Explore the vast range of titles available.

Background: During Stent for Life Initiative in Portugal lifetime, positive changes in ST elevation myocardial infarction treatment were observed, by the increase of Primary Angioplasty numbers and improvements in patients’ behaviour towards myocardial infarction, with an increase in those who called 112 and the lower proportion attending non primary percutaneous coronary intervention centres. Despite public awareness campaigns and system educational programmes, patient and system delay did not change significantly over this period. The aim of this study was to address the public awareness campaign effectiveness on peoples’ behaviour facing STEMI, and how Covid-19 has affected STEMI treatment. Methods: Data from 1381 STEMI patients were collected during a one-month period each year, from 2011 to 2016, and during one and a half month, matching first lockdown in Portugal 2020. Four groups were constituted: Group A (2011); Group B (2012&2013); Group C (2015&2016) and group D (2020). Results: The proportion of patients who called 112, increased significantly (35.2% Group A; 38.7% Group B; 44.0% Group C and 49.6% Group D, p = 0.005); significant reduction was observed in the proportion of patients who attended healthcare centres without PPCI (54.5% group A; 47.6% Group B; 43.2% Group C and 40.9% Group D, p = 0.016), but there were no differences on groups comparison. Total ischemic time, measured from symptoms onset to reperfusion increased progressively from group A [250.0 (178.0–430.0)] to D [296.0 (201.0–457.5.8)] p = 0.012, with statistically significant difference between group C and D (p = 0.034). Conclusions: During the term of SFL initiative in Portugal, patients resorted less to primary health centres and called more to 112. These results can be attributed the public awareness campaign. Nevertheless, patient and system delays did not significantly change over this period, mainly in late years of SFL, probably for low efficacy of campaigns and in 2020 due to Covid-19 pandemic.

Accurate ECG interpretation is crucial to identify occlusive myocardial infarction (OMI) to determine the need for immediate catheterization laboratory activation (CLA). STEMI-equivalent and STEMI-mimic ECG patterns deviate from conventional STEMI criteria, risking misclassification of OMI cases. The diagnostic accuracy for these complex ECGs is unknown. This study aimed to measure physician accuracy for interpreting STEMI-equivalent and STEMI-mimic ECGs for catheterization laboratory activation (CLA) and compare their performance to a machine learning-based artificial intelligence algorithm, Queen of Hearts AI (QoH AI). Fifty-three EPs and 42 cardiologists interpreted 18 ECGs (eight STEMI-equivalents, eight STEMI-mimics, with one STEMI, and a normal ECG as controls) to determine the presence of OMI requiring immediate CLA. The same ECGs were analyzed by QoH AI. Interpretations were compared against a reference standard based on angiography, troponin, echocardiography, and clinical follow-up. Interpretation accuracies were similar between EPs and cardiologists (65.6 %, 95 % CI [51, 78]; 65.5 %, 95 % CI [51, 77], respectively; p = 0.969), and significantly lower than QoH AI (88.9 %, 95 % CI [82, 93]) vs. physicians overall, 65.6 %, 95 % CI [52, 77]; p < 0.001). Physicians most frequently misclassified de Winter, Transient STEMI, Hyperacute T-wave OMI, and bundle branch block ECGs. QoH AI only misclassified left bundle branch block with OMI and left ventricular aneurysm without OMI. Physicians frequently misinterpret STEMI-equivalent and STEMI-mimic ECGs, potentially impacting CLA decisions. QoH AI demonstrated superior accuracy, suggesting a potential to reduce missed OMIs and unnecessary catheterization laboratory activations. Prospective studies are needed to validate these findings in clinical practice. •What is known: Physician ECG interpretation accuracy for cath lab activation decisions is 70 %.•What is unknown: How accurate physicians are for STEMI-equivalents and mimics; is AI superior?•What we found: Physicians 66 % accurate (miss 41 %/overcall 32 %); AI 89 % (miss 11 %/overcall 11 %).•Implication: AI use may reduce missed OMIs and false-positive cath lab activations.

Electromechanical association is a very unique physiological type of ECG artifact caused by the radial artery pulse tapping. ECG presentation of this artifact may imitate primary repolarization changes characteristic for acute coronary syndrome or electrolyte abnormalities. The peculiarity of electromechanical association is the synchronization with regular cardiac cycles, making a diagnostic challenge even for experience physicians. The present case is a rare example of an ECG artifact localized in a specific pattern mimics ECG changes of acute myocardial infarction with ST elevation (STEMI), including reciprocal ST depression. Moreover, serial prehospital ECGs verify evolution from hyperacute T waves to true ST elevation, as we seen in acute myocardial infarction. The key for artefact recognition was the knowledge about ECG leads derivation and identification the affected electrode. Electromechanical association frequency is unknown: it may be common, but often unrecognized finding. So far, electromechanical association in serial ECGs wasn’t reported, as per our knowledge.

