PCI Centre Research Articles

Abstract 11582: Implications of Glycoprotein 2b/3a Receptor Antagonist Use During Percutaneous Coronary Intervention

Introduction: Glycoprotein 2b/3a receptor antagonists (Gp 2b/3a) were once widely used during PCI. However, due to concerns for excess bleeding, the 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization downgraded their use during PCI to Class IIa. Hypothesis Higher rates of Gp 2b/3a use will be associated with higher bleeding rates, particularly in hospitals that use more femoral arterial access. Methods: We investigated the prevalence of Gp 2b/3a use during PCI among 18 PCI centers in a regional cardiac quality collaborative, between January 2017 and June 2021. Since radial access has lower bleeding rates than femoral access, we determined the impact of Gp 2b/3a use on total bleeding as defined by NCDR, stratified by access site. Results: During the study period 36,975 PCI were performed. The rate of Gp 2b/3a use among PCI centers ranged from 2.6% to 59.3% (mean ± SD 20.5% ± 18.5%). PCI centers were analyzed according to whether Gp 2b/3a use was above or below the mean frequency, and according to arterial access site preference (femoral > 45% or radial > 55%). Among low Gp 2b/3a use centers, centers that also favored radial access had lower bleeding rates than high femoral access centers (1.84% vs 2.43%, p=0.009). However, the bleeding risk benefit of radial access was lost in the high Gp 2b/3a usage hospitals, with bleeding rates of 4.54% in the high radial centers versus 3.41% in the high femoral centers (p<0.001) (Table). Among high radial access site centers, the rate of bleeding was 2.5-fold greater in high versus low Gp 2b/3a use centers (p<0.001). Conclusions: There is a wide range of Gp 2b/3a use during PCI. Above average Gp 2b/3a use increased total bleeding and neutralized the bleeding risk benefit of radial access. Further study is required to determine why bleeding rates in high radial centers were greater than high femoral centers, when Gp 2b/3a use was above average. Adherence to current guidelines for Gp 2b/3a use may reduce bleeding risk during PCI.

Time to coronary angiography in a real-life cohort of NSTEACS patients: are guidelines too optimistic?

Abstract Background and purpose In 2020, new recommendations against routine use of pretreatment in NSTEACS have been established, especially if an early invasive strategy (within first 24 hours) is planned [1]. These recommendations are mainly based on evidence from clinical trials that have included short intervals of time to coronary angiography (CA) [2,3]. However, this timing seems hard to achieve in daily clinical practice, above all, when high-risk NSTEACS patients are now advised for an early invasive strategy. We aimed to assess the feasibility of these recommendations in real-world clinical practice. Methods We performed a retrospective analysis of a real-life cohort of NSTEACS patients referred to CA in a tertiary-level hospital between January and December 2020. Results We analysed 347 consecutive NSTEACS patients referred to CA (21.7% unstable angina, 78.3% NSTEMI). Percutaneous coronary intervention was performed in 60.5% and the radial or cubital artery access were exclusively used in 86.7%. Median time from hospital admission to CA was 39.4 hours (IQR: 20.7–67.0 hours) and 31.4% patients had the CA performed within first 24 hours (Figure 1). Main differences regarding clinical and risk-related variables among those patients who underwent CA before and after first 24 hours are shown in Table 1. More patients with NSTEMI and dynamic changes in ECG tended to be referred earlier to CA, while those with impaired renal function were more likely to receive a delayed strategy. There were 282 patients (82.7%) who met the high-risk criteria from current ESC guidelines on NSTEACS (GRACE risk score >140, ST transient elevation or depression in ECG, raise of cardiac troponin levels above the 99th percentile of the upper reference limit, cardiogenic shock or cardiac arrest at presentation); of whom, only 95 (33.7%) were referred to CA in the first 24 hours. No differences were found according to patients being admitted to PCI or non-PCI centres (32.1% vs. 30.9% had the CA performed within first 24 hours, p=0.81) or receiving pretreatment with a P2Y12 receptor inhibitor or not (31.7% vs. 31.0% of the CA ≤24 hours group; p=0.87). Conclusion Evidence from this real-life registry shows that median time from admission to CA is far from current recommendations for high-risk NSTEACS patients. This might represent an important limitation at the moment of translating guidelines to daily clinical practice, especially those who presume patients to have a CA performed within first 24 hours. Funding Acknowledgement Type of funding sources: None.

