Duration Of Chest Pain Research Articles

Efficacy and safety of modified endoscopic submucosal tunnel dissection for superficial esophageal circumferential lesions.

To evaluate the efficacy and safety of intra-tunnel dissection using hemostatic forceps and needle-type device for patients with esophageal circumferential lesions (ECLs). Patients with ECLs were enrolled in the study and underwent endoscopic submucosal tunnel dissection (ESTD) or hemostatic forceps-based ESTD (ESFTD). All patients were divided into three subgroups according to longitudinal length of the lesions (LLLs): >8 cm, 4-8 cm and < 4 cm. The clinical data such as gender, age, length of lesions and operating time were collected. A total of 152 patients were included in this study and comprised 80 cases of ESFTD and 72 cases of ESTD. The procedure time was markedly shorter in the ESFTD group than in the ESTD group (P < 0.001). Moreover, ESFTD significantly increased the rate of complete resection and reduced specimen injury in LLLs >8 cm and 4-8 cm subgroup compared with ESTD (P < 0.001), but not in <4 cm subgroup (P > 0.05). The perforation and infection rate were similar in ESFTD and ESTD group (P > 0.05). However, ESFTD effectively decreased the muscular injury rate' the duration of chest pain and the time from endoscopic surgery to first occurrence of esophageal stenosis compared with ESTD group (P < 0.01). ESFTD has better efficacy and safety than ESTD in the treatment of ECLs, especially for large lesions. ESFTD could be recommended for patients with ECLs.

A Case of Takayasu Arteritis Presenting with Sensorineural Hearing Loss as First Manifestation

We report the case of a 26-year-old male patient diagnosed with Takayasu arteritis after 4 years of first manifestation. He developed sensorineural hearing loss in left ear, followed 2 years later by acute onset paraparesis and hypertension, and followed another 2 years later by short duration of upper backache, chest pain, palpitations, and breathlessness. On examination, he had hypertension without any significant blood pressure (BP) difference within arms with all peripheral pulses palpable. Diagnosis confirmed with computerized tomography aortography showing multifocal wall thickenings in entire aorta. In our case, the first presentation was otological followed 2 years later by hypertension. Our report points toward fact that hypertension, though the most common, may not be the first manifestation and characteristic examination finding of BP difference, and pulselessness may not be seen in all cases. High risk of suspicion and early use of specific investigation in cases of multisystem involvement in young hypertension are crucial for timely diagnosis.

Frequency of Left Anterior Descending Artery Involvement as a Culprit Vessel in Young Patient with ST Elevation Myocardial Infarction

Objective: To determine the frequency of left anterior descending artery involvement as a culprit vessel in young patient with ST elevation myocardial infarction (STEMI) at tertiary care hospital. Study Design: A cross-sectional study. Place and Duration: The Department of Cardiology, “National Institute of Cardiovascular Diseases, Karachi” Pakistan from October 2019 to April 2020. Methodology: Patients of both genders aged 25-45 years who were presented with onset of chest pain for more than 30 minutes with STEMI were included. All patients were clinically evaluated after detailed history. Routine biochemistry investigations were asked and ECG and echocardiography were performed. Frequency of left anterior descending artery involvement in patients with STEMI was noted. Results: In a total of 191 patients, mean age was 33.6±6.7 years while mean duration of chest pain was 42.5±8.3 minutes. There were 135 (70.7%) male and 56 (29.3%) female cases. In distribution of vessel disease, 76 (39.8%) had single vessel disease (SVD), 37 (19.37%) had double vessel disease (DVD) while 78 (40.84%) had triple vessel disease (TVD). Left anterior descending artery found to be positive in 88 (46.1%) patients. Practical Implications: To reduce the complications of STEMI, it is very important to increase the awareness and proper knowledge in the general public. Conclusion: Involvement of left anterior descending artery as a culprit vessel was fairly common in young patient with ST elevation myocardial infarction. Keywords: Left anterior descending artery, culprit vessel, ST elevation myocardial infarction, coronary artery disease

Efficacy analysis of high-sensitivity troponin I concentration and its changes in the diagnosis of acute myocardial infarction

