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Background Systematically monitoring results within cardiac rehabilitation (CR) has been highlighted as a possible way to improve CR outcomes. The nationwide SWEDEHEART registry has monitored quality of care post myocardial infarction (MI) in Sweden since the 1990s. Follow-up data describing treatment and outcomes within CR has been collected since 2006. Purpose To describe changes in risk factor control and use of secondary preventive medication for post MI patients after completion of CR in Sweden 2006–2017, and to compare with trends in the EUROASPIRE surveys. Methods All patients who suffered an MI and attended a one-year CR follow-up visit registered in SWEDEHEART 2006–2017 were included (n=66 666, 18–74 years, 75% men). Trends in risk factor control and secondary preventive medication were collected yearly and analyzed over the time period using Cochran-Armitage trend test. Comparisons were made to data from the EUROASPIRE III (2006–2007), IV (2012–2013) and V (2016–2017) surveys, where patients with coronary artery events or interventions were interviewed at approximately 1.2 years after the index event (n=25 225, 18–80 years, 74% men). Results Trends in blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) control, smoking, and central obesity are shown in the Figure. The proportion of patients achieving BP goal Conclusion Between 2006–2017, considerable improvements were achieved in risk factor control and use of secondary preventive medication for MI patients completing CR in Sweden, where all patients were monitored through the SWEDEHEART registry. The improvements were larger than observed in the EUROASPIRE surveys during the same time period. Continuous and nationwide auditing of CR outcomes, as well as local review of performance, could be possible explanations for some of the observed differences. Figure 1 Funding Acknowledgement Type of funding source: None

Background Obesity, assessed as body mass index (BMI), is an established risk factor for development of coronary heart disease (CHD). However, in patients with heart failure and atrial fibrillation there is an “obesity paradox” with better prognosis among obese patients. The association between BMI and cardiovascular outcomes in patients with stable CHD is unclear. Methods The prospective STABILITY trial included 15,828 patients with stable CHD with a follow-up of 3–5 years (median 3.7) on optimal secondary preventive treatment. BMI and waist circumference were measured at baseline (n=15,785). All cardiovascular outcomes were centrally adjudicated. Associations between obesity indices and outcomes were evaluated by multivariable Cox regression analyses with adjustments for age, sex, study treatment, and clinical risk factors. Results Mean age was 64 years and 19% were females. In total, 3250 (20.9%) patients had BMI 25 and 30. Underweight (BMI Figure 1 Conclusion In patients with stable CHD on optimal secondary prevention BMI had a U-shaped association with the risk of MACE, death, and heart failure and a linear association with the risk of MI. The lowest risk for MACE was seen for BMI between 25 and 30, considered as overweight. The findings do not support current recommendations to achieve an ideal BMI of 20–25 for weight adjustments in patients with CHD. Acknowledgement/Funding The original STABILITY study was funded by GlaxoSmithKline

Purpose: To investigate whether unrecognised myocardial infarctions (UMI) detected by late enhancement cardiac magnetic resonance (CMR) in patients with stable coronary artery disease is associated with stenotic lesions on coronary angiography. Methods: In this multicenter study we included patients (65±8 years-of-age) scheduled for coronary angiography with symptoms of angina, but without previously known myocardial infarction (MI) or coronary intervention. CMR was performed on a clinical 1.5T scanner and consisted of delayed-enhancement images using an inversion recovery gradient echo sequence covering the entire left ventricle in the short-axis and three long-axis views. At CMR, areas of delayed contrast enhancement that were visible in at least two imaging planes were noted and localised using the AHA 17-segment model. They were categorised in four groups where "subendocardial" and "transmural" in the following were labelled UMI, whereas "no late enhancement" and "other" were labelled no MI. CMR was followed by coronary angiography and the degree of narrowing of the diameter in each of the 19 coronary segments was categorized as 0-29% (normal), 30-49%, 50-69%, 70-99% or 100% (occlusion). If stenosis was 30% or above we determined visually, depending on the individual coronary anatomy, which of the myocardial segments in the AHA 17-segment model that downstream of the stenosis were affected by the lesion. Both CMR and coronary angiography were first evaluated separately by two independent radiologists and then in consensus, blinded for the result on the other examination. Results: 1. An analysis of the first 104 out of totally 267 included subjects showed that 26 out of the 104 had UMIs with a subendocardial component at CMR. 23 of those 26 subjects had at least one stenosis ≥70% at coronary angiography and 25 of 26 had at least one stenosis ≥30%. 2. An UMI was present in 53 out of 1768 (104*17) myocardial segments. 33 (62%) of those 53 segments were supplied by a coronary branch with ≥70% stenosis at coronary angiography. The prevalence of UMI was 1.6, 4.7 and 17.3% in the myocardial segments supplied by a coronary branch with a stenosis