Orbital atherectomy of calcified coronary ostial lesions.

To evaluate the feasibility and safety of coronary orbital atherectomy (OA) for the treatment of calcified ostial lesions. Percutaneous coronary intervention (PCI) is increasingly being completed in complex patients and lesions. OA is effective for severely calcified coronary lesions; however, there is a dearth of evidence on the use of OA in ostial lesions, especially with long-term outcome data. Data were obtained from a retrospective analysis of patients who underwent OA of heavily calcified ostial lesions followed by stent implantation from December 2010 to June 2019 at two high-volume PCI centers. Kaplan-Meier analysis was utilized to assess the primary endpoints of 30-day, 1-year, and 2-year freedom-from (FF) major adverse cardiac events (MACE: death, myocardial infarction, or target vessel revascularization), stroke, and stent thrombosis (ST). A total of 56 patients underwent OA to treat heavily calcified ostial coronary lesions. The mean age was 72 years with a high prevalence of diabetes (55%) and heart failure (36%), requiring hemodynamic support (14%). There was high FF angiographic complications (93%), and at 30-day, 1-year, and 2-year, a high FF-MACE (96%, 91%, and 88%), stroke (98%, 96%, and 96%), and ST (100%), respectively. This study represents the largest real-world experience of coronary OA use in heavily calcified ostial lesions with long-term outcomes over 2 years. The main finding in this retrospective analysis is that, despite the complex patients and lesions included in this analysis, OA appears to be a feasible and safe treatment option for calcified coronary ostial lesions.

Prehospital triage of patients with suspected non-ST-segment elevation acute coronary syndrome: Rationale and design of the TRIAGE-ACS study

BackgroundPatients with suspected non-ST-segment elevation acute coronary syndrome (NSTE-ACS) are currently transported and admitted to the nearest emergency department (ED) for risk stratification, diagnostic workup and treatment. Although such patients with NSTE-ACS can benefit from direct transfer to a PCI center for early invasive treatment, no reliable prehospital triage tools are available. Recently, the PreHEART score has been validated in the PreHEART study for prehospital triage of patients with suspected NSTE-ACS. MethodsThe primary objective of the TRIAGE-ACS study, a prospective cohort study, is to determine whether prehospital triage using the PreHEART score can significantly reduce time from first medical contact to final diagnostics and revascularization in patients in need of coronary revascularization. The first cohort (control cohort; n = 500) is observatory and is used as a reference group for the second cohort. In the second cohort (interventional cohort; n = 500) patients are stratified in the ambulance for direct transfer to either a PCI or a non-PCI center, based on the PreHEART score. These two cohorts will be compared with each other. In total, 1000 patients will be included. Follow-up for endpoints will be performed by reviewing the medical record after 30 days, 1 year, and 2 years. ConclusionThe TRIAGE-ACS study is the first prospective study to investigate the impact of prehospital triage using the PreHEART score on time to final invasive diagnostics and treatment in patients with NSTE-ACS in need of revascularization by transferring high risk patients directly to a PCI center and patients at a low risk of having an NSTE-ACS to a non-PCI center. Such triage strategy could potentially result in optimization of regional care for all ACS patients.

Short- and long-term survival after ST-elevation myocardial infarction treated with pharmacoinvasive versus primary percutaneous coronary intervention strategy: a prospective cohort study

ObjectiveCompare survival in patients with ST-elevation myocardial infarction (STEMI) treated with a pharmacoinvasive (PI) or primary percutaneous coronary intervention (pPCI) strategy based on estimated time to PCI.DesignProspective observational cohort study....

