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Funding Acknowledgements Type of funding sources: None. Introduction Although the presence of ventricular arrhythmias (ventricular tachycardia and ventricular fibrillation) in the context of acute coronary syndromes (ACS) has decreased in the era of early reperfusion, their occurrence may lead to fatal consequences. However, clear predisposing or protective factors have not been identified yet. Purpose Our purpose is to describe the prevalence of ventricular arrhythmias before reperfusion treatment in a population of patients hospitalized due to ACS, as well as the possible protective role of chronic intake of beta-blockers, among other factors. Material and methods Retrospective, single-center and observational registry of patients admitted to a Coronary Care Unit from July 2011 to September 2022 with a diagnosis of ACS. The baseline characteristics were described, as well as factors related to diagnosis and treatment. A multivariate analysis was performed to study possible predictors of arrhythmic events. Results A total of 3123 patients diagnosed with ACS were included. 682 patients (21.8%) had beta- blockers as a chronic treatment and 201 patients (7.1%) presented ventricular arrhythmias. In Table 1 we can see the baseline characteristics of both groups, as well as the differences between them. Previous intake of beta-blockers was associated with a lower incidence of ventricular arrhythmias in patients with ST-segment elevation myocardial infarction (STEMI) (11% vs 6%, p 0.002), while no differences were observed between patients without ST-segment elevation myocardial infarction (NSTEMI) (2.3% vs 1.6%, p = 0.435). As shown in the multivariate analysis (Table 2), prior intake of beta-blockers turned out to be a protective factor against the development of ventricular arrhythmias, while ST elevation and worse initial Killip were risk factors. Conclusion Chronic intake of beta-blockers could be a protective factor against the development of ventricular arrhythmias before revascularization in patients diagnosed with acute coronary syndrome, specially those with STEMI.

Funding Acknowledgements Type of funding sources: None. Introduction Atrial fibrillation (AF) and ischemic cardiomyopathy share common risk factors. The aim of the study was to analyse clinical profile and mortality of patients presenting new-diagnosed AF in the context of acute coronary syndrome (ACS). Methods Retrospective, observational study of patients presenting with ACS in Acute Coronary Care Unit (ACCU) between 2011-2022. Baseline, demographic characteristics and clinical outcomes were studied. Results 3161 patients with ACS were admitted to the ACCU during this period, of whom 5.1% presented de-novo AF. The remaining percentage were patients without AF (86.8%) or with previously known AF (8.1%). 73.7% were male and 52.8% of the ACS presented with ST elevation. Baseline characteristics in both groups are shown in Table 1. Most frequent culprit vessel was the anterior descending artery in both groups, followed by right coronary artery. Severe bleeding was significantly more frequent in patients with de-novo AF (25.4% vs 9%, p Conclusion De-novo AF is a relatively uncommon complication in ACS, identifying a high-risk profile patient with higher in-hospital mortality.

Funding Acknowledgements Type of funding sources: None. Introduction The incidence of ventricular tachycardia (VT) and ventricular fibrillation (VF) in the acute phase of infarction (first 24-48 hours) has declined over recent decades, probably due to the uptake of reperfusion strategies and the early use of beta-blockers. However, according to some series, 6–8% of patients still develop hemodynamically significant VT or VF during this phase. Purpose The objective of our study was to evaluate the baseline characteristics of patients who suffered VT or VF in the acute phase of the infarction and to create a predictive model of ventricular arrhythmias in this setting which allow us to anticipate arrhythmic events. Methods We performed an observational, retrospective, and single-centre study carried out through the review of clinical records of patients who suffered an acute myocardial infarction with ST-segment elevation (STEMI) and were admitted in our Coronary Care Unit between July 2011 and August 2022. Results In our cohort we observed 179 episodes of VT/VF (10,7%) in a population of 1668 patients underwent STEMI. The mean age in this subgroup was 61,69±12,61 years old, 78% were males and 56% smokers. Approximately a quarter of the patients were diabetic or obese. There was a very low percentage of previous myocardial infarction (12%) and heart failure (3%) (Table 1). We estimated the best prediction model (Mallows’ Cp=5.12) for VT/VF. The variables included in our model (LL=-435,43) were: male sex, absence of diabetes, smoking habit, use of fibrinolysis, worst Killip at admission and hypotension at admission (Table 2). Conclusion The presence of VT or VF in the acute phase of infarction is still considered a controversial factor in the prognosis of these patients. In our cohort we identified that males, smokers, non-diabetics, and the use of fibrinolysis and the worst haemodynamical situation at admission were independent predictors of developing VT/VF in this context.

