SUMMARYIntroduction: Primary percutaneous coronary intervention (pPCI) has become the preferred reperfusion strategy in patients with ST-elevation myocardial infarction (STEMI). Previous research studies have shown that certain clinical and laboratory parameters can be associated with early mortality in patients with acute myocardial infarction treated by primary PCI. The Aim: The aim of our study was to determine the clinical and laboratory predictors of an adverse early prognosis of our patients with STEMI treated by primary PCI. Material and Methods:The population of our IV phase, academic, observational, retrospective cross-sectional study comprises a total of 180 consecutive patients, 128 men and 52 women, aged 18, or older, who presented with clinical and electrocardiographic signs of acute STEMI within 12 hours after symptom onset. We analyzed the parameters which were registered in the database system of the Coronary Unit of Emergency Center. Results: The average age of the surviving patients was 58±11, and 67±9 in the deceased patient group but the correlation was not statistically signifi cant (p=0.075). The group of patients who didn't survive had signifi cantly more hypotension on admission (p=0.015), acute bundle branch block on ECG (p=0.032), higher creatinine on admission (p=0.036), patient history of hyperlipidaemia (p=0.044), creatinine clearance below 60ccs/min (p<0.001), Killip>1 heart failure on admission (p=0.038), but this group contained a signifi cantly lower number of smokers (p=0.021). Predictors of an adverse early event in multivariant analysis were: acute bundle branch block, diabetes, Killip> 1 on admission, hypotension on admission, creatinine clearance below 60ccs/min. Conclusions: Our study indicates that acute bundle branch block, diabetes, Killip>1 heart failure on admission, hypotension on admission, creatinine clearence below 60ccs/min, are independent clinical and laboratory predictors of early mortality in patients with STEMI treated by primary PCI.

Our paper presents the case of a patient, aged 34, with a previous anamnesis of three miscarriages and two normal children, transitory Raynaud phenomenon and livedo reticularis with no classical factors for coronary arterial disease, excluding smoking, who was diagnosed with myocardial infarction furthermore complicated by pulmonary embolism. The coronarography and ventriculography findings showed morphological signs of coronaritis, ostial occlusion of LAD, diffuse stenoses of RCA like a string of beads, aneurysm of the anterior wall and apex, ejection fraction of 20%, while echocardiography showed dilatative cardiomyopathy. Elevated IgM anticardiolipin (22 MPLU/mL) antibodies were found at first, and 8 weeks later both IgG (19.8 GPLU/mL) and IgM (15.6 MPLU/mL) were positive. The importance of relatively low levels of anticardiolipin antibody titres was confirmed by a positive anti-b2 GPI test. All other analyses encompassing investigations of thrombophilia, early atherosclerosis markers including Lp(a), homocysteine, immunological analyses specific for systemic diseases, antibodies against Borrelia burgdopheri, HCV, HBV, EBV, were negative. Though the one-year stabilisation of the clinical state and normalisation of acute phase reactants was achieved, along with six-time decrease in sedimentation rate, the disease ended lethally in a sudden death of the patient under home care. In compliance with our surveys, this is the first so far reported case of coexistent pearl-like pattern occurrence in coronary arteries with antiphospholipid syndrome.