Integrating Aster 07XT, Landsat 8, and aeromagnetic data for the delineation of potential mineralization sites in North Cameroon

In mineral exploration, detailed hydrothermally altered minerals mapping is an important approach prior to the field campaign. The study area contains several gold‐bearing quartz veins associated with hydrothermally altered zones rich in sulphides, muscovite/sericite, iron oxides, and hydrous silica. In this study, Aster 07XT, Landsat 8, and aeromagnetic data were integrated to detect potential zones associated with gold mineralization in Northern Cameroon. For this purpose, the relative band absorption depth, band ratioing, and analytic signal techniques were applied to enhance, identify and map hydrothermal alteration minerals, that is, hydroxyl‐bearing, iron oxide/hydroxide. In addition, a semi‐automatic approach was applied to extract remotely sensed and aeromagnetic lineaments from PCI Geomatica and Centre for Exploration Targeting Grid Analysis respectively. Hence, several potential mining targets were delineated from the processing of both remote sensing and aeromagnetic data. The major directions of the lineaments affecting the area include NE–SW/ENE–WSW, E–W, and N–S. Detailed field campaigns, petrographic analyses, and spectral measurements of rock samples were carried out in Tchollire and environs to verify the results from remotely sensed data. The analytical observations indicated the presence of quartz, epidote, chlorite, magnetite, haematite, sericite, galena, sulphide, telluride minerals, etc. Moreover, the target hydrothermal alteration zones were proved to be spatially associated with known mining areas and gold occurrences in the study area. Consequently, new prospective mining areas have been designated. This study confirmed the reliability and applicability of the processing of satellite imagery in mineral exploration in Northern Cameroon. It is suggested that the dataset used in this study provides a suitable tool for mapping hydrothermal alteration minerals linked to gold deposits and can be applied in other provinces with similar geological settings.

Scar related border zone channels assessed with cardiac MRI are associated with ventricular arrhythmia in patients with ST-segment elevation myocardial infarction

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Prediction of scar-related ventricular arrhythmia in ST-Segment Elevation Myocardial Infarction (STEMI) is important, but currently difficult. Late gadolinium enhancement cardiac magnetic resonance (LGE-CMR) permits characterization of left ventricular (LV) ischemic scars, including differentiation between core, border zone (BZ) and BZ channels. The latter represents potential electrical circuits of slow conductivity responsible for ventricular arrhythmic events. We hypothesized that detailed BZ channel characterization potentially serves as a risk marker for ventricular arrhythmia, therefore contributing to risk stratification following STEMI. Purpose The aim of this study was to assess scar-related arrhythmic BZ channels with advanced CMR in STEMI patients developing subsequent ventricular arrhythmia compared with controls. Methods This is a CMR sub-study of the DANAMI-3 STEMI multicenter trial (year 2011, n=1234) and Danegaptide phase II proof-of-concept clinical trial (year 2013, n=591). All patients were admitted for primary PCI in all primary PCI centers in Denmark. A total of 779 patients had a 3-month follow-up CMR. Of these, 21 patients subsequently experienced ventricular arrhythmia during 68 months of follow-up and were randomly matched 1:2 with 42 controls, who constituted the study population. Matching were based on left ventricular ejection fraction (LVEF), infarct location, culprit vessel, and revascularization status in patients with multivessel disease. Ischemic scar tissue including core, BZ and BZ channels were automatically detected by a specialized investigational software (1). To differentiate BZ from healthy tissue and BZ from core, thresholds of 40% ± 5% and 60% ± 5% of the maximum signal intensity were applied. A BZ channel in the LGE-CMR reconstruction was defined as a continuous corridor of BZ between 2 core areas or between a core area and a valve annulus (Figure 1). Results We included 63 patients (median age: 58.0 years; 84% men; median LVEF: 45 ± 10%), of whom 30 (48%) patients had an anterior located infarction, and 45 (71%) patients were completely revascularized. The median time from STEMI to a ventricular arrhythmic event was 3 ± 2 years. A significantly higher number of patients with ventricular arrhythmia had BZ channels (n=16 (76%) vs. n=18 (43%), P=0.02) including an increased number of BZ channels (2 ± 2 vs. 1 ± 1, P=0.02) compared with controls. Patients with subsequent ventricular arrhythmia had a larger scar mass (core mass + BZ mass) (27 ± 17g vs. 19 ± 11g; P=0.03), core mass (9 ± 8g vs. 6 ± 5g; P=0.06) and BZ mass (18 ± 10g vs. 13 ± 7g; P=0.01). Conclusion(s) Border zone channels visualized by LGE-CMR were associated with subsequent development of ventricular arrhythmia in patients with STEMI and may serve as risk stratification following STEMI.

