Aims  The aim of this study was to determine the contemporary use of reperfusion therapy in the European Society of Cardiology (ESC) member and affiliated countries and adherence to ESC clinical practice guidelines in patients with ST-elevation myocardial infarction (STEMI). Methods and results  Prospective cohort (EURObservational Research Programme STEMI Registry) of hospitalized STEMI patients with symptom onset <24 h in 196 centres across 29 countries. A total of 11 462 patients were enrolled, for whom primary percutaneous coronary intervention (PCI) (total cohort frequency: 72.2%, country frequency range 0–100%), fibrinolysis (18.8%; 0–100%), and no reperfusion therapy (9.0%; 0–75%) were performed. Corresponding in-hospital mortality rates from any cause were 3.1%, 4.4%, and 14.1% and overall mortality was 4.4% (country range 2.5–5.9%). Achievement of quality indicators for reperfusion was reported for 92.7% (region range 84.8–97.5%) for the performance of reperfusion therapy of all patients with STEMI <12 h and 54.4% (region range 37.1–70.1%) for timely reperfusion. Conclusions  The use of reperfusion therapy for STEMI in the ESC member and affiliated countries was high. Primary PCI was the most frequently used treatment and associated total in-hospital mortality was below 5%. However, there was geographic variation in the use of primary PCI, which was associated with differences in in-hospital mortality.

Background: COVID-19 has challenged the health system organization requiring a fast reorganization of diagnostic/therapeutic pathways for patients affected by time-dependent diseases such as acute coronary syndromes (ACS). Aim: To describe ACS hospitalizations, management, and complication rate before and after the COVID-19 pandemic was declared. Design: Ecological retrospective study. Methods: We analyzed aggregated epidemiological data of all patients > 18 years old admitted for ACS in twenty-nine hub cardiac centers from 17 Countries across 4 continents, from December 1st, 2019 to April 15th, 2020. Data from December 2018 to April 2019 were used as historical period. Results: A significant overall trend for reduction in the weekly number of ACS hospitalizations was observed (20.2%; 95% confidence interval CI [1.6, 35.4] P = 0.04). The incidence rate reached a 54% reduction during the second week of April (incidence rate ratio: 0.46, 95% CI [0.36, 0.58]) and was also significant when compared to the same months in 2019 (March and April, respectively IRR: 0.56, 95%CI [0.48, 0.67]; IRR: 0.43, 95%CI [0.32, 0.58] p < 0.001). A significant increase in door-to-balloon, door-to-needle, and total ischemic time (p <0.04 for all) in STEMI patents were reported during pandemic period. Finally, the proportion of patients with mechanical complications was higher (1.98% vs. 0.98%; P = 0.006) whereas GRACE risk score was not different. Conclusions: Our results confirm that COVID-19 pandemic was associated with a significant decrease in ACS hospitalizations rate, an increase in total ischemic time and a higher rate of mechanical complications on a international scale.

Data mining approach enabled the authors to develop a model capable of predicting the in-hospital outcome following percutaneous coronary intervention. The model showed excellent sensitivity and specificity during internal validation.

UVODU interpretaciji elektrokardiograma, aVR odvod ima višestruku kliničku primenu. Dobro je poznat značaj ovog odvoda u akutnoj plućnoj tromboemboliji gde pored dijagnostičke ima i prognostičku vrednost (1-4). Njegov značaj se pored kardioloških oboljenja opisuje i u dijagnozi trovanja tricikličnim antidepresivima (5, 6) i tenzionom pneumotoraksu (7). U kardiološkoj praksi analizi ovog odvoda ne poklanja se dovoljna pažnja. Promene u smislu recipročne depresije ST segmenta i elevacije PR segmenta u odnosu na ostale odvode opisane su u u akutnom perikarditisu (8, 9), dok je morfologija P talasa opisana kao značajna u razlikovanju atrijalnih tahikardija (10, 11). Pažljivija interpretacija aVR odvoda može da pomogne u dijagnostici akutne okluzije glavnog stabla leve koronarne arterije (LMCA) ili okluzije proksimalnog segmenta prednje silazne arterije (RIA), i na taj način utiče na vreme i vrstu terapije, ali i da ukaže na prognozu kod bolesnika sa akutnim infarktom miokarda (12, 13).Odvod aVR je pojačani unipolarni električni odvod sa desne ruke za koji se smatra da gleda u šupljinu srca s desnog ramena. Ovaj odvod ima vektor u frontalnoj ravni od -150º, koji direktno gleda u gornju desnu stranu srca i obezbeđuje specifične informacije, koje se odnose na izlazni trakt desne komore i bazalni deo interventrikularnog septuma ispod aortnog i pulmonalnog zalistka. Kroz šupljinu leve komore aVR odvod gleda u unutrašnju stranu apeksa i lateralnog zida i direktno se električno suprotstavlja standardnim odvodima DI, DII, aVL i prekordijalnim odvodima V4-V6. U praksi, većina kliničara smatra da aVR odvod daje recipročne informacije iz leve lateralne strane, koja je već pokrivena odvodima aVL, V4-V6. To je razlog za zanemarivanje aVR odvoda (14).Bazalni deo interventrikularnog septuma ishranjuje se najčešće iz septalnih grana proksimalnog dela RIA, a u slučaju njene okluzije, taj deo interventrikularnog septuma ishranjuje se iz heterokolateralne cirkulacije zadnje interventrikularne grane desne koronarne arterije. Transmuralni infarkt miokarda ove regije obično uzrokuje ST elevaciju u aVR odvodu (15, 16). DIJAGNOSTIČKI I PROGNOSTIČKI ZNAČAJ -REZULTATI ISTRAŽIVANJA

Background. Concurrent evidence about cardiogenic shock (CS) characteristics, treatment and outcome does not represent a global spectrum of patients and is therefore limited. The aim of this study was to investigate these regional differences. Methods. To investigate regional differences in presentation characteristics, treatments and outcomes of patients treated with all types of cardiogenic shock (CS) in a single calendar year on a multi-national level. Consecutive patients from 19 tertiary care hospitals in 13 countries with CS who were treated between January 1, 2018 and December 31, 2018 were enrolled in this study. Results. In total, 699 cardiogenic shock patients were included in this study. Of these patients, 440 patients (63%) were treated in European hospitals and 259 (37%) were treated in Non-European hospitals. Female patients (P<0.01) and patients with a previous myocardial infarction (P=0.02) were more likely to present at Non-European hospitals; whereas older patients (P=0.01) and patients with cardiogenic shock due to acute heart failure (P<0.01) were more likely to present at European hospitals. Vasopressor use was more likely in Non-European hospitals (P=0.04), whereas use of mechanical circulatory support (MCS) was more likely in European hospitals (P<0.01). Despite adjustment for relevant confounders, 30-day in-hospital mortality risk was comparably high in CS patients treated in European vs. Non-European hospitals (hazard ratio 1.08, 95% CI 0.84-1.39, P=0.56). Conclusion.Despite marked heterogeneity in characteristics and treatment of CS patients, including fewer use of MCS but more frequent use of vasopressors in Non-European hospitals, 30-day in-hospital mortality did not differ between regions.