Presentation Of Acute Coronary Syndrome Research Articles

Subgroup analysis of diabetes in COVID-positive revascularized patients: implications for clinical management

Abstract Background The management of revascularized patients with COVID-19, particularly in the presence of diabetes mellitus (DM), presents significant challenges. Understanding the clinical outcomes in this subgroup is essential for optimizing patient care during the pandemic. Purpose This study aimed to investigate the clinical outcomes of revascularized COVID-positive patients with and without DM, focusing on revascularization methods, hospitalization rates, mechanical ventilation requirement, mortality, stroke incidence, and presentation of acute coronary syndrome (ACS) subtypes. Methods A retrospective analysis was conducted on the cohort of 620 COVID-positive revascularized patients. Among them, 267 patients had diabetes mellitus (DM), while 353 patients did not. Data on revascularization methods, hospitalization rates, mechanical ventilation requirement, mortality, stroke incidence, and ACS presentation were collected and compared between the two groups. Statistical analysis was performed to assess the significance of differences observed. Results Among the 620 COVID-positive revascularized patients, 267 (43.1%) had diabetes mellitus, while 353 (56.9%) did not. Demographic analysis revealed that 299 (84.7%) of the COVID-positive patients with diabetes mellitus were male, compared to 181 (67.8%) of those without diabetes mellitus. This difference in gender distribution between the two groups was statistically significant (p < 0.001). Additionally, smoking was more prevalent among COVID-positive patients without diabetes mellitus (38.8%) compared to those with diabetes mellitus (22.5%), with a significant difference observed (p < 0.001) (Table 1). Among the revascularized patients, a higher proportion of patients with diabetes mellitus underwent coronary artery bypass grafting (CABG) compared to those without DM (32.6% vs. 24.1%, p = 0.019). Patients with diabetes exhibited significantly higher hospitalization rates (27.0% vs. 15.6%, p = 0.001) and a trend towards increased mechanical ventilation requirement (11.1% vs. 3.6%, p = 0.121). However, mortality rates, stroke incidence, and ACS presentation did not significantly differ between the two groups (Table2). Conclusion This study underscores the heightened vulnerability of revascularized COVID-positive patients with DM, as evidenced by higher hospitalization rates and a trend towards increased mechanical ventilation requirement. These findings emphasize the importance of tailored management strategies for this high-risk subgroup to optimize patient outcomes during the ongoing COVID-19 pandemic.Table 1Table 2

Temporal Trends of Acute Coronary Syndrome Presentations and Percutaneous Coronary Intervention in Older Australians: A 20-Year Statewide Population-Linkage Study

Temporal Trends of Acute Coronary Syndrome Presentations and Percutaneous Coronary Intervention in Older Australians: A 20-Year Statewide Population-Linkage Study

Comparison of the Clinical Manifestations of Acute Coronary Syndrome Between Diabetic and Non-diabetic Patients: A Systematic Review and Meta-Analysis.

The presentation of acute coronary syndrome (ACS) in patients with type 2 diabetes mellitus (T2DM) may differ from that of non-diabetic patients, potentially leading to delayed diagnosis and treatment. This meta-analysis aimed to compare the clinical presentation of ACS between diabetic and non-diabetic patients. A systematic search of PubMed, Excerpta Medica database (EMBASE), and Web of Science databases was conducted for observational studies published from January 2010 onwards. Studies comparing ACS symptoms between diabetic and non-diabetic patients were included. The odds ratio (OR) with 95% confidence intervals (CI) was calculated using a random-effects model. Eight studies with a total of 29,503 patients (23.03% diabetic) were included. Diabetic patients were significantly less likely to present with chest pain compared to non-diabetic patients (OR: 0.43, 95% CI: 0.30 to 0.63, p<0.001). Anxiety (OR: 2.20, 95% CI: 1.17-4.14), shortness of breath (OR: 1.49, 95% CI: 1.11-2.01), and neck pain (OR: 1.62, 95% CI: 1.03-2.54) were significantly more common in diabetic patients. Sweating/cold sweat was less common in diabetics (OR: 0.60, 95% CI: 0.34-1.07), though not statistically significant. Other symptoms showed minimal differences between groups. High heterogeneity was observed across studies for most symptoms. This meta-analysis demonstrates that diabetic patients with ACS are less likely to experience typical chest pain and more likely to present with atypical symptoms such as anxiety, shortness of breath, and neck pain. These findings emphasize the need for healthcare providers to maintain high vigilance for atypical ACS presentations in diabetic patients. Tailored diagnostic approaches, modified triage protocols, and enhanced patient education are crucial to improving the timely diagnosis and treatment of ACS in this high-risk population.