Objective: To explore the feasibility and accuracy of 0-1 h high sensitivity cardiac troponin I (hs-cTnI) concentration and its changes in judging non-ST segment elevation myocardial infarction (NSTEMI), and to investigate the feasibility of a simplified process. Methods: Patients with acute chest pain and suspected NSTEMI who were admitted to the emergency department of Fuwai Hospital, the First Affiliated Hospital of Sun Yat-sen University and Nanjing First Hospital from January 2017 to September 2020 were selected. Hs-cTnI test was carried out for the selected patients at the time of visit (0 h) and 1 h after visit. According to the 0-1 h hs-cTnI diagnostic process and threshold standard recommended by European Society of Cardiology (ESC) guidelines in 2015, the laboratory adjudication was determined. Cardiologists who did not participate in the project design and did not know the results of hs-cTnI test performed the clinical judgment according to the routine diagnosis and treatment process of emergency department. Taking clinical judgment as the gold standard, the diagnostic efficacy of 0-1 h hs-cTnI concentration and its change recommended by the guidelines for judging NSTEMI in Chinese population was analyzed. The guide process was simplified. Under the condition of not considering the time of chest pain, the guideline threshold was used for test and judgement, and the diagnostic efficacy of the simplified process was evaluated. Results: A total of 1 534 patients were enrolled in the study, aged (62±12) years and 952 (62.1%) patients were male. Among them, 402 patients (26.2%) were clinically diagnosed as NSTEMI and 1 132 patients (73.8%) were diagnosed as non-NSTEMI. According to the diagnosis and determination process recommended by the guidelines, NSTEMI was excluded in 672 patients (42.8%), and 464 patients (30.2%) were diagnosed as NSTEMI. The consistency rate with clinical determination reached 92.4% (1 050/1 136), the sensitivity of excluding diagnosis was 99.5% (95%CI: 98.0%-99.9%), the negative predictive value was 99.7% (95%CI: 98.8%-99.9%), and the negative likelihood ratio was 0.008 (95%CI: 0.002-0.335). The diagnostic specificity was 92.6% (95%CI: 90.9%-94.0%), the positive predictive value was 81.9% (95%CI: 78.0%-85.2%), and the positive likelihood ratio was 12.739 (95%CI: 10.356-15.670). According to the simplified process, NSTEMI was excluded in 675 patients (44.0%), and 463 patients (30.2%) were diagnosed as NSTEMI. The consistency rate with clinical judgment was 92.4% (1 051/1 138), the sensitivity of exclusion diagnosis was 99.3% (95%CI: 97.6%-99.8%), the negative predictive value was 99.6% (95%CI: 98.6%-99.9%), and the negative likelihood ratio was 0.012 (95%CI: 0.004-0.389). The diagnostic specificity was 92.6% (95%CI: 90.9%-94.0%), the positive predictive value was 81.9% (95%CI: 78.0%-85.2%), and the positive likelihood ratio was 12.705 (95%CI: 10.328-15.630). There was no significant difference in diagnostic efficacy between the simplified process and the recommended process (all P>0.05). Conclusion: The diagnostic process for judging NSTEMI according to the 0-1 h hs-cTnI concentration and its change criteria recommended by the 2015 ESC guidelines is applicable in the Chinese population and remains highly accurate in judging NSTEMI without considering the duration of chest pain at the time of presentation.

Morphine Use Did Not Eliminate the Effect of Pain on Complications After Acute Myocardial Infarction.

Background: Patients with Acute Myocardial Infarction (AMI) are usually present complaining of severe chest pain. This pain results from an imbalance between oxygen supply and demand, leading to severe complications. Different guidelines recommend using Morphine as a drug of choice for treating this pain. Objective: This study aimed to check the effect of chest pain and Morphine use on complications rate after AMI. Methods: This was a prospective observational study with a consecutive sample of 300 patients with AMI. Data were collected by direct patients interview and medical records review in the emergency departments &amp; Intensive Care Units (ICU). Any complication developed within the hospital stay and after AMI was recorded. All correlated variables were analyzed using the binary logistic regression model. Results: The sample included 176 (58.7%) men and 124 (41.3%) women with a mean age of 56.92±12.13 years. A total of 83 patients (27.7%) developed one or more in-hospital complications. Acute recurrent ischemia was the most frequent complication; 70 (23.3%). Severe chest pain (≥ 7), duration of chest pain (more than 5 minutes), history of previous MI, and history of hypertension increased the occurrence of complications by 13%, 7%, 63%, and 25%, respectively. However, the use of Morphine did not have any protective effect against the development of these complications. Conclusion: The severity and duration of chest pain increased the occurrence of complications. Morphine administration did not have any protective effect against the development of these complications. Thus, it is recommended to update different policies and guidelines to use other types of chest pain relief methods, e.g., treating the underlying cause of chest pain and addressing the imbalance between oxygen supply and demand.

