ST-elevation Myocardial Infarction Admissions Research Articles

Seasonal Variation in Short-Term Ambient Air Pollutants and ST-Elevation Myocardial Infarction Admissions: An Innovative Exploration of Air Pollution’s Health Consequences

Cardiovascular diseases (CVDs) persist as a significant contributor to global morbidity and mortality despite advances in medical technology. Air pollution has emerged as a significant contemporary challenge due to increased energy consumption and rapid economic development. The study utilized multivariable Poisson regression and Distributed Lag Models (DLM) to assess the link between brief exposure to outdoor air pollutants (PM10—particulate matter with a diameter ≤ 10 μm, NO2—nitrogen dioxide, and O3—ozone) and the risk of acute myocardial infarction with ST-segment elevation (STEMI) hospitalization, stratified by season. The research was conducted from January 2019 to December 2021 at the University Hospital in Timisoara, Romania, and daily records were collected for STEMI admissions, atmospheric pollutant levels, and meteorological parameters. The most pronounced impacts were observed with each 10 μg/m3 increase at lag 07 for PM10 during summer, leading to a 2% increase in STEMI admissions, and for NO2 during spring at lag 07, resulting in a 0.9% rise in CVD incidence. Men, middle-aged adults, and older adults exhibited greater susceptibility to elevated NO2 and PM10 concentrations than women and younger individuals. Brief exposure to diverse air pollutants heightens the likelihood of hospitalization due to STEMI, particularly among men and adults over 45. Effective measures must be implemented to mitigate these impacts, especially for vulnerable populations.

Use of secondary prevention medications in metropolitan and non-metropolitan areas: an analysis of 41 925 myocardial infarctions in Australia.

People in remote areas may have more difficulty accessing healthcare following myocardial infarction (MI) than people in metropolitan areas. We determined whether remoteness was associated with initial and 12-month use of secondary prevention medications following MI in Victoria, Australia. We included all people alive at least 90 days after discharge following MI between July 2012 and June 2017 in Victoria, Australia (n = 41 925). We investigated dispensing of P2Y12 inhibitors (P2Y12i), statins, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs), and beta-blockers within 90 days after discharge. We estimated 12-month medication use using proportion of days covered (PDC). Remoteness was determined using the Accessibility/Remoteness Index of Australia (ARIA). Data were analysed using adjusted parametric regression models stratified by ST elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). There were 10 819 STEMI admissions and 31 106 NSTEMI admissions. Following adjustment across NSTEMI and STEMI, there were no medication classes dispensed in the 90-day post-discharge that differed in a clinically significant way from the least remote (ARIA = 0) to the most remote (ARIA = 4.8) areas. The largest difference for NSTEMI was ACEI/ARB, with 71% (95% confidence interval 70-72%) vs. 80% (76-83%). For STEMI, it was statins with 89% (88-90%) vs. 95% (91-97%). Predicted PDC for STEMI and NSTEMI was not clinically significant across remoteness, with the largest difference in NSTEMI being P2Y12i with 48% (47-50%) vs. 55% (51-59%), and in STEMI, it was ACEI/ARB with 68% (67-69%) vs. 76% (70-80%). Remoteness does not appear to be a clinically significant driver for medication use following MI. Possible differences in cardiovascular outcomes in metropolitan and non-metropolitan areas are not likely to be explained by access to secondary prevention medications.

Impact of COVID-19 pandemic early response measures on myocardial infarctions and acute cardiac care in Singapore.

The COVID -19 pandemic impacted acute myocardial infarction (AMI) attendances, ST-elevation myocardial infarction (STEMI) treatments, and outcomes. We collated data from majority of primary percutaneous coronary intervention (PPCI)-capable public healthcare centres in Singapore to understand the initial impact COVID-19 had on essential time-critical emergency services. We present data comparisons from 'Before Disease Outbreak Response System Condition (DORSCON) Orange', 'DORSCON Orange to start of circuit breaker (CB)', and during the first month of 'CB'. We collected aggregate numbers of weekly elective PCI from four centres and AMI admissions, PPCI, and in-hospital mortality from five centres. Exact door-to-balloon (DTB) times were recorded for one centre; another two reported proportions of DTB times exceeding targets. Median weekly elective PCI cases significantly decreased from 'Before DORSCON Orange' to 'DORSCON Orange to start of CB' (34 vs 22.5, P = 0.013). Median weekly STEMI admissions and PPCI did not change significantly. In contrast, the median weekly non-STEMI (NSTEMI) admissions decreased significantly from 'Before DORSCON Orange' to 'DORSCON Orange to start of CB' (59 vs 48, P = 0.005) and were sustained during CB (39 cases). Exact DTB times reported by one centre showed no significant change in the median. Out of three centres, two reported significant increases in the proportion that exceeded DTB targets. In-hospital mortality rates remained static. In Singapore, STEMI and PPCI rates remained stable, while NSTEMI rates decreased during DORSCON Orange and CB. The severe acute respiratory syndrome (SARS) experience may have helped prepare us to maintain essential services such as PPCI during periods of acute healthcare resource strain. However, data must be monitored and increased pandemic preparedness measures must be explored to ensure that AMI care is not adversely affected by continued COVID fluctuations and future pandemics.

