Funding Acknowledgements Type of funding sources: None. Introduction ST-elevation myocardial infarction (STEMI) encompasses a heterogeneous group of patients with distinct prognoses. In worse clinical scenarios with the development of cardiogenic shock (CS), mortality may ascend to 40%. Observatoire Régional Breton sur l'Infarctus risk score (ORBIs) was developed to predict the development of in-hospital CS in patients with STEMI treated with primary percutaneous coronary intervention (PCI). Aim To validate ORBI score as a predictor of in-hospital mortality (IHM) and long-term outcomes in STEMI. Methods Retrospective analysis of 296 patients admitted for STEMI and treated with PCI. Patients presenting with CS at admission were excluded. ORBIs evaluates the presence of 11 variables: age >70 years, prior stroke/transient ischemic attack, cardiac arrest upon entry, anterior STEMI, first medical contact-to-PCI delay >90 min, Killip class, heart rate >90/min, a combination of systolic blood pressure <125 mmHg and pulse pressure <45 mmHg, glycemia>10 mmol/L, culprit lesion of the left main coronary artery, and post-PCI thrombolysis in myocardial infarction flow grade <3. The score derived from these variables allowed the classification of patients into four risk categories: low (0-7 points), low-to-intermediate (8-10 points), intermediate-to-high (11-12 points), and high (≥13 points). The Mann-Whitney U test was used for median comparison between groups. Kaplan-Meier survival plots were used to evaluate the predictive power of ORBIs on INM and on 12-month cardiovascular events (12MH). Results Mean age was 63,9±13 years; 75% were men. 11% had a history of coronary artery disease, and 8% had been submitted to PCI previously. Mean LVEF was 54±12%. 69% had radial artery access. Left anterior descending artery disease was present in 68% of patients. Mean time since beginning of symptoms and hospital admission was 369±492 minutes. Mean duration of hospitalization was 5,68±3,5 days. ORBIs was calculated, and the population was divided into 2 groups: 45% were included in low and low to intermediate risk group (LR) (n=134), and 55% in intermediate to high- and high-risk group (HR). IHM was 3,7%. HR ORBIs was significantly associated with in-hospital mortality (6,2% vs 0,7%; p<0,01; OR 8,8 IC 95% 1,1;69,7). HR ORBIs was also significantly associated with long-term events (mortality and hospitalizations) (15% vs 6%; p<0,01). In univariate analysis, HR group showed significantly different LV ejection fraction (53,6±14,3 vs 61,0±13,1; p<0,01), troponin I at admission (33,3±94,12 vs 15,2±41,9; p<0,01), BNP (424,9±533,4 vs 194,1±170,1; p<0,01), duration of hospitalization (6,1±3,1 vs 5,2±3,9; p<0,01) and age (68,2±12,7 vs 58,9±11,5; p<0,01). Conclusion Higher ORBIs is associated with increased mortality in patients with STEMI. ORBIs may be a simple predictive model for short and long-term mortality and cardiovascular events in STEMI patients.

Funding Acknowledgements Type of funding sources: None. Introduction High-risk pulmonary embolism (PE) is a life-threatening disorder associated with high mortality and morbidity. Multiple scores are used to predict in-hospital mortality of patients admitted to intensive care units. The purpose of this study is to assess which risk score is best at predicting in-hospital mortality in a specific population of patients requiring invasive mechanical ventilation. Methods Retrospective analysis of 33 patients admitted for high-risk pulmonary embolism requiring invasive mechanical ventilation in a general intensive care unit during a period of 15 years. Clinical, analytical, and imaging parameters were evaluated. The PESI, Apache II, SAPS II, and SOFA scores were obtained at ICU admission. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the predictive value of each score for in-hospital mortality. Results Mean age was 59,1±16 years; 55% were men. 27% presented with a cardiorespiratory arrest at admission. Mean values risk scores were: PESI 138±51, Apache II 23±9, SAPS II 49±23, and SOFA 8±3. In-hospital mortality was 45,4%. The mean duration of hospitalization was 14,8±17,9 days. Mean pulmonary systolic arterial pressure was 51,5±14,63mmHg. Mean values of maximum troponin I and d-dimers were 2,97±7,99 and 6603±5541 ng/mL, respectively. ROC curve analysis revealed that Apache II (AUC 0,752; p=0,02; CI 95% 0,58;0,92), SAPS II (AUC 0,718; p=0,04; CI 95% 0,52;0,91) and PESI (AUC 0,754; p=0,02; CI 95% 0,6;0,91) had best predictive performance for in-hospital mortality compared to SOFA (AUC 0,641; p=0,2; CI 95% 0,42;0,9). The following cut-off values were obtained: PESI of 130 (sensitivity (S)≈85% and specificity (E)≈53%), Apache II of 26 (S≈62% and E≈77%), and SAPS II of 52 (S≈69% and E≈70%). Conclusion In this population, PESI, Apache II, and SAPS II scores were better predictors of in-hospital compared to SOFA score.

