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The Coronavirus disease 2019 (COVID-19) pandemic has changed the way patients seek medical attention and how medical services are provided. We sought to compare characteristics, clinical course, and outcomes of patients presenting with acute myocardial infarction (AMI) during the pandemic compared with before it. This is a multicenter, retrospective cohort study of consecutive COVID-19 negative patients with AMI in Lithuania from March 11, 2020 to April 20, 2020 compared with patients admitted with the same diagnosis during the same period in 2019. All patients underwent angiography. Six-month follow-up was obtained for all patients. A total of 269 patients were included in this study, 107 (40.8%) of whom presented during the pandemic. Median pain-to-door times were significantly longer (858 [quartile 1=360, quartile 3 = 2,600] vs 385.5 [200, 745] minutes, p

Background. Sarcopenia is an age-related condition, defined by the muscle decline, impaired physical function, and deterioration in muscle tissue quality. The main cause for the interest of Sarcopenia is the apparent association of this disease with patient morbidity, mortality, prolonged hospitalization, and deterioration in the quality of life. The purpose of this review is to present a brief account of some age-related biological changes that may contribute to Sarcopenia. Materials and methods. We reviewed the literature based on data from Medline (PubMed), Google Scholar, Science Direct, and CAIRN. The research was done on articles in English or French, published before the 31st of December 2019. The research was based on the following Mesh headings (Medical Subject Headings): “sarcopenia” AND “aging” OR “muscle loss”. Conclusions. A multitude of etiological factors influences the aging-associated deterioration of muscle mass and function that constitute Sarcopenia, such as imbalanced protein synthesis and degradation, decreasing anabolic hormones, inflammation, and age-related morphological changes, which are described in the review. In the future, research might be conducted for identifying specific biomarkers, which may lead to an opportunity to assess and monitor the disease non-invasively, granting possibilities for a more efficient therapeutic approach.

Background: There are very limited scientific data available on cardiac troponin I release after intermittent exercise. To know the different factors that mediate cTnI release after exercise is of concern for scientists. In this regard, our study is based on two major goals: 1) to evaluate the cTnI release in individuals during a sports match; and 2) to understand the impact of the status of the athlete (biological) on the release of individual cTnI. Methods: A total of 44 players, including “22 adult professional [PFP]: 24.2±4.5 years, 22 adult amateur [AFP]: 26.5±3.6 years” were involved in a match simulated as real. Successive observations of cTnI release were obtained at different settings such as at rest, pre-exercise, and instant-post-exercise at regular intervals of 3, 6, and then 24 h post-exercise. Results: From the obtained results it was observed that the individual highest values were vastly varied, with higher levels of cTnI release baseline and post-exercise for PFP players as compared to those of AFP (all p < 0.05). Moreover, the cTnI levels were increased (peak post: 0.024 [0.004-0.244] μg/L; p < 0.05). Additionally, the cTnI peak values surpassed the upper limit of reference in 77.3% of PFP (17 PFP). Conclusions: Our study data results affirm that the cTnI release is highly affected by the status of athletes. The cTnI release is enhanced by intermittent exercise.