Funding Acknowledgements Type of funding sources: None. Introduction Women who suffer Acute Coronary Syndrome (ACS) have worse prognosis, with higher mortality and more complications. These results might be partially influenced by an older age and a higher number of comorbidities in women. Purpose The aim of the study is to analyse gender differences among patients with ACS admitted to our Coronary Care Unit (CCU). Methods Retrospective cohort of all patients with ACS admitted to a CCU between July 2011 and August 2022. Univariate analyses to assess gender influence in intrahospital mortality and complications were carried out. We also performed a multivariate analysis to identify predictive factors of intrahospital mortality. Results 3161 patients were included, with a mean age of 63 years old. Women accounted for 26.4% of patients. Women were older than men (68.9 vs. 61.71 years old), had a higher prevalence of hypertension (72.52% vs. 55.92%), diabetes mellitus (37.5% vs. 32.31%), heart failure and chronic kidney disease. On the other hand, smoking and chronic obstructive pulmonary disease were more frequent in men. In-hospital mortality was higher in women (OR 2.18, IC95% 1.63-2.92; p Treatment differences were observed in the study. Prasugrel, statins, beta-blockers and IECAS were less prescribed in women, while clopidogrel was prescribed more frequently for them. Ticagrelor was prescribed less for women at hospital discharge but no gender differences in in-hospital prescription were identified. Multivariate analysis adjusting for age, comorbidities and complications demonstrated that diabetes mellitus, age, previous chronic kidney disease, severe bleeding and Killip-Kimball category were predictors of mortality. Female sex however did not reach significance in multivariate analysis (OR 1.28, IC95% 0.89-1.84; p=0.169). Conclusion In our sample, women had higher intrahospital mortality and bleeding rates, although mortality differences disappeared after adjusting by age, complications and comorbidities. Pharmacological treatment was lower and less intensive in them. It is crucial to know these differences in order to guarantee a more equitable medical assistance.

Funding Acknowledgements Type of funding sources: None. Introduction Inotropic support is frequently needed after acute coronary syndromes(ACS) at coronary care units(CCU). Despite it has being long time since approval of levosimendan(LV) as inotropic support to cardiogenic shock, dobutamine(DB) still being the basis of this treatment. We think levosimendan is a secure and effective alternative. Purpose To analyse the use of levosimendan and dobutamine done in our ACS patients to determine if we have followed some clear criteria of selection, and try to draw a defined pattern for future use. Method Retrospective, analytic, observational study of all ACS admitted to our CCU between 08/2011- 02/2022. We confront patients treated with dobutamine versus levosimendan. X2, U-Mann Whitney and T-Student were used when necessary. Statistical significance: p-value Result 2881patients were admitted with ACS, 6.49%of them(n: 187) needed ionotropic support. Out of these, 60.96%(n: 114) were supported with dobutamine, 28.88%(n: 54) with levosimedan and 10.16%(n: 19)received in some time both drugs, so were excluded from the analysis. Mean age: 68.43±11.48years old. 66.66%(n: 112) men. 54.76%(n: 92)with persistent ST-segment elevation. No difference was found between groups, neither in past medical history, including cardiovascular risk factors, history of arrhythmias(11.3% of patients), previous use of betablockers(30.4%), antiarrhythmic drugs(0.6%) or having pacemaker(1.2%). 114 patients(67.86%)needed norepinephrine(70.17%with DB and 62.96% LV, p:0.35); 29(17.26%) were supported with intra-aortic balloon pump(20.18% in DB group and 11.11% in LV group, p:0.134), without differences by drug. 62 patients(36.9%) presented atrial fibrillation(33.33% in DB and 44.44% in LV, p:0.166), 58(34.52%)ventricular arrhythmias[sustained ventricular tachycardia/ventricular fibrillation](33.33% in DB and 37.04% in LV, p:0.638). In-hospital mortality of these patients was 29.17%(n:49), 29.82% in DB and 27.77% in LV, p:0.785. In multivariate analysis adjusted by clinic and epidemiologic factors, only cardiogenic shock resulted an independent predictor of in-hospital death. Pattern of use we use DB in those patients with worst Killip-kimball(KK) state(73.54%in DB group with KK-IV vs53.70%in LV´s) and LV in those in intermediate states of instability(38.88%LV in KK-II/III vs 8.84%DB in KK-II/III),p Conclusion In our experience, dobutamine has been the most frequent ionotropic drug used in last 11 years after an acute coronary syndrome. Nevertheless, a substitution by levosimendan trend is evolving. We did not detect differences in complications or prognosis dependent on the inotropic drug used, but the use of dobutamine were predominant in those patients with more severe situation.

