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The unprecedented and rapidly spreading Coronavirus Disease-19 (COVID-19) pandemic has challenged public health care systems globally. Based on worldwide experience, India has initiated a nationwide lockdown to prevent the exponential surge of cases. During COVID-19, management of cardiovascular emergencies like acute Myocardial Infarction (MI) may be compromised. Cardiological Society of India (CSI) has ventured in this moment of crisis to evolve a consensus document for care of acute MI. However, this care should be individualized, based on local expertise and governmental advisories.

We report a case of a 28-year-old African American male with months of diffuse, pleuritic, intermittent, non-exertional chest pain with elevated troponin and an ECG showing Wellens syndrome; he was found to have myocardial infarction with 80% proximal left anterior descending (LAD) coronary artery occlusion and 100% distal LAD occlusion. This patient's age and symptoms were not typical for cardiac ischemia, although the ECG was typical. Identification and proper management of Wellens syndrome rely on familiarity with its ECG patterns. Other information such as age, cardiac risk factors, chest pain with exertion and at rest, and elevated troponin are all helpful supplemental information, but as shown in this case report, presentations may vary. This case report demonstrates the importance of having a low threshold of suspicion for Wellens syndrome when faced with indicative ECG abnormalities, despite a patient's history of present illness and physical exam being inconsistent with typical presentations of a patient with cardiac ischemia., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Ledo et al.)

Myocardial infarction (MI) in young patients is rare. To address the gap in published all comers German studies concerning the clinical course and outcome of young patients aged ≤40 years with acute MI, the aim of this study was to identify differences between young and older, consecutive patients with MI and to compare these findings with previously published data. This analysis used data of the prospective Dresden Myocardial Infarction Registry (1/2005–9/2014), an all comers, prospective registry in the department of Internal Medicine and Cardiology at the Heart Center Dresden, University Hospital Dresden. In total, data from 119 patients ≤40 years and 5754 patients >40 years were included in the analysis. In contrast to the older patients, younger patients were more often male (79.0% vs. 70.5%), smokers, had a positive family history for MI, lower educational qualifications, and lived alone. Young patients experienced more frequently STEMI than NSTEMI (70% vs. 30%), while the older patient group showed an equal distribution of infarction types (50% vs. 50%). The in-hospital mortality of young patients (2.5% vs. 7.6%) was lower. The survival rate of young patients in the 2-year follow-up was significantly higher (95% vs. 82.7%). Lifestyle modifications as part of secondary prevention were only moderately implemented. Compared to older patients, the outcome of young patients is significantly better and the acute event resolved without serious sequelae in most cases. Despite good cardiologic follow-up, implementation of secondary prevention was only moderate, indicating a need for more efficient patient education. • Compared to older patients, the outcome of young patients is significantly better. • The acute event resolved without serious sequelae in most cases. • The in-hospital mortality of young patients was lower compared to older patients. • The survival rate of young patients in the 2-year follow-up was significantly higher. • Lifestyle modifications for secondary prevention were only moderately implemented. [ABSTRACT FROM AUTHOR]

Aim: New parameters are emerging to predict prognosis in patients with ST-segment elevation myocardial infarction (STEMI). In this study we aimed to determine and compare the prognostic values of some metabolic indices in terms of predicting long-term mortality in patients with STEMI. Method: A total of 1900 nondiabetic patients who presented with STEMI and underwent percutaneous coronary intervention were included in the study. Multivariable Cox proportional regression analysis was used to determine and compare the predictive performance of triglyceride-glucose (TyG) index, triglyceride-high-density lipoprotein ratio (Ty/HDL) and admission glucose. Results: In multivariable Cox regression analysis, the model based on TyG index had better predictive performance than the Ty/HDL and admission blood glucose. Conclusion: The TyG index is more informative than Ty/HDL and admission glucose level to predict long-term all-cause mortality.

Background Strategies to reduce DTB (door-to-balloon) time have been previously described. However, there is no well-established data-monitoring system that can be used for prompt feedback. The aims of this study were to use statistical process control (SPC) methodology to measure current processes, to provide real-time feedback on the impact of a change in service delivery and to identify individual outliers for specific investigation. Methods A prospective study was conducted in a tertiary centre in North England. Data were collected for 841 consecutive STEMI patients from the local district undergoing PPCI. The impact on median DTB time after changes in protocols were prospectively determined. Results Median DTB times fell significantly as a result of changes in protocol. The upper control limit (UCL) decreased from 209 to 86 min and narrower control limits indicated improved performance. The main outliers included patients presenting to the Accident and Emergency department and patients who developed STEMI while being treated in non-cardiology wards for other reasons (18.3% of the study population). Conclusions SPC provides a statistically robust mechanism for assessing the effect of process redesign interventions, and in this context provides a clear visual representation of DTB times for individual patients. Identification of significant outliers allows investigation of any variation with a special cause. It allows a unit to identify when a system of service delivery, albeit stable, is inadequate and needs redesign and can monitor the impact of changes in protocol. [ABSTRACT FROM AUTHOR]