Presentation A 61 year old man with a history of multiple lymph node metastasis of unknown primary cancer was admitted in the Emergency Room with sudden dyspnea preceded by left leg swelling. Physical examination revealed a blood pressure of 91/70mmHg, tachycardia, tachypnea and signs of deep vein thrombosis (DVT). Diagnosis and management Blood analysis showed increased serum lactate (SL) (5,5 mmol/L), a slight increase of cardiac enzymes and hypoglycemia, and imagiologic tests showed signs of bilateral pulmonary embolism (PE) and an increase of the right cardiac chambers. The patient was hospitalized with the diagnosis of intermediate-high risk PE. Because the patient presented persistent elevated SL and borderline hypotension, fibrinolysis was performed. However, the patient maintained high SL levels and hypotensive profile. After receiving the lymph node's biopsy result, which pointed towards a follicular lymphoma, the persistent hyperlactatemia, together with the hypoglycemic profile, was interpreted as a consequence of the Warburg Effect. Luckily, the patient didn't had any side effects of the fibrinolytic treatment. Learning points Acute high risk PE is marked by the presence of haemodynamic instability at presentation, and the finding of increased SL suggests peripheral hypoperfusion. Systemic thrombolytic therapy is indicated in most of patients with high risk PE. However, there are other causes of hyperlactatemia which the physician must be aware, as it can act as a confounder of PE risk assessment. The Warburg Effect may cause elevated SL in patients with cancer, which in turn are at risk of developing PE.

Funding Acknowledgements Type of funding sources: None. Introduction Prognostic value of programmed electrical stimulation (PES) in Brugada Syndrome (BrS) remains controversial. Substantial controversy exists regarding usefulness of PES in identifying BrS patients at risk of sudden cardiac death (SCD). Implantation of an implantable cardioverter-defibrillator is the only reliable form of SCD prevention in this specific population Purpose To determine if induction of sustained ventricular arrhythmia (VA) in PES is a predictor of cardiac events (CE), defined as the composite of SCD, appropriate ICD therapy for VA or unexplained syncope. Methods A retrospective analysis of 34 patients with spontaneous or pharmacologically induced type 1 Brugada pattern, submitted to electrophysiology study with PES between 2015 and 2019 in a Portuguese Center, was performed. Patients were followed for 24 months. Hospital records and monitoring data from cardiac devices were consulted. The Mann-Whitney U test was used for median comparison between groups. Binary logistic regression through the stepwise method was performed to evaluate categorical features. Results 35% (n=12) and 27% (n=9) had spontaneous type 1 and type 2 Brugada pattern in basal electrocardiography, respectively. 23% (n=8) had VA induced by PES. The mean age was 51,2±12,3 years. 71% (n=24) were male. 15% (n=5) had history of cardiac syncope, and 27% (n=9) had a family history of SCD. 9% (n=3) were carriers of a SNC5A mutation. Mean AH time and HV time were, respectively, 105±31,9, and 49±8,5ms. During the 24 months of follow-up, 9% (n=3) suffered a CE (2 unexplained syncope and 1 SCD). None of the patients who suffered CE had VA inducible at PES study. There was no statistical significance in the occurrence of cardiac events when comparing both groups (VA induced in PES vs. no induced arrhythmia) (p=0,49, OR 0,89, IC 95% 0,70;1,02). Through binary logistics, adjusted for potential confounders (gender, history of syncope, history of family SCD and identification of a genetic variant), patients with spontaneous type 1 Brugada pattern in basal electrocardiography were 2,2 times more likely to have a CE (IC 95% 0,12;40,2). Conclusion In this population, VA induced by PES was not a predictor of CE during the follow-up period, which highlights the difficulty of risk stratification in patients with BrS. New risk-stratification tools are urgently needed to select those patients at higher-risk of SCD, which are candidates for prophylactic ICD implantation.

Funding Acknowledgements Type of funding sources: None. Introduction Quick Sequential Organ Failure Assessment (qSOFA) is a bedside score widely used to identify patients at greater risk for a poor outcome outside the intensive care unit. Initially applied in patients with suspected infection, the score has recently emerged as a marker for poor prognosis or mortality across various patient groups. Aim To validate the qSOFA score as a predictor of in-hospital mortality and long-term outcomes in acute coronary syndrome (ACS) patients. Methods A retrospective analysis of 1296 patients admitted for ACS was performed. qSOFA score evaluates the presence of 3 variables: systolic blood pressure <120mmHg (1 point), respiratory rate ≥22 breaths per min (1 point), and Glasgow coma scale <15 (1 point). The score derived from these variables allowed the classification of patients into two risk categories: low risk (LR) (<2 points) and high risk (HR) (≥2 points). The Mann-Whitney U test was used for median comparison between groups. In addition, Kaplan-Meier survival plot was used to evaluate the predictive power of qSOFA score on in-hospital mortality and 12-month mortality (12MM). Results Mean age 69,1±13years; 70% were male. The mean time of hospitalization was 7,4±5days. 34% had a diagnosis of ST-elevation myocardial infarction (STEMI). Mean left ventricular ejection fraction (LVEF) was 56,4±14,6%. Global in-hospital mortality was 8%. qSOFA was calculated, and the population was divided into 2 groups: 78% had low risk (qSOFA <2) and 6% had high risk (qSOFA ≥2). HR group defined by qSOFA was significantly associated with in-hospital mortality (28% vs 8%; p<0,01, OR: 3,8 CI 95% 2,4;6,2). Kaplan-Meier survival analysis revealed that HR qSOFA was significantly associated with 12MM (p<0,01; 24% vs 7%; 260 vs 321 days until event, χ2 8,2). In logistic regression analysis, LVEF and diagnosis of STEMI did not increase the risk of a higher qSOFA score and in-hospital mortality (p=0,06 and p=0,94). HR group is significantly associated with left main coronary artery disease (12% vs 9%; p<0,01; OR 2,4; CI 95% 1,2;4,9) and in-hospital complications, including arrhythmia, mechanical complications, hemorrhagic events, acute kidney disease and hematological disorders (54% vs 28%; p<0,01; OR 3,0; CI 95% 1,9;4,6). Conclusion qSOFA score is associated with higher in-hospital mortality and 12 month-mortality in patients with ACS. Its use may identify patients with an increased risk of mortality, needing specialized care, and a close follow-up.