Ongoing COVID-19 Pandemic Effects on Admissions and In-Hospital Outcomes in Patients With ST-Elevation Myocardial Infarction (STEMI): An Albanian Observational Study.

BackgroundMultiple studies conducted worldwide and in Albania documented an important reduction of acute ST-elevation myocardial infarction (STEMI) admissions during the Coronavirus Disease 19 (COVID-19) pandemic. There are few studies regarding STEMI admissions and outcomes during the ongoing pandemic after the initial lockdown. We aimed to study STEMI admissions and in-hospital outcomes after the COVID-19 lockdown period.MethodsA retrospective single-center study was conducted, collecting data for all consecutive STEMI admissions from March 9th, (the first COVID-19 case) until April 30th, the corresponding period of 2020 total lockdown, for years 2019 and 2021. The control period was considered the year 2019 [pre-pandemic (PP)] and the study period was in 2021 [ongoing pandemic (OP)]. The incidence rate ratio (IRR) 95% confidence interval (CI) was used to compare all-STEMI admissions, invasive procedures, and risk ratio (RR) 95% CI to compare the mortality and complications rate between the study and control period.ResultsThe study included 217 STEMI patients admitted in 2019, and 234 patients during the 2021 period. The overall-STEMI admissions IRR is in a similar range during the 2021 OP compared to the 2019 PP period IRR=1.07 (95%CI 0.90-1.28). Similar invasive procedures were observed during OP compared to PP period, respectively for coronary-angiography IRR= 1.07; (0.87-1.31), for all-PCI [1.12 (0.92-1.35)], and primary percutaneous coronary interventions (PCI) [1.09 (0.89-1.34)]. The STEMI death rate during OP compared to PP period was similar (7.3 vs. 7.4%), RR=1.01 (0.53-1.96), and a non-significant lower primary-PCI-death rate (4.0 vs 4.8%), RR= 0.83 (0.30-2.3)].ConclusionsAfter the initial reduction of admissions and invasive procedures in STEMI patients during the 2020 lockdown period and the increase of all-STEMI mortality, the number of hospitalizations, invasive procedures, and mortality returned to a similar range during OP compared to the PP period despite a highly incident ongoing COVID-19 pandemic.

IMPACT OF COVID-19 PANDEMIC ON ST-SEGMENT-ELEVATION MYOCARDIAL INFARCTION ADMISSIONS AND OUTCOME IN THE NORTH OF IRAN

Objectives: To determine the incidence of ST-Elevation myocardial infarction (STEMI), patterns of care, and outcomes during the COVID-19 era in a hot-spot region. Methodology: From February to April 2020, all the STEMI patients were recruited and compared with the STEMI patients in the equivalent period of the previous year. Demographic and clinical information, coronary angiography data, and in-hospital mortality were collected and compared with the non-COVID-19 group. All data analysis was done using IBM SPSS version 20. Results: There was found a 40% reduction in STEMI admissions during the COVID-19 era compared to the equivalent period in 2019 (55 vs. 92, Rate Ratio (RR):0.60, 95% CI, 0.49-0.70, p<0.001). Compared with the pre-COVID-19 study group, STEMI patients hospitalized during the pandemic were significantly younger (mean age: 56.10 in 2020 vs. 60.83 in 2019 p=0.012). The percentage of primary percutaneous coronary intervention referral was significantly higher than the previous year (47.8% vs. 75.9% p=0.001). In-hospital death occurred in 4 (4.4%) of STEMI patients admitted before the COVID-19 time, while none of the COVID-19 period studied cases died in hospital (p=0.298). Conclusion: Admissions for STEMI were substantially reduced during the COVID-19 pandemic. No changes in overall in-hospital mortality or quality indicators were detected.

Effect of the COVID-19 pandemic on ST-elevation myocardial infarction presentation and survival.

Presentation and outcomes of patients with ST-elevation myocardial infarction (STEMI) may change during viral pandemics. We compared symptom-tocall (STC), call-to-balloon (CTB), doorto-balloon (DTB) times; high-sensitivity troponin (hs-cTnI) levels; and survival of patients (n=39) during the first wave of the COVID-19 pandemic (defined as a 'COVID period' starting four weeks before lockdown) to historical controls from a 'pre-COVID period' (n=45). STEMI admissions fell one week before lockdown by 29%. Median STC times began to rise one month before lockdown (54 vs. 25 min, p=0.06), with peak increases between 9 March and 5 April (166 vs. 59 min, p=0.04). Median CTB and DTB times were unchanged. Mean peak hs-cTnI increased during COVID-19 (15,225 vs. 8,852 ng/ml, p=0.004). Six-month survival following all STEMI reduced (82.1% vs. 95.6%, p<0.05). STC times are the earliest indicator that STEMI-patient behaviour changed four weeks before lockdown, correlating with higher troponin levels and reduced survival. These early signals could guide public health interventions during future pandemics.