Introduction The SYNTAX score is an angiographic tool used to grade coronary artery disease (CAD) burden and complexity. SYNTAX score predicts 1-year adverse outcomes for patients with multivessel and/or left main CAD who undergo percutaneous coronary intervention (PCI). However, the relationship of the pre-PCI (basal) SYNTAX score to long-term outcomes of patients with ST-elevation myocardial infarction (STEMI) treated with primary PCI is unknown. Purpose To evaluate the short-term (in-hospital) and long-term (5-year) prognostic value of basal SYNTAX score in patients with STEMI who were treated with primary PCI. Methods We retrospectively reviewed records of consecutive patients presenting with STEMI, admitted from January 2014 to December 2016, who underwent primary PCI. We categorized patients into two groups according to SYNTAX scores: low/intermediate (≤22, 23–32) and high (>33). We utilized the Cochran-Armitage test for trend, Chi-square test, Fisher's Exact test, and Kruskal-Wallis tests to assess differences in baseline characteristics and outcomes as appropriate. We used logistic regression and calculated the area under the receiver operating characteristic curve to determine the prognostic ability of SYNTAX score groups on 5-year outcomes for stroke, myocardial infarction (MI), cardiovascular death, target vessel revascularization (TVR), all-cause mortality, and major adverse cardiovascular events (MACE). Results There were 768 patients who met inclusion criteria for this study. 559 (72.8%) patients were in the low/intermediate SYNTAX score group and 209 (27.2%) patients were in the high SYNTAX score group. Baseline characteristics did not differ significantly between the two groups. In-hospital pacemaker implantation, in-hospital stent thrombosis, and in-hospital cardiac arrest and in-hospital death were rare and did not differ according to SYNTAX group (Table 1). However, the odds of experiencing stroke, MI, cardiovascular death, TVR, all-cause mortality, and MACE at 5 years were significantly higher in the high SYNTAX score group, even when adjusted for heart failure, total cholesterol, and age. The associated areas under the receiver operating characteristic curve indicated moderate-to-strong prognostic ability of the basal SYNTAX score (Table 2). Conclusion A high SYNTAX score in patients with STEMI who undergo primary PCI is associated poorer long-term outcomes, compared to patients with an intermediate/low score. This work confirms that a high burden of CAD in patients with STEMI portends a poorer long-term prognosis. Funding Acknowledgement Type of funding sources: None.

Background and Objectives: Serum cortisol has been extensively studied for its role during acute myocardial infarction (AMI). Reports have been inconsistent, with high and low serum cortisol associated with various clinical outcomes. Several publications claim to have developed methods to evaluate cortisol activity by using elements of complete blood count with its differential. This study aims to compare the prognostic value of the cortisol index of Endobiogeny with serum cortisol in AMI patients, and to identify if the risk of mortality in AMI patients can be more precisely assessed by using both troponin I and cortisol index than troponin I alone. Materials and methods: This prospective study included 123 consecutive patients diagnosed with AMI. Diagnostic coronary angiography and revascularization was performed for all patients. Cortisol index was measured on admission, on discharge, and after 6 months. Two year follow-up for all patients was obtained. Results: Our study shows cortisol index peaks at 7–12 h after the onset of AMI, while serum cortisol peaked within 3 h from the onset of AMI. The cortisol index is elevated at admission, then significantly decreases at discharge, furthermore, the decline to its bottom most at 6 months is observed with mean values being constantly elevated. The cortisol index on admission correlated with 24-month mortality. We established combined cut-off values of cortisol index on admission &gt, 100 and troponin I &gt, 1.56 μg/las a prognosticator of poor outcomes for the 24-month period. Conclusions: The cortisol index derived from the global living systems theory of Endobiogeny is more predictive of mortality than serum cortisol. Moreover, a combined assessment of cortisol index and Troponin I during AMI offers more accurate risk stratification of mortality risk than troponin alone.

Background: The optimal management strategy for patients with concurrent coronavirus disease-2019 (COVID-19) infection and ST-segment elevation myocardial infarction (STEMI) is unknown This study describes the clinical characteristics and outcomes in patients with concurrent COVID-19 infection and STEMI treated with fibrinolytic therapy Methods: This is a multicenter retrospective chart review of patients admitted with concurrent COVID-19 infection and STEMI from February 1, 2020, to April 15, 2020 [Formula presented] Results: There were 59 patients treated with fibrinolytic therapy as first-line therapy (Table 1);50 (84 7%) had successful fibrinolysis Alteplase was used in 21 (35 6%) patients, and Tenecteplase in 38 (64 4%) Median peak troponin was 83 [58, 98] ng/ml and median left ventricular ejection fraction after revascularization was 43 5% [40%, 48%] Hemorrhagic stroke occurred in 5 patients (8 6%) Six (10 2%) required invasive mechanical ventilation;5 (8 6%) required cardiac resuscitation;and 4 (6 8%) died (Figure 1) [Formula presented] Conclusion: In this case series of COVID-19 patients presenting with STEMI treated with fibrinolytic therapy, there was a high rate of hemorrhagic stroke (8 6%) Further studies are needed to better understand this treatment approach in this patient population Categories: CORONARY: Acute Coronary Syndromes

