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Background: As acute myocardial infarction (AMI) prevalence is increasing because of lifestyle changes, the incidence of atypical symptoms in acute coronary syndrome (ACS) is rising and making misdiagnosing of this fatal event more probable. To better approach the patients with atypical symptoms, we tend to present a rare case of AMI with wrist pain. Case report: A 41-year-old man presented to the emergency room (ER) with severe both-hand wrist pain and mild epigastric pain. His electrocardiogram (ECG) showed anterior ST-elevation myocardial infarction (MI) with an ejection fraction of 35–40%. His angiography showed severe left anterior descending artery (LAD), and first obtuse marginal artery (OM1) artery stenosis. He underwent Primary percutaneous coronary intervention (PCI). The patient recovered without serious complications and was discharged the day after PCI. Discussion: In this rare case of AMI with wrist pain, it is important to know that atypical symptoms can be present at various levels of symptoms, which prevents future misdiagnosis. [ABSTRACT FROM AUTHOR]

Background: Left ventricular (LV) thrombus has a higher incidence among patients with anterior ST-elevation myocardial infarction (STEMI) when compared to other types of acute myocardial infarction and is associated with worse prognosis. The management of LV thrombus diagnosis remains challenging. Contrast echocardiography (transthoracic echocardiography, TTE) has shown potential in improving the accuracy for its diagnosis, thereby influencing treatment strategies concerning antithrombotic/anticoagulation therapy. The aim of this study was to assess the effectiveness of contrast TTE as a routine screening method for detecting LV thrombus in the acute phase of anterior STEMI. Methods: A prospective, single center, randomized controlled trial was conducted among patients with anterior STEMI. The study group underwent contrast TTE, while the control group received a conventional approach. Demographical, clinical, and diagnostic data were collected. Thrombus detection rates were compared between groups. Results: A total of 68 patients were included (32 in the study group and 36 in the control group). No substantial baseline differences were observed between groups. Thrombus detection rate was 25.0% in the study group and 13.9% in the control group, however these results did not reach statistical significance (P = 0.24). The prevalence of anterior/apical aneurysm was higher in the study group (46.9% vs. 22.2%, P = 0.03). Conclusions: Conventional TTE may be adequate for diagnosing LV thrombus in the acute phase of anterior STEMI; however, further larger-scale and multicenter studies are necessary to obtain more robust and conclusive results. Ultrasound contrast may play a significant role in the detection of anterior/apical aneurysms, which are known risk factors for the subsequent development of thrombus. Trial registration: NCT06480929 (ClinicalTrials.gov, Retrospectively registered). [ABSTRACT FROM AUTHOR]

Background To date, vitamin K anticoagulants are the only recommended long-term therapy for mechanical heart valves. Bleeding episodes, thromboembolic events, and international normalized ratio monitoring are difficult and prevalent complications for these patients. This report reflects the late mechanical aortic valve dysfunction after long-term low molecular weight heparin therapy. Case summary A 66-year-old male patient underwent mechanical aortic valve replacement in 2007. He was administered therapeutic doses of enoxaparin for nearly 12 years due to warfarin-related bleeding complications and labile international normalized ratios. However, he experienced multiple cardiovascular and cerebrovascular thromboembolic events, including an anterolateral ST-elevation myocardial infarction with left anterior descending artery thrombus, treated with thrombus aspiration and stenting. The patient was eventually admitted with symptoms and signs of acute heart failure, and echocardiography, fluoroscopy, and a cardiac computed tomography detected mechanical aortic valve prosthesis dysfunction, with an immobile leaflet and pannus. The patient demonstrated no improvement despite switching to unfractionated heparin, and he ultimately underwent redo aortic bioprosthetic valve surgery with a favourable outcome. Discussion Low molecular weight heparin is prescribed for patients with aortic mechanical valves who are intolerant to vitamin K antagonists or as bridging in certain situations. Anti-Xa factor monitoring should be considered for long-term prescriptions. [ABSTRACT FROM AUTHOR]

Objective: In this study, we explored the determinants of ventricular aneurysm development following acute myocardial infarction (AMI), thereby prompting timely interventions to enhance patient prognosis. Methods: In this retrospective cohort analysis, we evaluated 297 AMI patients admitted to the First People's Hospital of Changzhou. The study was structured as follows. Comprehensive baseline data collection included hematological evaluations, ECG, echocardiography, and coronary angiography upon admission. Within 3 months post-AMI, cardiac ultrasounds were administered to detect ventricular aneurysm development. Univariate and multivariate logistic regression analysis were employed to pinpoint the determinants of ventricular aneurysm formation. Subsequently, a predictive model was formulated for ventricular aneurysm post-AMI. Moreover, the diagnostic efficacy of this model was appraised using the ROC curves. Results: In our analysis of 291 AMI patients, spanning an age range of 32–91 years, 247 were male (84.9%). At the conclusion of a 3-month observational period, the cohort bifurcated into two subsets: 278 patients without ventricular aneurysm and 13 with evident ventricular aneurysm. Distinguishing features of the ventricular aneurysm subgroup were markedly higher values for age, B-type natriuretic peptide(BNP), Left atrium(LA), Left ventricular end-diastolic dimension (LEVDD), left ventricular end systolic diameter (LVEWD), E-wave velocity (E), Left atrial volume (LAV), E/A ratio (E/A), E/e ratio (E/e), ECG with elevated adjacent four leads(4 ST-Elevation), and anterior wall myocardial infarction(AWMI) compared to their counterparts (p < 0.05). Among the singular predictive factors, total cholesterol (TC) emerged as the most significant predictor for ventricular aneurysm development, exhibiting an AUC of 0.704. However, upon crafting a multifactorial model that incorporated gender, TC, an elevated ST-segment in adjacent four leads, and anterior wall infarction, its diagnostic capability: notably surpassed that of the standalone TC, yielding an AUC of 0.883 (z = -9.405, p = 0.000) as opposed to 0.704. Multivariate predictive model included gender, total cholesterol, ST elevation in 4 adjacent leads, anterior myocardial infarction, the multivariate predictive model showed better diagnostic efficacy than single factor index TC (AUC: 0. 883 vs. 0.704,z =-9.405, p = 0.000), it also improved predictive power for correctly reclassifying ventricular aneurysm occurrence in patients with AMI, NRI = 28.42% (95% CI: 6.29-50.55%; p = 0.012). Decision curve analysis showed that the use of combination model had a positive net benefit. Conclusion: Lipid combined with ECG model after myocardial infarction could be used to predict the formation of ventricular aneurysm and aimed to optimize and adjust treatment strategies. [ABSTRACT FROM AUTHOR]