Symptomology, Outcomes and Risk Factors of Acute Coronary Syndrome Presentations without Cardiac Chest Pain: A Scoping Review.

For patients experiencing acute coronary syndrome, early symptom recognition is paramount; this is challenging without chest pain presentation. The aims of this scoping review were to collate definitions, proportions, symptoms, risk factors and outcomes for presentations without cardiac chest pain. Full-text peer reviewed articles covering acute coronary syndrome symptoms without cardiac chest pain were included. MEDLINE, CINAHL, Scopus and Embase were systematically searched from 2000 to April 2023 with adult and English limiters; 41 articles were selected from 2,954. Dyspnoea was the most reported (n=39) and most prevalent symptom (11.6-72%). Neurological symptoms, fatigue/weakness, nausea/ vomiting, atypical chest pain and diaphoresis were also common. Advancing age appeared independently associated with presentations without cardiac chest pain; however, findings were mixed regarding other risk factors (sex and diabetes). Patients without cardiac chest pain had worse outcomes: increased mortality, morbidity, greater prehospital and intervention delays and suboptimal use of guideline driven care. There is a need for structured data collection, analysis and interpretation.

The influence of perceived stress in acute coronary syndromes presentation

Abstract Funding Acknowledgements None. Introduction Acute coronary syndrome (ACS) is the result of a complex pathophysiological process, influenced by multiple factors, including stress. The 10-item Perceived Stress Scale (PSS-10) is a validated instrument to estimate stress levels in clinical practice and may be useful in the assessment of ACS (Figure 1). Purpose We aimed to assess if perceived stress had influence on the presentation of an ACS as a ST-elevation myocardial infarction (STEMI) or a non-ST-elevation myocardial infarction (NSTEMI), at admission, during hospitalization for this event, and at follow-up. Methods Single-center prospective study engaging patients hospitalized for ACS from 20/03/2019 to 31/03/2020. The PSS-10 was completed during the hospitalization period. Patients were divided into two groups, according to the type of ACS: group A – STEMI patients - and group B - NSTEMI patients. Follow-up of these patients (regarding death, readmissions for cardiac causes and readmissions for other causes) was carried out until December 11, 2022. Logistic regression was performed to assess if stress was a predictor of NSTEMI. Results A total of 166 patients were included: 52 in group A and 94 in group B. In group A, mean age was 63 ± 18 years and 34.60% were women, while in group B mean age was 66 ± 20 years, and 38.70% were female. Group B presented more with preserved ejection fraction (79.30% vs 60.40% in group A, p=0.018). There were no other statistically significant differences regarding clinical presentation, or intrahospital complications between the two groups. PSS-10 score in group A was 17.17 ± 8.62, while group B scored 20.83 ± 6.10 (p=0.039). The follow-up of these two groups did not show significant differences in terms of death (7.70% in group A vs 16.10% in group B, p=0.149), readmissions for other causes (19.20% in group A vs 28.00% in group B, p=0.243) or readmissions for cardiac causes (group A 9.60% and group B 22.60%, p=0.051). Logistic regression revealed that perceived stress was a predictor of NSTEMI (odds ratio (OR) 1.006, p=0.025, confidence interval (CI) 1.001-1.011). There were no statistically significant differences in follow-up between the two groups. Conclusions This is the first prospective study carried out in the Portuguese population regarding this thematic, which showed that perceived stress was a predictor of NSTEMI and can influence patients with ACS manifestations.Figure 1

Comparison between Imaging and Physiology in Guiding Coronary Revascularization: A Meta-Analysis.