Funding Acknowledgements Type of funding sources: None. Introduction Acute coronary syndrome (ACS) is one of the most common health problems in the world, and the leading cause of death. The goals of this study are to determine ACS incidence and the seasonal distribution of ocurrence (Spring/Summer/Autumn/Winter) as well as clinical outcomes per season. Methods Retrospective and observational analysis of consecutive patients hospitalized for ST-elevation myocardial infarction (STEMI) in the Critical Coronary Care Unit (CCCU) of a tertiary center with Mediterranean climate from July 2011 to September 2022. We analyzed the influence of the seasons on the incidence and characteristics of ACS. Results We enrolled a total of 1668 patients: 431 in Winter, 382 in Spring, 405 in Summer and 450 in Autumn, with the baseline characteristics summarized in Table 1. There were no differences in baseline characteristics among the 4 seasons, except for the higher prevalence of obesity in Autumn. There was no statistically significant difference in the incidence of STEMI among seasons, although numerically the highest incidence was recorded in Autumn. The occurrence of ACS was not different according to age or sex. ACS complications were not statistically different among seasons with similar incidence of ventricular arrythmias (VT, VF), invasive mechanical ventilation support, need for inotrope/vasopressor support or development of de-novo atrial fibrillation. In-hospital mortality is less frequent in Autumn, but the differences did not reach statistical significance. Conclusions In this Mediterranean climate cohort, STEMI incidence was higher in Autumn, although no differences in clinical profile or outcomes were found among seasons.

Funding Acknowledgements Type of funding sources: None. Introduction According to the literature, cardiogenic shock in the setting of right ventricular infarction (RV) has a high mortality, even equal to that related to left ventricular anterior infarction in some series. However, as well as many of the topics in acute cardiovascular care, more information is still necessary. Purpose We aim to assess the presence of differences in a cohort of patients with cardiogenic shock due to RV infarction versus anterior infarction. In order to achieve it, we analyzed the differences in baseline characteristics, in-hospital complications and mortality. Methods Descriptive, retrospective, observational, and single-center analysis of patients with ST-elevation myocardial infarction (STEMI) and cardiogenic shock admitted to our Coronary Care Unit between July 2011 and August 2022. We collected the data of patients with cardiogenic shock and compared basal characteristics and prognosis according to the infarction location (anterior or RV). Results A total of 241 patients were included, 30.7% with RV infarction. The mean age of our patients was 68.6 years and 68% were male. There were no differences in the main cardiovascular risk factors between the two groups. Regarding complications during their hospitalization, there was a significantly higher percentage of patients requiring invasive mechanical ventilation and hemodialysis in patients with shock due to anterior infarction. There was also no significant differences in the frequency of ventricular arrhythmias or atrioventricular block. At last, in our cohort, there is a higher in-hospital mortality rate among patients with shock associated with anterior infarction. Conclusions Despite the fact that in some series the high mortality in shock due to RV infarction is similar to the shock caused by anterior infarction, in our study cardiogenic shock related to anterior infarction involve worse prognosis with higher in-hospital mortality, as well as a higher need of mechanical ventilation and renal replacement therapy.

