PurposeIn this study, we sought to prospectively analyse the management and long term outcomes associated with revascularisation of left main stem disease via percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in our centre.MethodsThis prospective study enrolled all patients with unprotected left main stem disease undergoing revascularisation from January 2013 to June 2014. Baseline characteristics, hospital presentation and hospital stay length were collected. Patients were followed up at 1, 2 and 3 years. Primary outcomes of Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) were defined as death, Q wave myocardial infarction, stroke, repeat revascularisation and readmission within 30 days.Results56 patients with significant left main stem coronary artery disease were identified from the clinical registry. 27 patients underwent PCI (median age 67.7) and 29 CABG (median age 68.6). PCI patients had a higher surgical risk as measured by mean euroSCORE (4.95±5.8 vs 3.11±3.85). At 3 years, total MACCE occurred in 29.6% of the PCI cohort and 27.5% of the CABG cohort. Death occurred in three patients in the PCI group within the first 6 months. Death occurred in one patient in the CABG group over 2 years postprocedure. Two patients in the CABG cohort presented with Transient Ischemic Attacks (TIAs) at 2-year follow-up. At 3 years, revascularisation occurred in three patients in the PCI cohort. There were no revascularisation events in the CABG cohort.ConclusionsPCI with modern drug eluting stents is a reasonable treatment option for unprotected left main stem disease in a non surgical centre.

IntroductionLeft ventricular ejection fraction (LVEF) is an independent risk factor for adverse cardiac outcomes post ST elevation myocardial infarction (STEMI). Post-STEMI patients can have lower than expected LVEF due to reasons other than myocardial necrosis owing to physiological aspects such as hibernation and stunning of myocardium. Much interest in the literature focuses on the months post infarction. This project attempts to assess the acute window in the weeks post STEMI where it is hypothesised there can be considerable improvement in LVEF.MethodsThis retrospective study assessed follow up data on STEMI patients presenting to University Hospital Limerick (UHL) between January 2014 and January 2017. The study was initially presented to the UHL ethics committee and having being vetted was approved. An existing STEMI heartbeat database and PCI clinic database were used to identify the patient cohort estimated to be ten percent of STEMI cases based on an extensive literature review. Patients who had STEMI and had an inpatient transthoracic echocardiogram (TTE) showing LVEF of 35% or less were selected. Patients were excluded if they did not attend follow up in UHL or they did not have a repeat TTE done between 28 to 48 days post STEMI. Basic demographics, culprit vessel, time to follow up TTE as well as percentage improvement were recorded by accessing the patients electronic cardiology record comprising of TTE and coronary angiography reports via McKeeson Cardiology Software.ResultsThere were 634 STEMI cases presenting to UHL for primary percutaneous intervention (pPCI) during the study period. A total of 44 patients were identified to have a post-pPCI LVEF of 35% or less. 9 patients were excluded as they did not have repeat TTE within the requisite 48 day follow up period. 2 patients suffered fatal outcomes of death. 4 patients had not attended UHL for repeat TTE with repeat imaging at tertiary hospitals in Ennis and Nenagh respectively. Of the 29 patients with sufficient data, 83% (n=24) were male with the average age of 60.3 ±13.1 years. Culprit vessels were the left anterior descending artery in 83% (n=25) of patients, right coronary artery in 14% (n=4) patients and left circumflex artery in 3% (n=1). Average LVEF at baseline was 29.2% ±4.77%. Average time to repeat measurement was 37.4 ±5.3 days. There was an improvement in 20 patients, with an increase in LVEF of between 2.5% to 17.5%. 7 patients showed no improvement. 2 patients disimproved. This represents 69% of the cohort showing improvement within 48 days with a median increase in LVEF of 5% (interquartile range 15%).ConclusionsThis small sample of STEMI patients shows promise for improvement in LVEF within 48 days post STEMI. This shows potential for improved cardiac function in the weeks rather than months post STEMI in line with concepts of stunning and hibernation of myocardium post myocardial infarction. It also provides an estimate on post STEMI low LVEF patients that may be candidates for alternative novel or research therapies.

Purpose: The aim of SETANTA (Study of HEarT DiseAse and ImmuNiTy After COVID-19 in Ireland) study was to investigate symptom burden and incidence of cardiac abnormalities after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/COVID-19 and correlate these results with immunological response and biomarkers of coagulation. Methods: SETANTA was a prospective, single-arm observational cross-sectional study in a primary practice setting, prospectively registered with ClinicalTrials.gov identifier: NCT04823182. Patients with recent COVID-19 infection ≥6 weeks and ≤12 months before enrolment were enrolled. Primary outcomes of interest were markers of cardiac injury detected by cardiac magnetic resonance imaging (MRI), including left ventricular ejection fraction, late gadolinium enhancement and pericardial abnormalities, and serum biomarker levels. Results: 100 patients (n= 129 approached) were included, 64% were female. Mean age was 45.2 years. The median (interquartile range) time interval between COVID-19 infection and enrolment was 189 [125, 246] days. 83% had at least one persistent symptom. 96% had positive serology for prior SARS-CoV-2 infection. Late gadolinium enhancement, pericardial effusion, was present in 2.2% and 8.3% respectively; left ventricular ejection fraction was below the normal reference limit in 17.4% of patients. Von Willebrand factor antigen was elevated in 32.7% of patients. Fibrinogen and D-Dimer levels were raised in 10.2% and 11.1% of patients, respectively. Conclusion: In a cohort of primary practice patients recently recovered from SARS-CoV-2 infection, prevalence of persistent symptoms and markers of abnormal coagulation were high, despite a lower frequency of abnormalities on cardiac MRI compared with prior reports of patients assessed in a hospital setting. Trial Registration: Clinicaltrials.gov, NCT04823182 (prospectively registered on 30th March 2021)

and 94% had access to a private location. 76% of patients reported that they were able to access their appointment without limitations in comparison to in-person consultations, although some reported a decreased personal connection with their physician. Satisfaction scores reflected this positive outlook (90/100 for patients and 75/100 for physicians), although patients reported that they would prefer virtual consultations less than 50% of the time outside the pandemic. Information was collected from patients on what aspects could be improved on the virtual service. Conclusion and ImplicationsVirtual clinics could be increasingly implemented in modern Cardiology. Telemedicine could provide a high-quality service with reduced cost and increased accessibility, particularly for patients in rural areas. In addition, virtual care at scale could allow in-person visits to be prioritised for patients who would truly benefit from their use, while reducing the risk of transmissible infections including COVID-19 and others.

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