Caractéristiques des douleurs thoraciques au cours des syndromes coronariens aigus vus au service de cardiologie de Befelatanana (Madagascar)

IntroductionChest pain is one of the different elements of orientation for the diagnosis of acute coronary syndrome. Sometimes its clinical presentation is misleading. The objective of this study was to describe the characteristics of chest pain during an acute coronary syndrome in the cardiology department of the Joseph Raseta Befelatanana University Hospital Center, Antananarivo, Madagascar. MethodsWe carried out a cross-sectional, descriptive study of 10 months from January 2019 to October 2019. All patients diagnosed with acute coronary syndrome during this period were included. ResultsSixty-five cases were included. A “typical chest pain” was only encountered in 7.7% of cases. Advanced age (p = 0.04) and sedentary lifestyle (p = 0.03) were associated with the occurrence of silent myocardial ischemia, and. hypertension with a prolonged duration (≥15 minutes) of chest pain (p = 0.03). Dyslipidemia was associated with atypical irradiation of chest pain (p = 0.003). Alcoholism had an impact on pain triggered by effort (p = 0.01) and relieved by rest (p = 0.04). ConclusionThe current symptomatology of acute coronary syndrome is increasingly atypical. Knowledge of the factors that can influence the different characteristics of chest pain could serve as a benchmark in clinical practice in our population.

Association Between Costochondritis and Vitamin D Deficiency: An Observational Study

Background: Vitamin D is an integral part of bony health. Its deficiency leads to multiple bony pains, including costochondritis.&#x0D; Aims and Objectives: Present study aimed to evaluate the association of costochondritis with vitamin D deficiency.&#x0D; Materials and Methods: A total of 100 patients with chest pain with costochondral tenderness were taken. Clinical history, examination, investigation, including electrocardiogram, echocardiogram, and chest x-ray was made.&#x0D; Results: 63% and 37% were female and male, respectively. Mean vitamin D level was low in females as compared to males (21.9±8.47 and 31.7±6.23 respectively). Prolonged duration of chest pain was associated with low vitamin D level that was statistically significant (p&lt;0.001).&#x0D; Conclusion: Vitamin D deficiency is common in the Indian community, may lead to bony pains, costochondritis, osteomalacia. Replacement of vitamin D is recommended to alleviate skeletal manifestations.&#x0D; Keywords: vitamin D deficiency, non-cardiac chest pain, costochondritis

Characteristic differences of chest pain in male and female patients with acute coronary syndrome: A pilot study.

Background: The typical sign or main symptom in acute coronary syndrome (ACS) patients is chest pain, which is an initial benchmark or early sign for diagnosis. Certain factors, such as gender differences, the presence of diabetes mellitus or other clinical conditions, may make the patient not realize they have ACS. Therefore, this study aims to identify the characteristics of chest pain symptoms in male and female patients with ACS.Design and Methods: This is a non-experimental quantitative study, namely analytical observation using a cross-sectional approach within 4 months (January-April 2019). Furthermore, the samples were 53 ACS patients (28 male and 25 female).Results: The chest pain characteristics that have a significant relationship with gender differences in ACS patients are shown based on the aspects of location, pain duration and quality. Male patients are more likely to feel pain at the left or middle chest, the duration is between <20 to >20 min with moderate pain quality, which tends to become severe, while females are more likely to feel pain at the chest which radiates to the neck and chin, the duration is usually >20 min, with mild to moderate pain quality.Conclusions: The result showed a significant difference in chest pain characteristics in male and female patients with ACS. Regarding location, duration and quality of chest pain, male ACS patients mostly have more typical symptoms, while females’ symptoms are atypical.Significance for public healthThere are various characteristics of chest pain differences between male and female patients with Acute Coronary Syndrome. The findings of this study showed that it is important to provide optimal nursing care and also educate patients and families about the signs, or symptoms that often occur, especially atypical symptoms. This will reduce the tendency to delay in seeking treatment, which will affect prehospital delay time.

