Objective: To compare the early and late outcomes of primary percutaneous transluminal coronary angioplasty (PTCA) with fibrinolytic treatment among diabetic patients with acute myocardial infarction (AMI). Design: Retrospective observational study with data obtained from prospective registries. Setting: Tertiary cardiovascular institution with 24 hour acute interventional facilities. Patients: 202 consecutive diabetic patients with AMI receiving reperfusion treatment within six hours of symptom onset. Interventions: Fibrinolytic treatment was administered to 99 patients, and 103 patients underwent primary PTCA. Most patients undergoing PTCA received adjunctive stenting (94.2%) and glycoprotein IIb/IIIa inhibition (63.1%). Main outcome measures: Death, non-fatal reinfarction, and target vessel revascularisation at 30 days and one year were assessed. Results: Baseline characteristics were similar in these two treatment groups except that the proportion of patients with Killip class III or IV was considerably higher in those treated with PTCA (15.5% v 6.1%, p = 0.03) and time to treatment was significantly longer (103.7 v 68.0 minutes, p < 0.001). Among those treated with PTCA, the rates for in-hospital recurrent ischaemia (5.8% v 17.2%, p = 0.011) and target vessel revascularisation at one year (19.4% v 36.4%, p = 0.007) were lower. Death or reinfarction at one year was also reduced among those treated with PTCA (17.5% v 31.3%, p = 0.02), with an adjusted relative risk of 0.29 (95% confidence interval 0.15 to 0.57) compared with fibrinolysis. Conclusion: Among diabetic patients with AMI, primary PTCA was associated with reduced early and late adverse events compared with fibrinolytic treatment. E ven with the widespread availability of fibrinolytic treatment, diabetes mellitus remains an important adverse prognostic factor in patients with acute myocardial infarction (AMI).1-3 Although recent evidence from randomised trials has shown that primary percutaneous transluminal coronary angioplasty (PTCA) provides significantly better clinical outcomes than fibrinolysis for AMI in general, 4-9 its effect on diabetic patients remains unclear. A post hoc subgroup analysis of the GUSTO-IIb (global use of strategies to open occluded coronary arteries in acute coronary syndromes) angioplasty substudy found modest improvements in short and long term outcomes in diabetic patients treated with primary PTCA compared with fibrinolysis.

Background The 4S‐AF classification scheme comprises of four domains (stroke risk [St], symptoms [Sy], severity of atrial fibrillation (AF) burden [Sb] and substrate [Su]), which has been recommended in the 2020 ESC guidelines to characterize and evaluate patients with AF. Objectives We aimed to determine whether the 4S‐AF scheme would be useful for AF characterization and provides prognostic information in a large contemporary prospective Asian registry conducted by the Asia Pacific Heart Rhythm Society (APHRS). Methods Among 4666 patients enrolled in APHRS registry, 3586 of them whose data about left atrial (LA) dimension and European Heart Rhythm Association (EHRA) symptom score were available have constituted as the study population. The 4S‐AF score was calculated as the sum of each domain with a maximum score of 9. The clinical endpoint was defined as the 1‐year composite risk of any thromboembolic event, ischaemic stroke, heart failure, acute coronary syndrome, significant coronary artery disease requiring coronary intervention and all‐cause mortality. Results Based on the 4S‐AF domains, 86.7% were ‘non‐low risk’ for stroke; 94.3% had EHRA Class I‐II, 48.5% were newly diagnosed or paroxysmal AF; and only 8.4% had no cardiovascular risk factors or LA enlargement. The risk of clinical events was higher in patients who were ‘non‐low risk’ for stroke (aOR 2.175, 95% CI 1.060–4.461), with permanent AF (aOR 1.579, 95% CI 1.106–2.225) and increasing points for substrate (aORs 2.376–4.968 from score 2 to 4). When compared to the first tertile of 4S‐AF score (0–3 points), patients in the second tertile (4–5 points) had approximately 2.5‐fold increase in adverse events (OR 2.478, 95% CI 1.678–3.661, p < .001), while those in the third tertile (6–9 points), had a 3.5‐fold increase (OR 3.484, 95% CI 2.322–5.226, p < .001), both without significant differences between the 5 participating countries (p for interaction > .05). If all 4S‐AF domains were appropriately treated, this was associated with a lower risk of composite clinical outcomes (aOR 0.384, p < .001; p for interaction for different countries = .234). Conclusions Categorization according to the 4S‐AF scheme can be related to the risk of the composite adverse event rate in Asian AF patients, and appropriate treatments based on the 4S‐AF scheme resulted in better clinical outcomes. These observations support the characterization and management according to the 4S‐AF scheme in Asian patients.

Aims The aim of this study is to describe the implementation of the current guidance for stroke prevention and treatment option in atrial fibrillation (AF) and to evaluate mortality and morbidity in relation to therapeutic decisions, including persistence with treatment at 1 year in Asia-Pacific regions. Methods and results We recruited 4664 patients consecutive in- and outpatients with AF who presented to cardiologists in five countries under the Asia-Pacific Heart Rhythm Society (APHRS) in whom 1-year follow-up was completed for 4003 (65.5% male; mean age 68.5 years). Oral anticoagulant (OAC) use remained high, 77% at follow-up, including 17% prescribed a vitamin K antagonist (VKA) and 60% a non-VKA oral anticoagulant (NOAC). At 1-year follow-up, 93% and 88% remained on a VKA or NOAC, respectively. With good adherence to OAC therapy, 1-year mortality was only 2.7%. Most deaths were non-cardiovascular (72.3%) and the 1-year incidence of stroke/transient ischaemic events (TIA) was low (&lt;1%). Hospital readmissions were common for non-cardiovascular cases and atrial tachyarrhythmias. On multivariate analysis, independent baseline predictors of mortality and/or stroke/TIA/peripheral embolism were age, previous heart failure for &gt;12 months, and malignancy. Independent predictors of mortality were age, chronic obstructive pulmonary disease, malignancy, and diuretic use. AF as a primary presentation was predictive of lower mortality and/or stroke/TIA/peripheral embolism as well as mortality. Conclusion In this 1-year analysis of the APHRS-AF registry, overall OAC use and persistence were high and were associated with low 1-year cardiovascular mortality and morbidity, but mortality and morbidity related to non-cardiovascular causes were high in AF patients, particularly from malignancy and pneumonia.

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