Abstract 9878: Higher Rates of Cardiac Arrest with Lower Inpatient Mortality Following Hospitalizations for ST-Elevation Myocardial Infarction Among Young Cannabis Users (18-44 Years): A Nationwide Propensity-Matched Analysis

Introduction: Given the rising use of unmonitored cannabis use in the young population and scarcity of data on the subject, we aimed to compare the outcomes of ST-elevation myocardial infarction (STEMI) admissions in patients with vs without cannabis use disorder (CUD+ vs. CUD-). Methods: The National Inpatient Sample (October2015-2017) was queried to identify STEMI admissions in young patients with CUD vs without CUD using relevant ICD-10 codes. Propensity-matched cohorts were obtained adjusting for sociodemographic, hospital characteristics, cardiovascular/extracardiac comorbidities. Primary endpoints were in-hospital mortality and complications, whereas secondary endpoints were discharge disposition, mean length of stay (LOS) and hospital cost. Results: Matched cohorts, STEMI-CUD+ (n=940) and STEMI-CUD- (n=940) were comparable in terms of age, sex, race and rate of non-elective admissions (Table 1) . The rates of hypertension (52.1% vs. 46.3%) and hyperlipidemia (39.9% vs 34.6%) were higher in the STEMI-CUD+ cohort (p&lt;0.05) with comparable rates of other risk factors (diabetes mellitus, smoking, and obesity). Post-STEMI MACCE was significantly higher (23.9% vs. 19.1%, p=0.012) including cardiac arrest (from ventricular tachyarrhythmias, 14.4% vs 10.6%, p=0.015), though with lower all-cause mortality (2.7% vs 4.8%, p=0.015) compared to CUD- cohort. Although complication rates of cardiogenic shock (9.6% vs 8.5%), arrhythmias (22.3% vs 19.7%), and stroke (3.7% vs. 2.7%) were higher in the CUD+ cohort, the statistical significance was not achieved. Conclusions: This nationwide multicenter analysis demonstrated that CUD+ cohort among young STEMI admissions had higher rates of hypertension, hyperlipidemia and MACCE including cardiac arrest without translating into higher inpatient mortality compared to CUD- cohort. Future large-scale prospective studies are invited to investigate and confirm these findings.

Prognosis value of serum soluble ST2 level in acute ischemic stroke and STEMI patients in the era of mechanical reperfusion therapy.

Soluble form suppression of tumorigenicity 2 (sST2) is known to have prognostic value in ST-elevation myocardial infarction (STEMI) and could impact mortality after acute ischemic stroke (AIS). However, before considering sST2 as a therapeutic target, the kinetics of release and its association with adverse clinical events in both STEMI and AIS patients have to be determined. We prospectively enrolled 251 STEMI patients, treated with primary percutaneous coronary intervention, and 152 AIS patients treated with mechanical thrombectomy. We evaluated the level of sST2 in patient sera at five time point (admission, 4, 24, 48h and 1month from admission for STEMI patients and admission, 6, 24, 48h and 3months from admission for AIS patients). Major adverse clinical events (MACE) (all-cause death, acute myocardial infarction, stroke or hospitalization for heart failure) in STEMI patients and all-cause death in AIS patients were recorded during a 12-month follow-up. Mean age of the study population was 59 ± 12 and 69 ± 15years in STEMI and AIS patients, respectively. In STEMI patients, sST2 peaked 24h after admission (25.5ng/mL interquartile range (IQR) [14.9-29.1]) whereas an earlier and lower peak was observed in AIS patients (16.8ng/mL IQR [15.2-18.3] at 6h). Twenty-five (10.0%) STEMI patients experienced a MACE and 12 (7.9%) AIS patients had all-cause death within the first 12months. A high level of sST2 at 24h was associated with MACE in STEMI patients (hazard ratio (HR) = 2.5; 95% confidence interval (CI) [1.1-5.6], p = 0.03) and all-cause death in AIS patients (HR = 11.7; 95% CI [3.8-36.2], p < 0.01) within the first 12months. The study highlights that sST2 levels at 24h are associated with an increased risk to adverse clinical events in both diseases.

