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Background We hypothesized that female sex is a treatment effect modifier of blood flow and related 30‐day mortality after primary percutaneous coronary intervention ( PCI ) for ST ‐segment–elevation myocardial infarction and that the magnitude of the effect on outcomes differs depending on delay to hospital presentation. Methods and Results We identified 2596 patients enrolled in the ISACS ‐ TC (International Survey of Acute Coronary Syndromes in Transitional Countries) registry from 2010 to 2016. Primary outcome was the occurrence of 30‐day mortality. Key secondary outcome was the rate of suboptimal post‐ PCI Thrombolysis in Myocardial Infarction ( TIMI ; flow grade 0–2). Multivariate logistic regression and inverse probability of treatment weighted models were adjusted for baseline clinical covariates. We characterized patient outcomes associated with a delay from symptom onset to hospital presentation of ≤120 minutes. In multivariable regression models, female sex was associated with postprocedural TIMI flow grade 0 to 2 (odds ratio [ OR ], 1.68; 95% CI , 1.15–2.44) and higher mortality ( OR, 1.72; 95% CI , 1.02–2.90). Using inverse probability of treatment weighting, 30‐day mortality was higher in women compared with men (4.8% versus 2.5%; OR , 2.00; 95% CI , 1.27–3.15). Likewise, we found a significant sex difference in post‐ PCI TIMI flow grade 0 to 2 (8.8% versus 5.0%; OR , 1.83; 95% CI , 1.31–2.56). The sex gap in mortality was no longer significant for patients having hospital presentation of ≤120 minutes ( OR , 1.28; 95% CI , 0.35–4.69). Sex difference in post‐ PCI TIMI flow grade was consistent regardless of time to hospital presentation. Conclusions Delay to hospital presentation and suboptimal post‐ PCI TIMI flow grade are variables independently associated with excess mortality in women, suggesting complementary mechanisms of reduced survival. Clinical Trial Registration URL : http://www.clinicaltrials.gov . Unique identifier: NCT 01218776.

BACKGROUND ST-segment elevation myocardial infarction (STEMI) complicated by symptoms of acute de novo heart failure is associated with excess mortality. Whether development of heart failure and its outcomes differ by sex is unknown. OBJECTIVES This study sought to examine the relationships among sex, acute heart failure, and related outcomes after STEMI in patients with no prior history of heart failure recorded at baseline. METHODS Patients were recruited from a network of hospitals in the ISACS-TC (International Survey of Acute Coronary Syndromes in Transitional Countries) registry (NCT01218776). Main outcome measures were incidence of Killip class >= II at hospital presentation and risk-adjusted 30-day mortality rates were estimated using inverse probability of weighting and logistic regression models. RESULTS This study included 10,443 patients (3,112 women). After covariate adjustment and matching for age, cardiovascular risk factors, comorbidities, disease severity, and delay to hospital presentation, the incidence of de novo heart failure at hospital presentation was significantly higher for women than for men (25.1% vs. 20.0%, odds ratio [OR]: 1.34; 95% confidence interval [CI]: 1.21 to 1.48). Women with de novo heart failure had higher 30-day mortality than did their male counterparts (25.1% vs. 20.6%; OR: 1.29; 95% CI: 1.05 to 1.58). The sex-related difference in mortality rates was still apparent in patients with de novo heart failure undergoing reperfusion therapy after hospital presentation (21.3% vs. 15.7%; OR: 1.45; 95% CI: 1.07 to 1.96). CONCLUSIONS Women are at higher risk to develop de novo heart failure after STEMI and women with de novo heart failure have worse survival than do their male counterparts. Therefore, de novo heart failure is a key feature to explain mortality gap after STEMI among women and men. (C) 2019 by the American College of Cardiology Foundation.

Background and aims: An increasing proportion of women believe that smoking few cigarettes daily substantially reduces their risk of developing cardiovascular (CV) related disorders. The effect of low intensity smoking is still largely understudied. We investigated the relation among sex, age, cigarette smoking and ST segment elevation myocardial infarction (STEMI) as initial manifestation of CV disease. Methods: We analyzed data of 50,713 acute coronary syndrome patients with no prior manifestation of CV disease from the ISACS-Archives (NCT04008173) registry. We compared the rates of STEMI in current smokers (n = 11,530) versus nonsmokers (n = 39,183). Results: In the young middle age group (

The usefulness of β-blockers has been questioned for patients who have hypertension without a prior manifestation of coronary heart disease or heart failure. In addition, sex-based differences in the efficacy of β-blockers for prevention of heart failure during acute myocardial ischemia have never been evaluated. We explored whether the effect of β-blocker therapy varied according to the sex among patients with hypertension who have no prior history of cardiovascular disease. Data were drawn from the ISACS (International Survey of Acute Coronary Syndromes)-Archives. The study population consisted of 13 764 patients presenting with acute coronary syndromes. There were 2590 patients in whom hypertension was treated previously with β-blocker (954 women and 1636 men). Primary outcome measure was the incidence of heart failure according to Killip class classification. Subsidiary analyses were conducted to estimate the association between heart failure and all-cause mortality at 30 days. Outcome rates were assessed using the inverse probability of treatment weighting and logistic regression models. Estimates were compared by test of interaction on the log scale. Among patients taking β-blockers before admission, there was an absolute difference of 4.6% between women and men in the rate of heart failure (Killip ≥2) at hospital presentation (21.3% versus 16.7%; relative risk ratio, 1.35 [95% CI, 1.10–1.65]). On the opposite, the rate of heart failure was approximately similar among women and men who did not receive β-blockers (17.2% versus 16.1%; relative risk ratio, 1.09 [95% CI, 0.97–1.21]). The test of interaction identified a significant ( P =0.034) association between sex and β-blocker therapy. Heart failure was predictive of mortality at 30-day either in women (odds ratio, 7.54 [95% CI, 5.78–9.83]) or men (odds ratio, 9.62 [95% CI, 7.67–12.07]). In conclusion, β-blockers use may be an acute precipitant of heart failure in new-onset coronary heart disease among women, but not men. Heart failure increases the risk of death. Registration URL: https://www.clinicaltrials.gov . Unique identifier: NCT04008173.

