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Iqbal MB, Ilsley C, Kabir T, Smith R, Lane R, Mason M, Clifford P, Crake T, Firoozi S, Kalra S, Knight C, Lim P, Malik IS, Mathur A, Meier P, Rakhit RD, Redwood S, Whitbread M, Bromage D, Rathod K, MacCarthy P, Dalby M. Culprit vessel versus multivessel intervention at the time of primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction and multivessel disease: real-world analysis of 3984 patients in London. CIRCULATION-CARDIOVASCULAR QUALITY AND OUTCOMES 2014; 7:936-43. [PMID: 25371542 DOI: 10.1161/circoutcomes.114.001194] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND It is estimated that up to two thirds of patients presenting with ST-segment-elevation myocardial infarction have multivessel disease. The optimal strategy for treating nonculprit disease is currently under debate. This study provides a real-world analysis comparing a strategy of culprit-vessel intervention (CVI) versus multivessel intervention at the time of primary percutaneous coronary intervention in patients with ST-segment-elevation myocardial infarction. METHODS AND RESULTS We compared CVI versus multivessel intervention in 3984 patients with multivessel disease undergoing primary percutaneous coronary intervention between 2004 and 2011 at all 8 tertiary cardiac centers in London. Multivariable-adjusted models were built to determine independent predictors for in-hospital major adverse cardiovascular events (MACEs) and all-cause mortality at 1 year. To reduce confounding and bias, propensity score methods were used. CVI was associated with reduced in-hospital MACE (4.6% versus 7.2%; P=0.010) and mortality at 1 year (7.4% versus 10.1%; P=0.031). CVI was an independent predictor for reduced in-hospital MACE (odds ratio, 0.49; 95% confidence interval [CI], 0.32-0.75; P<0.001) and survival at 1 year (hazard ratio, 0.65; 95% CI, 0.47-0.91; P=0.011) in the complete cohort; and in 2821 patients in propensity-matched cohort (in-hospital MACE: odds ratio, 0.49; 95% CI, 0.32-0.76; P=0.002; and 1-year survival: hazard ratio, 0.64; 95% CI, 0.45-0.90; P=0.010). Inverse probability treatment weighted analyses also confirmed CVI as an independent predictor for reduced in-hospital MACE (odds ratio, 0.38; 95% CI, 0.15-0.96; P=0.040) and survival at 1 year (hazard ratio, 0.44; 95% CI, 0.21-0.93; P=0.033). CONCLUSIONS In this observational analysis of patients with ST-segment-elevation myocardial infarction undergoing primary percutaneous coronary intervention, CVI was associated with increased survival at 1 year. Acknowledging the limitations with observational analyses, our findings support current recommended practice guidelines.
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Affiliation(s)
- M Bilal Iqbal
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.).
| | - Charles Ilsley
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Tito Kabir
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Robert Smith
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Rebecca Lane
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Mark Mason
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Piers Clifford
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Tom Crake
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Sam Firoozi
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Sundeep Kalra
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Charles Knight
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Pitt Lim
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Iqbal S Malik
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Anthony Mathur
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Pascal Meier
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Roby D Rakhit
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Simon Redwood
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Mark Whitbread
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Dan Bromage
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Krishna Rathod
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Philip MacCarthy
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
| | - Miles Dalby
- From the Department of Cardiology, Royal Brompton and Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, United Kingdom (M.B.I., C.I., T.K., R.S., R.L., M.M., P.C., M.D.); Department of Cardiology, UCL Hospitals NHS Foundation Trust, Heart Hospital, London, United Kingdom (T.C., P. Meier); Department of Cardiology, King's College Hospital NHS Foundation Trust, London, United Kingdom (S.K., P. MacCarthy); Department of Cardiology, Barts Health NHS Trust, The London Chest Hospital, London, United Kingdom (C.K., A.M., D.B., K.R.); Department of Cardiology, St. George's Healthcare NHS Foundation Trust, St. George's Hospital, London, United Kingdom (S.F., P.L.); Department of Cardiology, Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital, London, United Kingdom (I.S.M.); Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom (R.D.R.); Department of Cardiology, BHF Centre of Excellence, King's College London, St. Thomas Hospital, London, United Kingdom (S.R.); and Department of Cardiology, London Ambulance Service, London, United Kingdom (M.W.)
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