Practical Aspects of the Use of Telematic Systems in the Diagnosis of Acute Coronary Syndrome in Poland.

Background and Objectives: The guidelines of the European Society of Cardiology (ESC) recommend the use of telematic methods in the diagnosis of myocardial infarction, allowing for transtelephonic electrocardiography (TTECG) from the emergency scene to centers performing percutaneous coronary interventions (PCI center). It has been proven that such a procedure has a beneficial effect on the survival of patients with ST elevation myocardial infarction (STEMI). Fewer data can be found on the correct use of these methods in everyday clinical practice. The aim of this study was to indicate potential indications and contraindications for the use of the TTECG system, and provide recommendations for proper collaboration between emergency medical systems (EMS) teams and PCI centers. Materials and Methods: The article is a systematic review of cardiological emergencies, with an assessment of indications for the use of the TTECG system. The authors introduced their own grading of the validity of indications for transmission of the TTECG, similar to those used in the official ESC guidelines.: Results:: The authors described individual cardiological emergencies occurring in the practice of EMS, considering specific indications or contraindications for the transmission of the TTECG. The article also discusses individual practical recommendations for proper cooperation between EMS teams and PCI centers in detail. All of the recommendations are compiled in a handy table to facilitate its use in everyday clinical practice. Conclusions: The summary presents a comparison of the realities of the functioning of the telematic support system in Poland in the field of STEMI diagnostics, with the model’s recommendations. The necessity of further educating the members of individual teams included in the network dealing with STEMI treatment was indicated, as well as the necessity of introducing legal regulations sanctioning the functioning of telematic systems in modern medicine.

Particularities of non-ST-elevation myocardial infarction in women

Despite the fact that women have lower incidence of non-ST-elevation myocardial infarction (NSTEMI) compared with men, they have a higher mortality, attributed to the impact of the age, higher burden of comorbidities, atypical symptoms and possible differences in the diagnosis and treatment of NSTEMI. Based on this, we aimed to evaluate the sex differences in the clinical presentation, management and major adverse cardiovascular events (MACE) of patients presenting with NSTEMI in the Republic of Moldova. Data were collected from the observational studies: retrospective (2019) and prospective (2020-2021), conducted in 3 PCI centers in Moldova, which included 351 consecutive patients with the clinical diagnosis NSTEMI. The data obtained were processed by descriptive statistical methods, using the t-test, the Pearson χ² test and the p-value. After analyzing the obtained results, we concluded that women had a lower incidence of NSTEMI, but had a higher rate of risk factors and comorbidities, compared to men, they presented more frequently atypical symptoms and more often had myocardial infarction with non-obstructive coronary arteries (MINOCA). At the same time, several gaps in the management of women with NSTEMI in the Republic of Moldova were highlighted. MACE proved to be similar at both sexes, but with a higher mortality at women. These data guide us to the need of a comprehensive approach of women with NSTEMI, taking into account the gender particularities in the clinical presentation and management of the disease.

English

BACKGROUND Primary percutaneous coronary intervention is one of the treatment options for STelevation myocardial infarction and is relatively safer and superior to thrombolytic therapy. The decrease in time to reperfusion leads to decreased infarct size and hence incidence of major adverse cardiac events (MACE). This knowledge has led to the concept of off-site percutaneous coronary intervention centres (without surgical backup). However, performing primary percutaneous coronary intervention at centres without surgical backup has been controversial. Controversy arises regarding the safety and efficacy of primary percutaneous coronary intervention in centres without onsite surgical backup. No such studies have been available among Indian population regarding the outcome in patients undergoing primary coronary intervention in centres without surgical backup. Thus, our study focusses on one year clinical outcomes in Indian patients undergoing primary percutaneous coronary intervention without on-site surgical backup.1-8 METHODS It was done as an observational, single centre, retrospective study. It included 139 patients, who were diagnosed with ST elevation myocardial infarction (STEMI) who underwent primary PCI from February 2019 to June 2020 at Rajah Hospital, Thrissur, Kerala, India. The primary endpoint of the study was occurrence of major adverse cardiac events, a sum of target vessel revascularisation (TLR), cardiac death, and myocardial infarction at one year after procedure. RESULTS 83.45 % were males. 30.21% were hypertensives and 48.92 % were diabetics. There were four cardiac deaths at 30-day follow-up and 4 (2.87 %) events of TLR at one-year follow-up. And additionally, the mean age of population was 56.05 years. CONCLUSIONS Considering these results, it can be concluded that mainly in the developing countries like India; primary PCI can be performed safely at PCI centres which lack the facility of on-site surgical backup. KEY WORDS ST-Elevation Myocardial Infarction, Percutaneous Coronary Intervention, Coronary Artery Disease.