Funding Acknowledgements Type of funding sources: None. Introduction Primary percutaneous coronary intervention (PCI) is the treatment of choice in patients with ST-Elevation Acute Myocardial Infarction (STEMI). Fibrinolysis is relegated to situations in which the intervention cannot be performed in the appropriate time. The indications for fibrinolysis and the criteria for reperfusion were established long ago. Furthermore, in many areas, patients undergoing fibrinolysis therapy represent a minority due to increased access to primary PCI-centres. Purpose We sought to evaluate the effectiveness of fibrinolysis and its safety compared to primary PCI in a real-world analysis. Methods This is a retrospective, observational, single-centre study in which we included patients with STEMI diagnosis admitted to the coronary unit from June-2011 to August-2022. It was differentiated if the patients underwent primary PCI or fibrinolysis (time to catheterization room >2 hours). The efficacy of fibrinolysis regarding the coronary reperfusion capability was analysed using the TIMI coronary grade flow scoring system. Similarly, the need for rescue PCI ( Results 1604 patients were included with an average age of 62 years, in which 137 (8,4%) of them underwent a fibrinolysis strategy. The rate of patients with coronary occlusion (TIMI 0) at the time of PCI was significantly lower in the fibrinolysis group (77.1% vs 36.1%; p Conclusion Fibrinolysis should continue to play an important role in patients who cannot reach PCI on time, given its effectiveness and because it does not represent a significant increase in mortality or adverse effects, except for ventricular arrhythmias. Likewise, the reperfusion criteria seem to be effective in differentiating patients with coronary reperfusion.

Funding Acknowledgements Type of funding sources: None. Introduction Inotropic support after Acute Coronary Syndrome (ACS) is commonly used in Cardiac Critical Care Units (CCU). In this context, dobutamine is widely used, given the large experience with this drug, however recently levosimendan has emerged as a safe and effective alternative. Objective Our objective is to analyze the clinical and prognostic differences between patients treated with dobutamine or levosimendan. We wanted to detect the pattern of use of these drugs and determine the best therapeutic option in our patients. Methods Retrospective observational study of patients admitted for ACS at our CCU between August 2011 and September 2022. Patients treated with dobutamine or levosimendan were included, excluding those who required both drugs. We compared baseline characteristics and clinical events in both therapy groups. Results Our sample included 184 patients admitted for ACS who needed inotropic support during the admission period, with either dobutamine or levosimendan. In our cohort, the mean age was 67.95 +/- 12.04 years. 126 (68.48%) patients received dobutamine and 58 (31.52%) levosimendan. Regarding baseline characteristics of our population, we only found statistically significant differences in Diabetes Mellitus as a Risk Factor (p=0.0172) and Congestive Heart Failure (p=0.0128). We tended to use dobutamine over levosimendan as an inotropic agent in shocked patients (p=0.036). No significant differences were found in other data collected in the clinical history, including noradrenaline or intra aortic balloon pump use, arrhythmic events or in-hospital mortality. Multivariate analysis adjusted for clinical and epidemiological factors detected cardiogenic shock as the only independient predictor of in-hospital mortality. Conclusions In our experience, comparing with levosimendan, dobutamine was the preferred inotropic support in shocked patients. We detected no differences in terms of complications and prognosis between both drugs use.

Funding Acknowledgements Type of funding sources: None. Introduction ST-elevation myocardial infarction (STEMI) requires starting dual antiplatelet therapy as soon as possible. Potent P2Y12 inhibitors (prasugrel and ticagrelor) are preferred over clopidogrel. However, real world data is scarce when comparing potent P2Y12 inhibitors. Purpose To compare in-hospital clinical outcome between patients presenting with STEMI and treated either with prasugrel or ticagrelor. Methods Observational retrospective study of consecutive patients with STEMI admitted to the Cardiac Intensive Care Unit (CICU) between July 2011 and September 2022. Baseline characteristics and clinical outcome were compared between prasugrel and ticagrelor. Results 1100 patients were gathered in this period. 417 of them were treated with prasugrel and 683 with ticagrelor, at medical discretion. Patients in the prasugrel group were younger (56±9 vs 61±12), predominantly male (86% vs 75%) and more commonly current smokers (60% vs 48%). The rest of baseline characteristics are shown in Table 1. We performed several multivariate logistic regression analysis to evaluate in-hospital efficacy and safety of these drugs. Prasugrel showed a lower non-adjusted in-hospital mortality over ticagrelor, that became not statistically significant after adjustment by baseline characteristics (Table 2). No significant differences were found between prasugrel and ticagrelor in respect of bleeding, which was associated with age and Killip-Kimball score. Conclusion In this real-world cohort, prasugrel showed a trend towards lower in-hospital mortality after adjusting for baseline characteristics. No differences in clinical bleeding were found.