Background: It remains uncertain whether female sex is itself a strong risk factor for worse outcomes in ACS. We hypothesized that sex differences in vulnerability to heart failure after ACS may modify the association between sex and outcomes Methods: Data were drawn from the ISACS-Archives network of registries (NCT04008173). The study population consisted of 87,812 patients with known time from symptom onset to hospital presentation. Participants were stratified by ACS subtypes: STEMI and NSTEACS Data on presenting heart failure symptoms were collected from medical record abstraction. Heart failure was categorized as Killip class >2. Time from symptom onset to hospital presentation was categorized as early (≤120 minutes) or late (>120 minutes). The primary outcome measure was 30-day mortality. Estimates were performed using a parametric balancing strategy by weighting and compared by test of interaction on the log scale Results: Among the study sample, 30922 (35.2%) patients were women. Patient outcomes varied according to subtype of ACS. The mortality rates at 30-days were significantly higher among women vs men in STEMI (RR:1.65; 95%CI: 1.56-1.73) compared with NSTEACS (RR:1.18; 95%CI: 1.09-1.28; P interaction

Background: Controversies persist about the role of statins in primary prevention of atherosclerotic cardiovascular disease (ASCVD). We sought to determine whether initiation of statin therapy for primary prevention of cardiovascular disease may lead to a reduction in cardiovascular outcomes across age, sex, and risk factors. Methods: We investigated 14,542 patients aged ≥40 years presenting to hospitals with ACS as first manifestation of cardiovascular disease from 2010 to 2019 in the ISACS Archives network of registries (NCT04008173). Individual risk of STEMI, acute heart failure (HF) on hospital admission and all-cause 30-day mortality were assessed using inverse probability of treatment weighting models matching for concomitant medications. Acute HF was defined as Killip class≥ 2. Estimates were compared by test of interaction on the log scale. Results: Among the study population 12.5% of patients were on statin therapy. Mean (SD) estimated 10-year risk for ASCVD was 25.8 (17.9) in statin users vs 22.5 (17.1) in non-users. The risk of STEMI was much lower in the statin-users than in the non-users (relative risk [RR] ratio 0.64; 95%CI 0.58-0.71). This effect persisted in both sexes, but was substantially stronger in men (absolute reduction: 11.5%; RR ratio: 0.61, 95%CI: 0.54-0.69) than in women (absolute reduction: 6.3%; RR ratio: 0.76, 95% CI: 0.64-0.90, p interaction=0.02). These benefits translated into reductions in acute HF on hospital admission with statin therapy for both women (RR ratio 0.66, 95%CI: 0.53-0.83) and men (RR ratio 0.74, 95%CI 0.62-0.89; p interaction=0.22). No effect on the rates of STEMI or acute HF was noted in patients with 10-year ASCVD risk lower than 10% for either sex. Acute HF was predictive of mortality at 30 days both in women and in men. Conclusion: Preventive statin therapy reduces the risk of STEMI as initial manifestation of cardiovascular disease and acute HF with potential benefits in mortality. The most gain is attained in male subjects with 10-year CV risk equal or more than 10%.

There is a rising concern about the environmental status of the seas of our planet. Such concern regards several kinds of anthropogenic activities and their impact on the marine ecosystems. Part of the adverse effects are recognised to be due to various forms of acoustic emissions generated by human activities related to the exploitation of sea resources and to shipping. The main regulatory bodies at international level, in the last decade, have started to look into the problem with the aim of monitoring the environmental status of marine waters, in particular the acoustical aspects) identify the situations where the anthropogenic impact is most intrusive and study and promote future actions for its control and reduction. The present work reports about the development and validation of a simulation tool able to predict the noise field generated by a set of ships sailing in a specific area. The simulation is based on real traffic data derived from the Automatic Identification System (AIS) normally used to monitor shipping traffic and on specific data characterising the environment of the zone of interest. The tool is meant to provide the Regulator with a means to study the present situation (with on-line AIS data) and/or study the effectiveness of possible measures devoted to reduce the acoustical impact of shipping by design and/or operative requirements. Motivation, bases and characteristics of the developed procedure are described in the paper, where a first validation of the tool is presented on the basis of data regarding a sea area off Barcelona (Spain). Data include AIS records, environmental parameters and underwater sound levels surveyed by an hydrophone placed in the area. The work has been developed in the framework of the collaborative project AQUO (Achieve QUieter Oceans by shipping noise footprint reduction), funded by the European Commission within a call of the 7th Framework Programme dedicated to the assessment and mitigation of noise impacts of the maritime transport on the marine environment, coordinated topic “The Ocean of Tomorrow”.

We investigate the impact of cooperative relaying on uplink multi-user (MU) wireless video transmission. We formulate the problem as an MU Markov decision process (MDP) that explicitly considers the cooperation at the physical layer and the medium access control sublayer, the video users' heterogeneous traffic characteristics, and the dynamically varying network conditions. Although MDPs notoriously suffer from the curse of dimensionality, our study shows that the complexity of the MU-MDP can be mitigated. Our simulation results show that cooperation allows users with feeble direct signals to achieve improvements in video quality on the order of 5-10 dB peak signal-to-noise ratio, with less than 0.8 dB quality loss by users with strong direct signals.