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Acute myocardial infarction (AMI) is the leading cause of death worldwide. Outcome has improved during the last decades due to secondary prevention and widespread coronary interventions, but recent studies still show sex differences and insufficient drug adherence. We aimed to determine differences in the treatment strategies and outcomes between women and men with ST-elevation myocardial infarction (STEMI) in Germany. From the Federal Association of the Local Health Insurance Funds (Allgemeine Ortskrankenkasse), 175,187 patients were identified who were hospitalized due to STEMI in Germany between January 1, 2010 and December 31, 2017. Compared to men, women were older (median 76 vs. 64 years) and had more often diabetes, hypertension, chronic heart failure, and chronic kidney disease (all p < 0.001). Women suffered from higher rates of in-hospital complications such as bleeding (9.3 vs. 6.6%), longer hospitalizations (12.2 vs. 11.7 days) and were less likely to undergo percutaneous coronary intervention (75.5 vs. 85.2%). After adjustment for patient's risk profile, female sex was associated with decreased overall survival (HR 1.02, 95% confidence interval (CI) 1.00–1.04; p= 0.036). Notably, more men received all four guideline-recommended drugs after STEMI (women 65.7% vs. men 69.8% after 90 days; p < 0.001). With increasing number of prescribed drugs, patients benefit even more. This concerned both sexes, but was more pronounced in men (with 4 prescribed drugs: women HR 0.52, 95%CI 0.50–0.55; men HR 0.48, 95% CI 0.47–0.50, p int = 0.014). In a contemporary nationwide analysis, women with STEMI were older, had more comorbidities, underwent revascularization less often and had an increased risk for major complications as well as overall survival. Guideline-recommended drug therapy was applied less frequently in women although associated with an improved overall-survival. [Display omitted] • Compared to men, women with STEMI were older and had more comorbidities. • Women had higher rates of inpatient complications, received percutaneous coronary intervention less often, and when adjusted for the risk profile, the female sex was associated with reduced overall survival. • After STEMI, women received all four guideline-recommended drugs less often, although the prognosis improved with the increase in these drugs. [ABSTRACT FROM AUTHOR]

Acute myocardial infarction (AMI) is the leading cause of death worldwide. Outcome has improved during the last decades due to secondary prevention and widespread coronary interventions, but recent studies still show sex differences and insufficient drug adherence. We aimed to determine differences in the treatment strategies and outcomes between women and men with ST-elevation myocardial infarction (STEMI) in Germany. From the Federal Association of the Local Health Insurance Funds (Allgemeine Ortskrankenkasse), 175,187 patients were identified who were hospitalized due to STEMI in Germany between January 1, 2010 and December 31, 2017. Compared to men, women were older (median 76 vs. 64 years) and had more often diabetes, hypertension, chronic heart failure, and chronic kidney disease (all p < 0.001). Women suffered from higher rates of in-hospital complications such as bleeding (9.3 vs. 6.6%), longer hospitalizations (12.2 vs. 11.7 days) and were less likely to undergo percutaneous coronary intervention (75.5 vs. 85.2%). After adjustment for patient's risk profile, female sex was associated with decreased overall survival (HR 1.02, 95% confidence interval (CI) 1.00–1.04; p= 0.036). Notably, more men received all four guideline-recommended drugs after STEMI (women 65.7% vs. men 69.8% after 90 days; p < 0.001). With increasing number of prescribed drugs, patients benefit even more. This concerned both sexes, but was more pronounced in men (with 4 prescribed drugs: women HR 0.52, 95%CI 0.50–0.55; men HR 0.48, 95% CI 0.47–0.50, p int = 0.014). In a contemporary nationwide analysis, women with STEMI were older, had more comorbidities, underwent revascularization less often and had an increased risk for major complications as well as overall survival. Guideline-recommended drug therapy was applied less frequently in women although associated with an improved overall-survival. [Display omitted] • Compared to men, women with STEMI were older and had more comorbidities. • Women had higher rates of inpatient complications, received percutaneous coronary intervention less often, and when adjusted for the risk profile, the female sex was associated with reduced overall survival. • After STEMI, women received all four guideline-recommended drugs less often, although the prognosis improved with the increase in these drugs. [ABSTRACT FROM AUTHOR]

