Tremendous progress has been made in the treatment of ST-segment elevation myocardial infarction (STEMI), the most severe and time-sensitive acute coronary syndrome. Primary percutaneous coronary intervention (PCI) is the preferred method of reperfusion, which has stimulated the development of regional STEMI systems of care with standardized protocols designed to optimize care. However, challenges remain for patients with cardiogenic shock, out-of-hospital cardiac arrest, an expected delay to reperfusion (>120 min), in-hospital STEMI, and more recently, those with Covid-19 infection. Ultimately, the goal is to provide timely reperfusion with primary PCI coupled with the optimal antiplatelet and anticoagulant therapies. We review the challenges and provide insights into the remaining knowledge gaps for contemporary STEMI care.

population. Analyses were stratified by gender and controlled for age, race, body mass index (BMI) category, comorbidities, smoking, and insurance. Complex sampling designs were adjusted for. A Markov model, populated by disease and mortality estimates and healthcare expenditures, was built to simulate lifetime healthcare expenditures for gender-race-age-BMI group subpopulations. RESULTS: We included 18,763 women and 14,793 men. We use insured, non-smoking individuals age 40 as an example. Without obesity-related comorbidities, remaining lifetime healthcare costs ranged from $90,125 (normal-weight, non-white, non-black men) to $149,761 (obese white women). With diabetes, costs ranged from $124,757 (overweight, non-white, non-black men) to $207,643 (obese white women); with hypertension, costs ranged from $118,084 (overweight, nonwhite, non-black men) to $197,343 (obese white women); with CHD, costs ranged from $141,753 (normal-weight, non-white, non-black men) to $225,575 (obese black men); with stroke, costs ranged from $107,803 (normal-weight, non-white, nonblack men) to $184,283 (obese white women). With two comorbidities, obese black men with hypertension and CHD had the highest costs ($274,104). With three comorbidities, obese white women with diabetes, hypertension, and CHD incurred the highest costs ($357,486). With all four comorbidities, obese white women had the highest costs ($432,102). CONCLUSIONS: This study suggests that obesityrelated comorbidities impose a significant economic burden. Some subpopulations, e.g., obese white women and obese black men, incur higher healthcare costs than others.OBJECTIVES: Poor adherence to medications for cardiovascular disease (CVD) is associated with adverse health outcomes, but little is known on its impact on healthcare utilization (HCU). We examined whether adherence is related to a longterm decrease in HCU. METHODS: A retrospective cohort study of 2220 patients with CVD enrolled in Maccabi Healthcare Services in Israel initiating CVD medication therapy between 2006 and 2008. Adherence was assessed by the proportion of days covered (PDC) with medications. Patients were defined as: non-adherent (PDC< 0.4), partially adherent (0.4≤ PDC< 0.8), and adherent (PDC≥ 0.8). HCU was estimated following treatment initiation and up to four years. Multivariable GEE models were used to analyze predictors of HCU. Model I included total adherence during the entire follow-up period as well as the interaction between this measure and the follow-up year. Model II included previous and current year's adherence as well as previous year's HCU cost. Both models were adjusted to potential confounders including: age, gender, socioeconomic status, ownership of voluntary supplementary health insurance, and comorbidities. RESULTS: The median age of patients was 63 (67% males). Fifty one percent of patients (n= 1139) were defined as adherent, 24% as partially adherent and 25% as non-adherent. Model I: The annual HCU costs of adherent patients decreased in 9% following treatment initiation (...