Background: The coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has had a major impact on the behavior of patients, as well as on the delivery of healthcare services. With older and more medically vulnerable people tending to stay at home to avoid contracting the virus, it is unclear how the behavior of people with acute myocardial infarction (AMI) has changed. The aim of this study was to determine if delays in presentation and healthcare service delivery for AMI exist during the COVID-19 pandemic compared to the same period a year prior. Methods: In this single-center, retrospective study, we evaluated patients admitted with ST-segment elevation myocardial infarction (STEMI) or non-ST-segment elevation myocardial infarction (NSTEMI) during early months of the COVID-19 pandemic (March 11, 2020 to April 20, 2020) compared to patients admitted with same diagnosis during the same period a year prior. Results: There were 30 and 62 patients who presented with NSTEMI in the pandemic and pre-pandemic eras, respectively. The median pain-to-door time was significantly larger during the pandemic compared to pre-pandemic era (1,885 (880, 5,732) vs. 606 (388, 944) min, P < 0.0001). There was a significant delay in door-to-reperfusion time during the pandemic with a median time of 332 (182, 581) vs. 194 (92, 329) min (P = 0.0371). There were 24 (80%) and 25 (42%) patients who presented after 12 h of pain onset in pandemic and pre-pandemic eras, respectively (P = 0.0006). There were 47 and 60 patients who presented with STEMI during the pandemic timeframe of study and pre-pandemic timeframe, respectively. The median pain-to-door time during the pandemic was significantly larger than that of the pre-pandemic (620 (255, 1,500) vs. 349 (146, 659) min, P = 0.0141). There were 22 (47%) and 14 (24%) patients who presented after 12 h of pain onset in the pandemic and pre-pandemic eras, respectively (P = 0.0127). There was not a significant delay in door-to-reperfusion time (P = 0.9833). There were no differences in in-hospital death, stroke, or length of hospitalization between early and late presenters, as well as between pandemic and pre-pandemic eras. Conclusions: In conclusion, this study found that patients waited significantly longer during the pandemic to seek medical treatment for AMI compared to before the pandemic, and that pandemic-specific protocols may delay revascularization for NSTEMI patients. These findings resulted in more than a threefold increase from the onset of symptoms to revascularization increasing the risks for future complications such as left ventricular dysfunction and cardiovascular death. Efforts should be made to increase patients’ awareness regarding consequences of delayed presentation, and to find a balance between hospital evaluation strategies and goals of minimizing total ischemic time. Cardiol Res. 2020;11(6):386-391 doi: https://doi.org/10.14740/cr1175

There is limited information regarding clinical characteristics and outcomes of patients with SARS-CoV-2 (COVID-19) disease presenting with ST-segment elevation myocardial infarction (STEMI). In this multicenter retrospective study, we reviewed charts of patients admitted with symptomatic COVID-19 infection and STEMI to a total of 4 hospitals spanning Italy, Lithuania, Spain and Iraq from February 1, 2020 to April 15, 2020. A total of 78 patients were included in this study, 49 (63%) of whom were men, with a median age of 65 [58, 71] years, and high comorbidity burden. During hospitalization, 8 (10%) developed acute respiratory distress syndrome, and 14 (18%) required mechanical ventilation. 19 (24%) patients were treated with primary Percutaneous Coronary Intervention (PCI) and 59 (76%) were treated with fibrinolytic therapy. 13 (17%) patients required cardiac resuscitation, and 9 (11%) died. For the 19 patients treated with primary PCI, 8 (42%) required intubation and 8 (42%) required cardiac resuscitation; stent thrombosis occurred in 4 patients (21%). A total of 5 patients (26%) died during hospitalization. 50 (85%) of the 59 patients initially treated with fibrinolytic therapy had successful fibrinolysis. The median time to reperfusion was 27 minutes [20, 34]. Hemorrhagic stroke occurred in 5 patients (9%). Six patients (10%) required invasive mechanical ventilation; 5 (9%) required cardiac resuscitation, and 4 (7%) died. In conclusion, this is the largest case series to-date of COVID-19 positive patients presenting with STEMI and spans 4 countries. We found a high rate of stent thrombosis, indicating a possible need to adapt STEMI management for COVID-19 patients.

