039 IMPACT OF A MULTI-PRONGED INTERVENTION ON THE RATE OF INAPPROPRIATE CATHETERIZATION LABORATORY ACTIVATION USING AN AUTOMATED SYSTEM OF PRE-HOSPITAL STEMI DIAGNOSIS M Riahi, C Naim, F Gobeil, S Mansour, A Matteau, R Essiambre, M Montigny, M Caron, I Sareault, B Potter Montréal, Québec BACKGROUND: In 2012, we reported on a novel “physician- less” automated system of pre-hospital ST elevation myocar- dial infarction (STEMI) diagnosis and cardiac catheterization laboratory (CCL) activation. Our analysis at that time demonstrated consistently short door-to-balloon (D2B) times and an acceptable low rate of inappropriate activations (IA). Nevertheless, a number of targets for protocol improvement were identified and implemented. Herein, we report on the impact of these changes on the performance of the activation algorithm. METHODS: Patient data were collected for all pre-hospital CCL activation from February 2010 to January 2015. ECG’s were performed by first-responders in the field for all patients with a complaint of chest pain or dyspnea. An electrographic diagnosis of STEMI (Zoll Medical Corporation) resulted automatically in CCL activation and direct transfer without physician interpretation of the ECG. Inappropriate activation was defined as any activation resulting from a non-diagnostic ECG (No ST-elevation, judged independently by 2 cardiol- ogist reviewers). Identified inappropriate activations were then analyzed for the reasons for erroneous CCL activation. Hu- man error was defined as an improper application of the referral algorithm. Machine error was defined as an incorrect automated diagnosis of STEMI for a tracing of adequate quality. In March 2013, the protocol was amended to exclude tachycardia >140bpm from automatic CCL activation and an educational campaign was implemented for ambulance tech- nicians in order to ensure proper application of the referral algorithm. RESULTS: Over the study period, we identified 489 pre- hospital CCL activations for STEMI (155 before protocol amendment). Full results will be presented at congress. The first 253 activations are presented here. Patient characteristics were similar both before and after protocol amendment. 225 patients (89%) presented ST-elevation on the ECG (ECG-appropriate; 213 confirmed STEMI and 12 ST-elevations without coronary occlusion). The remaining 28 activations (11%) were considered inappro- priate. Of these, 19 occurred prior to protocol amendment and 9 occurred after. The IA rate therefore decreased from 12% to 9% (25% relative reduction) with our intervention. CONCLUSION: Pre-hospital “physician-less” automated STEMI diagnosis provided durable performance characteristics in terms of both false positive and inappropriate CCL activation. Moreover, simple interventions appear to result in further meaningful reductions in the rate of IA. 040 TRANSRADIAL VS. TRANSFEMORAL ACCESS FOR CARDIAC CATHETERIZATION IN NON-ST ELEVATION ACUTE CORONARY SYNDROME: A META-ANALYSIS R Khan, M Al-Hawwas, E Joliecoeur, L Azzalini, HQ Ly Vancouver, British Columbia BACKGROUND: Transradial access (TRA) for cardiac catheter- ization (CCA) has been associated with reduced bleeding and mortality compared with transfemoral access (TFA) in acute coronary syndrome (ACS). However, there have been no randomized controlled trials (RCT) exclusively comparing TRA and TFA in non-ST elevations ACS (NSTEACS). Moreover, data from RCT substudies and registries examining TRA in this ACS subpopulation remains conflicting. METHODS: We conducted a systematic review and meta- analysis comparing clinical outcomes between TRA and TFA in studies examining NSTEACS populations. Primary out- comes were short-term (30 days) major bleeding (STMB) and mortality. Secondary outcomes included access-site bleeding, major adverse cardiovascular outcomes (MACE) and myocardial infarction (MI). RESULTS: A total of 7 studies (N¼47121) were included. Compared with TFA, TRA was associated with reduction in STMB (OR 0.58, 95% CI 0.44-0.76, p<0.0001) and access-site bleeding (OR 0.32, 95% CI 0.11-0.92). Reduction in STMB in TRA was noted when exclusively analyzing RCT substudies (OR 0.64, 95% CI 0.48-0.85) or observational registry-based studies (OR 0.32, 95% CI 0.11-0.92). There was only a trend toward reduction in STMB with TRA in studies that included patients undergoing both diagnostic CCA and PCI (OR 0.70, 95% CI 0.48-1.04). However, TRA was associated with a reduction in STMB in studies where all patients underwent percutaneous coronary intervention (PCI) (OR 0.52, 95% CI 0.36-0.74). There was no difference between TRA and TFA in short-term mortality (OR 0.91, 95% CI 0.66-1.24), MACE (OR 1.07, 95% CI 0.95-1.21) or MI (OR 1.12 95% CI 0.97-1.29). CONCLUSION: TRA is associated with reductions in STMB and access-site bleeding compared with TFA in patients with NSTEACS. No difference was noted in mortality or ischemic outcomes between access-site strategies. 041 HALF-DOSE TENECTEPLASE COMPARED TO CONVENTIONAL ST- SEGMENT MYOCARDIAL INFARCTION (STEMI) REPERFUSION STRATEGIES IN THE ELDERLY: AN OBSERVATIONAL ANALYSIS J Shavadia, K Bainey, B Tyrrell, N Brass, C Paterson, D Knapp, RC Welsh Edmonton, Alberta BACKGROUND: Although limited to 135 patients in a single clinical trial, half-dose tenecteplase (TNK) appears equi-effi- cacious to but safer compared to full-dose TNK in the elderly ( 75 years of age) STEMI population, (AHJ, STREAM). Real world clinical characteristics and outcomes of both, S20 Canadian Journal of Cardiology Volume 31 2015