Background: The research explores the predictive efficacy of the neutrophil-to-lymphocyte ratio (NLR) in conjunction with the Global Registry of Acute Coronary Events (GRACEs) score for inhospital major adverse cardiovascular events (MACEs) among acute ST-segment elevation myocardial infarction (STEMI) subjects with primary percutaneous coronary intervention (PCI) history. Materials and Methods: Patients were categorized into MACE (n = 58) and non-MACE cohorts (n = 184) based on MACE occurrence events during hospitalization. The predictive value of the NLR, GRACE score, and their combination for inhospital MACE events in STEMI subjects was assessed by the receiver operating characteristic curve (ROC). Results: NLR (8.99 [5.06, 12.01] vs. 5.15 [3.13, 7.66]) and GRACE scores (159.62 ± 43.39 vs. 116.96 ± 28.15) within MACE group notably surpassed the non-MACE group (P < 0.05). ROC curve analysis demonstrated that the area under the curve (AUC) for NLR in forecasting inhospital MACE events was 0. 72 (95% confidence interval [CI]: 0.645-0.795), with 0.655 sensitivity and 0.723 specificity, and optimal cutoff value as 7.01. The AUC for the GRACE score was 0.791 (95% CI: 0.717-0.865), with 0.862 sensitivity and 0.598 specificity, and the optimal cutoff value was 121.5. The combined AUC of NLR and GRACE score was 0.814 (95% CI: 0.745-0.884), with 0.707 sensitivity and 0.837 specificity. Conclusion: Both NLR and GRACE score independently predict inhospital MACE events in STEMI patients post-PCI. Integration of the NLR and GRACE score enhances accuracy in forecasting inhospital MACE event occurrences. [ABSTRACT FROM AUTHOR]

Objective: To analyze the prevalence of no-reflow and the 30-day mortality in a university center in a middle-income country. Method: We analyzed 2463 patients who underwent primary PCI from January 2006 to December 2021. The outcome measure was 30-day mortality. Results: Of a total of 2463 patients, no-reflow phenomenon was found in 413 (16.8%) patients, 30-day mortality was 16.7 vs. 4.29% (p < 0.001). Patients with no-reflow were older 60 (53-69.5) vs. 59 (51-66) (p = 0.001), with a higher delay in onset of symptom to emergency department arrival 270 vs. 247 min (p = 0.001). No-reflow patients also had had fewer previous myocardial infarction, 11.6 vs. 18.4 (p = 0.001) and a Killip class 1, 37 vs. 26% (p < 0.001). No-reflow patients were more likely to have an anterior myocardial infarction (55.4 vs. 47.8%; p = 0.005) and initial TIMI flow 0 (76 vs. 68%; p < 0.001). Conclusion: No-reflow occurred in 16.8% of STEMI patients undergoing primary PCI and was more likely with older age, delayed presentation, anterior myocardial infarction and Killip class > 1. No-reflow was associated with a higher mortality at 30-day follow-up. [ABSTRACT FROM AUTHOR]

Cardiac remodeling in rats with post-infarction chronic heart failure caused by anterior transmural myocardial infarction leads to an atypical location of areas of positive and negative cardioelectric potentials on the body surface before the onset of the PII-wave on the ECG in the limb leads, which is a sign of increased heterogeneity of atrial depolarization associated with the appearance of additional excitation focus in the left atrium. A course of therapy with fabomotizole leads to a decrease in the heterogeneity of atrial depolarization at the initial stages of the formation of the cardioelectric field of the atria on the body surface before the onset of the PII-wave, thereby producing an antiarrhythmic effect. [ABSTRACT FROM AUTHOR]

BACKGROUND: People with human immunodeficiency virus (HIV) infection (PWH) are at higher risk of myocardial infarction (MI) than those without HIV. About half of MIs in PWH are type 2 (T2MI), resulting from mismatch between myocardial oxygen supply and demand, in contrast to type 1 MI (T1MI), which is due to primary plaque rupture or coronary thrombosis. Despite worse survival and rising incidence in the general population, evidence-based treatment recommendations for T2MI are lacking. We used polygenic risk scores (PRS) to explore genetic mechanisms of T2MI compared to T1MI in PWH. METHODS: We derived 115 PRS for MI-related traits in 9541 PWH enrolled in the Centers for AIDS Research Network of Integrated Clinical Systems cohort with adjudicated T1MI and T2MI. We applied multivariate logistic regression analyses to determine the association with T1MI and T2MI. Based on initial findings, we performed gene set enrichment analysis of the top variants composing PRS associated with T2MI. RESULTS: We found that T1MI was strongly associated with PRS for cardiovascular disease, lipid profiles, and metabolic traits. In contrast, PRS for alcohol dependence and cholecystitis, significantly enriched in energy metabolism pathways, were predictive of T2MI risk. The association remained after the adjustment for actual alcohol consumption. CONCLUSIONS: We demonstrate distinct genetic traits associated with T1MI and T2MI among PWH further highlighting their etiological differences and supporting the role of energy regulation in T2MI pathogenesis.

Objective: Unusual or unexpected effect of treatment Background: Spontaneous coronary artery dissection can present with acute coronary syndrome, ventricular arrhythmias, or sudden cardiac death. Implantable cardioverter-defibrillator placement in patients with spontaneous coronary artery dissection is controversial. The purpose of publishing this case is to inform physicians of potential benefits of implantable cardioverter-defibrillator implantation in patients with spontaneous coronary artery dissection. Case Report: A 55-year-old woman presented with chest pain, with an electrocardiogram revealing anterior ST-elevation myocardial infarction and troponin peak of 53.8 ng/mL. Coronary angiography revealed mid-left anterior descending artery occlusion, with appearance of spontaneous coronary artery dissection that was not amenable to revascularization. The decision was made to treat medically. In recovery, the patient experienced ventricular fibrillation arrest. The patient was defibrillated once with achievement of return of spontaneous circulation. An Impella CP was placed to stabilize the patient. After the patient was stabilized, an implantable cardiovert-er-defibrillator was placed. Conclusions: Data on potential benefits of implantable cardioverter-defibrillator placement in patients with spontaneous coronary artery dissection are limited. Most patients with spontaneous coronary artery dissection recover normal coronary architecture; however, there are no guidelines for implantable cardioverter-defibrillator placement in patients with spontaneous coronary artery dissection. Patients with spontaneous coronary artery dissection with high-risk features may benefit from implantable cardioverter-defibrillator for secondary prevention of ventricular arrhythmia and sudden cardiac death, as shown with this case. [ABSTRACT FROM AUTHOR]