Background: Percutaneous coronary intervention (PCI) is a widely used revascularization strategy for coronary artery disease. The choice between imaging-guided and physiology-guided PCI has been a subject of debate. This meta-analysis aims to systematically compare outcomes between imaging and physiology-guided PCI and management of intermediate coronary lesions (ICLs). Methods: A comprehensive literature search was conducted across major databases for studies published up to December 2023 following PRISMA guidelines. Seven eligible studies comparing imaging-guided and physiology-guided PCI were selected for the final analysis. Relevant outcome measures included major adverse cardiovascular events (MACE), target vessel revascularization (TVR), target vessel failure (TVF), and target lesion revascularization (TLR). Subgroup analysis was performed for ICLs. Results: A total of 5701 patients were included in the meta-analysis. After a mean follow-up of 2.1 years, imaging-guided PCI was associated with lower rates of TVR compared to physiology-guided PCI (OR 0.70, 95% CI 0.52-0.95, p = 0.02); concerning MACE, TVF, and TLR, no differences were found. When the analysis was restricted to studies considering ICLs management, there were no differences between the two techniques. Meta regression analysis did not show any impact of acute coronary syndromes (ACS) presentation on MACE and TVR. Conclusions: The findings suggest that imaging-guided PCI may reduce the need for future revascularization of the target vessel compared to the functional-guided approach, and this result was not influenced by ACS presentation. These results may have important implications for clinical practice, guiding interventional cardiologists in selecting the most appropriate guidance strategy.

Spontaneous coronary artery dissection outcomes among pregnant vs. non-pregnant women.

Spontaneous coronary artery dissection (SCAD) has become increasingly recognized. It accounts for <1-4% of acute coronary syndrome presentations. Overall, however, it makes up over 40% of pregnancy-associated myocardial infarction. Furthermore, pregnancy-associated spontaneous coronary artery dissection (P-SCAD) is described to have a greater degree of clinical manifestations, including left ventricular dysfunction, shock, and left main or multivessel involvement. The findings are disconcerting, though many studies evaluating P-SCAD are based on case series data or are single centre studies. The aim of this study was to evaluate a larger national dataset to evaluate the outcomes of SCAD and specifically P-SCAD in an attempt to better characterize the severity and clinical nature of this condition. To conduct this study, we analysed the National Readmission Database from January 2016 to December 2020. Propensity matching was done using the Greedy 1:1 method. Multivariate logistics and time-to-event Cox regression analysis models were built by including all confounders significantly associated with the outcome on univariable analysis with a cut-off P-value of 0.2. In multivariate regression analysis, P-SCAD patients had a non-propensity matched odds ratio (OR) of 0.21 (0.3-1.54, P = 0.123) of dying and a propensity matched OR of 0.11 (0.02-0.61, P = 0.012) of dying. Thirty-day readmission rate for P-SCAD was 15.8% (n = 93) and for non-pregnant spontaneous coronary artery dissection (NP-SCAD) was 11.2% (n = 2286); non-propensity matched OR for readmission for PSCAD patients was 1.68 (1.24-2.29, P = 0.001) and propensity matched OR was 3.39 (1.93-5.97, P < 0.001). Among hospitalized patient, P-SCAD was associated with similar clinical outcomes and reduced incidence of death when compared with NP-SCAD, though had higher rates of 30-day readmission. Larger-scale observational data will be needed to ascertain the true incidence of cardiovascular complications as it relates to P-SCAD.

A Near Miss in the Emergency Department: Atypical Presentation of Acute Coronary Syndrome.

Acute coronary syndrome is an umbrella term encompassing three types of coronary artery disease that affect millions worldwide annually. Despite the availability of diagnostic tests (blood analysis, imaging, electrocardiogram, and screening tools), the diagnosis of myocardial infarction (MI) is still sometimes missed. According to the Centers for Disease Control and Prevention, the reported prevalence of heart disease is higher among males than females, with adults over the age of 75 having the highest prevalence. Typical "heart attack" features include chest pain that feels like pressure or squeezing, pain or discomfort in one or both arms that can radiate to the neck or jaw, shortness of breath, diaphoresis, nausea, vomiting, and lightheadedness. However, there are three subgroups where the typical warning signs do not always present: the elderly, individuals with diabetes, and females. The following is an atypical case presentation of unstable angina and non-ST-elevation MI.

