Background The coronavirus disease 2019 (COVID-19) pandemic has impacted many aspects of ST-segment elevation myocardial infarction (STEMI) care, including timely access to primary percutaneous coronary intervention (PPCI). Objectives The goal of the NACMI (North American COVID-19 and STEMI) registry is to describe demographic characteristics, management strategies, and outcomes of COVID-19 patients with STEMI. Methods A prospective, ongoing observational registry was created under the guidance of 3 cardiology societies. STEMI patients with confirmed COVID+ (group 1) or suspected (person under investigation [PUI]) (group 2) COVID-19 infection were included. A group of age- and sex-matched STEMI patients (matched to COVID+ patients in a 2:1 ratio) treated in the pre-COVID era (2015 to 2019) serves as the control group for comparison of treatment strategies and outcomes (group 3). The primary outcome was a composite of in-hospital death, stroke, recurrent myocardial infarction, or repeat unplanned revascularization. Results As of December 6, 2020, 1,185 patients were included in the NACMI registry (230 COVID+ patients, 495 PUIs, and 460 control patients). COVID+ patients were more likely to have minority ethnicity (Hispanic 23%, Black 24%) and had a higher prevalence of diabetes mellitus (46%) (all p < 0.001 relative to PUIs). COVID+ patients were more likely to present with cardiogenic shock (18%) but were less likely to receive invasive angiography (78%) (all p < 0.001 relative to control patients). Among COVID+ patients who received angiography, 71% received PPCI and 20% received medical therapy (both p < 0.001 relative to control patients). The primary outcome occurred in 36% of COVID+ patients, 13% of PUIs, and 5% of control patients (p < 0.001 relative to control patients). Conclusions COVID+ patients with STEMI represent a high-risk group of patients with unique demographic and clinical characteristics. PPCI is feasible and remains the predominant reperfusion strategy, supporting current recommendations.

AimsThe two components of disability‐adjusted life year (DALY), years of life lost (YLL) and years lived with disability (YLD), are underutilized in evaluating heart failure with reduced ejection fraction (HFrEF) and in assessing the global burden of disease. We aim to describe both the direct (medical) and the indirect (morbidity and mortality) inpatient cost of congestive heart failure in a high‐income non‐Organization for Economic Cooperation and Development Middle Eastern country in relation to YLL and YLD.Methods and resultsWe used the World Health Organization's global burden of disease methodology to calculate DALY, YLL, and YLD in 174 consecutive prospectively enrolled New York Heart Association Classes II–IV patients in a single‐centre heart failure registry using a 0.4 disability weight and a 3% future age discount. We reported the cost of hospitalization, re‐hospitalization, and non‐invasive and invasive procedures per 1000 HFrEF patients in US dollars (USD). Expressing results as per 1000 HFrEF capita revealed a DALY of 1480 ± 1909 vs. 2177 ± 2547 in women and men, respectively. The costs per HFrEF capita in USD were $909.00 ± 676.1 for a single‐day hospital stay, $7999 per single hospitalization, $12 311 ± 13 840 for annual hospitalizations, $20 486 ± 22 068 for all‐cause hospitalizations, and $37 355 ± 49 336 from the time of diagnosis until death or recovery.ConclusionsIn this study, HFrEF imposed a substantial economic and disability burden on one non‐Organization for Economic Cooperation and Development Middle Eastern country. However, men represented a higher economic burden than women.

Background: Left ventricular thrombus (LVT) is a well-recognized complication of myocardial infarction that affects patient outcomes and warrants screening. Methods: This retrospective study included 308 consecutive patients who presented with acute ST-elevation myocardial infarction and were treated with primary percutaneous coronary intervention. Results: Early screening for LVT by echocardiography and cardiac magnetic resonance revealed the following: LVT (þ) group (36 patients [11.7%]) and LVT (À) group (272 patients [88.3%]). The 2 powerful independent variables associated with LVT formation were left anterior descendingerelated infarct (odds ratio, 10.17; P < 0.0001) and severe left ventricular systolic dysfunction (odds ratio, 8.3; P ¼ 0.0001).

Introduction:Coronary artery disease (CAD) is a leading cause of death worldwide. The association of socioeconomic status with CAD is supported by numerous epidemiological studies. Whether such factors also impact the number of diseased coronary vessels and its severity is not well established.Materials and Methods: We conducted a prospective multicentre, multi-ethnic, cross sectional observational study of consecutive patients undergoing coronary angiography (CAG) at 5 hospitals in the Kingdom of Saudi Arabia and the United Arab Emirates. Baseline demographics, socioeconomic, and clinical variables were collected for all patients. Significant CAD was defined as ≥70% luminal stenosis in a major epicardial vessel. Left main disease (LMD) was defined as ≥50% stenosis in the left main coronary artery. Multi-vessel disease (MVD) was defined as having >1 significant CAD.Results: Of 1,068 patients (age 59 ± 13, female 28%, diabetes 56%, hypertension 60%, history of CAD 43%), 792 (74%) were from urban and remainder (26%) from rural communities. Patients from rural centres were older (61 ± 12 vs 58 ± 13), and more likely to have a history of diabetes (63 vs 54%), hypertension (74 vs 55%), dyslipidaemia (78 vs 59%), CAD (50 vs 41%) and percutaneous coronary intervention (PCI) (27 vs 21%). The two groups differed significantly in terms of income level, employment status and indication for angiography. After adjusting for baseline differences, patients living in a rural area were more likely to have significant CAD (adjusted OR 2.40 [1.47, 3.97]), MVD (adjusted OR 1.76 [1.18, 2.63]) and LMD (adjusted OR 1.71 [1.04, 2.82]). Higher income was also associated with a higher risk for significant CAD (adjusted OR 6.97 [2.30, 21.09]) and MVD (adjusted OR 2.49 [1.11, 5.56]), while unemployment was associated with a higher risk of significant CAD (adjusted OR 2.21, [1.27, 3.85]).Conclusion:Communal and socioeconomic factors are associated with higher odds of significant CAD and MVD in the group of patients referred for CAG. The underpinnings of these associations (e.g. pathophysiologic factors, access to care, and system-wide determinants of quality) require further study.