Introduction: The incidence of Acute Coronary Syndrome (ACS) in the young population has begun to rise. There is not enough data regarding the characteristics of young patients with ACS. Aim: To evaluate risk factors, clinical and angiographic profile of young patients with ACS. Materials and Methods: A prospective observational study was conducted from December 2017 to December 2020 at SSWH, Burdwan Medical College and Hospital, Burdwan, West Bengal, Kolkata, India among 100 patients. Patients with ACS and aged =45 years were enrolled in the study. Patients were divided into two groups: patients with and without obstructive Coronary Artery Disease (CAD). Clinical parameters and coronary angiography data were collected and analysed. The p-value <0.05 was considered significant. Results: The mean age of the study participants was 37.42±5.18 years, and 82 (82%) participants were male. Smoking was the most common risk factor observed in 71 (71%) of the study population, and the majority of these patients had obstructive CAD. The young population suffered more with a high incidence of ST-segment Elevation Myocardial Infarction (STEMI), with 37 (56.06%) had Anterior Wall Myocardial Infarction (AWMI). When analysed angiographically, Obstructive CAD was most commonly found 82 (82%); among those with obstructive CAD, Single-vessel diseases were predominant in 47 (47%) individuals. The percentage of stable angina was significantly higher among patients with obstructive CAD (53.6%) compared to non obstructive CAD (11.1%), (p=0.001). Conclusion: Two leading risk factors, smoking, and tobacco, were significantly associated with the onset of young ACS. The prevalence of single-vessel disease was higher in young patients with ACS compared to double and triple-vessel disease. [ABSTRACT FROM AUTHOR]

Background Metastatic tumours, notably lung cancer, can cause conditions resembling acute myocardial infarctions (AMIs), contributing to the minor percentage of AMIs unrelated to coronary atherosclerosis. These instances necessitate specialized diagnostic and therapeutic approaches due to the distinct underlying pathology. Case summary We report a case of a 65-year-old male with metastatic lung cancer presenting with prolonged angina pectoris. Elevated troponin and creatine kinase levels led to emergency catheterization, revealing a total occlusion of the distal left coronary artery attributed to tumour infiltration. Intervention attempts were unsuccessful, and given the palliative context, other revascularization strategies were not pursued. Two-dimensional transthoracic echocardiogram depicted tumour invasion at the heart's apex, confirming the diagnosis. The patient passed away shortly after receiving palliative radiation therapy. Discussion This case underscores the challenges in diagnosing and managing myocardial infiltrations from metastatic tumours mimicking AMI. It accentuates the importance of imaging studies for accurate diagnosis and the critical evaluation of intervention strategies, highlighting the need for focused palliative care in such complex scenarios. [ABSTRACT FROM AUTHOR]

Background: The efficacy and safety of low-pressure balloon pre-dilatation before intracoronary pro-urokinase (pro-UK) in preventing no-reflow during percutaneous coronary intervention (PCI) remains unknown. This study aimed to evaluate the clinical outcomes of intracoronary pro-UK combined with low-pressure balloon pre-dilatation in patients with anterior ST-segment-elevation myocardial infarction (STEMI). Methods: This was a randomized, single-blind, investigator-initiated trial that included 179 patients diagnosed with acute anterior STEMI. All patients were eligible for PCI and were randomized into two groups: intracoronary pro-UK combined with (ICPpD group, n = 90) or without (ICP group, n = 89) low-pressure balloon pre-dilatation. The main efficacy endpoint was complete epicardial and myocardial reperfusion. The safety endpoints were major adverse cardiovascular events (MACEs), which were analyzed at 12 months follow-up. Results: Patients in the ICPpD group presented significantly higher TIMI myocardial perfusion grade 3 (TMPG3) compared to those in the ICP group (77.78% versus 68.54%, P = 0.013), and STR ≥ 70% after PCI 30 min (34.44% versus 26.97%, P = 0.047) or after PCI 90 min (40.0% versus 31.46%, P = 0.044). MACEs occurred in 23 patients (25.56%) in the ICPpD group and in 32 patients (35.96%) in the ICP group. There was no difference in hemorrhagic complications during hospitalization between the groups. Conclusion: Patients with acute anterior STEMI presented more complete epicardial and myocardial reperfusion with adjunctive low-pressure balloon pre-dilatation before intracoronary pro-UK during PCI. Trial registration: 2019xkj213. [ABSTRACT FROM AUTHOR]

Objective: This study investigates the in-hospital outcomes of patients presenting with Anterior Wall Myocardial Infarction (AWMI) and Right Bundle Branch Block (RBBB) during the primary Percutaneous Coronary Intervention (PCI) era. It aims to assess the impact of primary PCI on these patients and identify factors contributing to poor outcomes. Methodology: A prospective observational study was conducted at the Department of Cardiology, Hayatabad Medical Complex (HMC), Peshawar, Pakistan. The study enrolled 150 patients diagnosed with AWMI and RBBB, undergoing reperfusion therapy. Data on demographics, clinical characteristics, and treatment outcomes were collected and analyzed using IBM SPSS version 21.0. Results: Among the 150 patients included in the study, there was a balanced gender distribution with a mean age of 51.15 years. The majority of patients, 136 (90.7%), survived their hospital stay. Primary PCI was significantly associated with improved survival rates compared to medical management alone. Factors such as TIMI and GRACE risk scores were crucial for risk stratification, highlighting the need for personalized management strategies. Conclusion: The findings underscore the effectiveness of primary PCI in improving in-hospital outcomes for patients with AWMI and RBBB. This study highlights the necessity of timely reperfusion therapy and personalized risk stratification to enhance patient prognosis. By documenting the impact of primary PCI and identifying factors leading to poor outcomes, this research provides valuable insights that aid in the optimization of treatment protocols for this high-risk patient group. [ABSTRACT FROM AUTHOR]

Electronic cigarettes (or e-cigarettes) and vape products have multisystemic adverse effects despite being advertised as a safer smoking alternative and cessation device. We present a 22-year-old Filipino male with sudden chest pain. He had no known comorbidities but had a two-year history of daily vape use. Work-up revealed elevated cardiac markers, anteroseptal ST-elevation myocardial infarction, hypokinesia of the anterior wall and interventricular septum, and an ejection fraction of 30%. Chest radiography showed consolidation pneumonia but culture studies and Biofire Pneumonia Panel were negative for microbial detection. Coronary angiography revealed chronic total obstruction of the mid-left anterior descending (LAD) and right coronary arteries (RCA). Percutaneous coronary angioplasty of the LAD was done. The patient eventually required mechanical ventilation for progressive respiratory distress but expired after three hospital days despite medical management. This case highlights a possible association between vape use and the development of both acute lung injury and myocardial infarction. [ABSTRACT FROM AUTHOR]