What are the predictors of heart failure in patients admitted with acute coronary syndrome? Data from a large national registry

Abstract Background Heart failure (HF) is a serious and frequent complication of acute myocardial infarction with important impact in outcome. Early treatment according to contemporaneous guidelines is essential to avoid that complication. Previous ischemic heart disease and HF are important predictors. Our objective is to identify additional predictors of HF in patients admitted with acute coronary syndrome (ACS). Methods Analysis of all consecutive patients prospectively included in a large national registry of ACS. Patients with a previous history of ACS, myocardial revascularization or heart failure were excluded from the analysis. The group that developed HF was compared with the group without HF and multivariate logistic regression analysis was performed to identify independent predictors of HF during hospitalization (Killip class &amp;gt;1). Results A total of 19,248 patients were included, and 17.3% developed HF during hospitalization. Patients with HF were older, less often males and smokers, and more often with hypertension and diabetes, as well as other comorbidities (p&amp;lt;0.001). ST elevation myocardial infarction (STEMI), atrial fibrillation, mechanical and electrical complications are also more frequent. Patients that developed HF have higher in-hospital mortality (0.9% vs. 12.1%). Independent predictors of HF are female gender (OR 1.64, 95% CI 1.15–2.33), age (1.42, 1.25–1.62, per 10-year increase) diabetes (1.97, 1.44–2.69), atrial fibrillation (2.65,1.66–4.23), STEMI (2.30, 1.70–3.10), multivessel disease (1.52, 1.13–2.05) and initial admission in a hospital without catheterization laboratory as a protective factor (0.71, 0.52–0.96). In STEMI patients, anterior location is also an independent predictor. Conclusions In patients admitted with a first ACS and without previous ischemic heart disease or heart failure, female gender, increasing age, diabetes, atrial fibrillation, STEMI and multivessel disease are the main predictors of worst outcome and these patients should be treated more aggressively to avoid HF development. Funding Acknowledgement Type of funding sources: None.

Impact of COVID-19 pandemic on a developing STEMI care system from a low-middle income country- a prospective observational study

Abstract Background COVID-19 pandemic has produced a great impact in the STEMI (ST Elevation Myocardial Infarction) care systems across the world. Patient hesitancy to seek medical attention for suspected STEMI, necessity of the health care systems to prioritize COVID-19 care, safety concerns of health care workers etc., have brought in unprecedented times for both patients and health care workers. The impact of COVID-19 pandemic on the establishment of a STEMI care system is less known Purpose To identify the impact of COVID-19 pandemic on a developing public STEMI care system in a low-middle income country in Asia, with reference to the type of reperfusion offered and outcome. Methods Data on number of STEMI admissions, type of reperfusion therapy and outcome are being collected from 12 teaching hospitals as a part of a developing public regional STEMI care system based on a hub and spoke model in a low middle-income country from August 2018. These 12 “thrombolysis only” hospitals were being upgraded as “primary percutaneous coronary intervention (PPCI) capable hub hospitals” in 2019. Though the hassles of COVID-19 pandemic affected this process significantly, daily data collection in our STEMI care system continued. The maximal COVID impacted period in 2020 was identified from the online database (1) as from April to December 2020. The number, type of reperfusion and outcome of the STEMI patients treated during this period were compared to the same data collected during April-December 2019. Results A total of 13,137 STEMI patients were treated in our system during the two time periods “April to December 2019” and “April to December 2020”. There was a 13.3% drop in the number of STEMI treated in 2020, compared to the number treated in 2019 (6101 vs 8925; P&amp;lt;0.001). This drop was in proportion to the number of new cases of COVID-19 reported in our state (Fig. 1a) We also noted a significant drop in the rate of PPCI and Pharmaco-invasive therapy (PIT) offered for STEMI in 2020 compared to 2019 in the same period (PPCI: 0.13% vs 5.9%-P&amp;lt;0.001 and PIT 0.64% vs 11%- P&amp;lt;0.001). This decrease in PPCI and PIT for STEMI also corresponded to the increase in number of new cases of COVID-19 reported (Fig. 1b). More patients received thrombolytic therapy for STEMI in 2020 compared to 2019 (73.6 vs 61.2% P&amp;lt;0.001). There was no change in the mortality of STEMI during this period. (Fig. 2) Conclusion We found a significant drop in number of patients seeking medical care for STEMI during COVID-19 pandemic. There was significant drop in the rate of PPCI and PIT offered in our STEMI care system. Thrombolytic therapy remained the predominant mode of reperfusion as before, but with a significant increased rate of thrombolysis. There was no change in mortality rate in STEMI patients. Thrombolytic therapy is an acceptable mode of reperfusion, when the balance of a STEMI care system is disturbed by extraneous influences like the COVID-19 pandemic. Funding Acknowledgement Type of funding sources: Public hospital(s). Main funding source(s): Tamil Nadu Innovation Initiative- Department of Planning and development, Govt of Tamil NaduNational Health Mission, Government of India