Cardiac catheterization procedures require intra-arterial contrast agent administration. The amount of utilized contrast agent volume (CAV) is a risk factor for contrast-induced side-effects. In this study, we assess trends and associations of CAV utilization in diagnostic cardiac catheterization (DCC) and percutaneous coronary intervention (PCI). All cardiac catheterization procedures reported for quality assurance between 2008 and 2018 in Germany were included. Available site, patient, and procedural parameters were analyzed. CAV was reported by interventional cardiologists after the procedure. Multivariate linear regression analysis was used to identify associated factors with clinically relevant CAV change (defined >10 ml). We included 9,106,511 procedures (DCC: 5,401,525, PCI: 3,704,986). Median CAV of all DCCs was 80 (interquartile range, IQR 60–110) ml. CAV for DCC significantly lowered by 22% during the retrospective observational period (p < 0.001) and significantly varied according to the leading diagnosis (p < 0.001). We observed significant 2.5-fold variability of CAV between the catheterization laboratories (5th percentile: 40 ml, 95th percentile: 100 ml, p < 0.001). Median CAV for PCIs was 170 (IQR 120–223) ml. Independent associated factors for clinically relevant higher CAV use in PCI were male gender, coronary-artery-bypass-graft surgery, total coronary occlusion, ostial lesions, and multi-vessel coronary artery disease (all p < 0.001). The results of this large, multi-center study show significant lowering of CAV in clinical routine DCC, however, the large inter-site variability demonstrates the need for additional CAV reduction to further lower the risk of adverse side-effects. In PCI practice, CAV should be limited in the presence of the identified high contrast-dose scenarios. • Contrast agent volume utilization for diagnostic cardiac catheterization in clinical practice decreased by 22% during the last decade • Significant 2.5-fold variability of median contrast agent volume between clinical institutions demonstrates the need for further contrast agent reduction in diagnostic cardiac catheterization • Contrast agent volume used for percutaneous coronary intervention in clinical practice remained stable during the last decade • Significant factors for contrast agent increase in percutaneous coronary intervention are prior CABG surgery, PCI of total coronary occlusion, ostial lesions, and multi-vessel CAD disease [ABSTRACT FROM AUTHOR]

Objective: In patients with ST-segment elevation myocardial infarction (STEMI), disturbed cardiac repolarization before percutaneous coronary intervention (PCI) is a risk factor for malignant ventricular arrhythmia. We tested the hypothesis that sleep-disordered breathing (SDB) in patients with STEMI is associated with disturbed cardiac repolarization.Methods: Thirty-three patients with STEMI who underwent PCI were prospectively enrolled. To assess cardiac repolarization, the heart-rate corrected interval from the peak of the T wave to the end of the T wave (TpTec) and QTc intervals were assessed with 12-lead electrocardiography before PCI, within 24 h after PCI, and 12 weeks after PCI. SDB defined as an apnea-hypopnea index (AHI) ≥15 per hour was diagnosed by polysomnography.Results: Before PCI, patients with SDB had a significantly prolonged TpTec interval compared to patients without SDB (133 vs 104 ms, p = 0.035). Within 24 h after PCI, the TpTec interval was 107 vs 92 ms (p = 0.178). QTc intervals showed a similar pattern (pre-PCI: 443 vs 423 ms, p = 0.199; post-PCI: 458 vs 432 ms, p = 0.115). In multiple linear regression analyses, AHI was significantly associated with prolonged TpTec intervals (pre-PCI: B-coefficient = 1.11, 95% confidence interval (CI) 0.48-1.74, p = 0.001; post-PCI: B = 0.97, 95% CI 0.29-1.65, p = 0.007), prolonged QTc intervals (pre-PCI: B = 1.05, 95% CI 0.20-1.91, p = 0.018; post-PCI: B = 1.37, 95% CI 0.51-2.24, p = 0.003), and higher TpTe/QT-ratios (pre-PCI: B = 0.16, 95% CI 0.05-0.27, p = 0.007; post-PCI: B = 0.13, 95% CI < 0.01-0.25, p = 0.036), independent of known risk factors for cardiac arrhythmia.Conclusion: In patients with STEMI, SDB was significantly associated with disturbed cardiac repolarization before and after PCI, independent of known risk factors. These findings suggest that SDB may contribute to the risk of developing malignant ventricular arrhythmia. [ABSTRACT FROM AUTHOR]