The benefits of myocardial revascularization in ST-segment elevation acute coronary syndrome after 12 to 24 hours from symptom onset remain a topic of debate, especially in patients who are stable and asymptomatic. We analyzed the benefit of late revascularization by primary coronary intervention in patients admitted to Moroccan cardiac intensive care units (CICUs) with ST-segment elevation myocardial infarction after 12 hours of symptom onset. We included a total of 406 patients who met the inclusion criteria: 262 patients in the invasive strategy group and 144 patients in the conservative strategy group. A total of 74.6% were men, and 25.4% were women. For the primary outcome, 46 all-cause deaths were observed at 1 year, with 33 patients in the conservative strategy arm and 13 patients in the invasive strategy group, with a significant difference between the 2 groups (p <0.001). For secondary outcomes, there was no difference in readmission for acute coronary syndrome or acute heart failure between the 2 groups (p = 0.277, p = 0.205). For in-CICU cardiogenic shock and ejection fraction <35% at discharge, more events are observed in the conservative strategy, with a significant difference for both (p <0.001). In multivariable analysis, 1-year all-cause mortality was independently associated with revascularization between 12 and 48 hours (hazard ratio [HR] 0.372, 95% confidence interval [CI] 0.182 to 0.762, p = 0.007), ejection fraction <35% at discharge (HR 1.92, 95% CI 1.22 to 2.54, p = 0.04), and cardiogenic shock in-CICU (HR 2.69, 95% CI 1.82 to 3.78, p = 0.005).Although no evidence exists to date on the true benefit of late primary coronary intervention revascularization in patients with ST-segment elevation myocardial infarction, this practice remains common, as indicated by the results of most registries.

Spontaneous coronary artery dissection (SCAD) is an increasingly recognized cause of myocardial infarction that most frequently affects younger women, making it an important cause of morbidity and mortality within these demographics. The evolution of intracoronary imaging, improved diagnosis with coronary angiography, and ongoing research efforts and attention via social media, has led to increasing recognition of this previously underdiagnosed condition. In this review, we provide a summary of the current body of knowledge, as well as focused updates on the pathogenesis of SCAD, insights on genetic susceptibility, contemporary diagnostic tools, and immediate, short‐ and long‐term management. Spontaneous Coronary Artery Dissection (SCAD) is an increasingly recognized cause of myocardial infarction that most frequently affects younger women, making it an important cause of morbidity and mortality within these demographics. The evolution of intracoronary imaging (C ‐ OCT image of IMH), improved diagnosis with coronary angiography (B ‐ Type 2 A SCAD in an obtuse marginal artery), and ongoing research efforts and attention via social media, has led to increasing recognition of this previously underdiagnosed condition (A ‐ IMH as the important pathophysiologic mechanism in SCAD). OCT, optical coherence tomography; IMH, intramural hematoma; SCAD, Spontaneous Coronary Artery Dissection.

Abstract Aims Cardiogenic shock (CS) and cardiac arrest (CA) are serious complications in ST-elevation myocardial infarction (STEMI) patients, with lack of long-term data according to their timing of occurrence. This study sought to determine the incidence and relationship between the timing of occurrence and prognostic impact of CS and CA complicating STEMI in the long-term follow-up. Methods and results We conducted a retrospective analysis of consecutive STEMI patients treated between 2004 and 2017. Patients were divided into four groups based on the occurrence of neither CA nor CS, CA only, CS only, and both CA and CS (CA−CS−, CA+, CS+, and CA+CS+, respectively). Adjusted Cox regression analysis was used to assess the independent association between the CS and CA categories and mortality. A total of 1603 STEMI patients were followed for a median of 3.6 years. CA and CS occurred in the 12.2% and 15.9% of patients, and both impacted long-term mortality [adjusted hazard ratio (HR) = 2.59, 95% confidence interval (CI): 1.53–4.41, P < 0.001; HR = 3.16, 95% CI: 2.21–4.53, P < 0.001, respectively). CA+CS+ occurred in 7.3%, with the strongest association with higher mortality (adjusted HR = 5.36; 95% CI: 3.80–7.55, P < 0.001). Using flexible parametric models with B-splines, the increased mortality was restricted to the first ∼10 months. In addition, overall mortality rates were higher at all timings (all with P < 0.001), except for CA during initial cardiac catheterization (P < 0.183). Conclusion CS and CA complicating patients presenting with STEMI were associated with higher long-term mortality rate, especially in the first 10 months. Both CS+ and CA+ at any timeframe impacted outcomes, except for CA+ during the initial cardiac catheterization, although this will have to be confirmed in larger future studies, given the relatively small number of patients. Graphical abstract Graphical Abstract Population and proportion of cardiogenic shock and cardiac arrest in ST-elevation myocardial infarction patients. Cardiogenic shock and cardiac arrest are the group with worse outcome. Both complications have higher mortality when occurring after initial cardiac catheterization.