Unusual Presentation of Acute Coronary Syndrome in a 22-Year-Old Male with Juvenile Idiopathic Arthritis: A Case Report

This case report documents the clinical journey of a 22-year-old male who was initially diagnosed with Rheumatoid Arthritis (RA) and later, at the age of 11, with Juvenile Idiopathic Arthritis (JIA). The patient manifested atypical symptoms, primarily marked by sudden and intense chest pain accompanied by sweating, leading to a collapse during his emergency room visit. Medical evaluation revealed an extensive myocardial infarction affecting the anterior wall. The patient underwent a successful percutaneous coronary intervention targeting the left anterior descending artery. This case underscores the rare incidence of acute coronary syndrome in young patients with a history of JIA.

Native coronary artery or bypass graft percutaneous coronary intervention in patients after previous coronary artery bypass surgery: A large nationwide analysis from the Netherlands Heart Registration

BackgroundPatients with previous coronary artery bypass surgery (CABG) who require repeat revascularization frequently undergo percutaneous coronary intervention (PCI). We sought to identify factors associated with the decision to intervene on the native vessel versus a bypass graft and investigate their outcomes in a large nationwide prospective registry. MethodsWe identified patients who underwent PCI with a history of prior CABG from the Netherlands Heart Registration between 2017 and 2021 and stratified them by isolated native vessel PCI versus PCI including at least one venous- or arterial graft. The primary endpoint of major adverse cardiac events (MACE) was a composite of all-cause death and target vessel revascularization (TVR) at one-year post PCI. The key secondary endpoint was a composite of all-cause death, myocardial infarction (MI), and TVR at 30 days. ResultsOut of 154,146 patients who underwent PCI, 12,822 (8.3%) had a prior CABG. Isolated native vessel PCI was most frequently performed (75.2%), while an acute coronary syndrome (ACS) presentation was most strongly associated with graft interventions. The primary outcome of MACE at one-year post PCI occurred more frequently in interventions including grafts compared with native vessels alone (19.7% vs. 14.3%; adjOR 1.267; 95% CI 1.101–1.457); p < 0.001) driven by TVR. There was however no difference in mortality or the key secondary endpoint between the two groups. ConclusionIn this nationwide prospective registry, ACS presentation was strongly associated with bypass graft PCI. At one year after PCI, interventions including bypass grafts had a higher composite of MACE compared with isolated native vessel interventions.

Broken Heart Syndrome: A Rare Case of Recurrent Reverse Takotsubo Cardiomyopathy Associated with Acute Respiratory Failure.

Takotsubo cardiomyopathy accounts for one percent of acute coronary syndrome presentations and has been increasingly recognized [1]. Reverse Takotsubo cardiomyopathy, a variant form of Takotsubo cardiomyopathy presenting with the hyperdynamic function of the apical segments and hypokinesis of the basal or mid-ventricular segments is the rarest type of acute stress cardiomyopathy, with mid-ventricular akinesia and preservation of apical and basal contractility [2]. We report a rare case of an elderly woman admitted to the Intensive Care Unit at Case Western Reserve University Hospital in Cleveland, USA. The patient experienced acute respiratory failure as a result of exacerbated chronic obstructive lung disease and heart failure. Echocardiography revealed reverse Takotsubo cardiomyopathy. Cardiac catheterization showed nonobstructive coronary artery disease. The wall motion abnormalities resolved within two weeks. The case is unique in that she had an identical presentation one year earlier after she had entered the same dusty room! Our case report is unique and describes the rarest form of recurrent reverse Takotsubo cardiomyopathy. Our case demonstrates that reverse Takotsubo cardiomyopathy with identical wall motion abnormalities can recur in a patient upon re-exposure to a similar stressful situation. Early recognition and appropriate treatment can prevent catastrophic outcomes.