Primary Percutaneous Coronary Intervention of ST-segment Elevated Myocardial Infarction- Experiences in a Tertiary Care Hospital

Background: Primary percutaneous coronary intervention (pPCI) is the preferred and established mode of treatment in ST elevated myocardial infarction (STEMI). Exact data on procedural outcome in patient undergoing primary PCI in our population is not well documented. Therefore, we have carried out this study to see the prognosis, in-hospital, and 12-month survival outcome of our patients.&#x0D; Methods: Patients were enrolled in the observational non-randomized prospective cohort between November 2017-Mar 2020, who were presented into our emergency department with acute onset of severe chest pain or angina with ECG evidenced acute ST elevated myocardial infarction. Total 182 patient (F 14; Male 168) were enrolled in this study.&#x0D; Results: Out of 182 patients, female :14 (7.7%) vs. Male: 168 (92.3%). Among, these patient females were more obese (BMI: Female 27.1 ± 2.1 vs. male 25.8 ± 4.1) and developed CAD in advance age (Female 59.1 ± 13.5 vs. Male 53.7 ± 10.5). Anterior MI were 47.8% (n=87) and Inferior MI 50.5% (n=92) and Lateral MI 1.6% (n=3). At presentation 10.4% (n=19) patents were in cardiogenic shock with STEMI, 42.1%(n=8) patients with Ant MI, 57.9%(n=11) in Inf MI group. Total, 15 (8.2%) patients died; 93.3%(n=14) within 1 week of pPCI due shock and poor LV function and subsequent development of LVF with arrhythmia and 6.7%(n=1) patient died 6 months after pPCI due to other cause. Death was more in Ant Wall STEMI than Inferior wall STEMI, though Cardiogenic shock at presentation were more in Inf MI STEMI than Ant wall STEMI.&#x0D; Conclusion: We may conclude from our observational study on STEMI PCI that the territory wise involvement of myocardium, baseline serum Troponin-I level, infarcted vessel, time to presentation, duration of anginal chest pain and door to balloon time may be the key determinant of better in hospital outcome.&#x0D; Cardiovasc. j. 2021; 13(2): 154-163

The expression levels of plasma dimethylglycine (DMG), human maternally expressed gene 3 (MEG3), and Apelin-12 in patients with acute myocardial infarction and their clinical significance.

To analyze the expression levels of plasma dimethylglycine (DMG), human maternally expressed gene 3 (MEG3), and Apelin-12 in patients with acute myocardial infarction (AMI) and explore their clinical significance. One hundred and ten patients with suspected AMI (chest pain duration <6 h) who were admitted to our hospital between December 2018 and June 2020 were included. Plasma DMG, MEG3, and Apelin-12 levels were measured at the time of admission. The levels of plasma DMG, MEG3, and Apelin-12, as well as the general data and admission baseline data of these patients were then compared with those of non-AMI patients. The receiver operating characteristic (ROC) curve was used to analyze the clinical value of plasma DMG, MEG3, and Apelin-12 levels for the early diagnosis of AMI. Among the 110 patients with chest pain suspected of AMI, 34 were clinically diagnosed with AMI, and 76 were non-AMI patients. The proportion of males, smoking, history of myocardial infarction, and congestive heart failure in the AMI group were higher than those of the non-AMI group. The proportions of systolic blood pressure (SBP), ST-segment elevation, and electrocardiogram (ECG) dynamic changes on admission were also higher in the AMI group compared to those of the non-AMI group (P<0.05). The plasma DMG, MEG3, and Apelin-12 levels of patients in the AMI group on admission were higher than those of the non-AMI group (P<0.05); all have diagnostic value for AMI upon admission. The area under the curve (AUC) of MEG3 was higher than that of both DMG and Apelin-12, however the difference was not statistically significant (Z=1.378, 0.934, P=0.168, 0.350). Using 0.015 as the cut-off value for MEG3-messenger ribonucleic acid (mRNA), the sensitivity and specificity for diagnosing AMI were 85.29% and 81.58%, respectively. Our results showed that the plasma levels of DMG, MEG3, and Apelin-12 in patients with AMI were high, and thus, they can be used as biomarkers for the early diagnosis of AMI. Among them, MEG3 was the most effective in early diagnosing AMI.