Background Left ventricular aneurysms (LVAs) are a well-appreciated complication of acute myocardial infarction. Ventricular aneurysms involving the left ventricle (LV) typically evolve as a result of anterior myocardial infarction and are associated with greater morbidity, complication rates, and hospital resource utilization. Incidence of LVA is decreasing with advent of modern reperfusion therapies; however, in the setting of excess morbidity, clinicians must maintain an appreciation for their appearance to allow timely diagnosis and individualized care. Case summary This case report describes the clinical history, investigation, appearance, and management of a patient with calcified apical LVA with history of previous anterior ST-elevation myocardial infarction. The patient was initially admitted for elective coronary angiography in the setting of worsening exertional dyspnoea and subsequently underwent coronary artery bypass graft, aneurysm resection, and LV reconstruction. Discussion Left ventricular aneurysms are an uncommon complication experienced in the modern era of acute myocardial infarction and current reperfusion therapies, but remain an important cause of excess morbidity and complication. Evidence-based guidelines for the diagnosis, workup, and subsequent management of LVAs are lacking. The imaging findings presented in this case serve as an important reminder of the appearance of LVAs so that timely diagnosis and individualized care considerations can be made. [ABSTRACT FROM AUTHOR]

In the thrombolytic care era, myocardial infarction in cigarette smokers was associated with better six-month outcomes compared to non-smokers. Aims: We tested the hypothesis that in patients with anterior myocardial infarction with ST-segment elevation (STEMI) treated with primary percutaneous coronary intervention (PPCI), cigarette smoking is associated with better coronary artery flow, myocardial perfusion, and left ventricular systolic function. Methods: Ninety-nine patients (sixty-six smokers) with anterior STEMI treated with PPCI were studied. Angiographic coronary artery flow TIMI grades, myocardial blush grades (MBGs) before and after PPCI, ST-segment elevation resolution, maximal troponin I and creatine phosphokinase blood levels, left ventricular echocardiographic systolic function as well as left anterior descending coronary artery (LAD) velocity parameters at admission and at discharge were evaluated. Results: Smokers and non-smokers were treated similarly. In smokers, the age was significantly younger, 54 ± 10, compared to non-smokers, 71.8 ± 10 years, p < 0.05, and had a lower prevalence of women, 13.6% compared to 36.6%. TIMI and MBG before and after PPCI were similar between smokers and non-smokers. Smokers had a lower prevalence of complete ST elevation resolution, 33% compared to 50% in non-smokers. Diastolic LAD velocity and integral were lower in smokers, p < 0.05. Maximal biomarker blood levels as well as LV systolic function at admission and on discharge were similar. Conclusions: Cigarette smokers with anterior STEMI treated with PPCI were younger with a lower prevalence of women and of complete ST elevation resolution and had lower LAD diastolic velocity and integral late after PPCI. However, angiographic parameters and LV systolic function parameters were similar. [ABSTRACT FROM AUTHOR]

The body surface potential mapping of the heart during the period of ventricular depolarization and the inotropic function of the ventricles were studied in rats under conditions of a translational model of post-infarction chronic heart failure developed by us. We revealed a statistically significant (p<0.001) correlation between the left-ventricular ejection fraction and the values of the maximum positive and negative extrema of the cardioelectric field on the body surface of rats with post-infarction chronic heart failure caused by anterior transmural myocardial infarction. The calculated linear regression equations have high predictive efficiency, which makes it possible to use the amplitude characteristics of the heart cardioelectric field as a marker of the development of chronic heart failure. [ABSTRACT FROM AUTHOR]

Background: The current guidelines have discouraged the routine use of intra-aortic balloon pump (IABP) in cardiogenic shock complicating acute coronary syndrome (ACS). Since then, the trend of IABP utilization in ACS has been declining. Nevertheless, the guidelines still preserve the recommendation of IABP use in hemodynamic instability or cardiogenic shock caused by post myocardial infarction (MI) ventricular septal rupture (VSR). Case presentation: A 46-years-old diabetic Southeast Asian female was referred from a peripheral facility with intractable heart failure despite treatment with vasoactive agents and diuretics for five days. The ECG suggested a recent anteroseptal myocardial infarction with normal high-sensitivity troponin-I value. The echocardiography detected a regional wall motion abnormality and a 10 mm wide ventricular septal defect. Invasive coronary angiography revealed a severe two-vessel coronary artery disease. We planned a delayed surgical strategy with preoperative optimization using IABP as a bridge to surgery. IABP implantation followed by significant hemodynamic improvement and rapid resolution of heart failure without any inotrope support. Afterwards, coronary artery bypass grafting (CABG) and VSR surgical repair were performed. We safely removed IABP on the third postoperative day with proper weaning and minimal vasoactive support. Conclusion: We report a case where IABP still provided benefits for a patient with intractable heart failure caused by undetermined onset MI complicated by VSR. The use of IABP in such a case is in accordance with the recommendation of the current guidelines. Several studies showed that IABP use during preoperative optimization in the case of post-MI VSR was associated with survival benefits. [ABSTRACT FROM AUTHOR]

Background: Acute coronary syndrome (ACS) is the most serious manifestation of coronary heart disease. The Infarction Code (according to its initialism in Spanish, CI: Código Infarto) program aims to improve the care of these patients. Objective: To describe the clinical presentation and outcomes of CI program in a coronary care unit (CCU). Material and methods: A database of a CCU with 5 years of consecutive records was analyzed. Patients diagnosed with ACS were included. The groups with acute myocardial infarction with and without ST-segment elevation were compared using Student's t, Mann-Whitney U and chi-squared tests. We calculated the relative risk (RR) and 95% confidence intervals (95% CI) of cardiovascular risk factors for mortality. Results: A total of 4678 subjects were analyzed, 78.7% men, mean age 63 years (± 10.7). 80.76% presented acute myocardial infarction with positive ST-segment elevation and fibrinolytic was granted in 60.8% of cases. Percutaneous coronary intervention was performed in 81.4% of patients, which was successful in 82.5% of events. Patients classified as CI presented mortality of 6.8% vs. 11.7%, p = 0.001. Invasive mechanical ventilation had an RR of 26.58 (95% CI: 20.61-34.3) and circulatory shock an RR of 20.86 (95% CI: 16.16-26.93). Conclusions: The CI program decreased mortality by 4.9%. Early fibrinolysis and successful coronary angiography are protective factors for mortality within CCU. [ABSTRACT FROM AUTHOR]