Abstract 11597: A Rare Cause of an NSTEMI: Left Main Coronary Artery Compression in a Patient With Pulmonary Hypertension

Background: Pulmonary hypertension has varying effects on cardiac function. Though uncommon, a dilated pulmonary artery can cause decreased coronary perfusion through extrinsic compression of the left main coronary artery (LMCA). While the most common presentation of LMCA compression is angina, acute coronary syndrome is rare. Case Summary: An 81-year-old female with a history of group 3 pulmonary hypertension presenting with neck and shoulder pain was found to have elevated cardiac biomarkers and EKG findings remarkable for isolated ST elevation in aVR with diffuse ST depressions in all other leads, consistent with a non-ST elevation myocardial infarction. Coronary angiography revealed left main coronary artery compression that was successfully intervened on with placement of a single drug eluding stent. Right heart catheterization was remarkable for evidence of severe pulmonary hypertension with a mean pulmonary artery pressure of 60 mmHg. Discussion: Given the patient’s past medical history, presenting symptoms, coronary and right heart catheterization findings the etiology of her acute coronary syndrome presentation was thought to be driven by left main coronary artery compression from pulmonary artery dilation. Pulmonary artery dilation in individuals with a history of pulmonary hypertension is common, with several modalities available to evaluate for this anatomic compensatory measure. Management for left main coronary artery compression in this patient population is percutaneous coronary intervention. Future studies to determine if routine screening for coronary compression in patients with pulmonary hypertension is needed.

Pathophysiology of spontaneous coronary artery dissection: hematoma, not thrombus.

Spontaneous coronary artery dissection (SCAD) accounts for 1.7%-4% of all acute coronary syndrome presentations, particularly among young women with an emerging awareness of its importance. The demarcation of acute SCAD from coronary atherothrombosis and the proper therapeutic approach still represents a major clinical challenge. Certain arteriopathies and triggers are related to SCAD, with high variability in their prevalence, and often, the cause remains unknown. The objective of this review is to provide contemporary knowledge of the pathophysiology of SCAD and possible therapeutic solutions.

Percutaneous Coronary Interventions in Women.

Cardiovascular disease is the leading cause of morbidity and mortality among women globally. Numerous studies show ongoing disparities in diagnosis, management, and outcomes of ischemic heart disease in women compared to men. We aim to review the factors contributing to sex-based differential outcomes of percutaneous coronary interventions in women. Hormonal influence on coronary arteries and progression of atherosclerosis in women results in distinct coronary plaque characteristics and unique pathological process such as spontaneous coronary artery dissection and myocardial infarction with non-obstructive coronary arteries. During the presentation of acute coronary syndromes, women are older and have higher burden of comorbidities, with higher short- and long-term mortality. Awareness of differences in vascular biology and unique risk factors for cardiovascular disease in women is essential for sustained improvement in cardiovascular mortality. Better representation of women in trials is crucial to address the gaps in knowledge and allow for individualized treatment approaches in women.

The Role of HEART Score in Predicting Major Adverse Cardiac Events in Patients with Possible Acute Coronary Syndrome Presenting to the Emergency Department

Introduction: Acute coronary syndrome is very challenging &amp; sometimes very confusing to diagnose. The HEART score was designed to be a prognostic prediction model, using information from the patient’s history, ECG, age, risk factors, and troponin level at the initial emergency department. This study was conducted to assess the role of HEART score in predicting major adverse cardiac events in patients with possible acute coronary syndrome presenting to the emergency department. Methods: This prospective observational study was conducted among 453 patients presented with acute coronary syndrome (ACS) at the Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh from January 2023 to June 2023 to assess the role of HEART score in predicting major adverse cardiac events (MACE) in patients with possible acute coronary syndrome. The study population was divided into two groups depending on HEART score. MACE was observed between these two groups. Results: Mean age of the respondents was 53.45±11.23 years where 77.7% of them were male. 55% had smoking habit, 36% had history of Diabetes Mellitus, and 38% had history of HTN. Among the respondents 62.9 % was improved. 11.03 % respondents developed heart failure, 14.34% recurrent ischemic pain, 7.9% of recurrent MI, 2.8 % cardiogenic shock, and 0.88 % cases of death. HEART score as predictor was statistically significant (X2=69.7, df=1, p&lt;0.05), indicated to distinguish between major adverse cardiac events and no major cardiac events. Conclusion: Almost one third of respondents with high HEART score had heart failure and recurrent ischemic pain. There was statistically significant difference in incidence of major adverse cardiac events between high and low HEART score groups. The HEART score can be used to predict risk for major adverse cardiac events effectively in patients with suspected ACS. This can help us to determine needs for urgent treatment and hospitalization among the patients who present with suspected ACS. Cardiovasc j 2023; 16(1): 9-16