The most independent predictors for proximal RCA lesion is MPI.

Epidemiologic evidence suggests a link between psychosocial risk factors such as marital status and coronary artery disease (CAD). Polygamy (multiple concurrent wives) is a distinct marital status practiced in many countries in Asia and the Middle East, but its association with CAD is not well defined. We conducted a multicenter, observational study of consecutive patients undergoing coronary angiography during the period from April 1, 2013, to March 30, 2014. Of 1,068 enrolled patients, 687 were married men. Polygamy was reported in 32% of married men (1 wife: 68%, 2 wives: 19%, 3 wives: 10%, and 4 wives: 3%). When stratified by number of wives, significant baseline differences were observed in age, type of community (rural versus urban), prior coronary artery bypass grafting (CABG), and household income. After adjusting for baseline differences, there was a significant association between polygamy and CAD (adjusted OR 4.6 [95% CI 2.5, 8.3]), multivessel disease (MVD) (adjusted OR 2.6 [95% CI 1.8, 3.7]), and left main disease (LMD) (adjusted OR 3.5 [95% CI 2.1, 5.9]). Findings were consistent when the number of wives was analyzed as a continuous variable. In conclusion, among married men undergoing coronary angiography for clinical indications, polygamy is associated with the presence of significant CAD, MVD, and LMD.

T ransient apical ballooning syndrome, or takotsubo cardiomyopathy, is a syndrome characterized by reversible dilation of the left ventricular apex. It usually occurs in response to stress, and resolves completely in a few weeks. In the present report, we describe a patient who presented with recurrent episodes of chest pain and syncope in response to emotional stress; subsequently, she was diagnosed with recurrent takotsubo cardiomyopathy. Case PresentationA 55-year-old Caucasian woman with a medical history of hypertension, dyslipidemia, peripheral vascular disease, chronic obstructive pulmonary disease, osteoarthritis and depression presented to the hospital with a two-day history of chest pain, and a syncopal episode that lasted for a few minutes and resolved spontaneously. These symptoms occurred after an argument with a family member. The patient was a smoker, but denied any ethanol use or drug abuse. On arrival to the hospital, she had a blood pressure of 100/70 mmHg and a heart rate of 58 beats/min. Her cardiac examination was unremarkable. The initial electrocardiogram (ECG) reading showed deep T wave inversion in the anterolateral and inferior leads (Figure 1), with a corrected QT (QTc) interval of 509 ms. Her troponin I was positive at 7.2 µg/L (normal less than 0.5 µg/L), while her creatine kinase was not elevated. The patient was started on acetylsalicylic acid, heparin and beta-blockers. She continued to have chest pain despite medical therapy. The patient subsequently underwent cardiac catheterization, which showed apical akinesis on left ventriculography (Figure 2) with no significant coronary artery disease. Results from the ergotamine challenge showed no evidence of coronary artery spasm. Echocardiography ( Figure 3) showed abnormal left ventricular contraction with akinesis of the distal segment and apex. Overall, the ejection fraction (EF) was 49%. A wall motion study (WMS) showed an EF of 72% with a moderately dilated left ventricle and dyskinesia in the apex and apical inferior regions. Results from a 24 h urine collection were as follows: adrenaline 0 nmol/L; noradrenaline 292 nmol/L; and dopamine 834 nmol/L. All these readings were within normal limits. Results from autoimmune screening were negative.At that time, the patient was diagnosed with myocarditis and was discharged on the following medications: metoprolol, ramipril, warfarin, rosuvastatin, amlodipine and acetylsalicylic acid. A WMS repeated six months later was within normal limits and suggested the absence of the previously noted wall motion abnormalities.Eighteen months following the initial presentation, the patient was admitted to the hospital with similar symptoms after the sudden death of her husband. She was on acetylsalicylic acid, ramipril, amlodipine, hydrochlorothiazide, atorvastatin, hydromorphone, triazolam and escitalopram, which was started recently. Her ECG was similar to the previous presentation, with a QTc interval of 556 ms. Her troponin I was positive and there were no significant changes on repeat cardiac c...

DMProg significantly decreased 1-year readmission rates, LOS, and in-house mortality.