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 Heart rate-corrected (QTc) interval may increase in the setting of ST-elevation myocardial infarction (STEMI) even after complete reperfusion of the infarct-related artery. The remaining ischemia affects ventricular repolarization and may be associated with an increased susceptibility for malignant ventricular arrhythmias. Two-dimensional (2D) speckle tracking echocardiography (STE) is an angle-independent technique for evaluating myocardial function. The study aimed to analyze the layers specific strain using STE in patients after percutaneous coronary intervention (PCI) and find a possible correlation with QTc interval. Methods 74 patients with STEMI and TIMI 3 flow after PCI were enrolled. The study did not include patients with bundle branch block, pacing, or treated with drugs that could increase the QTc interval. The evaluation consisted of clinical examination and laboratory tests. 12 leads electrocardiography evaluated QTc interval. Echocardiographic acquisitions were performed in the first 24–48 hours after PCI, and data were analyzed on the workstation. The global longitudinal strain was measured from apical views, at the level of the endocardium GLSAvgEndo, transmural GLSAvg, epicardium GLSAvgEpi; the difference bewtwen endocardium and epicardium longitudinal strain: GLSAvgEndo-GLSAvgEpi. Layer-specific GLS values were measured as the average of the longitudinal strain of 17 LV segments at each individual layer (Figure 1). Results Patients were diveded in two groups: the first included 32 patients with a single vessel disease (43.24%) and the second, 42 patients (56.75%) with multiple vessel damage, but without other indication for revascularization except the culprit lesion. Values for layers strain and QTc interval in the first group were: GLSAvgEndo: −16.2 (SD 2.98, CV 0.18), GLSAvg: −11.46 (SD 6.98, CV 0.6), GLSAvgEndo-GLSAvgEpi: 3.54 (DS 1.06, CV 0.29), QTc: 452.5 (SD 22.65, CV 0.05) and in the second group: GLSAvgEndo: −13.22 (SD 4.01, CV 0.3), GLSAvg: −11.3 (SD 3.39, CV 0.29), GLSAvgEndo-GLSAvgEpi: 3.47 (CV 1.28, CV 0.37), QTc: 490ms (SD 43.07, CV 0.08). QTc interval correlated with and layers strain in the first group: GLSAvgEndo: r=0.56, GLSAvg: r=0.67, GLSendo-GLSepi: r=0.54, and in the second group: GLSAvgEndo: r=0.73, GLSAvg: r=0.75, GLSAvgEndo-GLSAvgEpi: r=0.62. Conclusions 1. The present study identified decreased longitudinal strain in all myocardial layers in the first days after STEMI, even after a successful PCI. 2. Alterations of QTc dynamicity were more frequent in patients with multivessel lesions 3. The electrical instability related by QTc interval correlated with the myocardial tissue damage related by STE. The correlation was more evident in patients with multivessel disease, even with remaining nonsignificant lesions, suggesting an ongoing process of microcirculatory perfusion damage. Funding Acknowledgement Type of funding sources: None.
We present a complex Marfan case, with previous type A aortic dissection, subsequent progressing aortic arch aneurysm, type B chronic aortic dissection, and Barlow disease with severe mitral regurgitation, all expressions of the same phenotype, all needing staged complex surgical therapies. ( Level of Difficulty: Intermediate. )
Acute pulmonary edema is an often encountered medical emergency characterized by sever shortness of breath, orthopnea and pulmonary overload caused by left ventricular failure. The specific pharmacological and nonpharmacological therapies should be administered rapidly and their objective is to correct the hypoxemia and reduce the left ventricular afterload. Although the symptoms often regress quickly, the in-hospital and short-term mortality remain high. To improve the prognosis of these patients, long-term management is as important as the one in the acute setting, and includes the patient education, the correct and complete medical treatment of the subjacent heart disease and the prevention of risk factors.
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