Accumulating evidence suggests that influenza and influenza-like illnesses can act as a trigger for acute myocardial infarction. Despite these unprecedented times providers should not overlook acute coronary syndrome (ACS) guidelines, but may choose to modify the recommended approach in situations with confirmed or suspected COVID-19 disease. In this document, we suggest recommendations as to how to triage patients diagnosed with ACSs and provide with algorithms of how to manage the patients and decide the appropriate treatment options in the era of COVID-19 pandemic. We also address the inpatient logistics and discharge to follow-up considerations for the function of already established ACS network during the pandemic. Accumulating evidence suggests that influenza and influenza-like illnesses can act as a trigger for acute myocardial infarction.1, 2, 3, 4 In this document, we suggest recommendations as to how to triage patients diagnosed with acute coronary syndromes (ACSs) and provide with algorithms of how to manage the patients and decide the appropriate treatment options in the era of COVID-19 pandemic. We also address the inpatient logistics and discharge to follow-up considerations for the function of already established ACS network during the pandemic. Definitions To minimize the misunderstanding in COVID-19 case definitions between healthcare workers we recommend adopting the World Health Organization guidelines on case definitions as following:• Confirmed case (COVID-19 +) – a patient with laboratory confirmation of COVID-19 infection, irrespective of clinical signs and symptoms. • Suspected case (COVID-19 +/-) – a patient with acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath), OR a patient with acute respiratory illness (fever and at least one sign/symptom of respiratory disease, e.g., cough, shortness of breath), AND ...[...].

Objectives: Recanalisation of chronic total occlusions (CTOs) in interventional cardiology is one of the most challenging and complex procedures. Currently, no data are available about the impact of BMI on success rates among CTO patients undergoing percutaneous coronary intervention. The aim of this study was to investigate the impact that BMI has on success rates, complications, and procedure characteristics among a large group of CTO patients who underwent percutaneous coronary intervention. Methods: The present study retrospectively included 420 patients who underwent percutaneous coronary intervention for at least one chronic total occlusion in the Hospital of the Lithuanian University of Health Sciences of Kaunas. All patients were grouped by their BMI level based on the World Health Organisation classification. Statistical analyses were performed using SPSS 20.0 software. The value of p 0.05). Conclusion: This retrospective study indicates that BMI has no impact on in-hospital outcomes in patients with chronic total occlusion after percutaneous coronary intervention.

Nowadays it is believed that atherosclerotic plaque formation and coronary artery thrombosis are a result of a cascade of inflammatory processes. Leukocytes are one of the main mediators of the inflammation. We aimed to assess the correlation between leukocytes and long-term mortality in patients

Patients with STEMI undergoing primary percutaneous coronary intervention (PPCI) frequently have suboptimal platelet inhibition in the early hours after the ticagrelor loading dose. It has been hypothesized that early loading dose administration optimizes platelet inhibition in PPCI and, therefore

Advances in stenting technology and procedural technique are changing the role of percutaneous coronary intervention (PCI) in the treatment of left main coronary artery (LMCA) disease. The location of the lesion in LMCA has a great influence on the stenting strategy. In many cases, the length of the

Inflammation plays a key role in the process of the formation of the atherosclerosis and in the pathogenesis of acute coronary syndrome. Myocardial necrosis induces the release of proinflammatory markers. It may even lead to tissue damage and eventually to the development of undesirable events such

Bifurcation percutaneous coronary intervention (PCI) remains a challenging frontier in interventional cardiology. In percutaneous coronary intervention for de novo coronary non-left main bifurcation lesions, the optimal technique for stenting is still a matter of discussion. We sought to determine

The GRACE score is a prospectively studied scoring system used for risk stratification of patients diagnosed with ACS to estimate their in-hospital and 6-month to 3-year mortality. The SYNTAX I score is used to estimate the burden and complexity of coronary artery disease (CAD). The SYNTAX I score