The Impacts of COVID-19 Pandemic on Demographics and Management of Acute Coronary Syndromes: A Referral PCI Center Perspective

The Impacts of COVID-19 Pandemic on Demographics and Management of Acute Coronary Syndromes: A Referral PCI Center Perspective

Impact of universal health insurance on total ischemia time and door-to-balloon time in STEMI: A single-center study from a geographical adverse region

We studied the impact of a Universal Health Insurance (UHI) Scheme introduced in India on total ischemia time (an important determinant of ST-elevation myocardial infarction [STEMI] outcome). This is a retrospective hospital-based comparative study which evaluated the total ischemia time (min) of all the patients presenting with STEMI and undergoing primary angioplasty before (Group A) and after (Group B) implementation of this scheme. A total of 221 patients (mean age: 54.18 ± 13.02 years in Group A and 57.59 ± 11.42 years in Group B) were included in the study. Median pain to first medical contact time was 300 and 360 min (P = 0.49), whereas the median first medical contact to percutaneous coronary intervention PCI center time was 330 and 210 min (P = 0.32), for Groups A and B, respectively. A statistically significant difference was noted in the mean door-to-device time between two groups (67.46 ± 33.10 min in Group A vs. 58.48 ± 12.99 min in Group B; P = 0.02). A significant difference in door-to-balloon time was found after implementation of UHI, but total ischemia time was no different. It emphasizes the importance of establishing a system of STEMI care that can decentralize the benefits of early reperfusion like hub-and-spoke model.

Instantaneous wave-free ratio for guiding treatment of nonculprit lesions in patients with acute coronary syndrome: A retrospective study.

The aim of this study was to analyze the feasibility of a physiological coronary evaluation with the instantaneous wave-free ratio (iFR) of nonculprit lesions in patients with acute coronary syndrome (ACS) successfully revascularized. A multicenter registry including patients of four high-volume PCI centers with ACS and underwent successful revascularization of the culprit vessel and had other nonculprit lesions that were physiologically evaluated with the iFR between January 2017 and December 2019. The primary endpoint was a composite of cardiac death, nonfatal myocardial infarction, probable or definitive stent thrombosis and new revascularization (MACEs). A total of 356 patients with 472 nonculprit lesions were included. The mean age was 66 ± 11 years. The clinical presentation was ACS without persistent ST-segment elevation (NSTE-ACS) in 235 patients (66%) and ST-segment elevation myocardial infarction (STEMI) in 121 patients (34%). After a median follow-up period of 21 (14-30) months, the primary endpoint occurred in 32 patients (9%). There were no differences in outcomes regarding clinical presentation (NSTEMI vs. NSTE-ACS, 9.1 vs. 8.9%, padj =0.570) or iFR induced treatment strategy (patients with all lesions revascularized vs. patients with at least one lesion with an iFR > 0.89 deferred for revascularization, 10.5 vs. 8.4%, padj =0.476). The use of the iFR to guide percutaneous coronary intervention decision making in nonculprit lesions seems to be feasible, with an acceptable percentage of MACEs at the mid-term follow-up. Patients with deferred revascularization of lesions without physiological significance and patients undergoing complete revascularization had a similar risk of MACEs.