Up to half of patients undergoing primary percutaneous coronary intervention of a culprit stenosis in the context of the ST-elevation MI may present with multivessel disease. The presence of non-culprit stenoses have been shown to affect the outcomes of these patients, and the results of the more recent randomised trials highlight the importance of complete coronary revascularisation. In this paper, the authors review the main trials published on the topic and discuss tools for the assessment of non-culprit stenoses, while considering the right time for carrying out a complete coronary revascularisation., Competing Interests: Disclosure: The authors have no conflicts of interest to declare., (Copyright © 2021, Radcliffe Cardiology.)

Patients with ST-elevation MI (STEMI) usually have a huge thrombus burden in the infarct-related artery. Stenting may lead to high chances of the slow-flow/no-reflow phenomenon that leads to periprocedural MI and adverse cardiovascular events. Deferred stenting may be beneficial in this situation as the thrombus burden will reduce, mitigating the slow-flow/no-reflow phenomenon. However, routine deferral of stenting in patients with STEMI has not been found to be beneficial, but when the patient is properly selected, deferred stenting has the potential for reducing the final infarct size. The authors report the safety and feasibility of deferred stenting after 5 days of prolonged anticoagulation in a 45-year-old smoker with STEMI who had a large thrombus load shown on an angiogram. They review the registries, trials and meta-analyses on deferred stenting in the literature and analyse the benefits and harms of the strategy. They also propose an algorithm for applying a strategy for deferred stenting in clinical practice based on the available data., Competing Interests: Disclosure: The authors have no conflicts of interest to declare., (Copyright © 2021, Radcliffe Cardiology.)

The unprecedented and rapidly spreading Coronavirus Disease-19 (COVID-19) pandemic has challenged public health care systems globally. Based on worldwide experience, India has initiated a nationwide lockdown to prevent the exponential surge of cases. During COVID-19, management of cardiovascular emergencies like acute Myocardial Infarction (MI) may be compromised. Cardiological Society of India (CSI) has ventured in this moment of crisis to evolve a consensus document for care of acute MI. However, this care should be individualized, based on local expertise and governmental advisories., Competing Interests: Conflict of interest There is no conflict of interest with either the corresponding author or any of the authors/co-authors., (Copyright © 2020 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)

Objective: Information available on acid-base imbalance in ST-elevation myocardial infarction (STEMI) submitted to primary percutaneous intervention is limited and no data were present on intracoronary blood analysis, extracted from obstructed artery., Methods: This was a prospective study conducted over 12 months in which STEMI patients presenting in emergency and undergoing primary percutaneous coronary intervention were included. Blood gas analysis of intracoronary arterial blood from obstructed vessel and peripheral arterial blood was performed. Patients in whom adequate intracoronary sample could not be obtained were excluded. Intracoronary and peripheral arterial blood gas measurements were correlated and relationship of intracoronary parameters were compared with clinical parameters, investigational markers and short-term outcome., Results: The mean age of study population was 54.8 years and average symptom onset to door time was 162 min. On comparing intracoronary blood with peripheral blood arterial obtained, pH (95% confidence interval [CI] -0.01 to 0.02;p = 0.44), lactate (95% CI 0.03-0.1;p = 0.28), bicarbonate (95% CI 0.6-1.5;p = 0.64), pCO 2 (95% CI 1.1-2.4;p = 0.79) and pO 2 (95% CI 3.2-47.5; p = 0.06) were all found to be statistically insignificant. Intracoronary hyperlactatemia was present in patients presenting with higher symptom onset to door time (p = 0.025). Systolic blood pressure (SBP) (p = 0.03) was also significantly lower in patients who had high intracoronary lactate levels., Conclusion: The evaluation of intracoronary blood provides no additional information regarding the prognosis and short-term (30-day) outcome of the patients when compared with peripheral blood. However, there was a significant intracoronary hyperlactatemia in patients presenting late after symptom onset. SBP was also significantly less in patients with high intracoronary lactate, which signifies that predominant cause of hyperlactatemia was systemic hypoperfusion rather than local increase in lactate levels., (Copyright © 2019 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)