COVID-19 Infection and Myocardial Infarction Pathophysiology and Therapy

The relationship between COVID-19 and cardiovascular disease has been of interest since the beginning of the pandemic, with the focus more recently shifting towards thrombotic complications, including myocardial infarction (MI). While the inflammatory burden of infection has previously been implicated in the pathogenesis of MI, at least early in the pandemic, many hospitals were seeing fewer ST-elevation MI admissions and the delivery of acute coronary syndrome care was disrupted in multiple ways. Furthermore, patients presenting with both COVID-19 infection and MI have been noted in small studies to have unique characteristics that pose clinical challenges, and there is reason to believe that standard therapy for both the prevention and treatment of all thrombotic events, including MI, may not be adequate. The aim of this article is to review the data regarding MI and other thrombotic events during the pandemic, to explore the link between inflammation and thrombosis, and to suggest possible novel therapeutic options for the treatment and prevention of thrombosis in patients with COVID-19.

Associations of apparent temperature with acute cardiac events and subtypes of acute coronary syndromes in Beijing, China

Limited evidence is available on apparent temperature (AT) and hospital admissions for acute cardiac events. We examined the associations of AT with admissions for acute cardiac events and acute coronary syndrome (ACS), and explored the effect difference between ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction ACS (NSTE-ACS). Poisson regression with distributed lag non-linear model was applied to examine the temperature-lag-admission associations. Stratified analyses were performed by gender and age-groups for acute cardiac events. A total of 11,657 acute cardiac events admissions were collected from hospital-based chest pain centers in Beijing, during 2017–2019. The single day effect of low AT (− 11 °C, 2.5th percentile) appeared on the 2nd day and persisted until the 11th day, with estimated relative risk (RR) ranging from 1.44 (95% CI: 1.159, 1.790) to 1.084 (95% CI: 1.022, 1.150) for acute cardiac events and from 1.034 (95% CI: 1.010, 1.059) to 1.006 (95% CI: 1.000, 1.011) for ACS. The single day effect of high AT (34 °C, 97.5th percentile) was only observed on the current day. The cold effect on acute cardiac events was more pronounced among female and older patients. The cumulative effect of high AT on STEMI admissions and low AT on NSTE-ACS reached a peak RR peak of 2.545 (95% CI: 1.016, 6.375) and 3.71 (95% CI: 1.315, 10.469) on lag 0–6 days, respectively. Both high and low ATs were associated with increased risk of acute cardiac events and ACS admissions. STEMI admissions may be more sensitive to high AT while NSTE-ACS to low AT.

Impact of SARS-CoV-2 pandemic on ST-elevation myocardial infarction admissions and outcomes in a Portuguese primary percutaneous coronary intervention center: Preliminary Data.

IntroductionCoronavirus disease (COVID-19) has led to significant changes in healthcare systems and its impact on the treatment of cardiovascular conditions, such as ST-elevation myocardial infarction (STEMI), is unknown in countries where the healthcare systems were not saturated, as was the case in Portugal. As such, we aimed to assess the effect on STEMI admissions and outcomes in Portuguese centers.MethodsWe conducted a single-center, observational, retrospective study including all patients admitted to our hospital due to STEMI between the date of the first SARS-CoV-2 case diagnosed in Portugal and the end of the state of emergency (March and April 2020). Patient characteristics and outcomes were assessed and compared with the same period of 2019.ResultsA total of 104 STEMI patients were assessed, 55 in 2019 and 49 in 2020 (-11%). There were no significant differences between groups regarding age (62±12 vs. 65±14 years, p=0.308), gender (84.8% vs. 77.6% males, p=0.295) or comorbidities. In the 2020 group, there was a significant decrease in the proportion of patients transported to the hospital in pre-hospital emergency medical transportation (38.2% vs. 20.4%, p=0.038), an increase in system delay (49 [30-110.25] vs. 140 [90-180] minutes, p=0.019), a higher Killip-Kimball class, with a decrease in class I (74.5% vs. 51%) and an increase in class III (1.8% vs. 8.2%) and IV (5.5% vs. 18.4%) (p=0.038), a greater incidence of vasoactive support (3.7% vs. 26.5%, p=0.001), invasive mechanic ventilation usage (3.6% vs. 14.3%, p=0.056), and an increase in severe left ventricular dysfunction at hospital discharge (3.6% vs. 16.3%, p=0.03). In-hospital mortality was 14.3% in the 2020 group and 7.3% in the 2019 group p=0.200).ConclusionDespite a lack of significant variation in the absolute number of STEMI admissions, there was an increase in STEMI clinical severity and significantly worse outcomes during the SARS-CoV-2 pandemic. An increase in system delay, impaired pre-hospital care and patient fear of in-hospital infection can partially justify these results and should be the target of future actions in further waves of the pandemic.

