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We sought to assess the clinical impact of Covid-19 infection on mortality in patients with Non-ST elevation myocardial infarction (NSTEMI) admitted during the national outbreak in Italy.We analysed a nationwide, comprehensive, and universal administrative database of consecutive NSTEMI patients admitted during lockdown for Covid-19 infection (March,11st - May 3rd, 2020) and the equivalent periods of the previous 5 years in Italy. The observed rate of 30-day and 6-month all-cause mortality of NSTEMI patients with and without Covid-19 infection during the lockdown was compared with the expected rate of death according to the trend of the previous 5 years.During the period of observation, 48.447 NSTEMI hospitalizations occurred in Italy. Among these, 4981 NSTEMI patients were admitted during the 2020 outbreak: 173 (3.5%) with and 4808 (96.5%) without a Covid-19 diagnosis. According to the 5-year trend, the 2020 expected rate of 30-day and 6-month all-cause mortality was 6.5% and 12.2%, while the observed incidence of death was 8.3% (p = 0.001) and 13.6% (p = 0.041), respectively. Excluding NSTEMI patients with a Covid-19 diagnosis, the 6-month mortality rate resulted in accordance with the prior 5-year trend. After multiple corrections, the presence of Covid-19 diagnosis resulted one of the independent predictors of all-cause mortality at 30 days [adjusted odds ratio (OR) 4.3; 95% confidence intervals (CI) 2.90-6.23; p 0.0001] and 6 months (adjusted OR 3.5; 95% CI: 2.43-5.03; p 0.0001).During the 2020 national outbreak in Italy, a concomitant diagnosis of Covid-19 in NSTEMI was associated with a significantly higher rate of mortality.

The outcome of patients with acute myocardial infarction (AMI) may vary substantially based on baseline risk. We aimed at analyzing the impact of gender, age and heart failure (HF) on mortality trends, based on a nationwide, comprehensive and universal administrative database of AMI.This is a nationwide cohort study of patients admitted with AMI from 2009 to 2018 in all Italian hospitals. In-hospital mortality rate (I-MR) and 1-year post-discharge mortality rate (1-Y-MR) were assessed.Among the 1,000,965 AMI events included in the analysis, 43.6% occurred in patients aged ≥75 years, 34.7% in females and 21.8% in AMI complicated by HF at the index hospitalization. Both I-MR and 1-Y-MR significantly decreased over time (from 8.87% to 6.72%; mean annual change -0.23%; confidence intervals (CI): - 0.26% to -0.20% and from 12.24% to 10.59%; mean annual change -0.18%; CI: - 0.24% to -0.13%, respectively). This trend was confirmed in younger and elderly AMI patients, in both sexes. In AMI patients complicated by HF, both I-MR and 1-Y-MR were markedly high, regardless of age and gender.This contemporary, nationwide study suggests that I-MR and 1-Y-MR are still elevated, albeit decreasing over time. Elderly patients and those with HF at the time of index admission, present a particularly high risk of fatal events, regardless of gender.

a Department of Statistics and Quantitative Methods, Section of Biostatistics, Epidemiology and Public Health, University of Milano-Bicocca, Milan, Italy b Cardiology Division, Spedali Civili di Brescia and University of Brescia, Italy c Department of Cardiovascular Diseases, S. Giovanni-Addolorata Hospital, Roma, Italy d Department of Medicine, Section of Cardiology, University of Verona, Italy e Echocardiography Laboratory, Villa Bianca Hospital, Trento, Italy f Cardiology Unit, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy

Ultrasound carotid intima–media thickness, carotid plaque and cardiac calcium incrementally add to the Framingham Risk Score for the prediction of angiographic coronary artery disease: A multicenter prospective study☆☆☆ Nicola Gaibazzi ⁎, Fausto Rigo , Rita Facchetti , Scipione Carerj , Cristina Giannattasio , Antonella Moreo , Gianfrancesco Mureddu , Anna Paini , Elisabetta Grolla , Giacomo Faden , Francesca Cesana , Pompilio Faggiano g

Uncertainties on long-term outcomes after acute myocardial infarction (AMI) still exist, despite the ongoing progresses in the management of patients with AMI.Our aim was to appraise both the early prognosis and prognosis at 1-year after discharge of patients hospitalized due to AMI.This is a retrospective nationwide cohort study based on data from an administrative database on patients admitted with AMI from 2001 to 2011 in all Italian hospitals sites. Mortality and readmission rates within 30 days, 60 days and 1 year were calculated, as well as re-hospitalizations for all causes and for HF.A total of 1,110,822 patients were included. Index admission mortality rate (I-MR) and total in-hospital mortality rate (T-MR) at up to 1 year both decreased respectively from 11.34% to 8.99% and from 16.46% to 14.68% in the years 2001 to 2011 (both p0.0001), while fatal readmission rate (F-RR) at 1 year increased from 4.75% to 5.28% (p=0.0019). Patients that developed HF during the index admission had significantly higher I-MR and F-RR. I-MR, F-RR, and T-MR, however, remained low at any time point considered (30 days, 60 days and 1 year) in a subgroup of low-risk optimally-treated patients.The risk of fatal readmission at 1 year increased slightly over time, in spite of the remarkable improvements currently achieved in overall prognosis after AMI. The identification of patients at high risk (mainly due to HF complicating AMI), and of patients at low risk is crucial to define and support management strategies.

A 81-year-old was admitted to our intensive care unit because of syncope and recent onset palpitations. His clinical history included chronic heart failure with severe left ventricular dysfunction and previous mitral and aortic valves replacement by biological prosthetic valves, previous pace-maker implantation and chronic atrial fibrillation requiring oral anticoagulant therapy. At admission, the patient was conscious, eupnoic, without signs of peripheral ipoperfusion, although blood pressure was 80/60 mmHg. No rales were present at pulmonary auscultation. The ECG showed a large QRS tachycardia at 130 bpm. INR at admission was 2.04. Transthoracic echocardiography, performed during the arrhythmia, showed a severely depressed left ventricular function with an ejection fraction of 20% and a large ( mean 5.9 cm cm), soft, highly mobile, thrombus, apparently moving freely in the left ventricle (Fig. 1, Movie 1 to 3). The gradient across both mitral and aortic prosthetic valves were normal (Fig. 2). After a few cycles, during the same echocardiografic examination, without any interfering additional anticoagulant therapy, the thrombus suddenly vanished (Movie 4–5). Impressively, no clinical signs of peripheral embolization were observed. Neither brain computed tomography scan showed acute ischemic lesions. Once the thrombus had vanished, a weight-adjusted dose of low molecular weight heparin was given and amiodarone infusion was