OR75. The role of tricuspid annular plane systolic excursion for STEMI patients in the national PCI center

Abstract Aims Tricuspid annular plane systolic excursion (TAPSE) is one of the most established echocardiographic parameters to assess global function of the right ventricle (RV). This study sought to evaluate TAPSE to predict early outcomes and ascertain whether its value adds beneficial prognostic information to patients with myocardial infarction. Methods and Results Of all 899 patients who were diagnosed with ST-segment elevated myocardial infarction (STEMI) between July 2018 to June 2019, 576 patients underwent echocardiography examination within 24-hour of onset. The subjects were categorized into two groups: TAPSE ≤18 mm (n = 265) and TAPSE >18 mm (n = 311). Primary outcomes were the incidence of cardiogenic shock, cardiac arrest, and in-hospital mortality. A total of 576 patients (513 males, mean age 55±10) with STEMI diagnosis who underwent percutaneous coronary intervention were enrolled to this study. In the overall cohort, TAPSE ≤18 mm was statistically associated with greater incidence of cardiogenic shock (p = 0.001), cardiac arrest (p = 0.002), and in-hospital mortality (p = 0.001). Multivariate analysis showed that TAPSE ≤18 mm was an independent predictor of cardiogenic shock (OR, 2.951; 95% CI, 1.507 to 5.781), cardiac arrest (OR, 2.500; 95% CI, 1.381 to 4.527), and in-hospital mortality (OR, 2.868; 95% CI, 1.460 to 5.632). Conclusion The assessment of TAPSE that represents RV function among STEMI patients can be considered as a prognostic factor regarding early outcomes. Long-term follow-up is necessary to obtain more comprehensive prognostic information.

Abstract 13841: Sex Disparities in ST-Elevation Myocardial Infarction Stratified by Age: Insights From Regional ST-Elevation Myocardial Infarction Systems of Care

Introduction: Sex disparities in STEMI care are well recognized, with worse outcomes reported for women; however, it remains unknown whether these disparities are seen across all age groups. Methods: Using prospective data from 2 large regional STEMI systems; Minneapolis Heart Institute, Minneapolis, MN, and The Christ Hospital, Cincinnati, OH, from 2010 to 2020, we analyzed 4,815 consecutive STEMI patients stratified by sex and age groups as follows; young (18 to 44 years), middle-aged (45 to 64 years), and older (≥65 years). Results: Among 4,815 patients with STEMI, 30.7% were women. Among young patients, women had more diabetes. There were no differences in reperfusion times, but young women received medical management more often and were more likely to receive aspirin or antiplatelet at discharge. There were no differences in outcomes at 1-year follow-up between young women or men. Among middle-aged patients, women had more diabetes, hypertension, and stroke. There were no differences in PCI rates, but middle-aged women presented directly to the PCI center had longer door-to-balloon time (DBT). Middle-aged women were less likely to receive antiplatelet or statin at discharge and had higher in-hospital death rates than men. Among older patients, women had more hypertension but less history of smoking or coronary artery disease. There were no differences in PCI rates, but older women transferred to the PCI center had longer DBT. Middle-aged women were less likely to receive antiplatelet or statin at discharge. There were no differences in outcomes at 1-year follow-up between older women or men (Table). Conclusions: In 2 large regional STEMI databases, sex disparities varied among different age groups, with less PCI use in young women and less guideline-directed medical therapy at discharge in middle-aged or older women, supporting the need for ongoing standardized protocols to eliminate sex disparities.

TCT-204 Consequences of Covid-19 Policy on Myocardial Infarction Reperfusion Therapy and Prognosis in a High-Volume PCI Center in Chile

TCT-204 Consequences of Covid-19 Policy on Myocardial Infarction Reperfusion Therapy and Prognosis in a High-Volume PCI Center in Chile

Impact of availability of catheter laboratory facilities on management and outcomes of acute myocardial infarction presenting with out of hospital cardiac arrest