Bol u grudima i prehospitalno kašnjenje

Aim was to show the duration of chest pain in patients with Angina pectoris (AP) and acute coronary syndrome (ACS) prior to reporting to the ambulance as well as the patients' self management of the pain. Materials and methods. The study was done between 1st August 2014th and 1st October 2018th in the infirmary of EMS in Belgrade. The study involved 161 patients, out of 9437 patients in total, who were treated by one doctor and with confirmed or suspected diagnosis of an ACS or AP. Results. Patients with AP most commonly waited between 2-24 hours, while the patients with ACS waited &lt;1h from the pain onset until contacting EMS. Most patients with MI (17) as well as with AP (79) did not take any kind of therapy, while some patients administered one or more drugs in order to relieve the pain. In patients with AP, the drugs of choice were antihypertensive medications (17.42%) and in MI patients Nitroglycerin and analgesics (31.03%). All patients previously diagnosed with MI and AP have self-administered Nitroglycerin in 12.42% of cases. Conclusion. Patients with AP wait longer when having chest pain before calling EMS from patients with ACS, but their self-administered drugs of choice were antihypertensive medications. Nitroglycerine as the first appropriate drug of choice is used less and in most cases patients even do not have it readily available.

AI and telemedicine: total remote guidance of AMI management

Abstract Background For a decade, Latin American Telemedicine Infarct Network (LATIN) Telemedicine has transformed AMI management in Brazil, Colombia, Mexico, Chile, and Argentina. With a hub and spoke strategy, AMI coverage was expanded to 100 million population and 877,177 telemedicine encounters were performed. Cost savings from avoiding unnecessary transfer of patients was $291 million. We are now rapidly escalating on a path to making the telemedicine process “physician-free” by utilizing Artificial Intelligence (AI) protocols. Purpose To demonstrate that AI can replace a cardiologist for remote AMI telemedicine guidance. Methods The process of total AI guidance focused on both aspects of our telemedicine strategy – accurate AMI diagnosis and tele-guidance of the entire STEMI process. We developed our innovative approach by initially creating AI algorithms for computer-aided diagnosis. Next, we incorporated logistic variables (duration of chest pain, transfer times to LATIN hub, etc) to the algorithm for physician-free triage into thrombolysis, primary PCI and pharmaco-invasive management. The intent of creating AI algorithms was early STEMI detection and triage. After the patient was efficiently transferred to the hub, a final treatment decision was made by the hub cardiologists. Results Three crucial areas of telemedicine efficiency are being monitored – Time-to-Telemedicine Diagnosis (TTD), Door-In-Door-Out (DIDO) and Transfer Times (TT). All are showing improvements. Detailed results will be available at the time of presentation. Conclusions We are encouraged with the possibility of making the entire telemedicine guidance of AMI management “physician-free”. Next-Gen improvements are being contemplated by including a Single Lead EKG for AMI detection that will impact symptom-to-balloon times. Funding Acknowledgement Type of funding source: None

Clinical significance of the monocyte to high-density lipoprotein cholesterol ratio in the assessment of imperfect ST-segment resolution in elderly patients with acute ST-elevation myocardial infarction after percutaneous coronary intervention