Interplay between climate, pollution and COVID-19 on ST-elevation myocardial infarction in a large metropolitan region.

Collective risk factors such as climate and pollution impact on the risk of acute cardiovascular events, including ST-elevation myocardial infarction (STEMI). There is limited data however on the precise temporal and independent association between these factors and STEMI, and the potentially interacting role of government policies against Coronavirus disease 2019 (COVID-19), especially for Latin America. We retrospectively collected aggregate data on daily STEMI admissions at 10 tertiary care centers in the Buenos Aires metropolitan area, Argentina, from January 1, 2017 to November 30, 2020. Daily measurements for temperature, humidity, atmospheric pressure, wind direction, wind speed, and rainfall, as well as carbon monoxide (CO), nitrogen dioxide, and particulate matter <10 µm (PM10), were retrieved. Exploratory analyses focused on key COVID-19-related periods (e.g. first case, first lockdown), and Stringency Index quantifying the intensity of government policy response against COVID-19. A total of 1498 STEMI occurred over 1430 days, for an average of 0.12 STEMI per center (decreasing from 0.130 in 2018 to 0.102 in 2020, P=0.016). Time series analysis showed that lower temperature and higher concentration of CO and PM10 were all significantly associated with an increased rate of STEMI (all P<0.05), whereas COVID-19 outbreak, lockdown, and stringency of government policies were all inversely associated with STEMI (all P<0.05). Notably, environmental features impacted as early as 28 days before the event (all P<0.05), even if same or prior day associations proved stronger (all P<0.05). Multivariable analysis suggested that maximum temperature (P=0.001) and PM10 (P=0.033) were the strongest predictor of STEMI, even after accounting for COVID-19-related countermeasures (P=0.043). Lower temperature and higher concentrations of CO and PM10 are associated with significant increases in the rate of STEMI in a large Latin American metropolitan area. The reduction in STEMI cases seen during the COVID-19 pandemic is at least in part mediated by improvements in pollution, especially reductions in PM10.

Clinical Presentation and Outcome of Patients Experiencing Homelessness Presenting With ST-Segment Elevation Myocardial Infarction

BackgroundCardiovascular disease remains a major cause of morbidity and mortality among homeless adults. Despite major advances in the management of ST elevation myocardial infarction (STEMI), limited information is available for the clinical presentation and management and outcome of STEMI among patients experiencing homelessness (PEH). MethodsAll patients presenting with STEMI between January 1, 2008 and December 31, 2017 at a PCI capable STEMI network inner city hospital comprised the study population. Baseline characteristics, homeless status and clinical outcomes were determined from hospital records. The primary outcome of in-hospital mortality was compared between PEH and nonhomeless patients using a log-binomial regression model with propensity score adjusted standardised mortality ratio weighting (SMRW). ResultsAmong 2854 STEMI admissions during the study period, 75 patients (2.6%) were identified as PEH. The PEH group was younger (58 vs 63 years; P = 0.0002), predominantly male (96% vs 76%), and more likely to present with cardiogenic shock or cardiac arrest (17% vs 6%) compared with the nonhomeless group. The in-hospital mortality remained significantly higher among PEH (risk ratio 3.83, 95% confidence interval 1.27-11.60) after propensity score adjustment. ConclusionsDespite universal health care and contemporary STEMI management, PEH presenting with STEMI experienced a 4-fold higher in-hospital mortality compared with the nonhomeless cohort. Targeted interventions are needed to improve STEMI outcomes in this high-risk group.

In Covid-19 Era, STEMI Decreasing may Predicted with Google-Trend Data by Time-series Model

Introduction: The explanation for the decrease of ST elevation myocardial infarction (STEMI) due to Coronavirus Disease (COVID-19) is poorly described. Our goal is to identify whether there is a temporal association between COVID pandemics and STEMI admissions and investigate the decreased number of STEMI could be associated to the search volume of Covid, Death and chest pain, measured by Google-Trend (GT). Patients and Methods: We collected our hospital admission of STEMI data and search of covid, death and chest pain in GT search data between March 01, 2020 and May 21, 2020, also we compared to STEMI count same time-limit in the previous year. We used vector-autoregressive model (VAR) to combine the number of daily new cases STEMI and search index to relative association daily covid, and death term search in using GT. Results: During this time-frame, we collected a total of 302 STEMI admitted to our hospital when compared previous year we found a 34% reduction. Spearman’s correlation-coefficient between covid, stemi, and death trend with STEMI, results [(-0.560) p< 0.001, (-0.631) p< 0.001, respectively]; model-1 and model-2 VAR bivariate analysis results in coefficient (-0.532, -2.694), also we found Granger-causality for covid and death to STEMI. Impulse response functions (IRF) depicted the STEMI decreased a relatively large amount by death and covid trend. Conclusion: In the COVID-19 period, our study showed that the uses of Google-Trend data have predict decreasing STEMI cases. Also, plausible Granger causality relationships between covid, death GT data and daily counts of STEMI. GT about Covid and Death might provide to developing appropriate behaviour of patients with the STEMI for healthcare supporter