ObjectivesWe aimed to identify whether the availability of catheter laboratory affects clinical outcomes of out-of-hospital cardiac arrest (OHCA) complicating myocardial infarction (AMI). MethodsPatients admitted with a diagnosis of AMI and OHCA from the Myocardial Ischaemia National Audit Project (MINAP) between 2010 to 2017 were stratified into three groups based on initial hospital’s catheter laboratory status: hospitals without a catheter laboratory (No-catheter lab hospitals), hospitals with diagnostic catheter laboratory (Diagnostic hospitals), and hospitals with PCI facilities (PCI hospitals). We used multivariable logistic regression to evaluate factors associated with clinical outcomes. ResultsWe included 12,303 patients of which 9,798 were admitted to PCI hospitals, 1,595 to no-catheter lab hospitals, and 910 to diagnostic hospitals. Patients admitted to PCI hospitals were more frequently reviewed by a cardiologist (96%, p < 0.001) than no-catheter lab hospitals (80%) and diagnostic hospitals (74%), and more likely to receive coronary angiography (PCI hospitals (87%), diagnostic hospitals (31%), no-catheter lab hospitals (54%), p < 0.001). They also were more likely to undergo PCI (PCI hospitals (42%), diagnostic hospitals (17%), no-catheter lab hospitals (17%), p < 0.001). After adjustment, there was no significant difference in the in-hospital mortality (OR 0.76, 95% CI 0.55–1.06) or re-infarction (OR 1.28, 95% CI 0.72–2.26) in patients admitted to PCI hospitals nor in patients admitted to diagnostic hospitals (mortality (OR 1.28, 95% CI 0.72–2.26), re-infarction (OR 1.38, 95% CI 0.68–2.82)). ConclusionThere is variation in coronary angiography use between hospitals without a catheter laboratory and PCI centres, which was not associated with better in-hospital survival.

Impact of COVID-19 lockdown on the procedural and intra-hospital outcome of STEMI patients

Abstract Background While during the COVID-19 pandemic the number of patients presenting with ST-segment elevation myocardial infarction (STEMI) decreased, no change in patient or system delay could be shown due to local lockdown (LD) policy. Not much is known about the influence of LD on procedural details and intrahospital outcome of these patients. Methods Data was obtained from 511 patients treated for acute STEMI (24hours from symptom onset) from January 2019 to March 8th 2021 at two primary PCI (pPCI) centers in Germany. Patients presenting as intra-hospital STEMI, patients showing no culprit lesion and patients undergoing direct CABG were excluded. Overall, 456 patients (74% male, mean age 64±12) were included. These patients were divided into two groups: complete lockdown (LD; n=58; March 21st–April 20th 2020 and December 16th 2020–March 7th 2021) and no complete lockdown (No-LD; n=398)). Results There were no differences in pre-hospital care between the groups: Telemedicine (LD 23.5% vs. No-LD 34.9%; p=0.11), pre-alarm of the cath-lab staff (LD 59.6% vs. 66.6%, p=0.32) and direct admission to the cath-lab (LD 44.8% vs. No-LD 49.8%, p=0.58) were performed as often as in No-LD times. Neither the pain to first medical contact (LD 188±272 Min vs. No-LD 236±317 Min, p=0.29) nor the door to balloon time (55±54 Min vs. No-LD 49±58 Min, p=0.470) as well as other periods showed any difference. All over cardio-pulmonary resuscitation (CPR; LD 19.0% vs. No-LD 14.3%, p=0.35) or presentation with cardiogenic shock (25.9% vs 23.9%, p=0.74) was equally presented in both groups. However, left ventricular assist devices were implanted more often during LD (6.9% vs. No-LD 1.8%; p=0.017). Primary radial access was performed in the majority of the cases (LD 60.3% vs. No-LD 58.8%, p=0.82). During LD the culprit lesion was RCA in most cases (46.6% vs. No-LD LAD 46.7%, p=0.341). Stent thrombosis was not more common in out-of-hospital STEMI patients during LD (6.9% vs. 8.0%, p=0.76). Thrombus aspiration was performed in 10.3% during lockdown (vs. No-LD 4.5%, p=0.06), GP-IIb-IIIa inhibitors were not administered more often (LD 19.0% vs. No-LD 19.4%, p=0.92) and no reflow phenomenon was not seen more frequent (LD 20.7% vs. No-LD 21.3% p=0.91). TIMI III flow could be established in the majority of the cases (LD 86.0% vs. No-LD 91.5%, p=0.20). During further hospital stay, neither the frequency of ventilator (LD 17.2% vs. No-LD 17.0%, p=0.98) nor vasopressor use (LD 20.7% vs. No-LD 20.1% p=0.925) differed. Left ventricular function (47±13% vs. No-LD 45±12%; p=0.34) and maximum creatinkinase (LD 1827±1687 U/l vs. No-LD: 2292±4100 U/l, p=0.40) showed no difference between the groups as did intrahospital death (LD 10.3% vs. No-LD 11.6%, p=0.79). Conclusion Despite the known decline in STEMI patients during LD periods, patient care, procedural details and inta-hospital outcome of the ones presenting to a pPCI hospital do not change during LD periods. Funding Acknowledgement Type of funding sources: None.

