidence of microvascular obstruction, LV dilatation and increased LV mass. Clinical Trial Registration Information http://public. ukcrn.org.uk/search/StudyDetail.aspx?StudyID¼4058 Unique Identifier¼Study ID 4058.

CT angiography planning improves localisation of infarct and procedural success at the first attempt in ASA when compared to traditional methods. Follow-up to six months suggests a symptomatic, functional and haemodynamic improvement.

Background Previous studies have demonstrated the feasibility of primary percutaneous coronary intervention (PPCI) in carefully selected nonagenarians. Although current guidelines recommend immediate revascularization in patients with ST elevation myocardial infarction (STEMI) it remains unclear whether PPCI reduces mortality in nonagenarians. The objective of this study is to compare mortality in nonagenarians presenting via the PPCI pathway who undergo coronary intervention, versus those who are managed medically. Methods and results A total of 111 consecutive nonagenarians who presented to our tertiary center via the PPCI pathway between July 2013 and December 2018 with myocardial infarction were included. Clinical and angiographic details were collected alongside data on all-cause mortality. The final diagnosis was STEMI in 98 (88.3%) and NSTEMI in 13 (11.7%). PPCI was performed in 42 (37.8%), while 69 (62.2%) were medically managed. A significant number of the medically managed cohort had atrial fibrillation (23.2% vs 2.4% p = 0.003) and presented with a completed infarct (43.5% vs 4.8% p = 0.001). Other baseline and clinical variables were well matched in both groups. There was a trend towards increased 30-day mortality in the medically managed group (40.6% vs 23.8% p = 0.07). Kaplan Meier survival analysis demonstrated a significant difference in survival by 3 years (48.1% vs 21.7% p = 0.01). This was the case even when those with completed infarcts were excluded (44.3% vs 14.6%, p = 0.01). Conclusion In this series of selected nonagenarians presenting with acute myocardial infarction, those undergoing PPCI appeared to have a lower mortality compared to those managed medically.

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