Objective To investigate the clinical significance of the monocyte count/high-density lipoprotein cholesterol ratio(MHR)in evaluating imperfect ST-segment resolution in elderly patients with acute ST-elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI). Methods This was a retrospective cohort study.A total of 274 elderly patients with STEMI underwent PCI in our hospital from December 2015 to December 2018 were enrolled.Based on the extent of the ST-segment resolution of the postoperative electrocardiogram, patients were divided into an imperfect ST-segment resolution group(observation group, n=79)and a favorable ST-segment resolution group(control group, n=195). General clinical data were compared between the two groups, and logistic regression equation was used to analyze the association of MHR with ST-segment resolution.Receiver operating characteristic(ROC)curve was performed to assess the predictive value of MHR for imperfect ST-segment resolution. Results Compared with patients in the control group, patients in the observation group were associated with a significantly higher proportion of anterior wall myocardial infarction and heart failure(≥Killip 2), A longer duration of chest pain to balloon expansion, higher levels of creatine kinase isoenzyme, N-terminal pro-brain natriuretic peptide, hypersensitive C-reactive protein, blood sugar, blood uric acid, fibrinogen, triglyceride and mononuclear cell count, and lower levels of high density lipoprotein cholesterol and lymphocyte count(all P<0.05). Meanwhile, there was a significant difference in MHR between the observation group and the control group [(0.75±0.22)vs.(0.48±0.19), t=9.831, P=0.001]. Multivariate Logistic regression analysis showed that MHR was an independent risk factor for imperfect ST-segment resolution(OR=1.950, 95%CI: 1.646-5.430, P=0.003)and ROC curve showed the threshold value of MHR at 0.67, the area under the curve at 0.867, the sensitivity at 79.72%, and the specificity at 79.61%. Conclusions MHR may be an independent risk factor and a good predictive index for imperfect ST-segment resolution in elderly patients with STEMI after PCI. Key words: Monocytes; Lipoproteins HDL; Myocardial infarction

The association of chest pain duration and other historical features with major adverse cardiac events

ObjectiveWe sought to determine if the duration of pain or other features of the history predict major adverse cardiac events (MACE) in patients with chest pain in the emergency department (ED). MethodsThis was a prospective cohort study of patients presenting to a single ED with chest pain. Consenting patients filled out a survey about their symptoms. After 6 weeks, we assessed patients for MACE via chart review and direct contact. We used this data to calculate the likelihood ratios (LRs) of a number of historical features for acute myocardial infarction (MI) (primary endpoint) and MACE within 6 weeks (secondary endpoint). We planned a priori to analyze patients who reported chest pain for ≤1 min or continuously for ≥24 h. ResultsWe enrolled 1002 patients, and 83.6% had successful 6-week follow up. Regarding chest pain lasting for ≤1 min, the positive LR was 0.95 (95% CI 0.24 to 3.80) for acute MI and 0.67 (95% CI 0.17 to 2.72) for MACE within 6 weeks. The positive LRs of continuous pain lasting ≥24 h for acute MI and MACE within 6 weeks were 0.15 (95% CI 0.04 to 0.58) and 0.36 (95% CI 0.18 to 0.74), respectively. Amongst other historical features assessed, radiation to the right arm was the strongest positive predictor of acute MI. ConclusionPatients with continuous chest pain for ≥24 h are unlikely to have an acute MI. Chest pain lasting ≤1 min does not exclude acute MI.

P3352Telemedicine transcends national boundaries in quest of creating a behemoth ami program

Abstract Background The Latin America Telemedicine Infarct Network (LATIN) has exploited the remarkable competence of telemedicine for remote guidance. In doing so, LATIN created a mammoth population-based AMI network that employed experts located several hundred miles away to guide the reperfusion strategies for almost 800,000 screened patients. In this pioneering project, telemedicine was initially utilized to guide AMI management within national confines. We speculated whether LATIN telemedicine navigation could outstrip countrywide borders. Purpose To maximally harness the vast possibilities of telemedicine for improving AMI care. Methods During its pilot phase, LATIN began as a hub and spoke, AMI system in Colombia where 20 spokes (small community health centers and rural clinics) were configured with 3 hubs that could perform Primary PCI. These sites were linked through web-based connectivity. Expert cardiologists, located 50–250 miles away in Bogota, Colombia, used sophisticated telemedicine platforms for urgent EKG diagnosis and teleconsultation of the entire AMI process. Based upon the duration of chest pain and travel time to the hub, these experts guided patients through guideline-based strategies of thrombolysis, pharmaco invasive management or primary PCI. Efficiency of the telemedicine process was measured with the new metric of time to telemedicine diagnosis (TTD). Cloud computing, GPS navigation, and numerous business intelligent tools were gradually incorporated into LATIN telemedicine. As systems became more scalable, the program was expanded to Brazil, where LATIN flourished. Over the last 18 months, LATIN telemedicine capabilities have been pressed across national boundaries. Presently, all 82 LATIN centers in Mexico are guided by experts located in Bogota, Colombia and the 7 Argentina centers channeled through Santiago, Chile. Results 784,947 patients were screened for AMI at 350 LATIN centers (Brazil 143, Colombia 118, Mexico 82, Argentina 7). Navigation pathways are depicted in the attached figure. TTD remains extremely low in all four countries, and comparable efficiency and tele-accuracy have been achieved. With expanded geographic reach, 8,448 (1.08%) patients were diagnosed with STEMI and 3,911 (46.3%) urgently reperfused, including 3,049 (78%) with Primary PCI. Time to TTD ranged between 2.8 to 5.8 minutes, with a mean of 3.5 min. Tele-accuracy was 98.5%, D2B 51 min, and in-hospital mortality 5.2%. Various other comparative metrics for the 4 countries are being gathered and will be available at the time of presentation. Conclusions LATIN demonstrates the robust ability of telemedicine to transcend national boundaries to guide AMI management. This strategy can be adopted in under-developed countries in Asia and Africa to provide an umbrella of AMI care for the millions of disadvantaged patients.