This case report documents the clinical journey of a 22-year-old male who was initially diagnosed with Rheumatoid Arthritis (RA) and later, at the age of 11, with Juvenile Idiopathic Arthritis (JIA). The patient manifested atypical symptoms, primarily marked by sudden and intense chest pain accompanied by sweating, leading to a collapse during his emergency room visit. Medical evaluation revealed an extensive myocardial infarction affecting the anterior wall. The patient underwent a successful percutaneous coronary intervention targeting the left anterior descending artery. This case underscores the rare incidence of acute coronary syndrome in young patients with a history of JIA. [ABSTRACT FROM AUTHOR]

Background: Ventricular remodeling after acute anterior wall ST-segment elevation myocardial infarction (AAMI) is an important factor in occurrence of heart failure which additionally results in poor prognosis. Therefore, the treatment of ventricular remodeling needs to be further optimized. Compound Danshen Dripping Pills (CDDP), a traditional Chinese medicine, exerts a protective effect on microcirculatory disturbance caused by ischemia-reperfusion injury and attenuates ventricular remodeling after myocardial infarction. Objective: This study is designed to evaluate the efficacy and safety of CDDP in improving ventricular remodeling and cardiac function after AAMI on a larger scale. Methods: This study is a multi-center, randomized, double-blind, placebo-controlled, parallel-group clinical trial. The total of 268 patients with AAMI after primary percutaneous coronary intervention (pPCI) will be randomly assigned 1:1 to the CDDP group (n=134) and control group (n=134) with a follow-up of 48 weeks. Both groups will be treated with standard therapy of ST-segment elevation myocardial infarction (STEMI), with the CDDP group administrating 20 tablets of CDDP before pPCI and 10 tablets 3 times daily after pPCI, and the control group treated with a placebo simultaneously. The primary endpoint is 48-week echocardiographic outcomes including left ventricular ejection fraction (LVEF), left ventricular end-diastolic volume index (LVEDVI), and left ventricular end-systolic volume index (LVESVI). The secondary endpoint includes the change in N terminal pro-B-type natriuretic peptide (NT-proBNP) level, arrhythmias, and cardiovascular events (death, cardiac arrest, or cardiopulmonary resuscitation, rehospitalization due to heart failure or angina pectoris, deterioration of cardiac function, and stroke). Investigators and patients are both blinded to the allocated treatment. Discussion: This prospective study will investigate the efficacy and safety of CDDP in improving ventricular remodeling and cardiac function in patients undergoing pPCI for a first AAMI. Patients in the CDDP group will be compared with those in the control group. If certified to be effective, CDDP treatment in AAMI will probably be advised on a larger scale. (Trial registration No. NCT05000411) [ABSTRACT FROM AUTHOR]

Background and Objectives. Recent guidelines have downgraded the routine use of the intra-aortic balloon pump (IABP) in patients with cardiogenic shock (CS) due to ST-elevation myocardial infarction (STEMI). Despite this, its use in clinical practice remains high. The aim of this study was to evaluate the prognostic impact of the IABP in patients with STEMI complicated by CS undergoing primary PCI (pPCI), focusing on patients with anterior MI in whom a major benefit has been previously hypothesized. Materials and Methods. We enrolled 2958 consecutive patients undergoing pPCI for STEMI in our department from 2005 to 2018. Propensity score matching and mortality analysis were performed. Results. CS occurred in 246 patients (8.3%); among these patients, 145 (60%) had anterior AMI. In the propensity-matched analysis, the use of the IABP was associated with a lower 30-day mortality (39.3% vs. 60.9%, p = 0.032) in the subgroup of patients with anterior STEMI. Conversely, in the whole group of CS patients and in the subgroup of patients with non-anterior STEMI, IABP use did not have a significant impact on mortality. Conclusions. The use of the IABP in cases of STEMI complicated by CS was found to improve survival in patients with anterior infarction. Prospective studies are needed before abandoning or markedly limiting the use of the IABP in this clinical setting. [ABSTRACT FROM AUTHOR]

Coronary artery disease (CAD) commonly occurs in individuals over the age of 45 years. Several studies categorize “young” individuals with CAD or acute myocardial infarction as those below the ages of 40 and 45. The protection provided by young age has slowly been eroded by risk factors like smoking, obesity, and sedentary lifestyle that are becoming more common among young individuals. We report a case of 21-year-old male with family history of premature coronary artery disease, who presented with acute anterior wall ST elevation myocardial infarction. Coronary angiogram revealed 100% thrombotic occlusion of proximal left anterior descending coronary artery. Further evaluation of the lesion morphology using optical coherence tomography revealed plaque erosion. Thrombolysis in Myocardial Infarction coronary grade III flow was achieved after thrombus aspiration. Stent deployment was deferred to avoid the need for lifelong medication and its associated side effects in a young patient. Due to their anti-thrombotic qualities, we also recommend using novel oral anticoagulants in this situation for short-term therapy.

This article presents a case report of a patient who experienced a rare complication of a pulmonary embolism following a heart attack. The patient received prompt diagnosis and treatment, resulting in a positive outcome. The article highlights the importance of understanding the underlying causes and implementing appropriate evaluation and treatment strategies for this condition. The document is a list of references for a research paper on various topics related to cardiovascular health, including hypercoagulability, chest pain, and ST-segment elevation. The paper was received and accepted for publication in 2023. [Extracted from the article]

This article discusses the use of ultrasonography in determining the appropriate access site for percutaneous coronary intervention (PCI). While radial access (RA) has been recommended as the preferred access site, the novel technique of distal radial access (DRA) has gained popularity due to improved patient and operator comfort. The article presents a case study of a patient who underwent PCI via the right transradial approach but experienced complications due to the misplacement of the sheath in the narrow palmar superficial branch of the radial artery. The authors argue that preprocedural ultrasonography can help prevent such complications and advocate for its use in selecting between radial and distal radial approaches. [Extracted from the article]

