1048Characteristics of ST-Elevation Myocardial Infarction (STEMI) patients in Asia Pacific: findings from the ASPECT collaboration

Background The Asia Pacific Evaluation of Cardiovascular Therapies (ASPECT) Collaboration was established to better understand the characteristics of patients undergoing PCI and cardiac interventions across the Asia Pacific region, including STEMI. The aim of this study was to compare STEMI patient characteristics across Asia Pacific (AP) countries in order to understand regional differences. Methods Each site across Australia, Singapore, Malaysia, Vietnam and Hong Kong provided de-identified individual patient data. Comparison of characteristics by sites were performed using one-way ANOVA, Kruskal-Wallis or Chi-squared tests, using Stata 14.2. Results Of the 12,620 cases, there were more males (p < 0.001) and the average of patients’ age ranged from 55 (Malaysia) to 68 (Vietnam) years old. Family history of coronary artery disease was not common amongst Hong Kong (1%) and Singaporean (12%) patients, and most patients did not have history of congestive heart failure, peripheral vascular disease or coronary artery bypass grafting. History of dyslipidaemia varied significantly among patients in Malaysia (98%) and Vietnam (12%) (p < 0.001). About 37% of the Malaysian patients had previous myocardial infarction, which is greater than twice of other cohorts (p < 0.001). Most cohort had either normal or mild ejection fraction (EF) but 40% of the Singaporean patients had severely reduced EF (p < 0.001). Conclusions Patient characteristics varied significantly across AP countries. On-going analyses will focus on the impact of varying patient characteristics on clinical outcomes. Key messages As characteristics varied, prevention and procedural strategies need to be adapted carefully. Additional input from other AP countries will better inform these strategies.

A rare complication of STEMI: Anaphylactic shock post-fibrinolytic

ST-Elevation Myocardial Infarct (STEMI) is the most common emergency condition that causes sudden death. The revascularization speed of the occluded coronary artery is the key to success in STEMI management in both aspects of reducing morbidity and mortality. Primary Percutaneous Coronary Intervention (PCI) is the first line of reperfusion management in the treatment of STEMI patients, but in some conditions, such actions cannot be performed then pharmaco-invasive strategies should be done. There are several complications of STEMI after fibrinolytic therapy. In this case report, we presented a rare complication of anaphylactic shock in STEMI patient underwent fibrinolytic therapy. Keywords: Anaphylactic shock; Fibrinolytic; PCI; STEMI.

Outcomes of ST elevation myocardial infarction (STEMI) hospitalizations during corona virus disease 19 (COVID 19) era

Funding Acknowledgements Type of funding sources: None. Multiple studies reports a reduction of STEMI hospitalizations rates during COVID 19 pandemic outbreak. Contradictory STEMI complications rates are reported during COVID 19 pandemic regarding case fatalities rates, cardiogenic shock, life threatening arrhythmias and others. Purpose. To evaluate the impact of the COVID 19 outbreak on STEMI patient outcomes and complication rates in country with low COVID 19 incidence and mortality and without changes in Cardiology hospital services. Methods. Was conducted a retrograde study collecting data for STEMI hospitalizations, revascularization procedures and case fatalities and other complications from March 9th 2020 (first COVID 19 case in our country) to April 30th (period of total lockdown) compared with the same period of 2019 in our center. Incidence rate ratio (IRR) was used to compare STEMI admissions and revascularization procedures and risk ratio (RR) to compare case fatality rate and other complications rate. Results Hospital admissions for STEMI declined during 2020 (COVID 19 period) from a total of 217 patients in 2019 to 155 patients hospitalization in 2020 representing IRR 0.72 (p = 0.009). Reduction were observed in the number of primary PCI from 168 procedures in 2019 to 113 in 2020 (IRR 0.67 p = 0.001). Symptom onset to our ICU (including regional transportation) was significantly higher in 2020 than in 2019 (939.97 ± 1122 versus 436.15 ± 383 minutes p <0.0001) The STEMI case fatality was importantly increased during pandemic outbreak (13.55%) compared to 2019 (8.3%) (RR= 1.63 p = 0.001), but a similar a primary PCI-STEMI case fatality 6.2% versus 5.95%. Also an increase was observed for cardiogenic shock (IRR =1.75 p = 0.003). Results; Hospitalizations and related invazive revascularization procedures for STEMI significantly reduced during COVID 19 pandemic. We identified a substantial increase of STEMI case fatalities and cardiogenic shock during pandemic outbreak. Delayed timely reperfusion by primary PCI has an important impact on infarct related mortality.