BackgroundThere is limited data on STEMI in bed-confined (BC) patients. We aim to investigate the characteristics, comorbidities, and outcomes of BC patients presenting with STEMI compared to non-BC patients.MethodsAdults admitted with a primary diagnosis of STEMI, with and without BC status, were studied from the 2016–2020 National Inpatient Sample.ResultsOf the 851290 adults with STEMI, 1125 (0.1%) patients had a BC status. This patient group was on average older (mean age 75.24 vs. 63.54 years) and more likely female (57.3%), whereas most patients without BC status were males (69.5). Differences in comorbidities and patient characteristics are described in table 1, with the BC cohort recorded to have higher proportions of diabetes, prior stroke, peripheral vascular disease, and chronic kidney disease than non-BC individuals (p<0.01). The BC cohort was additionally more likely to be insured by medicare compared to privately, with the reverse being true in the non-BC cohort (p<0.01). With regard to outcomes, BC individuals expressed higher events for acute kidney injury (AKI), pulmonary embolism, and cardiogenic shock. While 80.0% of non-BC patients underwent percutaneous coronary intervention (PCI), only 35.6% of BC patients had PCI. In addition, 5.3% of non-BC patients and 3.1% of BC patients underwent coronary artery bypass graft (CABG) surgery. BC individuals also had a higher risk of pulmonary embolism (aOR 3.692, 95% CI 2.613–5.216, p<0.01) and death (aOR 1.975, 95% CI 1.696–2.300, p<0.01).ConclusionThe prevalence of comorbidities and cardiac risk factors was higher in the BC compared with non-BC patients admitted with STEMI. The BC population had worse outcomes, including significantly greater mortality and lower rates of PCI and CABG. Further study is indicated to understand the low utilization of reperfusion strategies in the BC population.Abstract 71 Table 1Characteristics of patients with and without bed confinement status admitted with a primary diagnosis of STEMI in the United States Characteristics No bed confinement (n=850 165) (%) Bed confinement (n=1125) (%) p-value Patient and hospital characteristics Females 30.5 57.3 <0.01 RaceWhiteBlackHispanic 75.58.88.6 61.519.79.6 <0.01 Comorbidities Diabetes 32.4 43.1 <0.01 Hypertension 47.7 30.7 <0.01 Peripheral vascular disease 5.1 7.6 <0.01 Chronic Kidney Disease 13.1 30.7 <0.01 Prior myocardial Infarction 11.9 12.9 0.308 Prior Stroke 5.2 13.8 <0.01 Cardiac events and arrhythmias Atrial Fibrillation 14.0 22.7 <0.01 Ventricular Tachycardia 12.6 8.4 <0.01 Abstract 71 Table 2Outcomes and complications of patients with and without bed confinement status admitted with a primary diagnosis of STEMI in the United States Outcome No bed confinement (n=850 165) (%) Bed confinement (n=1125) (%) p-value Death 7.9 25.0 <0.01 Acute Kidney Injury 17.1 32.0 <0.01 Cardiogenic Shock 13.7 24.4 <0.01 CABG 5.3 3.1 <0.01 PCI 80.0 35.6 <0.01 Pulmonary Embolism 0.4 3.1 <0.01 Conflict of InterestNone