Funding Acknowledgements Type of funding sources: Private company. Main funding source(s): The study project was financially supported by a no conditional grant (AstraZeneca) Background/Introduction With the advent of more potent antithrombotic agents, bleeding has emerged as an important safety concern in patients with acute coronary syndrome (ACS). Moreover, hemorrhagic complications have been strongly linked with subsequent mortality in this clinical scenario. Purpose We sought to determine the incidence, types, timing and prognostic relevance of major bleeding events in ACS patients treated with ticagrelor or clopidogrel in contemporary practice. Methods Prospective, observational, multicentre all-comers registry of ACS patients who were intended to receive a 12-month DAPT course with ticagrelor or clopidogrel. Major bleeding was defined as a type 3 or 5 bleed using the Bleeding Academic Research Consortium (BARC) definition. Bleeding was further classified according to the anatomic location. All bleeding episodes were analysed accounting for death as a competing event, using competing risk regression models based on the on-treatment principle (i.e., according to the P2Y12 inhibitor actually received from date of index admission until either time of DAPT cessation plus 14 days or censoring, whichever occurred first). Results Among 2070 patients surviving to hospital discharge (mean age 63 years, 27% women, 62.5% STEMI), 106 (5.3%, 0.6%/year) experienced major bleeding event at a median time of 92 days (interquartile range, 6–187 days) after discharge. Most events (n=59, 55.7%) were BARC type 3a bleeds with 2 fatal bleeds (type 5b). In most cases (53%), the site of bleeding was gastrointestinal, followed by intracranial (n=13, 12%). After adjustments for baseline predictors, ticagrelor was associated with increased but not statistically significant risk of major bleeding compared with clopidogrel (5.6% vs 5.2%, adjusted hazard ratio [aHR] 1.40, 95% CI 0.96 – 2.05; P = .075). Major bleeding was significantly associated with nearly 2-fold higher risk of mortality (aHR 1.94; 95% CI 1.32– 2.86; P = .001), irrespective of P2Y12 inhibitor treatment (P interaction = .159). Conclusion(s) Bleeding was not rare within 1 year after index ACS, with incidence rates peaked at 30 to 60 days post-index admission. The most common bleeding site was gastrointestinal followed by intracranial haemorrhage. Ticagrelor use was not associated with significantly increased risk of major bleeding compared with clopidogrel whereas bleeding led to a nearly 2-fold higher risk of major bleeding.

Funding Acknowledgements Type of funding sources: Public hospital(s). Main funding source(s): Hospital Universitario Virgen Macarena Introduction The time to diagnostic coronary angiography in patients with non-ST-segment elevation acute coronary syndrome (NSTEACS) is considered one of the main prognostic factors in patients at higher risk. Purpose Our aim is to know whether early coronary angiography modifies the prognosis of high-risk patients with NSTEACS and to compare it with performing this procedure later. Methods We include patients admitted to the coronary unit of a 3rd level hospital from January-2015 to December-2021 due to NSTEACS. We plan to examine whether the clinical characteristics of patients in whom early coronary angiography (ECA) is performed, the one performed in the first 24 hours from the onset of symptoms, differ from those in whom it is performed later. Likewise, we analyze the clinical results obtained according to the strategy. Results 811 patients were included (73.4% men and 26.6% women), with an average age of 65, in which 229 (28.2%) of them underwent early coronary angiography. Initially, we found more smokers (44.5% vs 32.8, p = 0.006), a higher frequency of risk electrocardiographic changes (ST decrease> 2 mm in 2 contiguous leads, transient ST segment elevation, left main stem pattern) (p = 0.000), greater need for inotropic drugs (14.5% vs 9.6%, p = 0.045), worse Killip-Kimball (KK) during hospital stay (p = 0.002), as well as higher frequency of cardiogenic shock (p = 0.005) among the patients in whom ECA was performed. Although in-hospital mortality was higher in patients who underwent ECA, no statistically significant difference was found. No differences were obtained in the other cardiovascular risk factors, previous history of acute myocardial infarction, heart failure, stroke, coronary revascularization, initial KK presentation, or post-catheterization LVEF. Conclusions In our study, we observed that in patients admitted for NSTEACS, we performed ECA more frequently in patients with a worse prognosis (pathological alterations in the initial ECG, greater frequency of support with inotropics and worse KK during hospital admission), without observing significant differences in in-hospital mortality or in post-catheterization LVEF. The results suggest that ECA improves the prognosis in the group with the worst clinical profile.