Funding Acknowledgements Type of funding sources: None. Introduction Hospitalization due to acute coronary syndromes (ACS) usually is the occasion that leads to diagnosis of type 2 diabetes mellitus (T2DM). Current literature suggests that the severity of the ACS could be associated with the presence and the severity of DM. Purpose To study the reliability of HbA1c in the diagnosis of T2DM in the acute phase of ACS, as well as the presence of possible correlation between the HbA1c and the severity of ACS. Methods We evaluated 160 consecutive patients admitted due to ACS. HbA1c was measured on day 1 and day 90. HbA1c >6.5% was used to diagnose T2DM and HbA1c 5.7-6.4% was used to diagnose pre-diabetes. The severity of ACS was assessed via Gensini score. Results are interpreted as mean ± SD. Comparisons were made by one way ANOVA(p < 0.05 was regarded statistically significant).Spearman’s rank correlation was used to study the correlation between Gensini score and the other parameters. Results Mean age was 59.73 ± 12.21 years. 103/160(64.37%) were male and 57/160(35.63%) were female. 19/160(11.87%) were diagnosed as STEMI and 141/160(88.13%) as NSTEMI. Mean BMI was 29.55 ± 8.41 kg/m2 and mean Hb 12.62 ± 2.08 g/dl. On day 1, 43/160 (26.87%) had HbA1c > 6.5% and 41/160(25.62%) HbA1c 5.7-6.4%. On day 90, 28/160 (17.5%) had HbA1c > 6.5% and 52/160(32.5%) HbA1c 5.7-6.4%. Gensini score varied between 0-144 with mean value 40.26 ±35.9. A strong correlation was found between Gensini score and HbA1c on admission as well as on day 90 (rho-0.36, p < 0.05 and rho = 0.32, p < 0.05 respectively). Conclusion HbA1c seems to be reliable in the identification of pre-diabetes but not T2DM in the acute phase of ACS. The correlation of the severity between ACS and HbA1c seems to relate with the worst prognosis of T2DM patients.

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In AVNRT patients, ventricular pacing and reentrant tachycardia significantly increase right atrial pressures and subsequently shorten ERP and MAPd90, leading to an enhanced propensity for AF.

Funding Acknowledgements Type of funding sources: None. Background Vaccination against Covid-19 has been proved an effective protective measure against the pandemic. It has been noticed that a number of patients visited the emergency department (ED) complaining of chest pain following their vaccination. Purpose To record the patients that visited the ED of our hospital referring chest pain following their vaccination with BNT162b2 vaccine, the clinical and laboratory parameters as well as their final diagnosis. Methods We recorded the patients that visited the ED of our hospital (secondary hospital) referring "chest pain after the vaccine", for a period of 6 months. We included patients that had received the first or the second dose of the vaccine 1-30 days prior their visit. We recorded basic demographic characteristics, ECG findings the laboratory test results as well as the possible diagnosis made in the ED. Results 207 patients visited the ED complaining of "chest pain after having the Covid-19 vaccine", 96 male and 111 female, with mean age 47±8.2 years. 7 patients(3.38%) had elevated high sensitivity troponin and were diagnosed with myocarditis ( 2 female patients aged 5 and 62 years and 5 males aged 18-24 years. In 5/7 ST elevations were recorded in the 12-lead ECG, in 4/7 the transthoracic echocardiogram(TTE) revealed mildly impaired left ventricular function. Myocarditis was confirmed via cardiac MRI in all patients. Virology tests were negative for the common viruses.6/7 visited the ED 2-5 days after the second dose, whereas 1/7 10 days after the first dose). 2 patients(0.96%) were diagnosed with pericarditis (Both of them had received the second dose 5-7 days prior their visit, presented with pericardial rub and diffuse ST elevations in the ECG, as well as elevated CRP and moderate pericardial effusion). For the remaining 198 patients (95.65%) we did not record any abnormal findings in the ECG or the chest X ray and the chest pain was regarded non cardiac. Interestingly enough, 107 patients (51.69%) found to have a mild to moderate increase in the D-Dimer levels (mean 1.1±0.6 mg/l).Pulmonary embolism and aortic dissection was excluded to all of them based on our hospital’s protocol. Conclusion The vast majority (95.65%) of patients complaining of post Covid-19 vaccine chest pain had normal ECG and laboratory findings, suggesting a non cardiac origin.There were diagnosed some cases with myocarditis or pericarditis, a well described possible side effect of the BNT162b2 vaccine. Moreover, 51.69% of these patients were found to have elevated D-Dimer levels but we did not record any clinical significance.

Funding Acknowledgements Type of funding sources: None. Background Atrial fibrillation (AF) is one of the most common reasons that patients visit the emergency department (ED). During the initial investigation, many of these patients are found to have increased troponin levels and it is not clear if this could be an indicator of underlying coronary artery disease (CAD). CHA2DS2-Vasc score is widely used to estimate the thrombotic risk in patients suffering from AF. Purpose To examine any possible relation between the elevated high sensitivity troponin I (hsTnI) observed in patients with AF that visited the ED of our hospital during one year and their CHA2DS2-Vasc score with the presence of underlying CAD. Methods We recorded the patients presenting in the ED with AF for a period of 12 months and found to have elevated troponin during their initial investigation. We calculated the CHA2DS2-Vasc score and then divided the patients in two groups : Group 1 (CHA2DS2-Vasc score >4) and Group 2 (CHA2DS2-Vasc score <4). We recorded the maximum level of hsTnI.All patients underwent noninvasive investigation for coronary artery disease (SPECT or stress ECHO) and when it was indicated coronary angiogram was performed. Results We recorded 428 patients, 256 male and 172 female wit mean age 64 ±10.72 years. Group 1 included 194 patients and group 2 234. We recorded a statisticaly significant difference in the maximum levels of hsTnI between the two groups (Group 1 8742±964.8 pg/ml vs Group2 1324±85.7 pg/ml, p<0.01). In Group 1 the non invasive investigation was suggestive for coronary artery disease in 168 patients (86.8%), whereas in Group 2 in 113 (48.2%)(p<0.05). The patients with positive SPECT or stress ECHO underwent coronary angiography or coronary CT scan. Non significant disease had (Group 1 vs Group 2 ) 17/194(10.11%) vs 75/234(66.37%)(p<0.01), one vessel disease 66/194(39.28%) vs 19/234(16.81%)(p<0.05), two vessels disease 54/194(32.14%) vs 14/234(12.38%) (p<0.05) and three vessels disease 31/194(18.45%) vs 5/234(4.42%)(p>0.05). Conclusions Higher CHA2DS2-Vasc score was related with higher levels of hsTnI in patients with AF. Moreover, patients with higher CHA2DS2-Vasc score were found to have more often underlying coronary artery disease and its severity was found to be related with the higher CHA2DS2-Vasc score. More studies are needed to investigate whether it would be useful to use CHA2DS2-Vasc score when evaluating the increased levels of hsTnI in patients with AF and if it could be included in an algorithm.