P1524Women are from venus and face barriers for AMI treatment

Abstract Background The Latin American Telemedicine Infarct Network (LATIN), a program for managing population-based AMI care, has utilized an innovative hub-spoke strategy and remote guidance to expand medical access in remote parts of Brazil, Colombia, Mexico, and Argentina. Based on the Global Lumen Organization for Women (GLOW) project, that has previously demonstrated gender inequalities and worse outcomes for women who undergo Primary PCI, our research explored the management of female patients in our network. Purpose To demonstrate gender disparities in a telemedicine-guided, population based AMI program. Methods Meta-analysis of &gt;750,000 patients within LATIN. Telemedicine was employed as a screening tool to accurately diagnose AMI. According to the duration of chest pain and transfer time, AMI patients were triaged into guidelines-based pathways of thrombolysis, pharmaco-invasive management or Primary PCI. Resource allocation was identical for men and women. Results Data from 784,395 screened patients reveals broad gender disparities. The critical results yielded that female patients have a lower prevalence of STEMI diagnosis and treatment regardless of the technique – PCI, pharmaco-invasive or CABG (p&lt;0.01). These findings assume more significance given the fact that more women than men, were screened through the Telemedicine pathway. Conclusions LATIN gender data signals the urgency to demand better AMI care for women.

Value of fibrinogen to albumin ratio on predicting spontaneous recanalization of infarct-related artery in patients with acute ST-segment elevation myocardial infarction

Objective: To investigate the value of fibrinogen to albumin ratio (FAR) at admission on predicting spontaneous recanalization of infarct-related artery (IRA) in patients with acute ST-segment elevation myocardial infarction (STEMI). Methods: Clinical data from 255 acute STEMI patients ((61.1±11.2) years old, 189 males) who underwent emergency coronary angiography within 12 hours in our hospital from December 2015 to April 2018 were retrospectively analyzed. The acute STEMI patients were divided into non-spontaneous recanalization group (thrombolysis in myocardial infarction (TIMI) flow grade 0-1, 203 cases) and spontaneous recanalization group (TIMI flow grade 2-3, 52 cases). Multivariate logistic regression analysis was used to evaluate related factors of IRA spontaneous recanalization. The receiver operating characteristic (ROC) curve was used to evaluate the value of FAR in predicting spontaneous coronary recanalization. Results: There was no significant difference in age,gender, hypertension, diabetes, smoking,systolic blood pressure,diastolic blood pressure,heart rate, duration of chest pain, type of infarction, infarct-related artery, door-to-balloon time, and drug used before admission between non-spontaneous recanalization group and spontaneous recanalization group (all P>0.05). The FAR and high-sensitivity C-reactive protein levels were significantly lower in the spontaneous recanalization group than in the non-spontaneous recanalization group (8.20±1.85 vs. 11.02±2.75, P<0.001; (6.87±3.36) g/L vs. (8.51±3.72) g/L, P=0.004). Multivariate logistic regression analysis showed that FAR (OR=0.492, 95%CI 0.354-0.686, P<0.001), serum uric acid (OR=0.994, 95%CI 0.989-0.999, P=0.018) and high-sensitivity C-reactive protein (OR=0.774, 95%CI 0.614-0.975, P=0.030) were independent negative correlation with spontaneous recanalization of infarct-related artery in patients with acute STEMI. The ROC curve showed that the area under the curve of FAR predicting spontaneous recanalization of infarct-related artery in patients with acute STEMI was 0.807 (95%CI 0.630-0.758, P<0.001), and the diagnostic threshold was 9.26, the sensitivity was 76.9%, the specificity was 75.9%. Conclusion: The level of admission FAR has certain predictive value for spontaneous recanalization of infarct-related arteries in patients with acute STEMI.