Outcomes of ST elevation myocardial infarction (STEMI) hospitalizations during corona virus disease 19 (COVID 19) era

Funding AcknowledgementsType of funding sources: None.Multiple studies reports a reduction of STEMI hospitalizations rates during COVID 19 pandemic outbreak. Contradictory STEMI complications rates are reported during COVID 19 pandemic regarding case fatalities rates, cardiogenic shock, life threatening arrhythmias and others.Purpose. To evaluate the impact of the COVID 19 outbreak on STEMI patient outcomes and complication rates in country with low COVID 19 incidence and mortality and without changes in Cardiology hospital services.Methods. Was conducted a retrograde study collecting data for STEMI hospitalizations, revascularization procedures and case fatalities and other complications from March 9th 2020 (first COVID 19 case in our country) to April 30th (period of total lockdown) compared with the same period of 2019 in our center. Incidence rate ratio (IRR) was used to compare STEMI admissions and revascularization procedures and risk ratio (RR) to compare case fatality rate and other complications rate.ResultsHospital admissions for STEMI declined during 2020 (COVID 19 period) from a total of 217 patients in 2019 to 155 patients hospitalization in 2020 representing IRR 0.72 (p = 0.009). Reduction were observed in the number of primary PCI from 168 procedures in 2019 to 113 in 2020 (IRR 0.67 p = 0.001). Symptom onset to our ICU (including regional transportation) was significantly higher in 2020 than in 2019 (939.97 ± 1122 versus 436.15 ± 383 minutes p <0.0001) The STEMI case fatality was importantly increased during pandemic outbreak (13.55%) compared to 2019 (8.3%) (RR= 1.63 p = 0.001), but a similar a primary PCI-STEMI case fatality 6.2% versus 5.95%. Also an increase was observed for cardiogenic shock (IRR =1.75 p = 0.003).Results; Hospitalizations and related invazive revascularization procedures for STEMI significantly reduced during COVID 19 pandemic. We identified a substantial increase of STEMI case fatalities and cardiogenic shock during pandemic outbreak. Delayed timely reperfusion by primary PCI has an important impact on infarct related mortality.

PROGNOSTIC SIGNIFICANS OF EARLIER HYPERTENSION, NORMAL AND HIGH ADMISSION SYSTOLIC BLOOD PRESSURE OF PATIENTS WITH MYOCARDIAL INFARCTION WITH AND WITHOUT ST ELEVATION

Abstract Objective: To study the effects of earlier hypertension and admission blood pressure on left ventricular ejection fraction (LVEF) and mortality in patients with acute myocardial infarction. Design and method: Retrospective study on 11346 consecutive patients (aged 67,28 + /-11,92years, 7421 (65,4%) male) admitted with ST-elevation myocardial infarction (STEMI) (8268 (72,9%)) and non-ST elevation myocardial infarction (NSTEMI) and normal and high normal (90–139mmHg) or high (&gt; = 140mmHg) systolic blood pressure (SBP) in our tertiary center from january 2013. to october 2019. Intrahospital left ventricular ejection fraction (LVEF) and mortality were recorded. Results: NSTEMI patient compared with STEMI were older (69,68 + /- 11,34 vs. 66,38 + /-12,01; p &lt; 0,001), more frequently had earlier hypertension (2119 (68,8%) vs 5015 (60,7%); p &lt; 0,001), diabetes (843 (27.4%) vs. 1620 (19.6%); p &lt; 0.001), dyslipidemia (909 (29,5,8%) vs 1727 (20,9%); p &lt; 0,001), had higher SBP (140.82 + /-26.03 vs. 139.13 + /-24.23mmHg; p = 0,001), higher proportion of admission hypertensive patients (1665 (54.09%) vs. 3411 (46.48%); p &lt; 0.001), higher LVEF (48.32 + /-11.30% vs. 47.31 + /-9.32%; p &lt; 0.001), and mortality (318 (10.33%) vs. 621 (7.51%) p &lt; 0.001), without diastolic BP difference (82.35 + /-14.02 vs. 82.80 + /-14.14 mmHg; p = 0.131). Only NSTEMI patients with earlier hypertension had higher LVEF (48.61 + /- 9.89% vs. 47.66 + /- 10,81%; p = 0.036) compared with patients without. All hypertensive patients on admission had higher LVEF (NSTEMI 49.05% vs 47.44% and STEMI 48.49% vs 46.30%; p &lt; 0.001), regardless od tipe of MI. NSTEMI patients, compared with STEMI, had higher LVEF, regardless of admission SBP. Only in NSTEMI patients mortality was higher in patients without earlier hypertension (12.2% vs. 9.49%; p = 0.022). Patients with STEMI and normal admission SBP had higher mortality compared with admission hypertensive patient (416 (10,6%) vs. 166 (4,9%); p &lt; 0,001), and even higher if they had prior hypertension. The same was registered in NSTEMI patients with normal SBP (201 (14,2%) vs. 117 (7,0%); p &lt; 0,001), but mortality was even higher without prior hypertension. Conclusions: Patient with NSTEMI more frequently had earlier hypertension, and admission hypertension. NSTEMI patients with normal admission SBP had lower LVEF, only in patients with prior hypertension, and higher mortality particularly in patients without prior hypertension. In STEMI patients mortality was higher in admission normotensive patients, particularly if thay had prior hypertension.