Objective To explore the predictive factors of earlyleft ventricular mural thrombus （LVT） after emergency PCI in elderly patients with acute anterior myocardial infarction. Methods A total of 435 elderly patients with anterior myocardial infarction who underwent emergency PCI in our hospital from January 2020 to January 2023 were continuously included in the study. Fortypatients with LVT formation during hospitalization were selected as LVT group; another eighty patients with a gender to age ratio of 1:2from non LVT patients asnon-LVT group. The risk factors and predictive factors of LVT were explored. Results The incidence of LVT was 9.2%. Continuous ST segment elevation at discharge, LVEF ≤ 0.40, ventricular aneurysm, STB ≥ 8 hours, postoperative TIMI blood flow < grade 3, and increased D-dimer/fibrinogen ratio （DFR） were risk factors for LVT formation （P < 0.05）. ROC curve analysis showed that DFR ≥ 0.30 had a sensitivity of 72.5% and a specificity of 78.7% for predicting LVT （AUC = 0.834, P < 0.01）. Conclusion Continuous ST segment elevation at discharge, LVEF ≤ 0.40, ventricular aneurysm, STB ≥ 8 hours, postoperative TIMI blood flow < grade 3, and increased DFR are independent predictive factors for early LVT. DFR has good predictive value for LVT. [ABSTRACT FROM AUTHOR]

Acute mesenteric ischaemia is divided into different clinical entities which are usually considered separately. Here we report a case of acute mesenteric ischaemia complicated with acute anterior myocardial infarction. The clinical picture suggested that non-occlusive mesenteric ischaemia and acute mesenteric arterial thrombosis were both present in this case. Thus, non-occlusive and occlusive ischaemia may coexist in a coordinated and perceptible pattern. [ABSTRACT FROM AUTHOR]

Introduction: Post-myocardial infarction ventricular septal rupture (post-MI-VSR) is a dreaded complication with high mortality. There is a varied survival pattern among patients who have undergone surgical repair. Aim: To assess the survival rates in patients who underwent surgical repair for post-MI-VSR in a single centre. Materials and Methods: A retrospective observational study was conducted in the Department of Cardiothoracic Surgery at Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, Karnataka, India. The patient records from January 2005 to December 2020, who underwent surgical repair of post-MI-VSR, were reviewed. The perioperative variables, mortality, and survival data were analysed. Kaplan-Meier analysis was performed to assess the survival time. Results: The mean age of the studied patients was 58.4±7.5 years. A total of 73 patients underwent surgery for post-MI-VSR. A total of 40 (55.80%) were males and 33 (45.20%) were females. Overall, 36 (49.32%) patients had diabetes, and 27 (36.99%) had hypertension. Anterior Myocardial Infarction (MI) (n=56, 76.71%) was the most common location of MI. The mean Cardiopulmonary Bypass (CPB) and clamp times were 144.05±59.09 and 105.38±38.34 minutes, respectively. The mean survival time was 2619.564 days {95% Confidence Interval (CI) 2105.936 to 3133.192}. Conclusions: As revascularisation confers a significant survival advantage, VSR repair with concomitant Coronary Artery Bypass Graft (CABG) appears beneficial. [ABSTRACT FROM AUTHOR]

Current myocardial infarction treatments focus on improving hemodynamics rather than addressing the problem of lost myocardium impairing left ventricular function. Epicardial infarct repair with a bioactive patch placed on the ischemic area is an emerging approach to promote endogenous myocardial repair. We report the use of a second-generation CorMatrix-extracellular matrix (ECM) patch as an adjunct to surgical revascularization in treating a young patient with diffuse, multivessel coronary artery disease unamenable to PCI and a large anterior myocardial infarction. The progressive myocardial scar shrinkage and increase in left ventricular ejection fraction from 10 to 51% are generally not observed with surgical revascularization therapy alone, suggesting this new patch has adjunctive potential to current revascularization therapy. [ABSTRACT FROM AUTHOR]

Background: Acute coronary syndrome (ACS) accounts for a quarter of all-cause mortality, with substantial loss of productivity and socio-economic implications. Analyses of the clinical presentation, age- and gender-specific differences, and mortality pattern are decisive in determining the clinical outcome of a patient. Aims and Objectives: The primary objective was to determine the in-hospital and 30th day outcomes in patients with ACS. The secondary objectives were to study cardiometabolic risk factors, the clinical presentation, and the clinical course of the patients with ACS during hospitalization. Materials and Methods: The present study was conducted for 1-year duration involving 110 patients diagnosed with ACS. The patients’ data pertaining to socio-demographic information, clinical features, details of hospitalization, and treatment modalities were collected. The outcomes based on mortality and major adverse cardiovascular events (MACE) were evaluated in two phases: (a) in-hospital and (b) at the 30th day from the date of hospitalization. Results: Out of 110 patients hospitalized with a diagnosis of ACS, the majority were male (71.82%), and their mean age was 58.45±9.18 years. Hypertension, obesity, smoking, and family history of ACS were reported by 40%, 30%, 30%, and 27.27% of patients, respectively. Chest pain was the commonest symptom, followed by sweating and radiating pain. The mean duration of hospitalization was 6.345±2.46 days. ST-segment elevation myocardial infarction (STEMI) was the commonest type of ACS, with a predominance of anterior wall myocardial infarction (MI). The mean door-to-needle time was 43.53±7.75 min, and 29.1% of patients underwent thrombolysis. During hospitalization, improvement and MACE were observed in 73.64% and 26.36% of patients, respectively. 30-day outcome MACE was significantly higher among STEMI patients. Mortality was significantly higher in patients with <30% left ventricular ejection fraction (LVEF), both during hospitalization and after 30 days. Conclusion: The present study revealed that the mean age of presentation was 58.45±9.18 years. Anterior wall MI was the commonest pattern of STEMI. Thus, the type of MACE and mortality were significantly higher among patients with either LVEF <30% or STEMI. Thus, type and severity of ACS, along with clinical presentation, existing risk factors, and access to medical care, play a determining role in the clinical outcome of a patient. [ABSTRACT FROM AUTHOR]

Background and aims: Primary percutaneous coronary intervention (PCI) is regarded as the most preferred strategy in ST-segment elevation myocardial infarction (STEMI). Thrombolysis in Myocardial Infarction (TIMI) flow grade has been an important and cohesive predictor of outcomes in STEMI patients. We sought to evaluate potential variables associated with the risk of suboptimal TIMI flow after PCI in patients with anterior wall STEMI. Methods: We evaluated 107 patients admitted to our hospital between 1 January 2019 and 31 December 2021 with a diagnosis of anterior wall STEMI treated with primary PCI. Results: Suboptimal TIMI flow grade (≤2) after PCI occurred in 14 (13%) patients while grade 3 was found in 93 (87%) of them presenting with anterior wall STEMI. Failure to achieve optimal TIMI 3 flow grade after PCI was associated with lower TIMI grade prior to PCI (OR 0.5477, 95% CI 0.2589–0.9324, p = 0.02), greater troponin concentration before (OR 1.0001, 95% CI 1–1.0001, p = 0.0028) and after PCI (OR 1.0001, 95% CI 1–1.0001, p = 0.0452) as well as lower mean minimal systolic blood pressure (OR 0.9653, 95% CI 0.9271–0.9985, p = 0.04). Conclusions: Among predictors of suboptimal TIMI flow grade after PCI, we noted lower TIMI grade flow pre-PCI, greater serum troponin concentrations in the periprocedural period and lower mean minimal systolic blood pressure. [ABSTRACT FROM AUTHOR]