Right Ventricle Involvement in Patients with Acute ST Elevation Myocardial Infarction: Is Echocardiography Good Enough in Diagnosing It?

Right ventricle (RV) dysfunction in patients with ST elevation myocardial infarction (STEMI) is more common and important than previously considered. The aim of this study was to determine the incidence of RV involvement in acute STEMI by using advanced echocardiography (Echo) methods, such as RV longitudinal strain and three-dimensional (3D) ejection fraction, and to prove that RV involvement is not exclusive to right coronary artery damage in STEMI. The study group was formed of 73 patients aged 30 to 60 years with confirmed first-time acute STEMI and coronary angiography performed. Abnormality thresholds for standard and advanced Echo parameters in case of STEMI for predicted RV dysfunction were RV 3D ejection fraction < 49% and RV free wall longitudinal strain > –24.5 %. Using these abnormality thresholds it was possible to detect RV dysfunction in 60% of STEMI cases. The acquired results are close to the cardiac magnetic resonance data found in literature, which is the gold standard for determination of RV systolic function. RV involvement did not depend on the damaged coronary artery, as there was no association detected (p = 0.09); therefore, RV function should be assessed in every STEMI patient, and Echo is an effective method for this purpose.

Can analysis of myocardial mechanic help me to predict heart failure development in my STEMI patient whose EF is equal or above 50% after pPCI?

Funding Acknowledgements Type of funding sources: None. onbehalf PREDICT-VT In spite of contemporary STEMI management, heart failure (HF) develops in 4% up to 28% of pPCI-treated patients, with the highest incidence in the first year. Left ventricular ejection fraction (EF) is strong predictor predominately for HFrEF development, but risk stratification in case of preserved post pPCI EF (i.e. EF ≥ 50%) is still challenging. Aim the current study is a sub-study of PREDICT-VT study (NCT03263949). Its aim is to define clinical and "echocardiographic" profile of STEMI patient at risk to develop HF despite preserved post pPCI EF, including not only conventional echocardiographic data, but data from myocardial mechanic analysis obtained by early speckle tracking echocardiography. Methods in 307 consecutive pts enrolled in PREDICT-VT study early echocardiography (5 ± 2 days after pPCI) was done and included LA and multilayer LV deformation analysis with longitudinal (L), radial (R) and circumferential (C) strain (S; %) and strain rate (SR, 1/sec), calculation of LV index of post systolic shortening for longitudinal (PSS LS) and circumferential (PSS CS) strains and thorough analysis of LV rotation mechanic. Results From 242 patients who completed 1-year follow-up, 109 pts (45 %) had post pPCI EF ≥50%. Of those patients 34 (31%) became NYHA ≥ 2 or died during 1-year follow-up (MACE+ group). Patients with MACE were older (63 ± 8 vs 55 ± 10, p &lt; 0.001), more frequently were female (47% vs 27%; p = 0.036) and more frequently had hypertension (40% vs 20%; p = 0.025). There were no significant differences in LV EF ( 56.5 ± 4.8% vs 56.3 ± 4.8 %; p = 0.849) and from conventional echo parameters only differences in E/A ratio (0.75 ± 0.24 vs 0.92 ± 0.32; p = 0.015) and MAPSE (1.54 ± 0.40 vs 1.36 ±0.27; p = 0.015) reached statistical significance. Surprisingly, there were no significant differences neither in LV longitudinal, nor circumferential deformations. However, LV radial deformation was significantly impaired in MACE+ pts both during systole (global radial strain: 16.4 ± 7.1 vs 21.1 ± 10.3; p = 0.008; end-systolic radial strain 13.1 ± 7.3 vs 18.1 ± 9.9; p = 0.005), early (radial SR E: -1.27 ± 0.66 vs 1.59 ± 0.79; p = 0.044) and late (radial SR A: -0.94 ± 0.41 vs -1.20 ± 0.59, p = 0.011) diastole. LV rotation was not significantly impaired, but slowed and delayed both during systole (time to peak systolic apical rotation (ms) 168 ± 86 vs 128 ± 70; p = 0.022) and diastole (rotation rate of LV base during early diastole (°/sec): 38.3 ± 27.4 vs 55.0 ± 31.5, p = 0.008; time to maximal LV untwisting rate (ms) 580 ± 210 vs 484 ± 154; p = 0.044), despite no differences in HR. Conclusion STEMI patients who will develop heart failure despite preserved post pPCI EF might have different clinical profile and different pattern of deviation in LV mechanic (predominately involving radial and rotational mechanic) and can be detected by contemporary echocardiographic techniques.