Predictors of left ventricle ejection fraction and early in-hospital mortality in patients with ST-segment elevation myocardial infarction: Single-center data from a tertiary referral university hospital in Istanbul.

Background:Little is known about the management and mortality rates of ST-segment elevation myocardial infarction patients in developing countries. In this study, to expose independent predictors of early (24 h) in-hospital mortality and ejection fraction, we report our experience with 362 ST-segment elevation myocardial infarction patients admitted to the Istanbul Medical Faculty, Istanbul University, a tertiary referral university hospital, and treated with primary percutaneous intervention.Methods:This is a retrospective study that enrolled all patients (362) admitted with ST-segment elevation myocardial infarction to Department of Cardiology, Istanbul Medical Faculty, Istanbul University, between January 2015 and December 2016. The clinical characteristics of patients were collected retrospectively from medical chart review. Collected data were analyzed using IBM SPSS Statistics (version 21).Results:In the forward stepwise logistic regression analysis, target vessel diameter (p = 0.001), systolic blood pressure (p < 0.001), and troponin T levels (p = 0.007) were independent predictors for early in-hospital mortality, while target vessel diameter (p = 0.03), troponin T level (p < 0.001), heart rate (p = 0.001), and chest pain (p = 0.001) duration were the independent predictors for ejection fraction of 50% and above.Conclusion:Our study is one of the few studies to investigate the predictors of early in-hospital mortality among patients hospitalized with ST-segment elevation myocardial infarction in a tertiary referral university hospital in a developing country. The identified predictors for mortality (including left ventricle ejection fraction and troponin T levels), left ventricle ejection fraction (including troponin T level, chest pain duration), and heart rate are consistent with what has been described in large registries in the United States and Europe.

Acute effect of primary PCI on diastolic dysfunction recovery in anterior wall STEMI - A non-invasive evaluation by echocardiography.

BackgroundIt is well established fact that acute coronary occlusion leads to diastolic dysfunction, followed by systolic dysfunction when myonecrosis occur. It is also proven that primary percutaneous coronary intervention (PPCI) is an excellent therapy for ST elevation myocardial infarction (STEMI) to improve outcomes. However there is a paucity of information on efficacy of PPCI in improving diastolic function. Evaluation of the role of PPCI in improving diastolic dysfunction is required.Methods61 patients with first anterior wall STEMI who underwent PPCI to left anterior descending artery were included. Echocardiographic evaluation was performed within 24 h of PPCI and then on day 15, 3 months and 6 months after PPCI. We evaluated the prevalence of diastolic dysfunction after PPCI and its recovery during 6 months along with effect of duration of chest pain on diastolic function.Results54.1% of patients had diastolic dysfunction after PPCI whereas it was only 21.3% after 6 months (p value < 0.001). Diastolic function indices like deceleration time, isovolumic relaxation time, E wave, A wave, E/A ratio, left atrial volume and index improved statistically from baseline to 6 months except mitral E/e′ ratio. As time required to achieve reperfusion increases (chest pain duration and D to B time) the incidence of residual diastolic dysfunction also increases (p value < 0.001). Patients with TIMI flow < III had more diastolic dysfunction (p value < 0.001).ConclusionsPrimary PCI improves diastolic dysfunction in patients with anterior wall STEMI over a period of 6 months. Time to achieve reperfusion and effectiveness of reperfusion have significant effect on diastolic dysfunction.

CRT-100.20 Longer Duration of Chest Pain Before Hospital Arrival in ST-elevation Myocardial Infarction Patients Is Associated With Adverse Cardiovascular Outcomes

The duration between onset of angina and reperfusion is a critical determinant of infarct size and the likelihood of adverse myocardial remodeling in patients with ST-elevation myocardial infarction (STEMI). There are no definite data examining the prognostic importance of duration of angina before