I ...Things are not always what they seem; the first appearance deceives many; the intelligence of a few perceives what has been carefully hidden.... i - Plato, I Phaedrus i A 66-year-old man with a history of previous anterior myocardial infarction and complete percutaneous revascularization attended a routine cardiological follow-up visit. Although it could look like a blocked premature atrial contraction, this isolated P wave is identically coupled to the sinus QRS complex, as the retrograde P waves that follow * and ** beats, arguing against a premature atrial contraction. B, JHE simulates a ventricular extrasystole with left bundle branch block (conduction to ventricles through right bundle branch) and retrograde conduction to the atria. [Extracted from the article]

Background: Elevation of ST segment in right sided chest leads V3R/V4R, which is commonly encountered in right ventricular myocardial infarction during acute inferior wall myocardial infarction, may also occur in patients with anterior STEMI. However, the clinical impact of this finding in the setting of anterior myocardial infarction has not been thoroughly investigated. This study aimed to investigate the correlation between the conus branch of right coronary artery and the pattern of ST-segment elevation in lead V1 and right sided chest leads V3R and/or V4R during acute anterior wall myocardial infarction and the in hospital outcome of this finding. Objectives: This study aimed to investigate the impact of the size and course of the right coronary artery conus branch and the pattern of ST segment elevation in leads V1 and V3R in patients with acute anterior myocardial infarction and also the prognostic value of the conus branch was assessed by the in hospital outcome of those patients. Methods: Patients with acute anterior myocardial infarction, upon admission, a standard 12 leads ECG with additional right sided chest leads V3R and V4R were obtained and coronary angiography performed within 48 hours of onset of chest pain. Patients were selected purposively after meeting the inclusion and exclusion criteria. A total ninety patients were selected and were allocated into two groups, 45 patients in each group based on the size and course of the conus branch; either large (≥0.5mm, reaching IVS) or small (<0.5mm, not reaching IVS). ECG and angiographic findings, as well as in hospital clinical outcome including heart failure, arrythmia, conduction disturbances, death and MACE were compared between two groups. The statistical tests of significance including chi-square, fisher's exact and unpaired t-test were done as appropriate. Results: ST segment elevation in right-sided leads and heart failure were significantly higher in the small conus branch group than the large conus branch group (91.1% vs24.4%, P<0.001 and 64.4%vs 20.0%, P<0.001 respectively). The presence of small conus branch was associated with significantly lower LVEF than large conus branch (43.62±3.31vs 46.02±4.03, P=0.003). There was no significant difference in mortality, arrythmia and conduction disturbance between the two groups. There was a significant difference in MACE between the two groups (64.4% in small conus group vs22.2% in large conus group, P<0.001). Conclusion: In patients with anterior MI, small conus branch was associated with higher rates of major adverse cardiac events mostly because of increased rate of acute heart failure. The presence of a large conus branch can protect the right side of the interventricular septum during left anterior descending artery occlusion in acute anterior myocardial infarction. [ABSTRACT FROM AUTHOR]

Diagnostic error is not uncommon and diagnostic accuracy can be improved with the use of problem representation, pre-test probability, and Bayesian analysis for improved clinical reasoning. A 48-year-old female presented as a transfer from another Emergency Department (ED) to our ED with crushing, substernal pain associated with dyspnea, diaphoresis, nausea, and a tingling sensation down both arms with radiation to the back and neck. Troponins were elevated along with an abnormal electrocardiogram. A negative myocardial perfusion scan led to the patient's discharge. The patient presented to the ED 10 days later with an anterior ST-elevation myocardial infarction. An overemphasis on a single testing modality led to diagnostic error and a severe event. The use of pre-test probabilities guided by history-taking can lead to improved interpretation of test results, ultimately improving diagnostic accuracy and preventing serious medical errors. [ABSTRACT FROM AUTHOR]

Objective: The study aimed to evaluate the prognostic value of relative wall thickness (RWT) in the patients with ST-segment elevation myocardial infarction (STEMI). Methods: A total of 866 patients with STEMI admitted in Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School from November 2010 to December 2018 were enrolled in the current study retrospectively. Three methods were used to calculate RWT: RWTPW, RWTIVS+PW and RWTIVS. The included patients were divided according to the median values of RWTPW, RWTIVS+PW, and RWTIVS, respectively. Survival analysis were performed with Kaplan–Meier plot and multivariate Cox proportional hazard model was established to evaluate the adjusted hazard ratio of the three kinds of RWT for all cause death, cardiac death and MACE (major adverse cardiac death). Results: There was no significance for the survival analysis between the low and high groups of RWTPW, RWTIVS+PW and RWTIVS at 30 days and 12 months. Nonetheless, the cumulative incidence of all cause death and cardiac death in the low group of RWTPW and RWTIVS+PW was higher than those in the high group at 60 months. The cumulative incidence of MACE in the low group of RWTPW was higher than the high group at 60 months. Multivariate Cox regression model showed that RWTPW were inversely associated with long-term cardiac death and MACE in STEMI patients. In the subgroup analysis, three calculations of RWT had no predictive value for the patients with anterior myocardial infarction. By contrast, RWTPW was the most stable independent predictor for the long-term outcomes of the patients with non-anterior myocardial infarction. Conclusion: RWTPW, RWTIVS+PW and RWTIVS had no predictive value for the long-term clinical outcomes of patients with anterior myocardial infarction, whereas RWTPW was a reliable predictor for all cause death, cardiac death and MACE in patients with non-anterior myocardial infarction. Key message: RWT is an index which can quantified the concentricity or eccentricity of the left ventricular using a simple formula. There are three methods to calculate RWT: RWTPW = 2 × PWth/LVDd; RWTIVS+PW = (IVSth + PWth)/LVDd; RWTIVS = 2 × IVSth/LVDd(IVSth: intraventricular septal thickness; LVDd: LV diameter at the end of diastole; PWth: posterior wall thickness). From our study we concluded that RWTPW, RWTIVS+PW and RWTIVS had no predictive value for the long-term clinical outcomes of patients with anterior myocardial infarction, whereas RWTPW was the most effective predictor of patients with non-anterior myocardial infarction. [ABSTRACT FROM AUTHOR]