Abstract 12886: Ten-year Trends in Patient Characteristics, Treatments, and Outcomes in St Elevation Mi Patients in the Us - A Report From NCDR CP-MI Registry

Introduction: The National Cardiovascular Data Registry affords a 10-year perspective of the landscape of STEMI patient characteristics, management, and clinical outcomes. Methods: Annual trends in patient characteristics and in-hospital treatments of 604,936 STEMI patients treated at 1226 US hospitals between 2009 and 2018 were analyzed. Using the ACTION mortality risk model incorporating cardiac arrest, the trend in in-hospitals risk adjusted mortality rates (RAMR) between 2011-2018 was tested. Results: While patient age (median 61 years) and sex (70.7% male) remained stable over time, the prevalence of diabetes (22.8% in 2009 to 28.3% in 2018) and atrial fibrillation (4.1% to 6.1%) increased, while smoking decreased (43.5% to 37.9%) . Among eligible patients, primary PCI use increased (82.3% to 96.0%) with more rapid door to balloon times for both direct arrival (median 62 min vs 56 min) and transferred-in pts (median 113 min vs 103 min, p for trend <0.001 for all). Thrombolytic use declined (10.1% to 5.0%) with no significant change in door to needle time (median 27 minutes). There was no significant change in RAMR (2.83% to 2.69%, p=0.46) from 2011-2018. (Figure 1). Discharge use of P2Y12 inhibitors (91.5% to 95.6%) and statins (94.9% to 98.5%) increased. Conclusions: Characteristics of patients presenting with STEMI changed over time with improvements in primary PCI use and timeliness. However, there was no significant reduction in risk-adjusted mortality over the past decade.

Do the ESC guidelines improve the treatment of acute myocardial infarction due to acute circumflex artery occlusion?