Renin-angiotensin system inhibitors and mortality among diabetic patients with STEMI undergoing mechanical reperfusion during the COVID-19 pandemic

BackgroundDuring the coronavirus disease 2019 (COVID-19) pandemic, concerns have been arisen on the use of renin-angiotensin system inhibitors (RASI) due to the potentially increased expression of Angiotensin-converting-enzyme (ACE)2 and patient's susceptibility to SARS-CoV2 infection. Diabetes mellitus have been recognized favoring the coronavirus infection with consequent increase mortality in COVID-19. No data have been so far reported in diabetic patients suffering from ST-elevation myocardial infarction (STEMI), a very high-risk population deserving of RASI treatment. MethodsThe ISACS-STEMI COVID-19 registry retrospectively assessed STEMI patients treated with primary percutaneous coronary intervention (PPCI) in March/June 2019 and 2020 in 109 European high-volume primary PCI centers. This subanalysis assessed the prognostic impact of chronic RASI therapy at admission on mortality and SARS-CoV2 infection among diabetic patients. ResultsOur population is represented by 3812 diabetic STEMI patients undergoing mechanical reperfusion, 2038 in 2019 and 1774 in 2020. Among 3761 patients with available data on chronic RASI therapy, between those ones with and without treatment there were several differences in baseline characteristics, (similar in both periods) but no difference in the prevalence of SARS-CoV2 infection (1.6% vs 1.3%, respectively, p = 0.786). Considering in-hospital medication, RASI therapy was overall associated with a significantly lower in-hospital mortality (3.3% vs 15.8%, p < 0.0001), consistently both in 2019 and in 2010. ConclusionsThis is first study to investigate the impact of RASI therapy on prognosis and SARS-CoV2 infection of diabetic patients experiencing STEMI and undergoing PPCI during the COVID-19 pandemic. Both pre-admission chronic RASI therapy and in-hospital RASI did not negatively affected patients’ survival during the hospitalization, neither increased the risk of SARS-CoV2 infection. Trial registration numberNCT 04412655

Impact of SARS-CoV-2 positivity on clinical outcome among STEMI patients undergoing mechanical reperfusion: Insights from the ISACS STEMI COVID 19 registry

Background and aimsSARS-Cov-2 predisposes patients to thrombotic complications, due to excessive inflammation, endothelial dysfunction, platelet activation, and coagulation/fibrinolysis disturbances. The aim of the present study was to evaluate clinical characteristics and prognostic impact of SARS-CoV-2 positivity among STEMI patients undergoing primary percutaneous coronary intervention (PPCI). MethodsWe selected SARS-CoV-2 positive patients included in the ISACS-STEMI COVID-19, a retrospective multicenter European registry including 6609 STEMI patients treated with PPCI from March 1st until April 30th, in 2019 and 2020. As a reference group, we randomly sampled 5 SARS-Cov-2 negative patients per each SARS-CoV-2 positive patient, individually matched for age, sex, and hospital/geographic area. Study endpoints were in-hospital mortality, definite stent thrombosis, heart failure. ResultsOur population is represented by 62 positive SARS-CoV-2 positive patients who were compared with a matched population of 310 STEMI patients. No significant difference was observed in baseline characteristics or the modality of access to the PCI center. In the SARS-CoV-2 positive patients, the culprit lesion was more often located in the RCA (p < 0.001). Despite similar pre and postprocedural TIMI flow, we observed a trend in higher use of GP IIb-IIIa inhibitors and a significantly higher use of thrombectomy in the SARS-CoV-2 positive patients. SARS-CoV-2 positivity was associated with a remarkably higher in hospital mortality (29% vs 5.5%, p < 0.001), definite in-stent thrombosis (8.1% vs 1.6%, p = 0.004) and heart failure (22.6% vs 10.6%, p = 0.001) that was confirmed after adjustment for confounding factors. ConclusionsOur study showed that among STEMI patients, SARS-CoV-2 positivity is associated with larger thrombus burden, a remarkably higher mortality but also higher rates of in-stent thrombosis and heart failure.