Background: Left ventricular thrombosis confers a life-threatening risk of systemic embolism; therefore, it requires prompt intervention. Although anticoagulation is the primary treatment, surgery is indicated in instances of large or/and mobile thrombus or when there is potential for recovery of ventricular contraction. However, standard left ventriculoplasty with thrombectomy carries risks of cardiac dysfunction due to left ventriculotomy. Case presentation: A 70-year-old man developed chest pain and vomiting 3 weeks before presenting to our hospital. A chest radiograph showed substantial cardiomegaly and mild pulmonary congestion; N-terminal pro-brain natriuretic peptide (5698 ng/L) was substantially increased, and troponin T (56 ng/L) levels were slightly above reference values. Transthoracic echocardiography showed akinesis of the anteroseptal and apical segments with an ejection fraction reduced to approximately 20%. We diagnosed subacute myocardial infarction and initiated pharmacotherapy. On hospital day 7, coronary angiography revealed a left anterior descending artery lesion with 99% stenosis; percutaneous coronary intervention was successfully performed the next day. That same day, transthoracic echocardiography revealed a large mobile left ventricular apical thrombus without any left ventricular aneurysm, and heparin therapy was initiated. On hospital day 10, three-dimensional computed tomography confirmed the location of an apical thrombus, and we planned a fourth intercostal approach. A thrombectomy was performed on hospital day 11 using an endoscopic trans-mitral approach with a right thoracotomy to avoid a left ventriculotomy. The patient was discharged from intensive care on postoperative day 2 under heparin and warfarin therapy. The subsequent postoperative course was uneventful, and he was discharged on postoperative day 14 with a vitamin K antagonist. At the 6-month follow-up, there was no recurrence of thrombus in the left ventricle and Ejection Fraction had improved to 46%. Conclusions: Totally endoscopic thrombectomy via a trans-mitral approach through right thoracotomy was effective for a left ventricular thrombus. When concomitant coronary artery bypass grafting or left ventriculoplasty are not required, this procedure can be an effective option. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to determine the frequency of multi-vessel coronary artery disease (MVD) in diabetic patients presenting with anterior wall myocardial infarction (AWMI). Methodology: In this descriptive cross-sectional study, we included diabetic patients with AWMI aged between 30-70 years. Patients with either a history of clinical diagnosis based on HbA1c >6.5% / fasting blood sugar > 126 mg/dL/ random blood sugar >200 mg/dL or taking anti-hyperglycemic treatment for at least six months were taken as diabetics. Patients with angiographic evidence of significant (>70%) stenosis in two major epicardial vessels were categorized for MVD. Results: A total of 196 diabetic patients with anterior wall MI were included. Of which the mean age was 57.6±12.3 years, and 128 (65.3%) were male patients. MVD was observed in 91 (46.4%) patients. The MVD was found to be associated with a BMI ≥ 24 kg/m² with a frequency of 51.5% vs. 35%; p=0.033, as compared to a BMI < 24 kg/m². The frequency of MVD was higher among middle-class patients, with a frequency of 36.2%, 58.3%, and 39.5% (p=0.014) for patients in the low, middle, and upper classes, respectively. Similarly, the MVD frequency was higher among patients with hypertension (60.6% vs. 28.7%) and hyperlipidemia (62.1% vs. 38.5%) compared to non-hypertensive and non-hyperlipidemia, respectively. Conclusion: It is to be concluded that MVD is highly prevalent in diabetic patients presenting with AWMI, and it was found to be associated with BMI ≥ 24 kg/m², middle class, hypertension, and hyperlipidemia. [ABSTRACT FROM AUTHOR]

Introduction: Over the past years, mapping and ablation techniques for the treatment of ventricular tachycardia (VT) have evolved rapidly. High Density (HD) substrate mapping is now routine and pre‐procedural imaging is increasingly used. The additional value of these techniques for long‐term VT‐free survival is not clear. Methods: We compared baseline and procedural characteristics, procedural success, safety and outcome of mapping and ablation of ventricular tachycardia in patients with ischemic heart disease between two groups. (1) Low Density (LD) group: VT mapping and ablation with a 4 mm single tip catheter (2) HD group: HD substrate mapping with the Pentaray (Biosense Webster, USA) or HD Grid (Abbott, USA) catheter and ablation with a 4 mm single tip catheter. Results: VT ablation was performed in 133 patients (71 patients in LD group and 62 patients in HD group). The median follow‐up was 5.0 years in LD group and 2.0 years in HD group. One‐, two‐, and five‐year VT recurrence rates were 47%, 56%, and 65% in the LD group versus 39%, 50%, and 55% in the HD group (log‐rank test for VT recurrence p =.70). One‐, two‐, and five‐year ICD shock recurrence rates were 14%, 18%, and 24% in the LD group versus 8%, 15%, and 19% in the HD group (log‐rank test for ICD‐shock p =.79). All‐cause mortality, cardiac (non‐arrhythmic), and arrhythmic death, were similar in both groups. Severe procedural complications (tamponade, stroke, or procedural death) occurred in four patients (5%, 1 vascular, 3 tamponade) in the LD group versus two patients (3%, both tamponade) in the HD group (NS). In univariate and multivariable analysis, only a higher LVEF was significantly associated with VT‐free survival. HD mapping was not significantly associated with VT‐free survival. Anterior infarct location and age were significantly associated with ICD recurrent shock in both univariate and multivariable analyses. Conclusions: In patients with ischemic cardiomyopathy, a HD substrate mapping, and ablation strategy did not lead to higher VT‐free survival and shock‐free survival compared to a single tip mapping and ablation strategy. In this study, only LVF is an independent predictor for VT recurrence. Anterior infarct location and age predict recurrent ICD shocks. [ABSTRACT FROM AUTHOR]

Congenital coronary artery anomalies are rare and represent 0.24-0.46% of all congenital heart defects. The most common is an anomaly in which the left coronary artery arises from the pulmonary artery (ALCAPA), also known as a Bland-White-Garland syndrome. Nonspecific symptoms typically appear at 2-3 months of age. We present the case of a 10-week-old boy admitted to the hospital due to cough and dyspnea, with suspicion of a respiratory tract infection with no clinical improvement after standard therapy. The chest X-ray revealed cardiomegaly. The electrocardiogram showed signs of anterolateral infarction. Echocardiography revealed signs of dilatated cardiomyopathy and color Doppler was of great value in establishing a final diagnosis. After confirming the diagnosis of ALCAPA in computed tomography angiography, the patient was operated on, with a good outcome. [ABSTRACT FROM AUTHOR]