Unveiling The Diagnostic Pitfall: Complete Heart Block Presenting in Acute Coronary Syndromes Without Chest Pain and Non-Ischemic Electrocardiography in A Young Adult

Background: The majority of studies indicate that the asymptomatic or atypical presentation of acute coronary syndrome (ACS) as a significant manifestation of coronary artery disease (CAD) is associated with a poor prognosis. The purpose of this study was to characterize the clinical characteristics and management of ACS patients who presented without chest pain and non-ischemic electrocardiogram (ECG). Case Illustration: A 31 years old man with syncope was brought to our hospital. ECG revealed total AV block (TAVB) without ST segment changes. First, he was diagnosed with cardiac syncope because his ECG showed no ischemic sign. He had a strong familial history of CAD, so we examined his cardiac enzymes and found an increase in serial cardiac enzymes. Then, he was diagnosed with non-ST elevation myocardial infarction (NSTEMI). Early invasive strategy with chronic total occlusion (CTO) at osteal right coronary artery (RCA) and acute total occlusion at mid RCA with implantation of 1 DES at osteal-proximal RCA was selected for this patient. After five days of hospitalization, he discharged home with medicines. Conclusion: In order to significantly lower their morbidity and mortality, this group of high-risk patients needs to receive improved early diagnostic and treatment choices. Keyword: Acute Coronary Syndrome, Chest Pain, Heart Block.

The Roles of microRNAs in the Cardiovascular System.

The discovery of miRNAs and their role in disease represent a significant breakthrough that has stimulated and propelled research on miRNAs as targets for diagnosis and therapy. Cardiovascular disease is an area where the restrictions of early diagnosis and conventional pharmacotherapy are evident and deserve attention. Therefore, miRNA-based drugs have significant potential for development. Research and its application can make considerable progress, as seen in preclinical and clinical trials. The use of miRNAs is still experimental but has a promising role in diagnosing and predicting a variety of acute coronary syndrome presentations. Its use, either alone or in combination with currently available biomarkers, might be adopted soon, particularly if there is diagnostic ambiguity. In this review, we examine the current understanding of miRNAs as possible targets for diagnosis and treatment in the cardiovascular system. We report on recent advances in recognising and characterising miRNAs with a focus on clinical translation. The latest challenges and perspectives towards clinical application are discussed.

Monitoring of emergency cardiovascular patients in the emergency department : Consensus paper of the DGK, DGINA and DGIIN

Patients with potential or proven cardiovascular diseases represent arelevant proportion of the total spectrum in the emergency department. Their monitoring for cardiovascular surveillance until the diagnostics and acute treatment are initiated, often poses an interdisciplinary and interprofessional challenge, because resources are limited, nevertheless ahigh level of patient safety has to be ensured and the correct procedure has a major prognostic significance. This consensus paper provides an overview of the practical implementation, the modalities of monitoring and the application in aselection of cardiovascular diagnoses. The article provides specific comments on the clinical presentations of acute coronary syndrome, acute heart failure, cardiogenic shock, hypertensive emergency events, syncope, acute pulmonary embolism and cardiac arrhythmia. The level of evidence is generally low as no randomized trials are available on this topic. The recommendations are intended to supplement or establish local standards and to assist all physicians, nursing personnel and the patients to be treated in making decisions about monitoring in the emergency department.

Acute Coronary Syndrome Presenting during On- and Off-Hours: Is There a Difference in a Tertiary Cardiovascular Center?