Impact of SARS-CoV-2 pandemic on ST-elevation myocardial infarction admissions and outcomes in a Portuguese primary percutaneous coronary intervention center: Preliminary Data

IntroductionCoronavirus disease (COVID-19) has led to significant changes in healthcare systems and its impact on the treatment of cardiovascular conditions, such as ST-elevation myocardial infarction (STEMI), is unknown in countries where the healthcare systems were not saturated, as was the case in Portugal. As such, we aimed to assess the effect on STEMI admissions and outcomes in Portuguese centers. MethodsWe conducted a single-center, observational, retrospective study including all patients admitted to our hospital due to STEMI between the date of the first SARS-CoV-2 case diagnosed in Portugal and the end of the state of emergency (March and April 2020). Patient characteristics and outcomes were assessed and compared with the same period of 2019. ResultsA total of 104 STEMI patients were assessed, 55 in 2019 and 49 in 2020 (-11%). There were no significant differences between groups regarding age (62±12 vs. 65±14 years, p=0.308), gender (84.8% vs. 77.6% males, p=0.295) or comorbidities. In the 2020 group, there was a significant decrease in the proportion of patients transported to the hospital in pre-hospital emergency medical transportation (38.2% vs. 20.4%, p=0.038), an increase in system delay (49 [30-110.25] vs. 140 [90-180] minutes, p=0.019), a higher Killip-Kimball class, with a decrease in class I (74.5% vs. 51%) and an increase in class III (1.8% vs. 8.2%) and IV (5.5% vs. 18.4%) (p=0.038), a greater incidence of vasoactive support (3.7% vs. 26.5%, p=0.001), invasive mechanic ventilation usage (3.6% vs. 14.3%, p=0.056), and an increase in severe left ventricular dysfunction at hospital discharge (3.6% vs. 16.3%, p=0.03). In-hospital mortality was 14.3% in the 2020 group and 7.3% in the 2019 group p=0.200). ConclusionDespite a lack of significant variation in the absolute number of STEMI admissions, there was an increase in STEMI clinical severity and significantly worse outcomes during the SARS-CoV-2 pandemic. An increase in system delay, impaired pre-hospital care and patient fear of in-hospital infection can partially justify these results and should be the target of future actions in further waves of the pandemic.

COVID-19 impact on ST-elevation myocardial infarction incidence rate in a Italian STEMI network: a U-shaped curve phenomenon.

Public health emergencies such as the COVID-19 outbreak may impact on the incidence rate of ST-elevation myocardial infarction (STEMI) in severely affected areas. However, this phenomenon demands attention also in areas where media and patients were focused on the COVID-19 pandemic, but the healthcare system was not overwhelmed by the huge number of COVID-19 patients. In this observational study, we compared the incidence rate of all consecutive STEMI patients admitted at the University Hospital of Trieste, Italy, during March and April 2020 with the same 2 months of the previous 5 years (2015-2019). Patient characteristics were compared between 2020 and 2019.The incidence rate of STEMI admission in March-April 2020 was lower than those in March-April 2015-2019, 36 vs. 56 cases per 100 000 inhabitants/year [relative risk (RR) 0.65, 95% confidence interval (95% CI) 0.42-0.96, P = 0.045]. Considering that the incidence rates were constant in the past years (P = 0.24), the turnaround in 2020 is most likely due to the COVID-19 outbreak. Interestingly, this reduction was a dynamic phenomenon with a U-shaped curve during the 2-month period. System-of-care times were similar between 2020 and 2019; however in 2020, patients presented more frequently signs of heart failure compared to 2019 (Killip class ≥2 in 68% vs. 29%, P = 0.003). During the COVID-19 outbreak, we observed a marked reduction in the STEMI incidence rate. This U-shaped phenomenon demands attention because a potential cause for the decrease in STEMI incidence may include the avoidance of medical care. Public campaigns aiming to increase awareness of ischemic symptoms may be needed during community outbreak.