Background Acute coronary syndrome (ACS) is a common disease. Smoking may increase the risk of ACS. The most advantageous therapy is percutaneous coronary intervention. This therapy may fail which is no-reflow phenomenon as the result. Total occlusion may increase the risk of no-reflow phenomenon which it could be worse with smoking as the habits. ST-elevation myocardial infarction (STEMI) may show in electrocardiogram (ECG). Case description A 37-year-old male came to the hospital with chest pain as the main complaint. ECG examination showed that there was wide anterior STEMI. Coronary angiography was then done and confirmed that there was total occlusion in left anterior descending artery. After two days hospitalization, the patient developed to cardiogenic shock and lead to acute decompensated heart failure. An ECG showed there was STEMI anterior after primary PCI. Discussion Many chemicals agent contain in cigarette smoking and it may induce the lipid oxidation which leads to plaque deposits. Plaque that deposits in coronary artery may rupture and make thrombus occlusion. This occlusion may partial or total, when there is total occlusion, STEMI was the result. Then, releasing the occlusion is needed for this situation ant PCI may be chosen as the therapy. Patient with wide ischemia may result the no-reflow phenomenon which may lead to heart failure and shock cardiogenic as the complication. Conclusion Smoking may induce ACS which leads to STEMI and may increase the failure of PCI therapy. No-reflow phenomenon is the evidence of miscarriage in therapy which it may increase because of smoking.

Choosing optimal P2Y12 inhibitor in frail older adults is challenging because they are at increased risk of both ischemic and bleeding events. We conducted a retrospective cohort study of Medicare Advantage Plan beneficiaries who were prescribed clopidogrel, prasugrel, or ticagrelor after percutaneous coronary intervention-treated ST-elevation myocardial infarction from January 1, 2010 to December 31, 2020. Frailty was defined using claims-based frailty index ≥0.25. We conducted multivariable logistic regression to identify factors associated with using potent P2Y12 inhibitors and multivariable-adjusted competing risk analyses to compare the rate of discontinuation of potent P2Y12 inhibitors in frail versus non-frail patients. There were 11,239 patients (mean age 74 years, 39% women). The prevalence of cardiovascular and geriatric co-morbidities was as follows: 32% chronic kidney disease, 28% heart failure, 10% previous myocardial infarction, 6% dementia, 20% anemia, and 12% frailty. The proportion of patients receiving clopidogrel decreased from 78.3% in 2010 to 2013 to 42.1% in 2018 to 2020, with a concurrent increase in those receiving potent P2Y12 inhibitors (mostly ticagrelor) from 21.7% to 57.9%. Frailty was independently associated with reduced odds of initiation (odds ratio 0.78, 95% confidence interval 0.67 to 0.90) but not with discontinuation of potent P2Y12 inhibitors (subdistribution hazard ratio 1.09, 95% confidence interval 0.98 to 1.22). In conclusion, frail older adults are less likely to receive potent P2Y12 inhibitors after percutaneous coronary intervention-treated ST-elevation myocardial infarction, but they are as likely as non-frail patients to continue with the prescribed P2Y12 inhibitor.

Background A guidewire‐free angiography‐derived microcirculatory resistance (AMR) derived from Quantitative flow ratio (QFR) exhibits good diagnostic accuracy for assessing coronary microvascular dysfunction (CMD), but there are no relevant studies supporting the specific application of AMR in patients with ST‐elevation myocardial infarction (STEMI). The study aims to evaluate CMD in patients with STEMI using the AMR index. Methods This study included patients with STEMI who underwent percutaneous coronary intervention (PCI) from June 1, 2020 to September 28, 2021. All patients were divided into two groups: the CMD (n = 215) and non‐CMD (n = 291) groups. After matching, there were 382 patients in both groups.1‐year follow‐up major adverse cardiac events (MACEs) were evaluated. Results After matching, the primary endpoint was achieved in 41 patients (10.7%), with 27 and 14 patients in the CMD and non‐CMD groups, respectively (HR 1.954 [95% CI 1.025–3.726]; 14.1% versus 7.3%, p = .042). Subgroup analysis revealed that 18 patients (4.7%) were readmitted for heart failure, with 15 and 3 in the CMD and non‐CMD groups, respectively (HR 5.082 [95% CI 1.471–17.554]; 7.9% versus 1.6%, p = .010). Post‐PCI AMR ≥ 250 was significantly associated with a higher risk of the primary endpoint and was its independent predictor (HR 2.265 [95% CI 1.136–4.515], p = .020). Conclusion The retrospective use of AMR with a cutoff value of ≥250 after PCI in patients with STEMI can predict a significant difference in the 1‐year MACE rates when compared with a propensity score‐matched group with normal AMR. A guidewire‐free and adenosine‐free angiography‐derived microcirculatory resistance (AMR) derived from quantitative flow ratio with flow velocity calculation exhibits good diagnostic accuracy for assessing coronary microvascular dysfunction. In our study, post‐PCI AMR ≥ 250 mmHg × s/m was significantly associated with a higher risk of the primary endpoint and was its independent predictor.