Background The left circumflex artery (LCX) and its branches are less often recognized as infarct related artery (IRA) in STEMI compared to NSTEMI patients because of lower ability to detect posterior AMI on 12leads ECG. Significant proportion of patients with acute LCX occlusion therefore did not receive immediate reperfusion therapy. The recent ESC guidelines recommendation of immediate coronary angiography for NSTEMI with ongoing ischemia should change the situation. Objectives To estimate the change in proportion of patients receiving immediate reperfusion therapy for acute LCX occlusion within last 20 years. Methods Prospective registry of patients with acute coronary syndromes treated in the cardiac centre. The group of patients treated with direct PCI as STEMI and the group of patients treated as NSTE ACS were compared. Results Of 369 STEMI patients treated with primary PCI in 1995–2000, the LCX was recognized as IRA in only 29 (8%) patients. In the group of 809 STEMI patients treated in period 2008–2011, the LCX was detected as IRA in 133 (16%). In he recent group of 1006 patients treated as STEMI in period 2016–2019 the LCX was IRA in 166 (16.5%) patients. LAD, LM and RCA were detected as IRA in 407 (40.5%), 17 (1.7%) and 415 (41%) patients respectively. In the parallel group of 1087 NSTE-ACS patients the proportion of LCX, LAD, LM and RCA as culprit artery was 271 (25%), 438 (40%), 52 (5%) and 326 (30%) respectively. The difference of LCX involvement in STEMI (16%) compared to NSTE-ACS patients (25%) was highly significant (p&lt;0,001). Conclusion The disproportion of LCX involvement among the patients with STEMI and NSTE-ACS is not decreasing in the course of last 10 years. Our data show that still significant part of patients with acute LCX occlusion are diagnosed as having NSTE-ACS and are not treated with adequate immediate reperfusion. So even in recent era of modern reperfusion therapy these patients which mostly suffer posterior AMIs have a lower chance to receive the proper treatment in our region. The new ESC guidelines did not change this fading yet. Better diagnostics of AMI due to the acute LCX occlusion (including 15 leads ECG) is routinely needed or every suspected NSTEMI patient should undergo the acute coronary angiogram as he would be a STEMI patient. Funding Acknowledgement Type of funding source: None

The Role of Pre-hospital and Hospital Emergency Staff in Time Management of Acute Myocardial Infarction

According to the latest guidelines, in ST-segment elevation myocardial infarction (STEMI) cases, the best intervention to restore blood flow in the occluded coronary arteries is angioplasty at a time less than 90 minutes. Delay in timely implementation of reperfusion is one of the key problems in the management of STEMI. In this review study, the aim is to investigate the role of pre-hospital and hospital emergency staff in time management of STEMI. For this purpose, the articles published 1999-2019 with available full texts in ProQuest, SID, Science Direct, Google Scholar and Scopus databases were searched using the keywords: Pre-hospital Emergency, Hospital Emergency, Primary Angioplasty, Time Management, Ischemia, and Acute Myocardial Infarction. A total of 59 articles in Persian and English (from 10 different countries) covering both qualitative and quantitative studies were initially yielded. Those which were not a review paper and their full texts were unavailable were excluded from the review. Faster reperfusion reduces the cardiac necrosis area, resulting in reduced morbidity and mortality. Early ECG recording by the pre-hospital emergency team followed by the activation of the code STEMI by the emergency team can increase the speed of diagnosis, decision making, and transfer of the STEMI patient to receive the best treatment.

Acute Coronary Syndrome Admissions and Mortality Rate During COVID-19 Pandemic in Gaza

Background: What is the nature and duration of changes to admissions for different types of acute coronary syndrome (ACS), among patients during coronavirus disease 2019 (COVID-19) pandemic in Gaza? Methods: The investigators analyzed data on hospital admissions in Gaza for types of ACS from August 25-2020, to October 1, 2020, that were recorded in the Alshifa Hospital Cardiology Department Service Admitted Patient Care database. Admissions were classified as ST-elevation myocardial infarction (STEMI) and non-STEACS and we calculate the diagnostic and percutaneous coronary intervention (PCI) rate. Results: Hospital admissions for ACS declined from rate of 99 admissions to 40 admission in 2020in this time, a reduction of 60%. During the period of declining admissions, there were reductions in the number of admissions for all types of ACS, including both STEMI and NON-STEACS, but relative and absolute reductions were larger for NSTEMI, (from 73 patients in 2019 to 26 patients in 2020) with a percent reduction of 64% In parallel, reductions were recorded in the STEMI ( from 26 patients in 2019 to 14 patients in 2020) percent reduction 46 %, the mortality rate for STEMI patient was 4% in 2019 and 21% in 2020, for non-STEMI patient was 0% in 2019 and 4% in 2020. The diagnostic coronary angiography decrease from 130 to 31 cases (76%) and PCI decrease from 35 to 18 cases (49%) during this period Conclusions: We found that significant reduction in the number of patients with ACS who were admitted to the hospital during the pandemic, but increase in mortality rate by 17% in STEMI and 4% in NON-STEACS in Gaza strip