Background and Objectives: ACS presents an acute manifestation of coronary artery disease and its treatment is based on timely interventional diagnostics and PCI. It has been known that the treatment and the outcomes are not the same for all the patients with ACS during the working day, depending on the availability of the procedures and staff. The aim of the study was to explore the differences in clinical characteristics and outcomes in patients admitted for ACS during on- and off-hours. Materials and Methods: The retrospective study included 1873 consecutive ACS patients admitted to a tertiary, university hospital that underwent coronary angiography and intervention. On-hours were defined from Monday to Friday from 07:30 h to 14:30 h, while the rest was considered off-hours. Results: There were more males in the off-hours group (on-hours 475 (56%) vs. off-hours 635 (62%); p = 0.011), while previous MI was more frequent in the on-hours group (on 250 (30%) vs. off 148 (14%); p < 0.001). NSTEMI was more frequent during on-hours (on 164 (19%) vs. off 55 (5%); p < 0.001), while STEMI was more frequent during off-hours (on 585 (69%) vs. off 952 (93%); p < 0.001). Patients admitted during on-hours had more multivessel disease (MVD) (on 485 (57%) vs. off 489 (48%); p = 0.006), as well as multivessel PCI (on 187 (22%) vs. off 171 (16%); p = 0.002), while radial access was preferred in off-hours patients (on 692 (82%) vs. off 883 (86%); p = 0.004). Left main PCI was performed with similar frequency in both groups (on 37 (4%) vs. off 35 (3%); p = 0.203). Death occurred with similar frequency in both groups (on 17 (2.0%) vs. off 26 (2.54%); p = 0.404), while major adverse cardio-cerebral events (MACCEs) were more frequent in the on-hours group (on 105 (12.4%) vs. off 70 (6.8%); p = 0.039) probably due to the more frequent repeated PCI (on 49 (5.8%) vs. off 27 (2.6%); p = 0.035). Conclusions: Patients admitted for ACS during working hours in a tertiary hospital present with more complex CAD, have more demanding interventions, and experience more MACCEs during follow-up mostly due to myocardial infarctions and repeated procedures.

Spontaneous coronary artery dissection (SCAD) websites: systematic appraisal of content, quality, readability and suitability of websites for SCAD survivors

Abstract Funding Acknowledgements Type of funding sources: Other. Main funding source(s): Solve CHD NHMRC Synergy Grant Background Spontaneous coronary artery dissection (SCAD) is estimated to account for 4% of acute coronary syndrome presentations but is a distinctly different disease and demographic from typical atherosclerotic heart attacks. Survivors of SCAD typically turn to the internet for information. However, websites are not subject to stringent quality regulation. Purpose This study identified and appraised websites containing SCAD information using a variation of a systematic review study design. Quality, suitability, readability and content accuracy and scope were assessed. Methods Keywords related to SCAD definition, rarity, treatment, support and life after SCAD were searched in Google. Results were screened and evaluated systematically. Information content was assessed using a point-scoring tool based on current SCAD consensus literature. Quality and suitability of the websites was assessed using the Suitability Assessment of Materials, Quality Component Scoring System (QCSS), the Health-Related Website Evaluation Form (HRWEF), and adherence to the Health on the Net code. Readability was assessed using the Simple Measure of Gobbledygook, Flesch-Kincaid, and a readability generator. Results Of the 600 screened, n=316 duplicates were removed and n=50 eligible websites were included. Websites were most frequently made by hospital groups (34%), independent organisations (20%) and survivors (24%). The most frequent grading of quality was poor (32%) or good (30%) using the QCSS and adequate using the HRWEF (74%). Suitability of materials was overall adequate (64%). Content, scope and depth across websites had a mean score of 47.5 (SD 25.0) and was rated poor. The websites with highest scores for factually accurate content were survivor made (57.9%) and national foundations (56.3%) versus professional associations (34.6%) and hospital groups (35.2%) which had the lowest. The emotional impact of SCAD was addressed in 52% and content regarding family or partners support was given in 40%. Survivors had input in 63% and survivor groups were recommended in 50%. Most websites were rated fairly difficult (46%) or difficult to read (42%), with a mean readability grade of 11.6 (SD 2.3). Conclusions Despite high availability and fair quality, websites for SCAD survivors to access have poor content depth and require higher reading proficiency to understand. Almost half neglect the emotional impact of SCAD on the survivor and their families. Given the generally poor content of information available online, it is essential that SCAD survivors are provided high quality information on discharge from hospital and during cardiac rehabilitation. Health authority website are considered authoritative sources and for SCAD need to be improved. Survivor and national foundation websites may be the most appropriate to recommend for SCAD information currently due to higher factually correct content scores, broader scope of information, and demographically contextual material.